{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T02:28:30Z","timestamp":1788661710729,"version":"build-2803163510"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["RS-2022-KH128210, HI22C1156"],"award-info":[{"award-number":["RS-2022-KH128210, HI22C1156"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected physical and mental health. Since the onset of the pandemic, the prevalence of depression and anxiety has significantly increased. Quarantine and social distancing, implemented to control the spread of COVID-19, have exacerbated social isolation. This study aimed to longitudinally examine how the severity of depression and anxiety, along with COVID-19 diagnosis, influenced the trajectory of social isolation throughout the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>This longitudinal study collected data from South Korea in three waves: 2021, 2022, and 2023. The final sample included 2,395 participants (mean age\u2009=\u200946.32, SD\u2009=\u200916.47) who completed a face-to-face interview survey. Depressive symptoms were measured using the Patient Health Questionnaire-9, while anxiety was assessed using the Generalized Anxiety Disorder-7. Social isolation was evaluated using the Loneliness and Social Isolation Scale. The data were analyzed using multilevel modeling with a three-way interaction design.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A significant three-way interaction was found between time, depression severity, and COVID-19 diagnosis, while anxiety severity showed no significant interaction. Among the participants diagnosed with COVID-19, those with severe depressive symptoms exhibited an increase in social isolation over time. The positive effect of time was strengthened when the depression severity was severe, whereas it was weakened in participants with moderate or mild depressive symptoms. For participants without a COVID-19 diagnosis, social isolation tended to decrease over time across all levels of depressive symptoms, excluding cases with no depressive symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The three-way interaction results indicated that the severity of depressive symptoms and COVID-19 diagnosis status significantly influenced social isolation trajectory over time. Individuals diagnosed with COVID-19, particularly those experiencing severe depression, have an increased risk of worsening social isolation over time. This underscores the need for intensive and sustained psychological support and intervention for vulnerable individuals.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0330118","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T17:47:32Z","timestamp":1757526452000},"page":"e0330118","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of depression, anxiety, and COVID-19 diagnosis on social isolation trajectories during the pandemic: A 3-year prospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3077-3915","authenticated-orcid":true,"given":"Juhee","family":"Choi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaeun","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4739-1788","authenticated-orcid":true,"given":"Ye-Seul","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee-Hong","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jungeun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4623-9899","authenticated-orcid":true,"given":"Subin","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"pone.0330118.ref001","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.euroneuro.2021.10.864","article-title":"The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves","volume":"55","author":"M Manchia","year":"2022","journal-title":"Eur Neuropsychopharmacol"},{"key":"pone.0330118.ref002","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.bbi.2020.07.037","article-title":"Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors","volume":"89","author":"MG Mazza","year":"2020","journal-title":"Brain Behav Immun"},{"issue":"7","key":"pone.0330118.ref003","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1177\/00207640211003121","article-title":"Prevalence of anxiety, depression, and psychological distress among the general population during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"67","author":"M Necho","year":"2021","journal-title":"Int J Soc Psychiatry"},{"key":"pone.0330118.ref004","doi-asserted-by":"crossref","first-page":"101348","DOI":"10.1016\/j.ssmph.2023.101348","article-title":"Prevalence of depressive symptoms in U.S. adults during the COVID-19 pandemic: A systematic review","volume":"21","author":"CK Ettman","year":"2023","journal-title":"SSM Popul Health"},{"issue":"29","key":"pone.0330118.ref005","article-title":"The Prevalence of Depression, Anxiety and Associated Factors among the General Public during COVID-19 Pandemic: a Cross-sectional Study in Korea","volume":"36","author":"DM Kim","year":"2021","journal-title":"J Korean Med Sci"},{"key":"pone.0330118.ref006","volume-title":"COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide","author":"World Health