Social alignment matters: Following pandemic guidelines is associated with better wellbeing

The Covid-19 global health crisis threatens to also be a mental health and wellbeing crisis. Vulnerabilities, however, are not evenly distributed, especially with wellbeing being a complex construct. Positive wellbeing is marked by subjective feelings of happiness, life satisfaction and having a sense of purpose in connection with the social environment one lives in [1, 2]. As such, a wide range of individual, physical, social and demographic factors combine to influence wellbeing both positively and negatively  – important to bear in mind when much emphasis has been on the negative changes associated with the pandemic. Moreover, wellbeing can fluctuate over time, rendering it critical to capture longitudinal trends. In this study, we test how adherence to Covid-19 physical distancing measures is linked to wellbeing using longitudinal, global survey data collected in April-August 2020.

Studies examining wellbeing during the pandemic have primarily focused on individual and group predictors, with findings showing associations with certain demographic factors. In particular, being a woman, being a young adult, having low educational attainment and income, and having prior mental health conditions were associated with poorer wellbeing [3‐6]. Meta-analytic and review studies have shown that compared to the pre-pandemic period, the public’s levels of depression and anxiety saw a small but significant increase in the first months of the pandemic, while findings remained mixed for overall wellbeing [3, 5, 6]. A closer look suggests that living alone and having less social support were associated with increased loneliness and depressive symptoms [4, 7‐9], and the fear of catching the disease was associated with increased anxiety [10‐12].

Early in the pandemic, The Academy of Medical Sciences reported adverse effects of the pandemic on mental health and wellbeing as the public were anxious about catching the disease and as social isolation increased because of lockdowns promoting physical distancing [13]. Experts highlighted how unnatural physical distancing measures are to human interactions and warned against potential negative effects of ‘Draconian’ lockdown measures on mental health and wellbeing [14]. In contrast to the sentiment that lockdowns and physical distancing adversely affect mental health and wellbeing, more recent research shows that more stringent pandemic measures were indeed associated with better wellbeing [15‐17]. A meta-analysis covering 226,000 participants from 26 countries revealed that only public transport closures, but not stay-at-home requirements, were associated with increased anxiety [3]. These findings can be partly explained by the majority support for lockdowns given their perceived benefits for protection from the disease [18].

Here, we focus on another reason why pandemic guidelines may be associated with better wellbeing – social alignment arising from the similarity in behaviours and experiences of a group of people. Social alignment has the potential for bringing people together under a new set of behavioural norms during a period of high threat and uncertainty [5]. Sharing common experiences during challenging times (as captured in the phrase “We’re all in it together!”) is a strong catalyst for forging social alignment and cohesion [19‐21], which can be rewarding [22] and lead to better wellbeing [23‐26]. Can, then, pandemic guidelines boost wellbeing, in contrast to the background expectation that social isolation would have negative effects? To inform evidence-based recommendations about behavioural policies, we need to identify the demographic and pandemic-specific factors that may underlie potential unifying effects of Covid-19 guidelines on wellbeing.

As per previous studies, we predicted that certain demographic groups, i.e., young adults, women, people with lower educational attainment and people living on their own, would have poorer wellbeing (Hypothesis 1). Regarding pandemic-specific factors, we predicted perceived vulnerability of self and others to the disease to be associated with poorer wellbeing (Hypothesis 2), whereas following physical distancing guidelines to be associated with better wellbeing (Hypothesis 3). To probe the origins of Hypothesis 3, we further examine whether positive effects on wellbeing were due to physical protection from catching Covid-19 or due to social alignment.

Using a cross-national sample, this study shows that key demographic factors and perceived vulnerability to the disease were risk factors for wellbeing, while social alignment attained through following pandemic guidelines was associated with better wellbeing. Our longitudinal analyses show that these effects were consistent throughout the 3-month period during which data were collected.

Beyond replicating known demographic risk factors, this study adds important extensions to our current knowledge. First, despite young adults aged 16–24 having the poorest wellbeing of all age groups, there was a significant improvement in welbeing  over time, which was specific to this age group. This shift may be due to an initial disruption to these young people’s study and work lives [33], but suggests a better adaptation to the new circumstances, and potential for resilience. Second, our sample included individuals who identified as non-binary, a group often unrepresented in psychosocial health studies [34]. We found that throughout the 3-month study period, non-binary individuals had the lowest wellbeing of all gender categories we presented, with improvements occurring over time. Future research is needed to address other demographic risk factors for which we did not collect data, such as having low household income or belonging to an ethnic minority, as well as important characteristics of participants’ history, such as pre-existing mental health conditions.

