LAUSR

Background: The 2019 coronavirus (COVID-19) lockdowns have been associated with significant increases in negative mood and stress, reduced (perceived) health and poorer quality of life [1]. These effects were particularly seen among people who live alone and lack daily social support of family or housemates. Objective: To compare mood and stress of those that lived alone or together with others during the COVID-19 lockdown, and to investigate the impact on perceived immune fitness and presence and severity of COVID-19 related symptoms. Methods: An online survey among Dutch adults compared the period before the lockdown (15 January–14 March 2020) with the lockdown period (15 March–11 May 2020) [2]. Participants indicated whether they ‘lived alone’ or ‘together with others’ during the lockdown. Mood (“anxiety”, “depression”, “fatigue”, “hostility”, “loneliness” and “happiness) and “stress” was assessed via 1-item scales [3]. Perceived immune fitness and quality of life was measured using a scale ranging from 0 (very poor) to 10 (excellent) [3,4]. The severity of COVID-19 symptoms was assessed using the COVID-19 Symptoms Scale [2]. Items could be rated as none (0), mild (1), moderate (2), or severe (3). The sum score served as severity score, and the number of items with a score > 0 as COVID-19 symptom presence score. Differences between outcomes of the groups that lived alone or lived together during lockdown were compared with Independent-Samples Mann-Whitney U tests. For each variable, difference scores (Δ, lockdown – before lockdown) were calculated and compared between the groups with analysis of variance. Pearson's correlations were calculated between difference scores. Results: Data of N=505 participants were analyzed. The mean (SD) age was 38.2 (15.8), and 65.5% of the sample were female. During the lockdown period, 115 (22.8%) lived alone and 390 (77.2%) lived together with others. The mean (SD) number of household members was 2.8 (1.6), with a range of 1 to 12. During the lockdown, individuals that lived alone reported significantly higher ratings (p<0.05) of loneliness, anxiety, depression, and significantly lower scores on happiness and quality of life compared to the group that lived together with others. Comparing difference scores (during lockdown – before lockdown) of both groups revealed that the group that lived alone reported a significant greater increase in loneliness (p=0.002), which was accompanied by a significant increase in reported COVID-19 symptoms (presence: p=0.019, severity: p=0.041), whereas a small decrease in symptom presence and severity was seen among the ‘lived together’ group. The Δ loneliness scores correlated significantly with Δ perceived immune fitness (r = -0.239, p<0.0001) and Δ presence (r = 0.144, p=0.001) and Δ severity (r = 0.160, p<0.0001) of COVID-19 symptoms. Conclusions: Living alone and associated feelings of loneliness have a negative impact on mood, perceived immune fitness, and the presence and severity of COVID-19 symptoms. Loneliness is an important determinant of mental health, though often underestimated. Future research should investigate how the impact of increased social support, for example with the aid of mobile technology, can counteract loneliness and thereby improve health and quality of life. No conflict of interest