Organization","year":"2022"},{"issue":"8","key":"pone.0330118.ref007","doi-asserted-by":"crossref","first-page":"3214","DOI":"10.1038\/s41380-022-01638-z","article-title":"A systematic review and meta-analysis on prevalence of and risk factors associated with depression, anxiety and insomnia in infectious diseases, including COVID-19: a call to action","volume":"27","author":"K Yuan","year":"2022","journal-title":"Mol Psychiatry"},{"issue":"1","key":"pone.0330118.ref008","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1038\/s41398-021-01501-9","article-title":"Public mental health problems during COVID-19 pandemic: a large-scale meta-analysis of the evidence","volume":"11","author":"X Liu","year":"2021","journal-title":"Transl Psychiatry"},{"key":"pone.0330118.ref009","doi-asserted-by":"crossref","first-page":"114243","DOI":"10.1016\/j.psychres.2021.114243","article-title":"Long term impact of Covid-19 infection on sleep and mental health: A cross-sectional study","volume":"305","author":"GK Ahmed","year":"2021","journal-title":"Psychiatry Res"},{"issue":"1","key":"pone.0330118.ref010","doi-asserted-by":"crossref","DOI":"10.1186\/s43045-023-00351-z","article-title":"Anxiety and depression among COVID-19 survivors: a cross-sectional study","volume":"30","author":"AM Abulsaad","year":"2023","journal-title":"Middle East Curr Psychiatry"},{"key":"pone.0330118.ref011","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.amsu.2020.12.012","article-title":"Preparing for COVID-19 exit strategies","volume":"61","author":"M Griffin","year":"2020","journal-title":"Ann Med Surg (Lond)"},{"issue":"1137","key":"pone.0330118.ref012","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1136\/postgradmedj-2020-137738","article-title":"COVID-19 in South Korea","volume":"96","author":"JY Choi","year":"2020","journal-title":"Postgrad Med J"},{"issue":"7","key":"pone.0330118.ref013","doi-asserted-by":"crossref","DOI":"10.1093\/geronb\/gbaa111","article-title":"Loneliness and Mental Health During the COVID-19 Pandemic: A Study Among Dutch Older Adults","volume":"76","author":"TG van Tilburg","year":"2021","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"5","key":"pone.0330118.ref014","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1017\/S1041610222000199","article-title":"Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"35","author":"Y Su","year":"2023","journal-title":"Int Psychogeriatr"},{"issue":"2","key":"pone.0330118.ref015","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1177\/08919887221078564","article-title":"Sense of Alienation and Its Associations With Depressive Symptoms and Poor Sleep Quality in Older Adults Who Experienced the Lockdown in Wuhan, China, During the COVID-19 Pandemic","volume":"35","author":"W-C Chen","year":"2022","journal-title":"J Geriatr Psychiatry Neurol"},{"key":"pone.0330118.ref016","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12992-021-00704-5","article-title":"Feelings of loneliness and mental health needs and services utilization among Chinese residents during the COVID-19 epidemic","volume":"17","author":"L Bao","year":"2021","journal-title":"Global Health"},{"issue":"2","key":"pone.0330118.ref017","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/geronb\/gbac174","article-title":"Social Isolation, Loneliness, and Depressive Symptoms: A Twelve-Year Population Study of Temporal Dynamics","volume":"78","author":"M Luo","year":"2023","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"1","key":"pone.0330118.ref018","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1186\/s12888-023-05069-0","article-title":"Associations between constructs related to social relationships and mental health conditions and symptoms: an umbrella review","volume":"23","author":"E Pearce","year":"2023","journal-title":"BMC Psychiatry"},{"key":"pone.0330118.ref019","doi-asserted-by":"crossref","DOI":"10.1037\/tra0000703","article-title":"Loneliness, isolation, and social support factors in post-COVID-19 mental health","volume":"12","author":"LY Saltzman","year":"2020","journal-title":"Psychol Trauma"},{"key":"pone.0330118.ref020","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.3389\/fpsyg.2020.02201","article-title":"Psychological Consequences of Social Isolation During COVID-19 Outbreak","volume":"11","author":"G Pietrabissa","year":"2020","journal-title":"Front Psychol"},{"issue":"9","key":"pone.0330118.ref021","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1007\/s12603-020-1500-7","article-title":"Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations","volume":"24","author":"W Sep\u00falveda-Loyola","year":"2020","journal-title":"The Journal of nutrition, health and aging"},{"issue":"12","key":"pone.0330118.ref022","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1080\/13607863.2018.1506742","article-title":"Social isolation, cognitive reserve, and cognition in older people with depression and anxiety","volume":"23","author":"IEM Evans","year":"2019","journal-title":"Aging Ment Health"},{"issue":"11","key":"pone.0330118.ref023","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/j.jaac.2020.05.009","article-title":"Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19","volume":"59","author":"ME