Social networks are complex systems of interpersonal relationships that have long been acknowledged to be highly influential on mental health and general well-being [1, 2]. Strong, positive social connections with friends, family, neighbors, and community members are essential components of psychological resilience [3]. These relationships include the main elements of social support, namely belonging, emotional reinforcement, and instrumental or material aid (e.g., helping with daily tasks) [4]. The presence of a robust social network is consistently associated with lower rates of depression and anxiety, in addition to other psychiatric disorders, especially in times of stress [5].
The onset of the coronavirus disease 2019 (COVID-19) pandemic has been a reminder of not only the importance of robust social relationships, but also the complex interplay between social networks and mental health. Prior to the widespread availability of vaccines, one of the main prevention methods against the spread of COVID-19 involved social distancing measures implemented by local, regional, and national governments worldwide [6]. These policies resulted in drastic changes to everyday life, characterized by isolation, uncertainty, and disrupted social norms [7]. Within this context, the way social networks and mental health interact has become a focal point of research. Through the onset of the pandemic, positive social interactions shifted dramatically from being a vital source of emotional sustenance to being potential conduits for viral transmission [8]. At the same time, perceived social support appeared to be a powerful buffer against the psychological turmoil resulting from the pandemic’s upheaval [8]. While social networks are known to affect mental health [9, 10], some research has shown that psychiatric symptoms can also predict future levels of perceived social support [11]. It is therefore important to investigate the existence of any bidirectional relationships between these variables.
Amidst the height of the COVID-19 pandemic in 2020–2021, an abundance of literature explored how social interactions evolved over time during the pandemic. However, most prior investigations relied on isolated time-point assessments [12, 13], had limited sample sizes [14], or focused on singular facets of social networks [15]. The intricate composition of an individual’s social network calls for a more nuanced exploration, demanding comprehensive data collected from larger cohorts and over multiple time points. Moreover, several studies have investigated individual factors, such as social isolation and social connectedness, during the pandemic and how these factors have impacted mental health, although many of these studies have focused on population subgroups such as adolescents [16, 17] or healthcare workers [14, 18]. While it is widely accepted that these groups are more susceptible to poor mental health outcomes during a crisis, it is important to examine mental health outcomes across all ages and demographic characteristics, especially in anticipation of future pandemics [19]. Previous research has also indicated that the prevalence of mental illness differs across genders and ages. For example, major depression and depressive symptoms are more common in women than in men [20], and symptoms peak, and eventually stabilize, at different stages in life depending on gender [21]. Social networks also vary by age [22], but findings on gender differences in social engagement are heterogeneous [23].
While many European countries chose to implement mandatory social distancing policies to help mitigate viral spread in the beginning of the pandemic, Sweden’s constitution prohibited the enforcement of a general nationwide lockdown, thus limiting the government’s ability to control individuals’ mobility [24]. This approach varied significantly from other Scandinavian countries such as Norway and Denmark, where more restrictive measures were enforced. [25, 26]. The Swedish strategy evolved over the course of the pandemic, ranging from relatively relaxed measures in the early stages to more strict adjustments in response to changing COVID-19 incidence [27]. Thus, an examination of the connections between social network and mental health in Sweden across various time-points during the COVID-19 pandemic is warranted.
This study aimed to investigate the relationships between components of social networks and depressive and anxiety symptoms in a large Swedish community cohort over a 12-month period during the COVID-19 pandemic. The following hypotheses were tested: (1) Positive social networks (i.e., more frequent social contacts and more positive perceptions of emotional support) are negatively correlated with the prevalence of depressive and anxiety symptoms during the pandemic; (2) The correlation between social network and depressive and anxiety symptoms changes over time during the pandemic; and (3) There is a cross-lagged effect in the bidirectional association between social network and mental health, namely that current social network influences future mental health status whereas current mental health influences future perceived social network. In sum, this study aims to offer a comprehensive understanding of how social networks influence mental health, especially in the context of a crisis such as the COVID-19 pandemic, considering potential variations related to sex and age.