The aim of this study was to provide an insight into the impact of quarantine and social distance on participation in activities of daily living and social interaction, based on data extracted from the responses of 461 people in Iran. In fact, the preliminary results of 461 participants showed that restrictive measures during the outbreak of COVID-19 have negative effects on the areas of the home integration, community integration, and productive and purposeful activities. The total score in the social participation questionnaire of the participants in the study has decreased by 47% compared to "before" the COVID-19 outbreak and restrictions. During similar epidemics (SARS prevalence between 2002 and 2004), previous research has shown several negative effects of quarantine measures on social participation that have been associated with reduced individual well-being {Hawryluck, 2004 #247}{Reynolds, 2008 #248}. These negative cases have also been reported in a recent series of COVID-19 reports, highlighting the fact that people in quarantine report more symptoms of mental distress. In addition, some of these symptoms appear to persist long after the end of quarantine{Lima, 2020 #249}. With previous negative results from the COVID-19 pandemic in the field of social participation, the present findings, supported by previous reports, highlight the risk of socio-psychological stress in the period of quarantine and social distancing.
In particular, the decrease in the total score recorded in the Social Participation Questionnaire in all three areas of integration at home, integration in the community and integration in productive and purposeful activities compared to before the outbreak of COVID-19, means that participants after the outbreak of COVID-19 They were rarely involved in social activities and were therefore at greater risk for social isolation. This can be explained by social constraints, reduced engagement, quarantine, and distancing measures taken by government agencies to curb the spread of the virus {Pancani, 2020 #250}. The findings of this study show that the decrease in the total score of social participation was mainly due to the decrease in social participation through recreational activities (71% decrease). Continuous and daily leaving the house also shows the second-largest decrease (54% decrease). The widespread social isolation imposed on society by COVID-19 is detrimental to mental health. Indeed, a study of 1,006 quarantined Italians following the outbreak of COVID-19 found that quarantine increased depression, social isolation, and feelings of helplessness among individuals {Pancani, 2020 #250}. In addition, people who stopped and quarantined for 1 month in China reported poor mental health and distress after 1 month {Zhang, 2020 #251}.
COVID-19 has a profound effect on all aspects of society, including mental and physical health. Although concerns and ambiguities about epidemics are common, some of them cause unwanted disturbances in social and occupational functions {Lima, 2020 #249}. In addition to the damage that the disease does to its sufferers, the fear of being infected, the loss of loved ones, the loss of a job, the loss of educational opportunities, recreation, freedom, and support, have profound psychological effects. Not only getting it but also the fear of getting it has led to a lack of access to resources that can improve people's resistance to this pandemic. The direct and indirect psychological and social effects of COVID-19 are widespread and can affect mental health {Rajkumar, 2020 #252}.
A general population study conducted in this study shows the broad effects of this disease on social interactions and its consequences on lifestyle and social participation. Social participation is a tool for empowerment through which individuals learn to take responsibility for their own health problems and work to develop their communities {Hyyppä, 2003 #39}{Myroniuk, 2015 #142}. One of the effective factors in social growth and achieving optimal health is presence in social fields and active participation in society. People with high social participation have fewer physical and mental problems. There is a direct relationship between people's social participation and health-related quality of life. Also, social participation and social resources are strong presuppositions of health {Lindström, 2001 #147}{Sirven, 2008 #146}.
The direct and indirect psychological and social effects of COVID-19 are widespread and can affect mental health. A general study of the population, conducted in this study, showed the widespread effects of the disease on social integration and its consequences on lifestyle and social participation. Social participation is a means of empowerment through which people learn to take responsibility for solving their health and wellness problems and strive to develop their communities{Hyyppä, 2003 #141}{Myroniuk, 2015 #142}. One of the effective factors in social development and achieving optimal health is being in social fields and active social participation. People with high social participation had fewer physical and mental problems. There is a direct relationship between people's social participation and the life-quality associated with health. Social participation and social sources are strong predicting of health (36, 37). People with higher social participation have more ability and skill in managing their own and other people's emotions while facing problems and issues of occupational and life environment, and therefore face hardships, problems in daily life, and psychological tensions (38, 39). As a result, they are more likely to respond to adversity, daily life difficulties, and psychological problems and pressures, which in turn increase their resistance to mental disorders and their symptoms, and on the other hand increasing their success, satisfaction, and optimism, and thus increasing their happiness and health (37, 39, 40).
People with higher social participation, due to awareness of their emotions and feelings, strong and healthy management, control and monitoring, stronger social networks, empathy, social skills, and greater social associations, can better resist various sources of permanent job stress, family, or social communication problems (38, 41). They can effectively resolve issues and problems. Therefore, these people can better communicate with their peers compared to people with lower levels of social participation. Besides, better manage their responsibilities, perform better and have an effective, fresh, and healthier presence in the workplace and other areas of their lives by spreading and gaining positive emotions about themselves(38, 41, 42). Because mental fatigue and mental pain are the sources of many physical diseases, they will mutually affect a person's mental health and well-being. A person with mental and physical problems will be fragile in the face of environmental and occupational stress (38, 41, 42). Long-time stressful stimuli result in the occurrence of depression, the first manifestation of which is extremely emotional and psychological fatigue, and lead to a decrease in public health and community productivity.
People who are more socially involved have more mental abilities to understand the situation temporarily and to respond to the pressures and tensions of the internal and external environment. Such capabilities usually empower the people for resistance against the symptoms of anxiety, stress, mental disorder, severe depression, stress, and social functioning(39, 40).
Fear of infecting by the disease associates with increased anxiety, depression, stress, and other negative emotions, and concerns about the practical consequences of the epidemic. It has a profound effect on the mental health of family members. Further, the disease affects psychological processes such as cognition, emotions, and behavior, as well as lifestyle and social communication, which ultimately affects mental health.
One of the social consequences of this disease is widespread anxiety disorders and depression. These include suicide and self-injury, alcohol and drug abuse, gambling, child abuse, and psychosocial disorders (such as interrupting social communication, being caught on the Internet, cyberspace addiction, feeling of stress, unemployment, homelessness, and losing social relationships). The consequences of the COVID-19 epidemic are likely exacerbated by isolation and social loneliness. Isolation and social disintegration are distinct problems and may show different risk pathways.
These data are critical in determining the causal mechanisms associated with poor mental health, including loneliness. In the face of the consequences of this disease, the available social and personal resources (e.g., meeting family and relatives), are among the resilience associated factors to resolve mental health problems in certain stressful situations, while the disease has attacked the resilience sources and destroyed them.