The social impact of Covid-19 – how increased isolation has affected our health and wellbeing

In this episode of Covid Matters we speak to Dr Alexandra Burton, who as part of UCL’s massive COVID-19 Social Study – which has sent out over a million questionnaires – has been looking into the effect of the pandemic on loneliness and social isolation.

Isolation and loneliness have affected many of us, whether directly or through family and friends.  For that reason it felt important to be able to speak to Dr Alexandra Burton, a Senior Research Fellow in the Department of Behavioural Science and Health at University College London.

Her research background was in how social support and isolation impacted our physical and mental wellbeing, but when the pandemic forced a clinical trial to be put on hold, she joined the Covid-19 Social Study launched by Dr. Daisy Fancourt at University College London.  Starting from March 2020, the team tracked 70,000 people in the UK via monthly surveys, exploring the effects of the virus and social distancing measures on adults in the UK during the outbreak of Covid-19.  They also carried out one-to-one remote interviews with 280 participants, focusing on groups of people who were particularly socially isolated, like those with mental health conditions or whose lives were particularly disrupted.

They found that different circumstances impacted people’s mental health in different ways.  Those with long-term health conditions were anxious about the health consequences of catching Covid-19 near the start of the pandemic, eventually suffering from social isolation as the pandemic went on; while young adults were concerned about missing out of key milestones of finishing school or starting university, and wrestling with the uncertainty of their future regarding jobs and education; and parents of young children struggled with a loss of routine and juggling multiple roles of being a teacher, parent, partner, while working and looking after the house.  

Interestingly, they found that some people have had improved mental health during the pandemic.  They were able to slow down, focus on their hobbies, and regain flexibility in living their lives.  Some also engaged more with others, reconnecting with old friends and talking to local communities, united by the sense that everyone was in it together and needed support.

The results from the study are fed into government policy meetings as well as different organisations and charities.  Dr Alexandra Burton hopes that going forward, people can continue to be more open in speaking of their mental health and be able to access more support.  Regarding the legacy of the study, she wishes to work towards addressing the inequalities that this pandemic has uncovered, and that society will be able to keep people connected to safeguard against loneliness.

Takeaway quotes from the episode

  1. On the mental health impacts on non-healthcare key workers: “It’s a voice we haven’t heard a great deal of. They’ve told us they haven’t felt [recognised] for the work they’ve been doing in terms of safety.  They were feeling very vulnerable to bring the virus home… We even had a bus driver say he’d had to move out of his family home to protect his partner.”

  2. On the narrative of young people being resilient: “They weren’t as bothered about the health consequences to themselves.  But there were concerns about... the disruption that their lives have had.  Now things are opening up some young people feel very anxious about socialising after just talking to friends online.”

  3. On people’s protective factors: “Some people have had improved mental health during this time people with mental health conditions told us that they felt less accountable to others.  [Others were] reconnecting with old friends and engaging more with neighbours and local communities… there was this sense… that everyone was in it together.”

  4. On some results that were surprising: “I’ve been surprised at the level of some peoples’ comfort in some of the situations that we found ourselves in; not having the social pressure … to go out and socialise, and having a break from very busy lives.”

  5. On positive changes going forward: “The young adults that we spoke to felt much more open in speaking about their mental health.  If it can open up people accessing more support then that’s something to continue going forward.”

Episode transcription

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Michael MacLennan  

So it's very reassuring. But yeah, thank you very much for joining us. And it'd be great to know a bit about your own background and what the background was to the social study.

