Social Cognition and Covid-19: a rapid scoping review

Social Cognition and Covid-19: a rapid scoping review

Tommaso Barlattani1, Simonetta Mantenuto1, Chiara D’Amelio1, Arianna Di Berardo1, Francesco Capelli1, Valentina Leonardi1, Valentina Socci1, Rodolfo Rossi2, Alessandro Rossi1, Francesca Pacitti1

1Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, Italy; 2Department of Systems Medicine, University of Rome Tor Vergata, Italy.

Summary. The Covid-19 pandemic has enormously impacted health, the economy, and social organisations worldwide. Public health interventions such as vaccines, protective equipment and social distancing have brought profound changes in the general and clinical population’s behaviour, with different levels of adherence to social and health standards. To understand these phenomena, it is essential to know how models and theories of social behaviour influence patterns of adherence to preventive measures in the context of the pandemic. Research on social cognition can explain behavioural variables and their impact on mental well-being, creating the basis for interventions that promote adherence to prevention rules. This PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) rapid review aims to identify and analyse current evidence on the pandemic’s impact on social cognition components. First, we conducted a comprehensive literature review and discussed the findings narratively. Tables were constructed, and articles were sorted based on study characteristics. Finally, 14 eligible articles were identified. Our findings suggest that restrictions aimed at stemming infections and social isolation led to changes in patterns of social cognition in clinical and general populations. Among the clinical population, subjects with autism spectrum disorders and Parkinson’s disease reported changes in social cognition. Among the general population, older adults and front-line workers also reported variations. Our results suggest that planning-oriented social cognition models could effectively promote adherence to preventive norms. These findings can help develop behavioural intervention models by identifying appropriate approaches for the general population and specific subgroups.

Key words. Covid-19, pandemic, preventive measures, SARS-CoV-2, social cognition.

Cognizione sociale e Covid-19: una scoping review.

Riassunto. La pandemia Covid-19 ha avuto un impatto enorme sulla salute, sull’economia e sulle organizzazioni sociali in tutto il mondo. Gli interventi di sanità pubblica, come i vaccini, i dispositivi di protezione e il distanziamento sociale, hanno portato profondi cambiamenti nel comportamento della popolazione generale e clinica, con diversi livelli di adesione alle norme sociali e sanitarie. Per comprendere questi fenomeni, è essenziale sapere come i modelli e le teorie del comportamento sociale influenzino i modelli di adesione alle misure preventive nel contesto della pandemia. La ricerca sulla cognizione sociale può spiegare le variabili comportamentali e il loro impatto sul benessere mentale, creando le basi per interventi che promuovano l’adesione alle norme di prevenzione. Questa revisione rapida PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) mira ad identificare e analizzare le prove attuali sull’impatto della pandemia sulle componenti della cognizione sociale. In primo luogo, abbiamo condotto una revisione completa della letteratura e abbiamo discusso i risultati in modo narrativo. Sono state costruite delle tabelle e gli articoli sono stati ordinati in base alle caratteristiche dello studio. Infine, sono stati identificati 14 articoli idonei. Tra la popolazione clinica, i soggetti con disturbi dello spettro autistico e malattia di Parkinson hanno riportato cambiamenti nella cognizione sociale. Tra la popolazione generale, anche gli adulti più anziani e i lavoratori in prima linea hanno riportato variazioni. I nostri risultati suggeriscono che i modelli di cognizione sociale orientati alla pianificazione potrebbero promuovere efficacemente l’adesione alle norme preventive. Questi risultati possono aiutare a sviluppare modelli di intervento comportamentale, identificando approcci appropriati per la popolazione generale e per sottogruppi specifici.

Parole chiave. Cognizione sociale, covid-19, pandemia, misure preventive, SARS-CoV-2.

