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Abstract
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ntil the beginning of 2020, we believed that our modern societies had replaced microbial epidemics with behavioral epidemics such as depression, opioid use, and the most silent one, suicide.1 Contributing to these epidemics, as Jeste et al1 highlighted, the “lethal behavioral toxins of loneliness and social isolation increase the risk of mortality comparable with smoking and obesity.” This explains why in recent years the World Health Organization declared that social disconnection had become a major new public health challenge, and the United Kingdom created a Ministry of Loneliness! Ironically, our beloved globalization brought us a new dystopia, in which the fight against the coronavirus disease 2019 (COVID-19) epidemic is essentially based on social distancing all over the world, with perhaps half of humanity being in quarantine today. While loneliness is already highly prevalent in the general population, it is feared that it will be more pronounced during the COVID-19 outbreak quarantine, leading to dramatic effects on the most vulnerable people, including psychiatric patients. Psychiatrists must be cautious about the negative psychological consequences of quarantine in both the short term and long term.
Indeed, quarantine due to COVID-19 increases the possibility of psychological and mental problems because it gradually distances people from each other. The psychological impact of this imposed “social distancing” should lead us to consider the associated suicidal risk. Indeed, some cases of suicidal acts related to the quarantine have already been reported.2 Social isolation (such as living alone) and loneliness, defined as a distressing feeling arising from perceived deficiencies in one’s social relationships,3 are strong contributors to suicidal risk. Durkheim4 initially pointed out that egoistic suicide occurred when an individual was insufficiently integrated within a specific group, ie, had few social bonds. Recently, Joiner’s interpersonal theory of suicide5 proposed that suicidal ideation emerges in individuals experiencing simultaneously thwarted belongingness (ie, a lack of desired, reciprocally caring relationships) and perceived burdensomeness (ie, the feeling that one’s friends, family, or society would be better off if the person were dead). Hopelessness regarding future changes in level of social connection and contributions to others was positively correlated to suicide risk.6 At the biological level, loneliness and social exclusion have been associated with increased hypothalamic pituitary adrenocortical activity and inflammation, both pathways involved in suicidality. At the brain level, processing of social rejection may differ in patients vulnerable to suicide, engaging regions important for social cognitions and pain tolerance, possibly leading to hypersensitivity to social stress ...
In a 2020 review on the psychological impact of quarantine, Brooks et al8 reported that the “confinement, loss of usual routine, and reduced social and physical contact with others were frequently shown to cause boredom, frustration, and a sense of isolation from the rest of the world, which was distressing to participants” and “exacerbated by not being able to take part in usual day-to-day activities, such as…social networking activities via the telephone or Internet.” Other stressors of the quarantine have been pointed out: the long duration; fears of infection for oneself and one’s family; the inadequate supplies of basic needs, including the interruption of regular medical follow-ups and difficulties in renewing prescriptions; and the lack of clarity in the information provided by health and government officials. The confinement of individuals possibly induces a fear of being separated from loved ones and caregivers. People may face exacerbated intra-family problems, which are frequent triggers of suicidal acts ...
Language: en |