Bland, AR

Elliott, R

Mehta, MA

Robbins, TW

Roiser, JP

Sahakian, BJ

English

UCL Discovery

Psychological Medicinecambridge.org/psmCorrespondenceCite this article: Bland AR, .Roiser JP, MehtaMA, Sahakian BJ, Robbins TW, Elliott R (2020).COVID-19 induced social isolation; implicationsfor understanding social cognition in mentalhealth. Psychological Medicine 1–2. https://doi.org/10.1017/S0033291720004006Received: 17 September 2020Revised: 1 October 2020Accepted: 6 October 2020Key words:Affective bias; COVID-19; social cognition;social connectivity; social isolationAuthor for correspondence:A. R. Bland, E-mail: a.bland@mmu.ac.uk© The Author(s), 2020. Published byCambridge University Press. This is an OpenAccess article, distributed under the terms ofthe Creative Commons Attribution licence(http://creativecommons.org/licenses/by/4.0/),which permits unrestricted re-use,distribution, and reproduction in any medium,provided the original work is properly cited.COVID-19 induced social isolation; implicationsfor understanding social cognition inmental healthA. R. Bland1 , J. P .Roiser2, M. A. Mehta3, B. J. Sahakian4,5, T. W. Robbins5,6and R. Elliott71Department of Psychology, Manchester Metropolitan University, Manchester, UK; 2Institute of CognitiveNeuroscience, University College London, London, UK; 3Institute of Psychiatry, Psychology and Neuroscience,King’s College London, London, UK; 4Department of Psychiatry, University of Cambridge, Cambridge, UK;5Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; 6Department ofPsychology, University of Cambridge, Cambridge, UK and 7Division of Neuroscience and Experimental Psychology,University of Manchester, Manchester, UKSocial distancing measures to combat the spread of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infections are likely to have unintended consequences on mentalhealth and emotional wellbeing. Social isolation, loneliness and uncertainty are key risk factorsfor developing mental health problems and pose a significant concern for the long-term con-sequences of social distancing (Vatansever, Wang, & Sahakian, 2020). Nevertheless, this pan-demic has illuminated the struggle of many people with mental health disorders, who livesocially disconnected and isolated lives every day, long before the emergence of coronavirus2019 (COVID-19) and societal ‘lockdown’.Social integration has been found to be robustly linked to social cognitive ability; the mentaloperations needed to perceive, interpret and process information for adaptive social interac-tions (Green, Horan, & Lee, 2019). Without the ability to interpret emotional facial expres-sions in others and understand subtle social cues, social integration and maintaining socialsupport networks is problematic. A fundamental question remains as to whether social cogni-tion deficits are inherent vulnerability markers of mental health problems, whereby peoplewith impaired social cognitive skills have difficulty with forming normal social support net-works resulting in withdrawal and loneliness, or whether they are a secondary consequenceof prolonged periods of isolation and poor social connections resulting from mental healthsymptoms.Social distancing measures have presented a unique opportunity to examine the effects ofsocial isolation on people without prior mental health disorders in order to ascertain whethersocial isolation has a detrimental impact on social cognitive ability. This will inform the extentto which social cognitive deficits are attributable to reduced social contact. This has importantimplications for how we interpret social cognitive deficits in mental health disorders andinform the development of appropriate interventions. Indeed, if social isolation causes directimpairments to a particular aspect of social cognition, this suggests that preventing or reducingperceived isolation, enhancing social support and reducing loneliness may prevent the devel-opment of social cognitive deficits associated with mental health problems. This has criticalimplications for outcomes such as maintaining interpersonal relationships and face-to-faceemployment. Alternatively, if social isolation does not produce impairments in aspects ofsocial cognition in the absence of mental health problems, it may be the case that social cog-nitive disruption is inherent to the pathology of mental health disorders. In this case, treat-ments should target symptom-specific impairments in order to improve social cognitionand linked functional outcomes. This not only has important implications for understandingthe effects of social isolation due to COVID-19 pandemic, but also has wider implications forunderstanding the interactions between social isolation, social cognition and mental health.We examined social cognitive ability during the most stringent period of UK governmentenforced ‘lockdown’ (21 April to 10 May) in 107 adult participants who had not previouslyexperienced mental health problems. Following ethical approval and with informed consent,we distributed online neuropsychological tasks assessing emotion recognition, emotionalattention and cooperative behaviour to examine social cognitive ability in comparison to nor-mative performance data obtained pre-COVID-19. For emotional facial recognition specific-ally, which is thought to be a robust marker of mental health disruption, we observedsignificantly reduced positive biases [F(1306) = 13.46, p < 0.001, ηp2 = 0.09]. This was driven bysignificantly reduced accuracy in recognising happy faces [F(1306) = 6.01, p = 0.003, ηp2 = 0.04]and significantly increased accuracy in recognising sad faces [F(1306) = 9.92, p < 0.001, ηp2 =0.07]. Interestingly, we found that affective biases during COVID-19 were related to howconnected people were during lockdown with people who experienced greater disruption tohttps://www.cambridge.org/core/terms. https://doi.org/10.1017/S0033291720004006Downloaded from https://www.cambridge.org/core. University College London (UCL), on 25 Mar 2021 at 13:58:01, subject to the Cambridge Core terms of use, available attheir usual social network, showing the greatest decline in positivebias in emotional recognition. Our results point towards the sig-nificant impact of social distancing measures on social cognitiveability. However, it remains unclear whether the impact of socialisolation is transient and returns to typical levels upon normalsocial connectivity resuming or whether the impact continueslonger-term. Understanding these cognitive mechanisms bywhich enforced social isolation impacts mental health is vital.This will inform development of treatment and preventative inter-ventions that target specific aspects of social cognition to improvefunctional outcomes and help inform specific targets for effectivechange and intervention for people at risk of debilitating mentalhealth disorders.Conflict of interest. BJS consults for Cambridge Cognition, GreenfieldBioVentures and Cassava Sciences. She receives funding from the WallittFoundation and Eton College. Her research is conducted within the NIHRBrain Injury MedTech and in vitro diagnostics Cooperative (MIC,Cambridge) and the NIHR Cambridge Biomedical Research Centre (MentalHealth and Neurodegeneration Themes). TWR provides consultancy forCambridge Cognition, Lundbeck, Greenfield Bioventures, Cassava, Takedaand Unilever, and has research grants with Shionogi and GlaxoSmithKline.Financial support. This research received no specific grant from any fund-ing agency, commercial or not-for-profit sectors.ReferencesGreen, M. F., Horan, W. P., & Lee, J. (2019). Nonsocial and social cognition inschizophrenia: Current evidence and future directions. World Psychiatry:Official Journal of the World Psychiatric Association (WPA), 18(2),146–161. https://doi.org/10.1002/wps.20624Vatansever, D., Wang, S., & Sahakian, B. J. (2020). Covid-19 and promisingsolutions to combat symptoms of stress, anxiety and depression.Neuropsychopharmacology, 0, 1–2. https://doi.org/10.1038/s41386-020-00791-9.2 A. R. Bland et al.https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0033291720004006Downloaded from https://www.cambridge.org/core. 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COVID-19 induced social isolation; implications for understanding social cognition in mental health

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COVID-19 induced social isolation; implications for understanding social cognition in mental health

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