Introduction

Social cognition is an adaptive human capacity, including cognitive functions, that allows people to learn and use information about others and social contexts1. This skill involves the ability to decide what to think and how to behave and make accurate predictions about the behaviour of others to enable success in social interactions and in achieving one’s goals2. Aspects of social cognition are complex and nuanced, representing the interplay between emotions and cognition in interactions3. In social cognition, the various components include empathy, altruism, collaboration, inclusion, prosocial behaviour and adherence to social norms, together with fundamental socio-economic aspects, and cognitive skills, such as the interpretation of facial expressions, joint attention, theory of mind and moral constructs2. Social cognition, therefore, underlies the understanding of human experience, which includes variability in interactions and behavioural changes that lead to decision-making. In psychopathology, great importance is given to social cognition in the context of various disorders, to the point of even considering it a potential transdiagnostic construct4-6.

The advent of the Covid-19 pandemic exerted significant consequences in the social sphere7 but also in mental health: it has led to an increase in the incidence of mental disorders such as acute stress, anxiety, irritability, depressive symptoms, insomnia, post-traumatic stress disorder (PTSD), obsessive-compulsive symptoms (OCS)8 and suicidal behaviours9. Measures implemented to counter the spread of the virus, such as quarantines, lockdowns and interpersonal distancing, have brought about radical changes in the population’s habits10,11. Furthermore, prevention rules such as physical distancing, the use of masks, the ban on gatherings, hand sanitisation, self-isolation and quarantine gradually became a new routine. Several studies have highlighted the need to base prevention interventions on behavioural theories12,13 to obtain greater effectiveness and efficiency of measures14,15. In this scenario, social cognition theories have proven essential to identify mechanisms and determinants that allow us to understand and predict behaviours and their changes16-18. In particular, theories on the social cognition of Covid-19 have played a relevant role in planning preventive behaviours against the pandemic19.

The social cognition approach has been traditionally applied to examine the determinants of health behaviors. In a classical social cognition model, the Theory of Planned Behavior20 intention is the most proximal predictor of behavior. Intention is a function of three constructs including attitude (i.e., positive or negative evaluations towards the consequences of performing the intended behavior), subjective norm (i.e., perceived expectations of significant others approving the intended behavior), and perceived behavioral control (i.e., beliefs in capability to perform the intended behavior).

To predict intention and behavior more effectively, subsequent models on health-related behavior included additional factors such as health knowledge (i.e., the knowledge about a disease’s causes and consequences and its prevention), perceived self-efficacy (i.e., the beliefs about the ability to start the behavior) and risk perception (e.g., perceived susceptibility and severity of specific health threat). These constructs have been consistently suggested as additional predictors of intention and health behaviors21.

In this review, we aim to summarise the impact of pandemic coping behaviours on social cognition in clinical and general population samples and the contribution of research on social cognition theories to predicting behaviour and changes in habits during the pandemic. Specifically, we want to underline the importance of social cognition theories in planning actions in the healthcare sector to benefit clinical and general populations.

Methods

An extensive review of the literature was carried out on Pubmed up to April 17th 2023, employing Medical Subject Headings (MeSH) descriptors (“Covid-19” [Mesh]) AND” social cognition” [Mesh]). The studies included were then discussed in a narrative overview. To cover a broad literature overview, a rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review, following the statement guidelines for scoping reviews22, was identified as the most appropriate method to carry out the present study23. Only articles published between March 2020, the pandemic declaration, and April 2023 were selected. We also included articles delving into other aspects of social cognition, such as emotional cognition, other cognitive elements (such as memory ability), and relational behaviours (such as personality traits), or concerning the application of models of social cognition. Moreover, we included papers investigating social cognition during the pandemic in some specific clinical groups, such as individuals with autism spectrum disorder (ASD) or with Parkinson’s disease (PD). We excluded studies based on topics other than social cognition and the Covid-19 pandemic, infection and disease. Only papers published in English were included. In line with scoping review guidelines, the quality of studies was not necessarily addressed24. Therefore, meta-analysis, reviews, and systematic reviews were excluded. Editorials, comments, narrative papers, letters to editors, book chapters and case reports were excluded, as they would not provide significant insight into the researched topic. Two independent reviewers [V.S. and A.D.B.] screened citations for inclusion. One reviewer [T.B.] conducted data extraction and verified by a second reviewer [C.D.A.]. Tables were then constructed, and articles were sorted out by authors, title, location of the study, sample size, nature of the sample, purpose/aim of the study, principal findings, and implications. Finally, studies were described in the narrative overview, and results were discussed.