Loades","year":"2020","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"3","key":"pone.0330118.ref024","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1080\/07347332.2021.1913780","article-title":"Psychosocial impact of the COVID-19 pandemic on cancer patients, survivors and caregivers","volume":"39","author":"I Amaniera","year":"2021","journal-title":"J Psychosoc Oncol"},{"issue":"1","key":"pone.0330118.ref025","doi-asserted-by":"crossref","DOI":"10.1192\/j.eurpsy.2021.17","article-title":"Social isolation, mental health, and use of digital interventions in youth during the COVID-19 pandemic: A nationally representative survey","volume":"64","author":"C Rauschenberg","year":"2021","journal-title":"Eur Psychiatry"},{"issue":"1","key":"pone.0330118.ref026","doi-asserted-by":"crossref","first-page":"51","DOI":"10.32350\/ccpr.41.04","article-title":"Social Isolation, Mindfulness, and Mental Wellbeing among Covid-19 Survivor University Students","volume":"4","author":"khan Sana","year":"2022","journal-title":"CCPR"},{"issue":"4","key":"pone.0330118.ref027","doi-asserted-by":"crossref","first-page":"291","DOI":"10.4306\/jknpa.2021.60.4.291","article-title":"Development and Validation of Loneliness and Social Isolation Scale","volume":"60","author":"SJ Hwang","year":"2021","journal-title":"J Korean Neuropsychiatr Assoc"},{"issue":"18","key":"pone.0330118.ref028","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1001\/jama.282.18.1737","article-title":"Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire","volume":"282","author":"RL Spitzer","year":"1999","journal-title":"JAMA"},{"issue":"10","key":"pone.0330118.ref029","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"pone.0330118.ref030","first-page":"119","article-title":"Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9)","volume":"6","author":"SJ Park","year":"2010","journal-title":"Anxiety Mood"},{"issue":"1","key":"pone.0330118.ref031","doi-asserted-by":"crossref","DOI":"10.1214\/14-EJS890","article-title":"A note on BIC in mixed-effects models","volume":"8","author":"M Delattre","year":"2014","journal-title":"Electron J Statist"},{"issue":"7","key":"pone.0330118.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0219663","article-title":"Health risks associated with social isolation in general and in young, middle and old age","volume":"14","author":"O H\u00e4mmig","year":"2019","journal-title":"PLoS One"},{"issue":"10","key":"pone.0330118.ref033","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1007\/s00127-021-02174-x","article-title":"Social factors and the prevalence of social isolation in a population-based adult cohort","volume":"57","author":"S R\u00f6hr","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"3","key":"pone.0330118.ref034","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1177\/00221465221109634","article-title":"Gender and Social Isolation across the Life Course","volume":"63","author":"D Umberson","year":"2022","journal-title":"J Health Soc Behav"},{"issue":"19","key":"pone.0330118.ref035","doi-asserted-by":"crossref","first-page":"9982","DOI":"10.3390\/ijerph18199982","article-title":"Impact of the COVID-19 Pandemic on Loneliness and Social Isolation: A Multi-Country Study","volume":"18","author":"R O\u2019Sullivan","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0330118.ref036","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jad.2023.02.096","article-title":"Emotional and social loneliness and their unique links with social isolation, depression and anxiety","volume":"329","author":"NE Wolters","year":"2023","journal-title":"J Affect Disord"},{"issue":"1","key":"pone.0330118.ref037","doi-asserted-by":"crossref","DOI":"10.1192\/j.eurpsy.2022.2320","article-title":"Social isolation and suicide risk: Literature review and perspectives","volume":"65","author":"C Motillon-Toudic","year":"2022","journal-title":"Eur Psychiatry"},{"key":"pone.0330118.ref038","doi-asserted-by":"crossref","first-page":"714","DOI":"10.3389\/fpsyt.2020.00714","article-title":"Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions","volume":"11","author":"WB Jemberie","year":"2020","journal-title":"Front Psychiatry"},{"issue":"1","key":"pone.0330118.ref039","doi-asserted-by":"crossref","first-page":"5","DOI":"10.12809\/eaap2176","article-title":"Posttraumatic Stress, Anxiety, and Depression in COVID-19 Survivors","volume":"32","author":"KK Wu","year":"2022","journal-title":"East Asian Arch Psychiatry"},{"key":"pone.0330118.ref040","doi-asserted-by":"crossref","first-page":"591120","DOI":"10.3389\/fpsyt.2020.591120","article-title":"Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK","volume":"11","author":"CE Robb","year":"2020","journal-title":"Front Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330118","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T17:47:37Z","timestamp":1757526457000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330118"}},"subtitle":[],"editor":[{"given":"Yan-Min","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330118","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]}}}