Social isolation and its impact on child and adolescent development: a systematic review

Almeida, Isabelle Lina de Laia; Rego, Jaqueline Ferraz; Teixeira, Amanda Carvalho Girardi; Moreira, Marília Rodrigues

doi:10.1590/1984-0462/2022/40/2020385

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Brasil

Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2020385 copy

Social isolation and its impact on child and adolescent development: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

This study aims to analyze the effects of social isolation on children's and teenagers’ development, with emphasis on the possible impacts over their physical and mental health.

Data source:

Review of the literature following the standards of PRISMA using the SciELO, LILACS and PubMed databases. The following key-words were used: “social isolation” and “child development”, “quarantine” and “adolescent development” according to the Medical Subject Headings (MESH) and their translation to the Portuguese. Studies in English, Portuguese and Spanish from inception were included.

Data synthesis:

519 studies were screened and 12 were included in the systematic review. Five of those focused the psychology and social issues, two of them the effects of pandemics on these issues; four studies reported on impacts on general health and two consequences over the hypothalamus- hypophysis - adrenal axis and the cognitive and social development.

Conclusions:

The review shows a strong association between social isolation and anxiety and depression in children and adolescents. Social isolation leads to higher levels of cortisol and worse cognitive development. Therefore, the mental and physical health of children and adolescents need a careful follow up by health professionals during and after the COVID-19 pandemic.

Keywords:
Social isolation; Quarantine; Child development; Adolescent development; COVID-19

Author/year	Location	Study design	Sample and study duration	Score^* * score of the methodological quality of the studies: low quality=0 to 3, moderate quality=4 to 7, and high quality=8 to 11.
Danese et al., 2009⁶6. Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, et al. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. ArchPediatrAdolesc Med. 2009;163:1135-43. https://doi.org/10.1001/archpediatrics.2009.214 https://doi.org/10.1001/archpediatrics.2...	New Zealand	Prospective cohort	972 NB followed up until they turn 32 years of age.	8
Saurabh et al., 2020³3. Saurabh K, Ranjan S. Compliance and psychological impact of quarantine in children and adolescents due to covid-19 pandemic. Indian J Pediatr. 2020;87:532-6. https://doi.org/10.1007/s12098-020-03347-3 https://doi.org/10.1007/s12098-020-03347...	India	Retrospective cohort	252 children and adolescents aged 9–18 years (121 with quarantine experience and 131 with experience of social isolation only).	7
Sprang et al., 2013¹⁰10. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7:105-10. https://doi.org/10.1017/dmp.2013.22 https://doi.org/10.1017/dmp.2013.22...	USA, Mexico, and Canada	Retrospective cohort	398 children and adolescents.	5
Schinka et al., 2013¹³13. Schinka KC, Dulmen MH, Mata AD, Bossarte R, Swahn M. Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence. J Adolesc. 2013;36:1251-60. https://doi.org/10.1016/j.adolescence.2013.08.002 https://doi.org/10.1016/j.adolescence.20...	USA	Prospective cohort	832 NB followed up until they are 15 years of age.	9
Vanhalst et al, 2011¹⁴14. Vanhalst J, Klimstra TA, Luyckx K, Scholte RH, Engels RC, Goossens L. The interplay of loneliness and depressive symptoms across adolescence: exploring the role of personality traits. J Youth Adolesc. 2012;41:776-87. https://doi.org/10.1007/s10964-011-9726-7 https://doi.org/10.1007/s10964-011-9726-...	Netherlands	Prospective cohort	428 adolescents aged 13–16 years followed up for five years.	7
Martin et al., 2001¹⁵15. Sanchez-Martin JR, Cardas J, Ahedo L, Fano E, Echebarria A, Azpiroz A. Social behavior, cortisol, and sIgA levels in preschool children. J Psychosom Res. 2001;50:221-7. https://doi.org/10.1016/s0022-3999(01)00192-1 https://doi.org/10.1016/s0022-3999(01)00...	San Sebastian (Spain)	Prospective cohort	48 preschool children.	7
Koss et al., 2014¹⁶16. Koss KJ, Hostinar CE, Donzella B, Gunnar MR. Social deprivation and the HPA axis in early development. Psychoneuroendocrinology. 2014;50:1-13. https://doi.org/10.1016/j.psyneuen.2014.07.028 https://doi.org/10.1016/j.psyneuen.2014....	USA	Prospective cohort	155 children between 15 and 36 months of age followed up for 25 months.	7
Caspi et al., 2006¹⁷17. Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006;160:805-11. https://doi.org/10.1001/archpedi.160.8.805 https://doi.org/10.1001/archpedi.160.8.8...	Dunedin, New Zealand	Prospective cohort	1,037 NB followed up until they were 26 years old.	5
Li et al., 2020¹⁸18. Li HY, Cao H, Leung DY, Mak YW. The psychological impacts of a COVID-19 outbreak on college students in China: a longitudinal study. Int J Environ Res Public Health. 2020;17:3933-44. https://doi.org/10.3390/ijerph17113933 https://doi.org/10.3390/ijerph17113933...	Hebei, China	Prospective cohort	555 graduate students with an average age of 19.6 years followed up for two years.	7
Fox et al., 2011¹⁹19. Fox NA, Almas AN, Degnan KA, Nelson CA, Zeanah CH. The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project. J Child Psychol Psychiatry. 2011;52:919-28. https://doi.org/10.1111/j.1469-7610.2010.02355.x https://doi.org/10.1111/j.1469-7610.2010...	Bucharest, Romania	Prospective cohort	259 children under 30 months of age followed up until they were 8 years old (187 lived in foster care institutions and 72 lived with their families).	7
Andersen et al., 1990²⁰20. Andersen KL, Seliger V, Rutenfranz J, Nesset T. Physical performance capacity of children in Norway. V. The influence of social isolation on the rate of growth in body size and composition and on the achievement in lung function and maximal aerobic power of children in a rural community. Eur J Appl Physiol Occup Physiol. 1980;45:155-66. https://doi.org/10.1007/bf00421323 https://doi.org/10.1007/bf00421323...	Norway	Prospective cohort	39 children aged 8 years of age followed up until they are 12 years old.	6
Lacey et al. 2014²¹21. Lacey RE, Kumari M, Bartley M. Social isolation in childhood and adult inflammation: evidence from the National Child Development Study. Psychoneuroendocrinology. 2014;50:85-94. https://doi.org/10.1016/j.psyneuen.2014.08.007 https://doi.org/10.1016/j.psyneuen.2014....	Great Britain	Prospective cohort	8,233 children aged 7 years of age followed up until they are 50 years old.	7

