Anxiety Disorder and Social Isolation during the COVID-19 Pandemic and Lockdown in China

Background: The COVID-19 pandemic and lockdown measures can have a profound impact on emotions, anxiety and mental health of affected communities. Although previous studies have captured the overall impact of quarantine on mental health outcomes, few have looked at the effects among different groups. There is lack of knowledge about possible generational and geographical differences for mental health. This study aims to examine the impact of COVID-19 related quarantine on generalized anxiety disorders (GAD) among parents and children, and to compare the outcomes of residents from the initial epicenter in China and in surrounding areas.

Methods: Data were collected by the Social Cognition and Behavior Investigation of COVID-19 in Hubei province, China from January 31 to February 8, 2020 (N = 4,503). The Generalized Anxiety Disorder Screener-2 item scale was used to measure GAD symptoms, and respondents were asked about their social isolation and quarantine experiences during the pandemic. This study used propensity score radius matching to reduce the sample selection bias from the nonprobability sample of cross-sectional survey between the isolated and non-isolated groups. Ordinary least squares regressions were conducted to examine the relationship between social isolation and GAD symptoms based on the matched samples. Subgroup analyses were conducted by differentiating child (12-18 years old) and parent (30-63 years old) samples, and by Wuhan city and other cities of Hubei. Overall, about 9% (n = 191) of children and 9% (n = 207) of the parent sample reported that they had been isolated during the COVID-19 pandemic.

Results: Quarantine had more psychological impact on parents than children regardless of geographic locations. Parents who experienced social isolation in Wuhan city, the first epicenter, reported significantly higher GAD levels than those who did not, but parents from other cities showed no such difference. Children who experienced social isolation showed no statistically significantly different GAD symptoms from their counterparts. For both children and parents, interpersonal communication about COVID-19 and social media exposure to pandemic related information were linked to GAD symptoms.

Implications: Considering that COVID-19 is still spreading in many regions throughout the world, important prevention measures, such as regional shutdown and quarantine may still take place. Therefore, it is important to understand the mental health consequences and developing appropriate intervention methods for hardest-hit areas, like Wuhan. The findings showed significantly higher GAD symptoms among parents from Wuhan city who experienced social isolation than their Wuhan counterparts who did not, yet parents from other cities who experienced social isolation showed no such differences in their GAD symptoms. This study highlights the need to develop targeted psychological interventions to mitigate negative mental health outcomes related to COVID-19 pandemic. It also has significant implications for not only policy makers but also practitioners for developing policies and providing services to address the adverse impacts of COVID-19. It is necessary to consider the geographic differences, and to tailor programs and interventions to the needs of parents and children.