Search results

The initial PubMed search yielded 15 results. Six additional titles were identified through other sources (citation tracking, website searching and reference chaining). All records were in full text and screened: 5 were excluded as the article’s primary focus was not the correlation between social cognition and Covid-19; therefore, it was irrelevant to the present study’s aim. Among the remaining 16 papers, only 2 articles were excluded, one being a review and the other a letter to the editor. In conclusion of the screening process, 14 papers were finally identified as of particular interest. The selected articles are presented in table 1 and discussed in the narrative overview. For specifics about the study design, consult figure 1.

Narrative overview

Non-clinical population

Most selected articles investigated social cognition constructs during the pandemic focusing on general population samples25.

A study carried out in the UK by Bland et al.26 examined the impact of Covid-19 social isolation on aspects of emotional and social cognitive function. Measurement tools included two questionnaires probing social isolation and anxiety levels and five neuropsychological tasks assessing emotional and social cognition. Notably, this study included emotional recognition tasks evaluating the presence of positive and negative biases in respondents. Positive affective biases represent a participant’s tendency to be more accurate in identifying happiness relative to sadness; in contrast, reduced positive biases or negative affective biases (i.e. a greater accuracy in recognising sadness) have been observed in depression. Results showed reduced positive bias in emotion recognition of emotional facial expressions associated with reduced contact with friends, household size and communication method during social isolation. In addition, reduced positive bias for attention to emotional faces was related to the frequency of contact with friends during social isolation. Further, more excellent cooperative behaviour in an ultimatum game was associated with frequent contact with friends and family during social isolation. The study provides insights into subjective and objective social isolation’s detrimental effects on affective and cognitive processes in subjects with no prior mental health problems. Disruption to these social cognitive markers has been previously identified in mental health disorders and may reflect a key indicator of social well-being26.

Another study conducted in China on the general population27 aimed to identify the determinants of three preventive behaviours of older adults during the Covid-19 pandemic using an Integrated Social Cognition Model. The first survey assessed demographics, social cognition constructs (motivational self-efficacy, risk perception, attitude, subjective norm, health knowledge, intention, volitional self-efficacy, planning and action control), and three preventive behaviours. The three preventive behaviours were measured again during the second-wave online survey one month later. Models showed that attitude, motivational self-efficacy and subjective norm were consistent predictors of intention; motivational self-efficacy was a consistent predictor of volitional self-efficacy; planning and volitional self-efficacy were consistent predictors of action control, and health knowledge was a consistent predictor of behaviours across all three preventive behaviours. These findings supported the Integrated Social Cognition Model. They identified critical modifiable determinants of preventive behaviours, highlighting the importance of social cognitive constructs, such as health knowledge and action control, in predicting behaviours. In addition, this work identifies older adults as a category for future interventions.

The study of Giusti et al.28 investigated the impact of distance education (DE) on mental health, social cognition, and memory abilities in a sample of university students during the national Covid-19 lockdown in Italy and to identify the predictors of academic performance. The study demonstrated how half of the student sample reported significant impairment in concentration and learning abilities during DE. Regarding psychological health, 19.7%, 27.1%, and 23.6% of the sample reported mild, moderate, and severe depressive symptoms, respectively. Correlation analyses showed a statistically significant negative association between depression and the overall subjective evaluation of DE. Learning concentration impairment during DE, anxiety about Covid-19 contagion for oneself or others, female gender, and depressive symptomatology were the strongest predictors of poor academic performance. Concerning social cognition abilities, no differences were observed among students with different levels of depression28.

