INtegrating loneliness mitigation measures in pandemic management plans: an interdisCiplinary in-depth expLoration of psychologically and ethically sUitable interventions to DecreasE social isolation [INCLUDE]

Introduction: It is widely acknowledged that the Covid-19 pandemic, and successive Coronavirus-related restriction measures, have caused serious disruption to ordinary lives and a deterioration in public mental health. Apart from illness and death, a distinctive mark of the pandemic has been disrupted social interactions, increasing social isolation and loneliness. Mental health consequences varied widely and were significantly dependent on an individual's unique social context. While the National COVID-19 Science Task Force (NCS-TF) proposed already in June 2020 that mitigation measures for main stress factors should be included among pandemic management plans (PMPs), in-depth research on concrete measures and on the ethical balancing between prevention of mental health problems versus prevention of virus spread remains scarce. Given the high diversity of how people cope with social isolation, there has recently been a growing recognition that the concept of loneliness captures best the difference between being alone versus lonely, and that loneliness and its mitigation (during and beyond pandemics) need to be at the center of much needed further research.Already before the pandemic, globally, between one fifth and a third of the world suffered from loneliness. In 2005, 26% of the Swiss population reported feeling lonely and by 2017 the figure had increased to 38% (above the global average of 33%). It is well established that loneliness is a serious health risk that affects both psychological and physical health. There is a vital need to include loneliness prevention and alleviation interventions (LPAIs) in PMPs. To do so requires not only thorough knowledge about feasible and available measures and their usefulness, but also a well-argued and well communicated psychologically and ethically sound balancing between measures, especially those measures that may alleviate isolation, but at the same time increase virus spreading. Taking loneliness into account in future PMPs will reduce the harmful psychological, physical and behavioral effects of social isolation measures, increase individual and social welfare, and enable more transparent and just strategies to reduce the burden associated with pandemics. Objectives and study parts: We will use a mixed methods approach to fill the existing research gap. The aim is to provide an in-depth exploration into the experiences of people affected by loneliness in order to identify types and justifications of loneliness prevention and alleviation interventions that can inform PMPs. The study has the following main objectives and study parts:1. Identify the broad types of interventions offered by different levels of society to counter loneliness. Utilizing a gold standard classification system, a broad review of the types of loneliness interventions offered during the pandemic will be identified. These include direct and indirect interventions offered by individuals, local communities, and society as a whole (state/canton interventions). These interventions, identified through desk-top research and focus groups with local social actors, will be addressed in the interview guide in part 2a and taken up in parts 2b and 3 of the study. 2a: Explore and analyze experiences of loneliness: qualitative explorative research will be conducted using semi-structured interviews with a purposive sample of ca. 30-40 participants (15-20 from French speaking and 15-20 from German speaking Switzerland) who experienced loneliness, focusing on at-risk groups identified in part 1 (e.g. young, single, or mentally ill persons and recent migrants). Questions will center on the self-reported impact of the pandemic on loneliness and will incorporate explorative questions around the types of interventions identified in part 1 of the study. Data collected in this part will be subjected to qualitative content analysis with a view to considering the self-reported impact of the pandemic on loneliness, and the perceived effectiveness of types of interventions identified in part 1 that were the basis for participant interview guides in part 2a of the study.2b: Use a quantitative approach (questionnaires, Swiss and Canadian data) to confirm the perceived usefulness - including how participants balance harms and benefits - of loneliness alleviation measures.3. Triangulate findings from the preceding parts and carry out an ethical analysis related to how the balancing of prevention of loneliness vs. virus containment does and should affect the choice of measures. Use a participatory Delphi approach to produce recommendations for policy makers on the types of loneliness interventions that should be included in PMP. Part 3 of the project will enable recommendations to be put forward for individual, local and national PMP that will be targeted at alleviating loneliness in future pandemics when significant disruptions of social contact become necessary. Results will be discussed with stakeholders during national workshops and international conferences and reported in various publications.Benefit: The project is highly beneficial as it will 1) produce practical recommendations for future PMP including a white paper for policy makers, 2) provide new much needed Swiss in-depth as well as quantitative data; it will 3) provide an analysis of the types of LPAIs identified in the literature as effective and will 4) benefit national and international academic and practical debates on better crisis management and increased individual and collective welfare.