Author	Data collection/social isolation criteria	Theme	Results	Limitations
Saurabh et al.³3. Saurabh K, Ranjan S. Compliance and psychological impact of quarantine in children and adolescents due to covid-19 pandemic. Indian J Pediatr. 2020;87:532-6. https://doi.org/10.1007/s12098-020-03347-3 https://doi.org/10.1007/s12098-020-03347...	Online interview with the presence of parents. People living in a quarantine context were considered socially isolated by COVID-19.	Psychosocial	Quarantine increased the incidence of psychological problems, such as fear, nervousness, and boredom.	Sample size is small and with little socioeconomic variety among participants, mostly from immigrant families.
Sprang et al.¹⁰10. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7:105-10. https://doi.org/10.1017/dmp.2013.22 https://doi.org/10.1017/dmp.2013.22...	Interview and filling of forms and checklist of PTSD by parents/guardians. People who have already lived through quarantine situations due to pandemics have entered the isolation criterion.	Psychosocial	The experience of social isolation or quarantine in childhood increased the likelihood of PTSD symptoms in this age group.	Results of the study depend on the memory of the parents who are reporting the events of years ago.
Schinka et al.¹³13. Schinka KC, Dulmen MH, Mata AD, Bossarte R, Swahn M. Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence. J Adolesc. 2013;36:1251-60. https://doi.org/10.1016/j.adolescence.2013.08.002 https://doi.org/10.1016/j.adolescence.20...	Four interviews at 7, 9, 11, and 15 years of age to apply some questions and checklist of depression and social skills. Loneliness classification by the Loneliness and Social Dissatisfaction questionnaire.³⁶36. Asher SR, Hymel S, Renshaw PD. Loneliness in children. Child Dev. 1984;55:1456-64. https://doi.org/10.2307/1130015 https://doi.org/10.2307/1130015...	Psychosocial	Children with a high level of loneliness are more likely to be depressed, aggressive, and have suicidal ideation.	Very long time spans between the four questionnaires, and the result obtained was at risk of bias as it was answered by the interviewee himself.
Vanhalst et al.¹⁴14. Vanhalst J, Klimstra TA, Luyckx K, Scholte RH, Engels RC, Goossens L. The interplay of loneliness and depressive symptoms across adolescence: exploring the role of personality traits. J Youth Adolesc. 2012;41:776-87. https://doi.org/10.1007/s10964-011-9726-7 https://doi.org/10.1007/s10964-011-9726-...	Five annual questionnaires, answered by the family, with a checklist application for loneliness, depressive symptoms, and personality traits. Loneliness classification by the Loneliness and Aloneness Scale for Children and Adolescents questionnaire.³⁷37. Marcoen A, Goossens L, Caes P. Lonelines in pre-through late adolescence: exploring the contributions of a multidimensional approach. J Youth Adolesc. 1987;16:561-77. https://doi.org/10.1007/bf02138821 https://doi.org/10.1007/bf02138821...	Psychosocial	In all stages of childhood and adolescence analyzed, there was a correlation between loneliness and the manifestation of depressive symptoms.	Low diversity among the analyzed group (mostly white and raised with the presence of both parents).
Li et al.¹⁸18. Li HY, Cao H, Leung DY, Mak YW. The psychological impacts of a COVID-19 outbreak on college students in China: a longitudinal study. Int J Environ Res Public Health. 2020;17:3933-44. https://doi.org/10.3390/ijerph17113933 https://doi.org/10.3390/ijerph17113933...	Assessment of children and adolescents before the COVID-19 pandemic and after two weeks of isolation, using the questions from the Positive and Negative Affect Schedule (PANAS) and the Patient Health Questionnaire (PHQ-4).	Psychosocial	After two weeks of isolation, participants showed an increase in symptoms of anxiety and depression.	Low diversity among the analyzed group (mostly female undergraduate students).