Another study conducted by Milad and Bogg29 examined prospective relations between demographic factors, personality traits, social cognition and guideline adherence, mask-wearing, symptoms, and viral testing in a US sample during the initial surge of Covid-19 deaths in the United States between late March and early May 2020. Results showed greater baseline agreeableness, conscientiousness, and extraversion were associated with more frequent baseline guideline adherence. More liberal political beliefs, excellent guideline adherence intentions, and frequent guideline adherence at baseline predicted frequent mask-wearing at follow-up. Female sex, lower perceived health, and greater neuroticism at baseline predicted greater symptom counts at follow-up. Reports of viral testing were relatively low yet were consistent with concurrent national reporting and limited availability of testing. The results further clarify how personality traits related to social responsibility (i.e., agreeableness, conscientiousness) are associated with following new norms for prescribed behaviours and how symptom reporting can be as much a marker of perceived health as emotional stability29.

The study by Mckeown et al.30 focused on how changes in socialisation and working during the lockdown could impact thought patterns in daily life. They compared the prevalence of thought patterns between two independent real-world, experience-sampling cohorts before and during lockdown. In both samples, young (18 to 35 years) and older (55+ years) participants completed experience-sampling measures five times a day for seven days. Dimension reduction was applied to these data to identify common “patterns of thought.” Linear mixed modelling compared the prevalence of each thought pattern before and during the lockdown, in different age groups, and across various social and activity contexts. During the lockdown, therefore, in a condition of isolation, social thinking appears to be reduced. Furthermore, lockdown was associated with lowering future-directed problem solving, with a reinstation of pre-lockdown levels when individuals engaged in work. In conclusion, the study suggests that limiting socialising and working activities contributed to changes in ongoing thought patterns during the lockdown30.

The study by Hamilton et al.31 conducted in 2020 examined social cognition determinants of social distancing behaviour during the Covid-19 pandemic in samples from Australia and the US guided by the health action process approach (HAPA). A sample of Australian and US residents was recruited via an online research panel company. Participants were screened on the demographic characteristics of age, gender, and geographical region, and quotas were imposed to ensure that the sample comprised similar proportions of these characteristics to the national population of each country. Results showed that intention and action control significantly influenced social distancing behaviour in both samples. Significant indirect effects of social cognition constructs through intentions were observed. The current findings suggest multiple potential routes to behavioural performance that can serve as a basis for developing intervention31.

Bogg and Milad’s study32 examined patterns and psychosocial correlates of coronavirus guideline adherence in a US sample during the initial 15-day period advocated by the White House Coronavirus Task Force. Guided by a disposition-belief-motivation model of health behaviour, path analyses tested associations of personality traits and demographic factors to overall adherence via perceived norms, perceived control, attitudes, and self-efficacy related to guideline adherence, as well as perceived exposure risk and perceived health consequence if exposed. Adherence ranged from 94.4% reporting always avoiding eating/ drinking inside bars/restaurants/food courts to 13.6% reporting always avoiding touching one’s face. Modelling showed total associations with overall adherence for greater conscientiousness, openness, perceptions of social endorsement, positive attitudes, self-efficacy, and the presence versus absence or uncertainty of a shelter-in-place order. Age, self-rated health, sex, education, income, children in the household, agreeableness, extraversion, neuroticism, perceived exposure risk, and perceived health consequence showed null-to-negligible associations with overall adherence. The results highlight characteristics associated with greater adherence and suggest the importance of clearly communicating adherence benefits, costs, and timelines32.

The study of Lin et al.33 utilised an integrated social cognition model to explain Covid-19 preventive behaviours in a general population sample from Iran. All participants completed self-reported measures of demographic characteristics, intention, attitude, subjective norm, perceived behavioural control, and action self-efficacy at an initial data collection occasion. One week later, participants completed self-report measures of maintenance self-efficacy, action planning and coping planning, and, a further week later, measures of Covid-19 preventive behaviours. Hypothesised relationships among social cognition constructs and Covid-19 preventive behaviours, according to the proposed integrated model, were estimated using structural equation modelling. The proposed relationships among model constructs were all statistically significant. Coping and action planning were the social cognition constructs with the most considerable effects on Covid-19 preventive behaviours. Findings suggest that targeting change in coping planning and action planning may most effectively promote participation in Covid-19 preventive behaviours33.

