Shortly after the pandemic was declared in March 2020, more than 2 million people in the UK were advised to fence off their homes as they were deemed “extremely clinically vulnerable” to the effects of COVID-19. This included people with compromised immune systems and underlying health conditions.
With the advent of COVID vaccines and treatments, advice to shield expired in August 2021. Despite the encouragement to reintegrate into society, many people continued to screen their homes. As of May 2022, 13% of people classified as clinically vulnerable were still shielding, while 69% said they were taking extra precautions (such as social distancing or wearing a mask).
We know the psychological impact of long-term social isolation is significant. This is compounded by the effects of limited access to medicines, health care and basic services.
Research we did during the first wave of the pandemic in March 2020 confirmed that that shielding was not only physically vulnerable, but also: the most vulnerable psychological. We found that people classified as clinically extremely frail were more depressed, anxious and anxious about their health in general than the general population.
In our new research, we questioned a group of sentries a year later to see how they were doing. This time we also included participants who shielded other people, for example partners or close relatives of people who are vulnerable.
In both studies, participants were spread across the UK, mostly women, predominantly white and had a mean age of 40 years.
Our new research: what we did and what we found
During the lockdown in February 2021, we recruited 700 people through social media in three groups: those who protect themselves, those who protect others and those who never protected themselves during the pandemic.
We asked them to complete a series of questionnaires about their personal circumstances, mental health and behavior in relation to the then government guidelines. We were particularly interested in the fear of contamination and the protective measures people took, as these were important predictors of fear in past pandemics†
Equivalent to our first study, people who shielded themselves reported being more anxious (38%) than the general public (16%). People who shielded others scored between those two groups (23%). Meanwhile, the foreclosure people showed the highest rate of health anxiety (40%), while the other groups were much lower, about 12%.
Comparing these results to our previous study, it turns out that the general public became less anxious over time, while that shielding became more anxious. But these are separate studies with largely different participants, so we need to be careful about making comparisons.
The longer people shielded themselves, the more anxious they were about their health (but not anxious overall). We also found that those in shielding groups were more afraid of contamination and more likely to follow government advice and restrictions and take precautions beyond official guidelines.
In addition, older people were more anxious about their health and women were more affected than men, which we also saw in our previous study.
One of the most interesting things we found was the idea of ”vicarious health anxiety” among those shielding others. To investigate this, we used an existing health anxiety questionnaire and slightly adjusted the focus. For example, we’ve replaced the question “I spend a lot of my time worrying about my health” with “I spend a lot of my time worrying about my family member’s health.”
Our results suggest that half of those who screened others were concerned about another person’s health. This is incredibly high, despite the relatively small group size, and deserves further investigation.
Interestingly, we found that participants with vicarious health anxiety were not at all concerned about their own health. You might speculate that the burden of the health of a vulnerable person you care about — especially knowing that inadvertently passing COVID to them could have dire consequences — is more emotionally challenging than taking responsibility for your own health.
Where to from here?
While our research provides new insight into sentinel mental health, it’s important to recognize that it only captures a snapshot. What would have provided more information is to track the same group during the pandemic and beyond.
Our research also reveals the possibility of another invisible group that seems to be silently grappling with the pressure to protect someone else, and may need support of its own.
Unsurprisingly, those who are clinically vulnerable are anxious during a fluctuating multi-wave pandemic. If they weren’t, that would be more unexpected. fear is a rational response to a virus – specifically one that continues to mutate and spread rapidly, and one that remains life-threatening to the most vulnerable.
While vulnerable people have been and will continue to be prioritized for vaccines and treatments, many expressed concern that the abolition of UK Government restrictions and foreclosure directives most vulnerable with the greatest risk.
Vulnerable groups is still advised to take a variety of precautionsincluding working from home if they can and feel more comfortable doing so. But these guidelines will be revised in late July, and many face the possibility of returning to the office and being pushed into a “new normal” when they may not feel safe or ready.
Given the level of suffering we have seen in our research, it is important that these groups are recognized and properly supported. Indeed, we know that the more a person avoid something scary (e.g., interacting with others), the more troubling the prospect of doing it will be.
At the start of the pandemic, few of us would have expected that two and a half years later, there would still be a physically and psychologically vulnerable group carrying an incredible personal burden. But there is, and we need to better serve their needs now and in the future.
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