Introduction
ocial participation in daily living activities require the maintenance of a variety of social relationships and engagement in various social activities in life [1]. These activities include meeting and interacting with family and friends [2], participating in religious activities [3], in a job or social roles (a voluntary work) [4], in cultural, sports, and academic activities [5], in various meetings (e.g. business meetings), or in home works and self-care [6]. Proper social participation and engagement in daily living activities can increase the feeling of attachment, provide a stable sense of identity, and increases one’s sense of worth, belonging, and dependence on society. In this regard, Prilleltensky et al. [7] reported that social integration and participation in social activities increase well-being, psychological status, and the sense of belonging. Smetana et al. also showed that social participation increases adolescents’ self-confidence and self-control, and improve the psychological health of people [8]. Increasing social participation is one of the important goals of health professionals [9]. The World Health Organization (WHO) recommends a special attention to social participation, especially for older people because they spend less time in structured social environments [10]. Social participation has a positive and important role in personal well-being (e.g. life satisfaction) [11] and social well-being [4]. On the other hand, participation in personal leisure activities is of great importance for physical and mental health, and for improving the quality of life [12]. Lack of social communication leads to anxiety, loneliness, depression, panic, mental disorders, and many other problems in life and affects the society [13].
Recently, Coronavirus Disease 2019 (COVID-19) has infected about 100 million people (until January 1, 2021) worldwide, of whom about 2.14 million has died [14]. It has become a pervasive disease [15] and a serious threat to public health. The WHO has identified COVID-19 as an “high-level” threat [16]. Currently, therapeutic strategies to combat this disease are fully supportive, and prevention is the best way to break the transmission chain in the community. Social distancing and quarantine in different countries have led to a gradual decrease in the number of patients [17]. These measures are a restriction on the activities or separation of people who are not sick but may be exposed to infectious agents or disease. Due to social distancing and quarantine in many countries, people’s participation in many areas of social life and daily activities has been disrupted [18]. Although quarantine measures have already been used to combat infectious diseases (such as cholera, SARS, and Ebola) [15, 19, 20], this level of quarantine on a world- population scale is unprecedented in history [21]. Although these measures are an effective way to slow the spread of infectious diseases, they can have negative effects on mental health and several behaviors including social participation and life satisfaction.
Recent studies have shown that quarantine measures to control COVID-19 increase the number of inactive individuals [22, 23]. These people experience unhealthy dietary behaviors [22], psychological and emotional disorders, as well as lower sleep quality due to lockdown at home [22, 24]. Regarding social participation and life satisfaction, it has been reported that COVID-19 and related quarantine measures may be associated with feelings of loneliness, sadness, and loss of life satisfaction [25, 26, 27]. Social distancing affects the perspective of our social life and causes changes in social interactions and daily life functions. Various studies have shown the effect of COVID-19 pandemic on people’s lives and its severe consequences including social anxiety, panic, economic recession, and psychological stress [13, 28, 29, 30, 31]. There is an urgent need for research to help the public better understand the psychological consequences of this disease [32]. 
In an attempt to elucidate the psychosocial effects of COVID-19 pandemic, this survey study aims to assess the results of quarantine and social distancing on psychological status and various lifestyle behaviors during the COVID-19 outbreak to provide an insight into the effects of this pandemic on home activities, community, productive activities, and social participation in general. The findings can help find a solution to overcome the social isolation caused by the disease and to adjust the social system of the country by proper planning, regardless of the fears and threats of the disease. The ultimate goal is to emphasize the importance of establishing programs to support people during this crisis.
Materials and Methods 
This is a cross-sectional survey study conducted from May to June 2020 in Iran approved by the Ethic Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran (Code: IR.USWR.REC.1399.228). A total of 461 participants (Mean age= 36.86±5.8 years) participated who were selected from among students, patients, people with disabilities, their families and relatives, and others who could use smartphones, computers, tablets, and laptops. They completed the Community Integration Questionnaire (CIQ) online in a 2-month period along with a demographic form surveying gender, marital status, level of education, employment status, living status, and any disability. The questionnaires were sent to the participants on WhatsApp or via email. The inclusion criteria for entering the study were: Having a tablet, computer or mobile phone with the Internet access, and living in Iran. Those with incomplete questionnaires or with the same IPs were excluded from the study.
There are two forms of CIQ, one for patients and one for family members. We used the family form. This questionnaire can be used to identify barriers to productive activities. It has three subscales: Home integration with 5 items and a score from 0 to 10 (including shopping, food preparation, housework, childcare, and planning social arrangements), community integration with 6 items and a score from 0 to 12 (including personal finance management, shopping, meeting friends, engaging in leisure activities, visiting family or friends, and having a best friend), and productive activities with 4 items a score from 0 to 7 (including travel, employment status, student, volunteer activities). The total CIQ score ranges from 0 to 29. A higher score indicates more social support and better interaction. The items related to home and community interaction subscales are rated on a scale from 0 to 2. The item 4 stating “Who usually cares for the children at home?” was rated on a 4-point scale as myself alone, myself and someone else, someone else, and not applicable. Its score is calculated using averaging the scores of items 1, 2, 3, and 5. To rate the items 13 to 15, we used the instructions provided at www.rehabmeasures.org. The CIQ has good validity and reliability for adults [33, 34]. Its Persian version also has good validity and reliability [35]. The items were revised to show the individuals’ social interaction before and after the pandemic. Therefore, two sets of data were collected: Before and after the COVID-19 outbreak. Collected data were analyzed in SPSS v. 22 software. The differences in test scores before and after the COVID-19 pandemic were analyzed using paired t-test.
Results
The demographic characteristics of participants are presented in Table 1.