A study by Hagger et al.12 applied an integrated social cognition model to identify the determinants of social distancing behaviour and the processes involved in the context of the Covid-19 pandemic. In a prospective correlational survey study, samples of Australian (n=365) and US (n=440) residents completed online self-report measures of social cognition constructs (attitude, subjective norm, moral norm, anticipated regret, and perceived behavioural control [PBC]), intention, action planning, habit, and past behaviour concerning social distancing behaviour at an initial occasion. Follow-up measures of habit and social distancing behaviour were taken one week later. Structural equation models indicated that subjective norm, moral norm, and PBC were consistent predictors of intention in both samples. Intention, action planning, and habitat follow-up were consistent predictors of social distancing behaviour in both samples. Action planning did not have consistent effects in mediating or moderating the intention-behaviour relationship. Findings highlight subjective norm, moral obligation, and PBC as determinants of social distancing intention and intention and habit as behavioural determinants12.

In a cross-sectional study, Kaushal et al.34 employed a socioecological framework to investigate how the availability of exercise equipment at home could predict behavioural decisions, namely intention, planning, and habits, concerning participation in physical activity. Participants (n=429) were adults (over 18) residing in the United States with state-endorsed ‘lockdown’ measures in May 2020. All the measures included were framed regarding physical activity expectations over the next two weeks. The availability of large cardiovascular and strength training equipment demonstrated significant predictive effects with intention, planning, habit, and autonomous motivation. Equipment effects on proximal intentional (perceived behavioural control and affective judgement) and behavioural determinants (planning and habit) provide valuable notes for designing randomised controlled trials. Indirect effects from exercise equipment on perceived behavioural control suggest that interventions should ensure that participants have the skill and ability to use exercise equipment they may receive. Similarly, the indirect effects of exercise equipment on affective judgement suggest that the provided equipment should be enjoyable for participants. Additionally, assisting participants in developing exercise plans specific to the type of equipment could help translate their exercise intentions into behavior34.

An article by Mazza et al.35 focused on people’s moral decision-making during an emergency. The aim of the study was to evaluate moral decision-making, level of perceived stress, ability to mentalise, and empathy in Italian university students and workers. Two hundred twenty-four front-line workers (FLW), 413 second-line workers (SLW), and 663 university students completed an online questionnaire during Italian Phase-1 of the lockdown. Results showed that individuals in the FLW group were more likely to choose utilitarian solutions and consider those actions finalised to save more people’s lives as morally acceptable, even if they would require the sacrifice of a lower number of individuals. At the same time, decision-making was experienced as less unpleasant and less arousing when compared to the other two groups, demonstrating a more remarkable ability to maintain emotional control under pressure. Moreover, results showed that healthcare professionals were more stressed and emotionally involved than public safety personnel, with higher empathic concern and arousal in moral decision-making. Authors suggest that providing immediate psychological support and monitoring workers’ physical and emotional well-being on the front-line during emergencies like the Covid-19 pandemic is essential to prevent moral distress or mental health problems35.

Taken as a whole, investigations applying social cognition theories in the context of Covid-19 pandemic suggest that social distancing preventive measures influenced social cognition abilities in the general population; moreover, these studies elucidate key modifiable determinants of preventive behaviours, thus encouraging the implementation of social cognition approaches to promote adherence to norms in health emergencies contexts.

Clinical populations

Among the selected articles, we identified two focusing on a clinical population.

The first study carried out by Tamon et al.36 in 2022 selected a cohort of children and adolescents with ASD, analysing the relationship between RRB (restricted interests and repetitive behaviours) characteristics and mask-wearing and social cognition, using the CoRonavIruS Health Impact Survey (CRISIS) – Adapted for Autism and Related Neurodevelopmental conditions (AFAR), an internationally developed questionnaire designed for ASD. Results showed that children and adolescents who exhibited lower-order RRB before the pandemic had difficulties going out with mask-wearing, more challenges with mask-wearing, and difficulty referring to others’ emotions while wearing masks. An association was also shown between higher-order RRB before the pandemic and an uncomfortable sensation and difficulties in referring to others’ emotions while wearing masks. These findings also suggest the need to provide extra support for social communication to children and adolescents with ASD36.