Regarding pandemic-specific factors, we found that while perceived vulnerability to the disease was associated with poorer wellbeing, higher adherence to social and physical distancing guidelines was associated with better wellbeing. A supplementary model confirmed that adherence contributed to better wellbeing, and not that people with better wellbeing simply adhered to the guidelines more (Table S6).

The reasons why adherence to pandemic guidelines could benefit wellbeing are not straightforward. Our additional analyses indicate social alignment, and not protection from the disease, is the driving force. Our data revealed that, over time, following the guidelines exactly as given – not doing more or less than required – was best for one’s wellbeing. Other pandemic research examining coordinated helping behaviour [35] and stringency of lockdown measures [3] similarly suggested that conditions leading to increased behavioural alignment among people can be positively associated with wellbeing. Replications of the positive link between social alignment and better wellbeing is an important avenue for future research in crisis contexts such as the pandemic. Using similar proxy measures of alignment as in this study, future studies could use satellite and population-level data to examine whether higher degrees of behavioural alignment in communities is linked to better mental health. In a broader context, our findings demonstrating the beneficial wellbeing effects of social alignment are in line with the social cure model, which emphasises the importance of shared social identities for promoting physical and mental health, both during [36, 37] and beyond the pandemic [38].

The mean wellbeing values obtained in this study (Table S15) were similar to those found in other UK-based pandemic studies using WEMWBS [39, 40]. This is important to note in consideration that this study did not have a representative sample, an issue partially addressed also by controlling for important risk factors for wellbeing, such as age and gender, in the analyses. A qualitative comparison shows that the wellbeing scores obtained in our sample (M = 21.6) were lower and considerably more distributed towards the lower end of the scale as compared to those reported in pre-pandemic studies. These previous community sample studies using the same measure (short WEMWBS) revealed scores ranging from 23.6 in the UK [41] to 25.4 and 26.4 in Denmark and Iceland, respectively [42]. Studies using the long version of WEMWBS, whose scores can be halved to roughly equate the short WEMWBS scores, revealed scores ranging from 46.1 to 59.9 in Australia [43], Austria [44], France [45, 46], Germany [46], Italy [47], Spain [48], the UK [28] and the USA [46]. These comparisons indicate that the 7-item short WEMWBS used in this study captured pandemic-induced decreases in welbeing, a point important to consider by public health professionals and policymakers. In addition, our study provides support for the use of short WEMWBS in future research examining rapid changes in mental health and wellbeing.

It may initially seem counterintuitive that pandemic guidelines can be positive for wellbeing beyond their disease prevention function, given that these measures also meant less face-to-face contact with loved ones [9, 49]. In our sample, the median size of people’s close social circle (n = 4) was comparable to that found in previous, pre-pandemic studies [50, 51]. Thus, it seems that following distancing guidelines did not necessarily mean social isolation, which may explain why, contrary to mental health experts’ cautioning, adherence to guidelines was not associated with poorer wellbeing. Importantly, our findings do not invalidate concerns over Covid-19 measures potentially increasing the likelihood of specific mental illnesses, such as anxiety or depressive disorders. Although mental health and wellbeing are closely related, people with a mental illness can have good wellbeing, and people without a mental illness can have poor wellbeing [52].

Overall, we highlight that following the distancing guidelines promoted better wellbeing through increased social alignment. Social alignment was marked by people behaving more similarly to others around them, sharing experiences and responsibility. Pre-pandemic literature shows that social alignment through behavioural similarity and shared experiences is associated with increased social support, cohesion and wellbeing [19, 24]. Further, people are more likely to relinquish individual responsibility about decisions in threatening and uncertain situations, which is associated with reduced stress [53]. Hence, following the guidelines may have boosted wellbeing via reducing the burden of individual responsibility during the pandemic.

This study asserts that adhering to a challenging change in behavioural norms, here distancing measures, is associated with better wellbeing irrespective of people’s perceived vulnerability to the disease or other demographic risk factors for wellbeing. Thus, social alignment can be a powerful tool in high-threat and uncertain situations like the Covid-19 pandemic. We recommend that policymakers and public health officials emphasise the required actions as collective actions in local and national communities. Such an approach is key for promoting both adherence to guidelines and people’s wellbeing, which are essential for long-term coping and social cohesion.