Their CIQ scores are presented in Table 2.


As can be seen, the total CIQ score and the score of its three domains decreased significantly after the COVID-19 pandemic. The trend of decrease in three domains are illustrated in Figures 1, 2, 3 and 4. After the pandemic, the home integration subscale score decreased significantly in the participants (Figure 1). The social integration related activities also decreased significantly after the COVID-19 pandemic (Figure 2). There was also a significant decrease in productive activities domain and in total CIQ score after the COVID-19 pandemic (Figures 3 and 4). According to the results, about 25% of participants reported that, before the COVID-19 outbreak, someone else had prepared food or other necessities at home, which increased to 37% after the COVID-19 outbreak. Moreover, despite the relative increase in shopping alone (from 24% to 28%), their participation in shopping with someone else decreased from 49% to 32%. About 10% of participants stated that they did not participate in gatherings with friends and family before the outbreak, which increased to 61% after the outbreak. The rate of people who held gatherings decreased from 15% to 7%; the percentage of those who held gatherings with someone else decreased from 56% to 20%; and the percentage of those who held gatherings alone decreased from 15% to 9%. This indicates a sharp decline in social integration and planning of such gatherings.
Before the outbreak, the rate of people whose personal finances were managed by someone else was 16%, which increased to 29% after the outbreak. Also, the level of participation in personal finance management with someone else decreased from 25% to 17%. Before the outbreak, only 2% did not leave home for shopping in the past month, which has increased to 20% after the outbreak; the percent of people who went out shopping five or more times a month also decreased (from 61% to 15%).
The level of participation in leisure activities also decreased significantly. Ninety-two percent of respondents reported that they went out for leisure activities at least once a month, before the outbreak, which dropped to 18%. The rate of those who went out four times a month to participate in leisure activities decreased from 48% to 12%. Moreover, the rate of people who went out 5 or more times a month dropped from 41% to 3%. Prior to the COVID-19 outbreak, only 4% of respondents did not leave home to visit friends and family within a month, which increased to 41% after the outbreak; however, the rate of people who left home 5 or more times a month to visit friends and family dropped from 43% to 7%.
Seven percent of respondents were reported to participate in leisure activities alone before the outbreak, which increased to 27% after the outbreak. Although participation in such activities with family increased from 32% to 70%, the participation in these activities with friends decreased from 57% to almost 0%. Prior to the outbreak, only 3% reported going out rarely/never (or less than once a week), which increased to 43% after the outbreak. The rate of people leaving home every day to engage in various activities also decreased from 76% to 22%. Although the percent of people who participated in part-time activities increased from 51% to 61%, the percent of those who participated in full-time activities decreased from 32% to 10%.
Discussion and Conclusion
The purpose of this study was to provide an insight into the impact of quarantine and social distancing on participation in daily living activities and social interaction, based on data extracted from the responses of 461 people in Iran. The preliminary results showed that restrictive measures during the outbreak of COVID-19 have negative effects on home integration, community integration, and productive activities. The total score of CIQ decreased by 47% after the outbreak. This highlight the risk of socio-psychological stress during quarantine and social distancing. The decrease in the total CIQ score and in its three domains indicates that participants were rarely involved in social activities after the outbreak and were, therefore, at greater risk for social isolation. This can be explained by social constraints, reduced engagement, quarantine, and