COVID-19 is caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).¹ At present, COVID-19 has led to a large number of deaths with tens of thousands of confirmed cases globally, giving rise to a serious public health crisis. The control of COVID-19 largely relies upon avoiding or minimizing physical contact with people.² Therefore, a nationwide lockdown was imposed in India to contain the spread of the virus from March 25^th to May 31^st, 2020.³ The social isolation, along with the financial and psychosocial burden, flared up after the COVI-19 lockdown, which was further compounded by the rising number of cases and mass panic and anxiety in the country.⁴

Loneliness is defined as an unpleasant experience that derives from deficiencies (qualitative and quantitative) in one’s network of social relationships.⁵ Social integration and connections are imperative for an individual’s development and well-being across the lifespan. Research suggests that loneliness can adversely influence an individual’s physical, mental and cognitive health.⁶ Loneliness has been associated with a greater risk of cardiovascular disease, dementia, anxiety and depression.⁷ Loneliness can impair daily activities and functioning and even exacerbate already existing mental health conditions.⁷

With restricted interpersonal contact opportunities and physical distancing in place, rates of loneliness increased all around the world during the COVID-19 pandemic. Recent evidence reported high levels of loneliness and stress in the UK.⁸ A study in Spain found that perception of self as a burden, lower quality of sleep and being more exposed to news about COVID-19 were associated with higher feelings of loneliness.⁹ In a survey among adolescents in Belgium during the COVID-19 quarantine found that participants who experienced loneliness were more inclined to use social media to cope with lack of social contact.¹⁰ A study among adults in Italy during the lockdown period, participants with perceived loneliness reported spending more time on social media which was also associated with increasing levels of anxiety.¹¹

Very few studies have explored loneliness among general population during the ongoing COVID-19 pandemic in India.^{12, 13} Understanding the magnitude of the problem at hand and the factors associated with loneliness will help in the development of interventions to address loneliness. Hence, the aim of the study was to estimate the prevalence of loneliness among general population and to examine the family related factors associated with loneliness in south India during the COVID-19 lockdown.

The aim of the study was to estimate the prevalence of loneliness and its association with family related factors amongst adults aged 18-65 during the COVID-19 lockdown in Southern India.

Results show that the overall prevalence of loneliness was 62.5% during the COVID-19 lockdown in South India. In another study conducted in the earlier phase of the lockdown in Japan, it was found that over 40% (41.4%) of the Japanese adults were lonely.¹⁵ In a comparative study from Hong Kong, the prevalence of loneliness pre-COVID-19 phase was 40.6% and peri-COVID-19 phase was 71.1% among older adults.¹⁶ Recent research published in the United Kingdom show a prevalence rate of 27% for loneliness during the lockdown.⁸

The high prevalence of loneliness in this study which is comparable with the other Asian countries could be due to the fact that they are collectivistic nations emphasizing on cultural and social ties.^{17, 18} However, with urbanization and migration, and social structure rampantly changing, the risk of loneliness increases.¹⁹ The lower prevalence of loneliness in the UK when compared to India could be due to cross-cultural differences that emphasize on individualistic societies.²⁰

Results show that as the severity of family discord increases, the levels of loneliness increase. Similar results were observed in Taiwan, which showed that that those with stronger family cohesion during early adolescence were less likely to suffer from serious loneliness in young adulthood.²¹

With familial discord and an unhealthy family climate, family members may perceive a discrepancy in the quality of interactions that they have with one another, which may lead them to self-identify as lonely. The uncertainty of the pandemic, financial and academic stress, lack of personal space, resurfacing of past trauma, differences in ideologies and values among family members may have influenced the family climate leading to loneliness.²²

In the study, no gender differences in loneliness experienced, younger age group (< 30 years of age) and being single were found to be associated with higher prevalence of loneliness. Studies in Spain and UK have found that women reported higher feelings of loneliness; however, no differential impact on gender was observed in our study. This may be due to the major cultural influences and norms in India. Women may not acknowledge and express feelings of loneliness due to the stigma and socio-cultural taboo surrounding it. It may also reflect the difficulty in voicing one’s own concern and feeling burdensome to the family members.

Consistent with previous studies, those who had a spouse, or a partner were found to show lower levels of loneliness as opposed to those who were single. This reflects that being in a relationship can act as a protective factor. The companionship and intimacy of a partner reduces the feelings of loneliness. Considering the study was done with individuals who had access to the internet and social media, it indicates that the digital connectivity does not necessarily translate to a reduction in perceived loneliness.

An inverse relationship with age and loneliness was found, with very high prevalence of loneliness among the younger age group. The prevalence of loneliness decreased with age with 18-30-year old’s having the highest frequency of loneliness (67.5%). Younger adults may be affected disproportionately due to the cessation of opportunities to visit schools, colleges or workplaces where they could interact and socialize. It is also important to consider that as young adults one’s social needs are much higher and emotional regulation is not fully developed.²³

Studies from the UK, Spain along with our current study have found that the youth is at higher risk for loneliness.^{8, 9}This is also an indicator that the interventions to alleviate loneliness should target younger people. A good starting point is by addressing loneliness and isolation in the classrooms and workplaces.

Limitations of the current study are: 1. This was a cross-sectional study done with individuals who have access to the internet. Hence, the results will be not generalisable to all sections of population; and 2. The age range of the participants included is restricted and not included children.

More follow-up studies can be done to assess the risk factors and impact of loneliness. This study will also help us in setting out immediate priorities and long-term strategies for social connectedness and well-being at the community level.

More than two-thirds of the population reported feeling lonely in Southern India. Family discord has also been found to be associated with loneliness. This can be detrimental to physical and mental health as well as how communities function at large. Therefore, novel interventions using digital platforms that provide a sense of belongingness and enhance community engagement should be developed. It is essential to place loneliness and social relationships high on the wider public mental health and research agenda.