Dr Alexandra Burton  

And so I guess in my research before the pandemic, I'm particularly interested in how social support and social isolation impacts both our mental and physical well being. So there's lots of evidence to suggest that, for example, loneliness, social isolation leads to worse health outcomes in people with both mental and physical health problems. So that's where my research background sort of was coming from. And then at the start of the pandemic, I was about to start a new role. And so on the first of April 2020, I was about to start working on a clinical trial, which was exploring face to face singing groups for women with postnatal depression. And so I was going to evaluate how that worked, and what kind of mechanisms were helpful for women attending those groups. However, the pandemic hit, and the study was put on hold. And obviously, singing indoors is not something that's come back. Even now, I think we're only allowed to do community singing groups in groups of six or less. So it's really been impacted that that study that I was supposed to be working on, however, we've been trialling that online. So alongside that, as I started my new role, the COVID social study was launched by Dr. Daisy fancourt, at University College London. And so we've been exploring the psychological and social impact of the pandemic. And that's included a survey with over 70,000 people in the UK, where they asked, weekly, and then it's gone to monthly, about their psychological well being their social lives, things around behaviours, and compliance with guidelines, attitudes to vaccines, and how they've been spending their time. So we've been tracking people since March 2020. And we can sort of see when things have happened, for example, new lockdowns have come in or when rules have changed or shifted, we can see whether that sort of impacts people's mental health and well being. But my specific role, I guess, has been exploring a bit more detail using qualitative interviews, sort of how and why people's mental health has been impacted during this time. So we've been doing one to one remote interviews with different groups of people. And we sort of thought about picking people who we think might have been particularly socially isolated or had particular mental health problems during this time. So we've spoken to people with long term health conditions, people with mental health conditions, and then people whose lives have probably been very disrupted. So parents with young children, for example, key workers and young adults. So that's kind of work that I've been doing for the past year.

Michael MacLennan  

How has people's mental health been impacted?

Dr Alexandra Burton  

So we're finding that people's mental health has been impacted, predominantly, sort of associated with different characteristics. So people's age, their health, their living situations, their working situations are really sort of feeding into their experiences of the pandemic and on their mental health and well being. So I guess, for example, those with long term health conditions who At the start of the pandemic Mattel to shield, you know, there was a lot of fear and anxiety related to the potential health consequences of catching COVID. And then I think as time went on the sort of social isolation and not being able to see family and friends has fed into sort of poorer wellbeing. And that's been quite similar among people with mental health conditions as well that, especially those that live alone, have been feeling particularly socially isolated during this time. I guess young people, we've spoken to young adults, they've not been as anxious about the health consequences of COVID. And their main concerns really centred around the huge disruptions that they've had to deal with, to their social lives to their education. And they told us about missing out on key milestones, so finishing school, starting University, and just a real uncertainty about what the future holds for them, particularly around jobs and education. So I guess the worries are different, depending on people's circumstances and experiences. And I think, for parents of young children, and surprisingly, there was a complete loss of routine. At the beginning, when when children were at home, and a lot of guilt and a lot of stress around not being able to fulfil multiple roles. And suddenly all of these roles are under one roof. You're a teacher, you're a parent, you're a partner, you're cleaning the house, you're trying to work you're trying to cook for the family. And it becomes exhausting. And I think, again, not knowing when things will return to some level of normality really fed into that. And of course, lone parents. And those experiences were heightened for lone parents. And I think one of the most difficult groups we've interviewed, not in terms of difficult groups, but difficult experiences we've encountered is among non healthcare, key workers. And it's a voice that we haven't heard a great deal of, I think there have been times in the pandemic when the media have reported on it. But I think, you know, they've continued to work through some very uncertain periods. They've told us they haven't feel supported by they haven't felt supported by their organisations in terms of recognition for the work that they've been doing. In terms of safety. They felt disempowered and undervalued. I think we had clap for carers, but it was for health professionals and people felt very forgotten. And I think just feeling very vulnerable to bring in the virus home, especially if they were living with vulnerable family members. It's been a huge source of fear throughout the pandemic for people. And we had some quite traumatic experiences of people sleeping in separate rooms, for example, to protect partners, or family members. And in one case, I think we even had a bus driver say that he'd had to move out of his family home to protect his partner. So obviously, feelings of loneliness. And you know, when is this gonna end?

Michael MacLennan  

At the beginning of the pandemic there was a sense of everybody's being affected. It was almost like we're all in it together. Your work  illustrates similarities, but then also the way in which certain groups have been more affected than others. Has there been particular groups that you think have been disproportionately impacted?

Dr Alexandra Burton  

I think the younger adults have been disproportionately impacted in terms of their mental health. And as I said, as those key workers, I think the older adults that we spoke to seem to be doing better, it felt that they were more resilient and, and they had used coping strategies that they used previous experiences to, to sort of lean back on those, those strategies that they might have used before when they've had periods of illness or times of uncertainty. So yes, definitely, I think, even within our groups, I think we've we see different experiences, like I say, with the lone parents having particularly difficult times. And at the moment, we haven't got the results yet, but we are focusing more on, I guess, vulnerable groups of people experiencing financial difficulties. homelessness, drug and alcohol use, just to see how services have been impacted as well. So that's another sort of area of work that we're we're looking at at the moment.

