BACKGROUND
Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the coronavirus disease 2019 (COVID-19) pandemic. As early as March 2020, a national survey reported that 36% of U.S. adults felt the pandemic would have a serious impact on their mental health. In April 2020, another survey found that 14% of U.S. adults reported serious psychological distress, compared to 4% during a similar time period in 2018. Rates of loneliness have also been high, with 36% of U.S. adults—including 61% of adults aged 18-25—reporting significant loneliness in an October 2020 survey. More recently, a March 2021 survey found that 48% of adults reported higher levels of stress in their lives compared to before the pandemic, and 61% reporting undesired weight changes.
This health sequelae of the COVID-19 pandemic are multifactorial, and social isolation is likely an important contributor. Because of physical distancing mandates, quarantines, and fear of illness, a substantial proportion of Americans have limited their physical contact with others outside of their household. This trend has likely contributed to social isolation and loneliness. Household isolation is analogous to quarantining, and research has shown that quarantining is a risk factor for a variety of adverse mental and emotional health outcomes. These include increased stress, anxiety, depression, fear, and detachment from other people.
The Centers for Disease Control and Prevention (CDC) recently recommended that researchers examine drivers of adverse mental health during COVID-19 pandemic. One driver that has received little attention is the role that COVID-19 risk misperceptions may play in the behavioral decision to limit physical contact with others. While COVID-19 risk perceptions have been associated with protective health behaviors, they may lead to suboptimal behavioral choices, if individuals substantially overestimate or underestimate risk. Overestimation, in particular, is of concern in the context of mental and emotional health and well-being because it tends to amplify social isolation and reduce contact with others. Using survey data from the Franklin Templeton-Gallup Economics of Recovery Study, we assessed the association of COVID-19 risk misperceptions with household isolation. Our findings are relevant to policy measures to reduce COVID-19-related social isolation and may inform the management of future epidemics and pandemics.
OBJECTIVE
To examine the association of COVID-19 risk misperceptions with household isolation, a potential risk factor for social isolation and loneliness.
METHODS
We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July 2020-December 2020) of 24,649 U.S. adults. We also analyzed data from the Gallup Panel (March 2020-February 2021) which included 123,516 observations about loneliness. Primary outcome was household isolation, which we defined as a respondent reporting having no contact or very little contact with people outside their household, analogous to quarantining.
RESULTS
From July-December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years-old accounted for 7% of total U.S. deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased likelihood of household isolation, from 7.7 percentage points in July/August (P<0.001) to 11.8 percentage points in December (P<0.001). Characteristics associated with household isolation from the July/August 2020 survey and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, living in household isolation was associated with a higher prevalence of loneliness.
CONCLUSIONS
Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines.
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