social distancing measures imposed by governmental sectors to prevent the spread of the virus [36]. The decrease in the total CIQ score may be mainly due to the decreased participation in leisure activities (71%) followed by the decrease in leaving home (54%). The social isolation imposed on society by the COVID-19 is detrimental to mental health. A study on 1,006 quarantined people in Italia following the COVID-19 pandemic showed that quarantine increased depression, social isolation, and feelings of helplessness among individuals [36]. In another study, it was reported that people who self-quarantined for 1 month in China had poor mental health and distress after 1 month [37]. The COVID-19 has a profound effect on all aspects of health, including mental and physical [38]. In addition to health threats of COVID-19, the fear of being infected and losing loved ones, job, educational opportunities, recreation, freedom, and support have profound psychological effects. Not only getting infected, but also the fear of getting infected can lead to a lack of access to resources that can improve people’s resistance to this pandemic [39].
This study revealed the significant negative effects of COVID-19 on social interactions, lifestyle and social participation. Social participation is a way for empowerment through which individuals learn to take responsibility for their own health and work to develop their communities [40, 41]. One of the effective factors in social development and achieving optimal health is social presence and active social participation. People with high social participation have fewer physical and mental problems. There is a direct relationship between social participation and health-related quality of life. Social participation and social resources are strong presuppositions of health [42, 43]. People with higher social participation have more ability to manage own and other’s feelings while facing problems in life and workplace; therefore, can better deal with hardships, everyday problems, and psychological tensions [44, 45], which in turn increase their resistance to mental disorders and their symptoms; on the other hand, it improves their success, satisfaction, and optimism, and consequently their happiness and health [42, 45, 46]. People with higher social participation can provide a better response to various job, family, or social communication problems due to awareness of emotions and feelings, better management, higher control and monitoring, more empathy, and having social and communication skills [44, 47]. Since mental fatigue and mental problems are the sources of many physical diseases, they can affect a person’s mental health and well-being. Therefore, a person with mental and physical problems will be fragile in the face of environmental and occupational pressures [44, 47, 48]. People with more social interactions have greater mental ability to understand the situation and to respond to internal and external pressures and tensions. Such abilities usually enable people for cope with the symptoms of anxiety, stress, mental disorder, major depression, stress, and social functioning [45, 46]. Some of the consequences of this pandemic are anxiety, depression, suicide and self-injury, alcohol and drug abuse, gambling, child abuse, and psychosocial disorders. These consequences can be exacerbated by social isolation and loneliness. 
 The COVID-19 pandemic have negative effects on various aspects of social life. These destructive effects disrupt the lives and health of people and their social participation relevant to home integration, community integration and productive activities. Among these, community integration related activities has been disrupted more by the pandemic. Social participation in the form of visiting family and friends has been reduced due to imposed restrictions.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethic Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran (Code: IR.USWR.REC.1399.228).

Funding
The present article is the result of a research project approved at the University of Science Welfare and Rehabilitation of Tehran with number 2513.

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest.


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