The study on a clinical population affected by PD was conducted in Italy by Dodich et al.37 in 2021. In the study, a neuropsychological battery that included socio-cognitive tasks was employed before the introduction of Covid-19 restrictive measures (i.e., social distancing and isolation), followed later by an online assessment, carried out during the last two weeks of the first lockdown, through a structured interview, to assess patients’ health status, perception of Covid-19 emergency, changes in caregivers’ burden, and patients’ social isolation. At baseline evaluation, half of the PD patients showed sociocognitive dysfunctions, mainly on mentalising abilities. Patients with impaired social cognition skills showed a significantly lower concern about the possible effects of Covid-19 on their health. Caregiver burden and patients’ social network remained stable during the lockdown. Therefore, developing educational and preventive programs targeting this population is recommended37.

Although limited in number, this evidence suggests the need to explore further the impact of health emergencies on social wellbeing and mental health in vulnerable populations. At the same time, these studies suggest the importance of developing educational and preventive programs to increase awareness of health consequences in these individuals.

Conclusions, implications, and future directions

The present study aims to explore the contribution of research applying social cognition theories to predict and change behaviour in the context of the Covid-19 pandemic. It stands out how the scientific literature available on this subject is currently limited. Despite that, results suggest variations in social cognition patterns during the Covid-19 pandemic, both in the clinical and general population. Regarding the former, individuals with ASD presented difficulties with mask-wearing and social communication36. Subjects with PD demonstrated the presence of socio-cognitive dysfunctions, mainly in mentalising abilities37. Focusing on the general population, the detrimental effects of subjective and objective social isolation upon affective and cognitive processes26 suggest that reduced social connectivity may mediate the pathway to social cognitive deficits in mental health disorders38. The drastic modification in daily routine during lockdown is related to thought patterns in daily life, which were associated with changes to daily routine during lockdown30. Furthermore, relations between variables from social cognition, motivational, and socio-ecological theories add insight into home-based physical activity intentions and habits34. On the other hand, studies analysing the relationship between demographic factors, personality traits, social cognition and guideline adherence, mask-wearing, symptoms, and viral testing revealed how personality traits related to social responsibility are associated with new norms for prescribed behaviours and how symptom reporting can be as much a marker of perceived health as emotional stability29: patterns and psychosocial correlates of Coronavirus guideline adherence clarifies adherence frequency, highlight characteristics associated with greater adherence, and suggests the need to communicating adherence benefits, costs, and timelines32. A few studies focused on specific subgroups, such as FLW, SLW, and university students. Healthcare professionals reported more significant stress and emotional engagement than security personnel, and their moral decision-making was distinguished by heightened arousal and empathic concerns35. Despite the impairment in concentration and learning abilities during DE, no differences were observed among university students concerning social cognition28. Through the Integrated Social Cognition Model, it is possible to identify critical modifiable determinants of preventive behaviours, highlighting the importance of social cognitive constructs, such as health knowledge, subjective norm, moral obligation, and PBC, in predicting behaviours14,27. In healthcare contexts, identifying intervention targets can improve the development of behavioural interventions, suggesting that change in coping planning and action planning may be most effective in promoting participation in Covid-19 preventive behaviours33. Results from the present review revealed how, in clinical conditions, social distancing measures had an impact on social cognition, highlighting the need to take into consideration the clinical population when predisposing behavioural public health measures to supply the support that may be needed both to individuals and caregivers. On the other hand, social cognition theories can also be applied to the general population to explain specific behaviours and how those behaviours may influence adherence to norms, and implementing approaches based on social cognition theories helps modulate and prevent mental health problems. Nevertheless, social cognition theory studies specifically applied to this context seem understudied. Further research may be needed to understand this topic better.

Conflict of interests: the authors have no conflict of interests to declare.

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