Autor	Data collection/social isolation criteria	Theme	Results	Limitations
Danese et al.⁶6. Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, et al. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. ArchPediatrAdolesc Med. 2009;163:1135-43. https://doi.org/10.1001/archpediatrics.2009.214 https://doi.org/10.1001/archpediatrics.2...	Interviews with the group at 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, and 32 years old and physical, psychiatric, and laboratory tests (CRP, BMI, glycated hemoglobin) at the end of the study. Evaluation of social isolation through the application of the RutterChild Scale questionnaire.³⁸38. Elander J, Rutter M. Use and development of the Rutter parents’ and teachers’ scales. Int. J. Methods Psychiatr. 1996;6:63-78. https://doi.org/10.1002/(sici)1234-988x(199607)6:2<63::aid-mpr151>3.3.co;2-m https://doi.org/10.1002/(sici)1234-988x(...	Overall health	Adverse conditions experienced in childhood, such as social isolation, increase the likelihood of depression, cardiovascular disease, and metabolic diseases in adulthood.	It does not explore all the adverse conditions that a child may experience, taking into account only three of them: social isolation, precarious socioeconomic conditions, and mistreatment.
Andersen et al.²⁰20. Andersen KL, Seliger V, Rutenfranz J, Nesset T. Physical performance capacity of children in Norway. V. The influence of social isolation on the rate of growth in body size and composition and on the achievement in lung function and maximal aerobic power of children in a rural community. Eur J Appl Physiol Occup Physiol. 1980;45:155-66. https://doi.org/10.1007/bf00421323 https://doi.org/10.1007/bf00421323...	Annual assessment of body size and composition, respiratory characteristics, and capacity for physical performance. Children from the periphery were considered in isolation, while those from the center had normal social life.	Overall health	The reduction in habitual physical activity caused by social isolation increased the amount of fat in the body composition and reduced the achievement of physical performance during growth.	Some of the differences that appear between children are not statistically significant. In addition, data were lacking regarding the relevance of the study.
Caspi et al.¹⁶16. Koss KJ, Hostinar CE, Donzella B, Gunnar MR. Social deprivation and the HPA axis in early development. Psychoneuroendocrinology. 2014;50:1-13. https://doi.org/10.1016/j.psyneuen.2014.07.028 https://doi.org/10.1016/j.psyneuen.2014....	Follow-up physical, laboratory, and psychological tests were performed at the ages of 5, 7, 9, 11, 13, 15, 18, 21, and 26 years. Assessment of social isolation by applying the RutterChild Scale questionnaire.³⁷37. Marcoen A, Goossens L, Caes P. Lonelines in pre-through late adolescence: exploring the contributions of a multidimensional approach. J Youth Adolesc. 1987;16:561-77. https://doi.org/10.1007/bf02138821 https://doi.org/10.1007/bf02138821...	Overall health	Socially isolated children were at significantly higher risk of health problems in adulthood compared to non-isolated children.	It is not known whether the findings of this study can be generalized to all ethnic groups, as it only looks at the population of New Zealand.
Lacey et al.²⁰20. Andersen KL, Seliger V, Rutenfranz J, Nesset T. Physical performance capacity of children in Norway. V. The influence of social isolation on the rate of growth in body size and composition and on the achievement in lung function and maximal aerobic power of children in a rural community. Eur J Appl Physiol Occup Physiol. 1980;45:155-66. https://doi.org/10.1007/bf00421323 https://doi.org/10.1007/bf00421323...	Follow-up of participants at intervals of 4–10 years with physical examinations, laboratory tests (CRP) and checklist of social isolation and economic factors. Assessment of social isolation by applying the RutterChild Scale questionnaire.³⁷37. Marcoen A, Goossens L, Caes P. Lonelines in pre-through late adolescence: exploring the contributions of a multidimensional approach. J Youth Adolesc. 1987;16:561-77. https://doi.org/10.1007/bf02138821 https://doi.org/10.1007/bf02138821...	Overall health	Socially isolated children had higher levels of CRP in middle age and were more likely to have psychological changes in adulthood.	CRP was measured only at age 44, so it is not known to what extent isolation affected CRP at each stage of development.