Michael MacLennan  

For me, it's one of the interesting things because when you're speaking about young people. It's always subjective, but it seems to be more of a narrative that they have actually been quite relaxed. ‘The disease's doesn’t impact them as much and therefore they're not as bothered.’ I guess that's not what you found then?

Dr Alexandra Burton  

No, I think obviously, they weren't as bothered about the health consequences to themselves. But there were obviously concerns about yet bringing the virus home to vulnerable family members. And actually the disruption that their lives have have had. It has been in other areas such as social lives and and sort of work and, and we're also currently interviewing young carers as well as this to sort of expand that group and just how everything just suddenly falls into the home. And there are no outlets if people are struggling. So I think, I think I think now things are opening up. And we're sort of I think young people are sort of seen as the spreaders and they know that they're going out and socialising. But the other side of that story is that some young people feel very anxious about socialising and going back into the real world after having this time where they've just been on zoom, or Facebook or talking to friends online, it they're certainly feeling quite anxious about reintegrating, in a way and, and returning to face to face. Communications, but that's not about the virus. It's more about social anxiety and some GM people for examples, I have forgotten how to have a conversation, I'm worried about really going out again, and socialising. So I think it's a very mixed story for the young adults.

Michael MacLennan  

For somebody whose background was looking at people with isolation and loneliness and that side of things, then for people who are already experiencing that, however, they found, it must be as kind of an odd situation in the sense that everybody's plunged into a situation that some people been experiencing for many years.

Dr Alexandra Burton  

Yeah. Yeah, I think, I think it's exacerbated it because even I think people who live alone, for example, they sort of told us that, obviously, their lives were being restricted even further, because the things that they would normally do had just disappeared. So people were often members of groups or sort of would see people have physical contact outside of the home. And suddenly, all of that disappeared. So I think it was exacerbated. But then for others, I guess there was that sense of well, finally, you know, everyone's in the same situation. And they can understand or empathise, perhaps, with my situation and how I'm feeling. And I think that's one of the things that's come out of this is maybe more of an awareness of, of mental health and isolation among the media among people just having these conversations. I think it's definitely raised that awareness of sorry. It's definitely raised the awareness of these issues, and further.

Michael MacLennan  

In terms of the protective factors and coping strategies, what have you found people have been using?

Dr Alexandra Burton  

I think, I suppose that's another side of the study that has really come out strongly. So actually, some people have had improved mental health during this time. And I think going forward, it's going to be important to learn from those experiences as well. So I think just having that chance to slow down, focus more on things that they enjoy doing, but maybe didn't have time to do before. Spending time with family. I think some people with mental health conditions told us that they felt less accountable to others, they felt less pressure to conform to social norms. So for some people, it did feel quite protective. And also, I guess, for some people, there was more flexibility in how they lived their lives, more opportunities to organise their lives in different ways rather than commuting to work, being at work, particularly for people who were able to work from home. And I think just reconnecting with old friends and engaging more with neighbours and with local communities, like you said, I think, you know, there was this sense among some groups that everyone was in it together and supporting each other. So doing some volunteering, supporting people who needed essential items or medications, for example, all of that came out in the interviews. And I guess, yeah, just engaging in hobbies and active It is more or less sort of learning new things and just sort of trying new things out has really helped people to cope.

Michael MacLennan  

How have you found things to be shifting over the past few months as we enter the summertime. It is obviously a very complex situation in a number of ways.

Dr Alexandra Burton  

Yeah. So I guess the survey is picking that up more. And we report every sort of at the end of every month, but with the interviews, because they're one off, it's quite difficult to sort of track changes. But the interviews that we're doing now are quite reflective, I guess, obviously, we've interviewed people when they're in the thick of it when they're in a lockdown when they're in this strange tiered situation where their community is in tier three, but the community next door is in tier two. So I think now, people are still quite reflective of all those moments, and they're still quite, I don't know, they can still sort of talk about how it was. But I think there might be a little bit of fear about what happens next, and how things go forward. I think it's still quite uncertain for a lot of people, even with the vaccine, I think people are still a little bit worried and not really sure whether this is the right path to be going down. But as I say, I think when we when we have the next results of the survey, it'll be interesting to see now we've had these new announcements. Whether mental health has changed whether trust in government has changed. So that's to be reported on.

