Potential impact of physical distancing on physical and mental health: a rapid narrative umbrella review of meta-analyses on the link between social connection and health

  1. Nexhmedin Morina
  2. Ahlke Kip
  3. Thole Hilko Hoppen
  4. Stefan Priebe
  5. Thomas Meyer

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Abstract

The imperative for physical distancing (mostly referred to as social distancing) during COVID-19 pandemic may deteriorate physical and mental health. We aimed at summarising the strength of evidence in the published literature on the association of physical and mental health with social connection via social isolation, living alone and loneliness.

Methods

We conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social connection and any physical or mental health outcome. The findings were summarised in a narrative synthesis.

Results

Twenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. The results suggest that lack of social connection is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life and suicidal ideation.

Conclusions

The existing evidence clearly indicates that social connection is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures.

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  1. ScreenIT

    SciScore for 10.1101/2020.10.06.20207571: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Ethics approval and consent to participate: This study did not require ethical approval.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    To select relevant meta-analyses on the association between social isolation and physical or mental health outcomes we conducted a systematic search on 6th April 2020 using the databases Medline, PsycINFO, and Web of Science.
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: This is, to our knowledge, the first review to synthesize the existing evidence that has been reported in meta-analyses on the link between social isolation and physical and mental health outcomes. The findings reflect a reasonable number of meta-analyses which in total included 692 studies. Thus, the overall conclusions of this umbrella review are based on an extensive body of empirical evidence. However, the review also has several limitations. Firstly, we considered different indicators of social isolation, and our method did not allow us to identify whether one indicator is more relevant than another. Secondly, half of the included meta-analyses for both physical and mental health outcomes had an overall quality rated on AMSTAR-2 as low or critically low, with inadequate consideration of risk of bias being the most frequent critical flaw. Thirdly, the quality of the primary research studies that went into the included meta-analyses also varied and their different methodological shortcomings cannot be adequately considered in this review. Fourthly, the results on the association between living alone and health outcomes need to be interpreted with caution. As reported above, living alone is not necessarily indicative of feeling lonely.2 Finally, the review included a wide range of health outcomes and did not quantify the strength of the associations for different outcomes. Implications: The review leaves little doubt that social isolation is linke...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1136/bmjopen-2020-042335
  3. Version published to 10.1101/2020.10.06.20207571v1 on medRxiv