Author	Data collection/social isolation criteria	Theme	Results	Limitations
Fox et al.¹⁹19. Fox NA, Almas AN, Degnan KA, Nelson CA, Zeanah CH. The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project. J Child Psychol Psychiatry. 2011;52:919-28. https://doi.org/10.1111/j.1469-7610.2010.02355.x https://doi.org/10.1111/j.1469-7610.2010...	Collection of data on children's birth and previous health. Evaluation of the relationship with the caregiver, language development and IQ at 30, 42, 54 and 96 months of age. Children in foster care institutions were considered to be in social isolation.	Cognitive and social development	Institutionalization during childhood results in the child's social isolation and becomes detrimental to his cognitive and social development.	Many of the children in the intervention and control groups were no longer residing in their original location.
Martin et al.¹⁵15. Sanchez-Martin JR, Cardas J, Ahedo L, Fano E, Echebarria A, Azpiroz A. Social behavior, cortisol, and sIgA levels in preschool children. J Psychosom Res. 2001;50:221-7. https://doi.org/10.1016/s0022-3999(01)00192-1 https://doi.org/10.1016/s0022-3999(01)00...	Video recordings of behavior in interactions and play in the school environment. Evaluation of cortisol and sIgA levels in saliva samples. The criterion for isolation was the behavioral patterns presented by each child.	Hypothalamic-pituitary-adrenal axis	Social isolation was the only behavioral pattern that increased cortisol levels.	The samples were collected in only one type of situation experienced by the children (games).
Koss et al.¹⁶16. Koss KJ, Hostinar CE, Donzella B, Gunnar MR. Social deprivation and the HPA axis in early development. Psychoneuroendocrinology. 2014;50:1-13. https://doi.org/10.1016/j.psyneuen.2014.07.028 https://doi.org/10.1016/j.psyneuen.2014....	Home collection of salivary cortisol in three samples (morning, noon, bedtime), for three days. In the same period, care in the pre-adoption period, the child's growth and socio-emotional capacity were evaluated. Children in foster care institutions were considered to be in social isolation.	Hypothalamic-pituitary-adrenal axis	Children in isolation exhibited less pronounced daytime cortisol compared to non-isolated peers of the same age; these differences did not diminish over the two-year period. It was found that early social deprivation can contribute to the early programming of the hypothalamic-pituitary axis.	Some families refused to participate in the study. Of those who agreed, not all were able to start shortly after adoption and therefore were not included in this analysis. The collection of all samples was a challenge for some of them and required several weeks, extending the time period for each collection.

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[1] *Corresponding author. E-mail: isabelle.lina@outlook.com (I. L. L. Almeida).