Michael MacLennan  

And in terms of the findings, were and to whom have you been presenting them?

Dr Alexandra Burton  

Yeah, so we've been feeding into government policy meetings, we've been speaking to different sort of organisations, charities. We I personally have been spoken to the campaign to end loneliness, for example, on some of the findings. We report to Public Health England as well, on some of the findings, so we're really trying to feed into the sort of strategy, the government strategies, particularly around mental health and supporting people's mental health throughout this.

Michael MacLennan  

And have there been results that have, surprised some of those people that you've been speaking to? Or yourself?

Dr Alexandra Burton  

Um, I guess, I think that there's been perhaps more resilience, then among some groups, then perhaps we were expecting, I think, I think I think I've been surprised at the level of some people's comfort in some of the situations that we found ourselves in. And like I say, not having the social pressure, not feeling pressured to, to do things just to go out and, and socialise. And almost having sort of a break from very busy lives, I think has been something that maybe surprised me. I'm trying to think if there's anything else, it's quite difficult when you're in the hole. In the midst of the data collection, I think it's a sort of sort of reflect on your own feelings about it.

Michael MacLennan  

In terms of positive changes that you'd hope to see going forward, I guess you answered that in a sense, with the opening up of people to be able to speak about mental health issues and that side of things.

Dr Alexandra Burton  

Definitely, I think the young adults in particular that we spoke to had, they told us that they felt much more open in speaking about their mental health and well being to family to friends that they hadn't spoken to about these kinds of issues before. And I think that's a real positive from this, that if it can open up conversations, and it can open up people accessing more support than I think that's definitely something we should continue as we go forward. The only problem then is though, that we need services, resources and funding for much needed mental health support and services as we go forward. If people are more likely to seek this out now, so I think that's definitely something we need to continue.

Michael MacLennan  

Due to the ongoing nature of the study I guess this might be a hard question to answer. But is there an end date in mind? Or is there a way in which it will continue?

Dr Alexandra Burton  

So I think Originally, we had planned to finish the data collection this spring, because we'd hoped that things might have changed. And, you know, we, we would be at the point of sort of reflecting on our findings, but I think the plan is to carry on actually till next March with the survey. And the interviews that we're carrying on with will be done, hopefully by the auditor. And then I guess it's going to be a case of really building on what happens next. And, you know, what we found? How can we influence sort of responses services support, because I think a lot of services may have disappeared, or not being able to open up again, in the same way that they were before. So it's thinking about how we support those kind of decisions and those kind of services for mental health going forward?

Michael MacLennan  

Then, I appreciate this is potentially also a difficult question when you're in the weeds of things. But if you were to think about it in five or 10 years time, looking back and assessing an aim or outcome, or something that you would really hope to take from the work that the study and yourself have been doing.

Dr Alexandra Burton  

Yeah, I think it's, again, it's about that raised awareness. And I think it's just to get that message out that, you know, different groups of people continue to be impacted by this in different ways. And, you know, it's there hasn't been an equal experience, you know, among the different groups of people. So I think it's, you know, as a society, how do we address some of the inequalities that we've sort of uncovered? Looking at how people have been treated, or how they've experienced this pandemic? I think we need to really keep that on the agenda as we as we go forward. And I think just thinking about the social isolation element. I guess just keeping that on the agenda, as well. And, and thinking about if, how, you know, how do we make sure people aren't lonely, they are being connected with other people that were able to signpost to say community groups or volunteering activities, and have these kinds of organisations and support groups in in our local communities. And just be more mindful of wider social networks as well, I guess. And then, of people who might be struggling, who we haven't heard from in a while, I think that's really clear message to sort of take forward, given how we've all been affected by this.

Michael MacLennan  

And then finally, I know that there's still studies looking for more participants. So how can people get involved and where can they find more information?

Dr Alexandra Burton  

So we have a website, which is www.covidsocialstudy.org. And on there, you can click on the join study link. And that has all the information and ways that you can contact us if you would like to take part in an interview. So we're particularly interested in speaking to people who are young carers, as I said, people who've experienced financial difficulties, homelessness or drug or alcohol use during the pandemic, so all of the information is on the website.

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