Loneliness, Social Isolation Affected Mental Health of Patients With Rheumatic Disease During COVID-19 Pandemic

Patients with rheumatic disease experienced a substantial proportion of loneliness and social isolation, which was linked to depression and anxiety, during the COVID-19 pandemic.

Social isolation during the COVID-19 pandemic was shown to affect the mental health of patients with rheumatic diseases, according to study findings published in American College of Rheumatology.

Depression has been shown to disproportionately affect those with rheumatic diseases, with prevalence found to be as high as 39%. The COVID-19 pandemic increased physical distancing and social restrictions, which are important facets of psychosocial health.

Researchers aimed to characterize loneliness and social isolation during the COVID-19 pandemic and determine their association with depression and anxiety in patients with rheumatic disease.

Researchers conducted an international online survey between April and September 2020. Participants were enrolled through social media, as well as well as arthritis organizations. Participants who were 18 years and older and had self-reported rheumatic disease were included in the study. Selected individuals who consented to a follow-up survey were evaluated between December 2020 and February 2021.

Information in the questionnaire included disease type, severity, duration, and use of prescription and nonprescription medications.

Our results further illustrate a need for clinician assessment of loneliness and social isolation…

Loneliness was evaluated using the 3-item UCLA Loneliness Scale (UCLA-3) and social isolation using the Lubben Social Network Scale (LSNS-6). Self-reported symptoms of depression were collected using the Patient Health Questionnaire (PHQ-9). Generalized Anxiety Disorder 7-item (GAD-7) was used to assess self-reported generalized anxiety disorder.

Multivariate linear regression models were used to evaluate associations between loneliness and social isolation and depression and anxiety. 

In total, 718 individuals participated in the survey, of whom321 (51.1%) reported experiencing loneliness. Those who completed both surveys did not have a significant change in their UCLA-3 score (mean difference, 0.12; P =.155).

A total of 199 (30.3%) participants reported feeling socially isolated, of whom 67.4% were married and 87.4% shared their household with 1 or more people.

A total of 273 (42.8%) participants who completed the PHQ-9 questionnaire had symptoms of depression at baseline, and 221 (34.0%) had symptoms of anxiety.

Unadjusted models found that loneliness (ß=4.87; 95% CI, 3.83-5.92) and social isolation (ß=2.85; 95% CI, 1.28-4.41) were independently, as well as in combination (ß=8.02; 95% CI, 6.83-9.21), associated with higher depression scores. Those who reported loneliness and social isolation had an average of 7.27 higher depression score (95% CI, 6.08-8.47).

Multivariate models showed that anxiety scores for those experiencing loneliness without social isolation were an average of 2.93 units (95% CI, 1.93-3.92) higher compared with those without loneliness and social isolation. When loneliness and social isolation were present, anxiety scores were on average 5.14 units (95% CI, 4.00-6.28) higher.

Study limitations included self-reported diagnosis and the majority of participants being women.

The study authors stated, “Overall, these findings accentuate psychological associations with loneliness and social isolation for individuals with rheumatic disease, which have been exacerbated by the COVID-19 pandemic.”

They concluded, “Our results further illustrate a need for clinician assessment of loneliness and social isolation, which can be accomplished during a general assessment of mental health and social support needs, or more directly with the use of brief validated questionnaires such as the UCLA Loneliness Scale.”


Howren A, Avina-Zubieta JA, Puyat JH, et al. Impact of loneliness and social isolation on mental health outcomes among individuals with rheumatic diseases during the COVID-19 pandemicACR Open Rheumatol. Published online March 25, doi:10.1002/acr2.11539