One Month into the Reinforcement of Social Distancing due to the COVID-19 Outbreak: Subjective Health, Health Behaviors, and Loneliness among People with Chronic Medical Conditions

Abstract

We sought to examine how the near-lockdown measures, announced by the Israeli government in an effort to contain the COVID-19 outbreak, impacted the self-rated health (SRH), health behaviors, and loneliness of people with chronic illnesses. An online cross-sectional survey was carried out about one month (20–22 April 2020) after the Israeli government reinforced the severe social distancing regulations, among a convenience sample of 315 participants (60% women) with chronic conditions (27% metabolic, 17% cardiovascular, 21% cancer/autoimmune, 18% orthopedic/pain, 12% mental-health). Results suggested that about half of the participants reported a decline in physical or mental SRH, and as many as two-thirds reported feeling lonely. A significant deterioration in health behaviors was reported, including a decrease in vegetable consumption (p = 0.008) and physical activity (p < 0.001), an increase in time spent on social media (p < 0.001), and a perception among about half of the participants that they were eating more than before. Ordinal regression suggested that a decline in general SRH was linked with female gender (p = 0.016), lack of higher education (p = 0.015), crowded housing conditions (p = 0.001), longer illness duration (p = 0.010), and loneliness (p = 0.008). Findings highlight the important role of loneliness in SRH during the COVID-19 lockdown period. Future studies are warranted to clarify the long-term effects of social-distancing and loneliness on people with chronic illnesses.

Variations in health behaviors among pregnant women during the COVID-19 pandemic

“…Physical activity participation tends to decline in the third trimester of pregnancy compared to other trimesters ( Borodulin et al., 2009 ; Evenson and Wen, 2010 , 2011 ) and we also found women in the 2 nd and 3 rd trimesters were more likely to report stopping physical activity participation compared to women in the first trimester. These decreases in activity may have been due to social distancing and isolation policies as reported in non-pregnant populations ( Ammar et al., 2020 ; Elran-Barak and Mozeikov, 2020 ; Tison et al., 2020 ), but we are unable to disentangle these two potential drivers of physical activity reduction.…”

“…variation was likely masked when comparing average diet quality before and during the COVID-19 pandemic rather than specifically asking about changes in diet. Other studies examining dietary changes during COVID-19 in non-pregnant populations have generally reported mixed results ( Ammar et al., 2020 ; Di Renzo et al., 2020 ; Elran-Barak and Mozeikov, 2020 ; Scarmozzino and Visioli, 2020 ; Sidor and Rzymski, 2020 ).…”

“…Several items from the Pandemic Stress Index ( Harkness et al., 2020 ) and a survey examining social connections ( Ensminger et al., 2009 ) were included in the survey and adapted for pregnancy to estimate stress related to the COVID-19 pandemic. Relevant items hypothesized to have an association with health behaviors were included in the present study ( Elran-Barak and Mozeikov, 2020 ; Gollwitzer et al., 2020 ; Pampel et al., 2010 ; Umberson and Montez, 2010 ), including: (1) income loss due to COVID-19, (2) social distancing practices, and (3) connections with neighbors/community, friends, family, and partner. Loss of income was assessed by asking “Did you lose your source of income because of COVID-19?” Response options were yes or no.…”

“…High levels of perceived stress, such as those produced by social distancing and isolation during a pandemic, are associated with poorer diet, physical inactivity, and reduced sleep duration and quality ( Elran-Barak and Mozeikov, 2020 ; Kim and Dimsdale, 2007 ; Ng and Jeffery, 2003 ). Pregnant women may be more vulnerable to adverse lifestyle changes in response to the COVID-19 pandemic, due to the accumulation of multiple sources of perceived stress ( Rashidi Fakari and Simbar, 2020 ).…”

The COVID-19 Social Monitor longitudinal online panel: Real-time monitoring of social and public health consequences of the COVID-19 emergency in Switzerland

“…Similar results for Switzerland and countries of the EU can be found for working-related indicators, such as higher reported fear of losing employment during the COVID-19 pandemic. Social isolation, loneliness and the loss of employment are known risk factors for mental health problems across different population subgroups such as older persons, chronically-ill persons or children [8][9][10][11][12]. New prevention strategies specifically addressing such subgroups are of great importance from a public health perspective [13][14][15].…”