Summary by Dr. Julianne Ludlam
As individuals around the world face quarantines and isolation due to the COVID-19 pandemic, researchers at King’s College in London conducted a “rapid review” of the available research on the psychological impacts of quarantine (Brooks et al., 2020). Rapid reviews are systematic reviews of the literature conducted in an expedited fashion and are recommended by the World Health Organization (2017) in emergency contexts. This article provides a summary of this rapid review; the full review was published in The Lancet, and a link to the full text of the article can be found in the references.
As many of us are now aware, a quarantine involves separating people who may have been exposed to a contagious disease and restricting their movements in order reduce the likelihood of infecting others. Isolation involves separating individuals who have actually been diagnosed with a contagious disease from those who have not. Both of these experiences are likely to be unpleasant and disruptive for a variety of reasons, including being apart from friends and family, losing freedom of movement, feeling anxiety about contagion, and even experiencing boredom. As public health experts have made clear, quarantines and isolation are necessary in order to save lives, despite these negative impacts. However, it is also important to explore the likely impacts on the mental health and well being of individuals who experience these unwelcome conditions. The King’s College rapid review included 24 research papers that specifically addressed the psychological impact of quarantines; these studies spanned ten countries and five different contagious diseases.
General Psychological Impacts
In general, individuals who have been quarantined were more likely to show high levels of psychological distress than those who had not been quarantined. One of the most common forms of distress involved symptoms of Acute Stress Disorder or Posttraumatic Stress Disorder (PTSD). In one study, being quarantined predicted post-traumatic stress symptoms in hospital employees as long as three years later. Depressive symptoms were also a common response to quarantine; individuals displayed low mood, sadness, guilt, or grief reactions. As with PTSD symptoms, there was some evidence that depressive reactions could persist years after the event. Irritability and anger were also common reactions, as were anxiety, nervousness, fear, and insomnia. Finally, some studies reported the presence of exhaustion and emotional exhaustion, numbness, detachment from others, poor concentration, indecisiveness, and deteriorating work performance.
Longer-term impacts, measured by two studies several years after a quarantine had ended, included alcohol abuse and dependency symptoms as well as avoidance behaviors. Avoidance behaviors are part of a particularly problematic cluster of post-traumatic symptoms. In one study, health care workers were found to avoid contact with patients and going to work; other individuals avoided people who were coughing and sneezing as well as crowded or public places.
Predictors of Adverse Psychological Impacts
Some factors appear to increase the risk for negative psychological outcomes from quarantine. In terms of pre-existing factors, health-care workers did appear to be at a higher risk for more severe post-traumatic stress symptoms than other individuals and had higher levels of other symptoms as well; this finding was not always consistent but was found in several studies.
During quarantines, increased distress was associated with longer quarantines, inadequate basic supplies, and inadequate information. One study found that those quarantined for more than 10 days exhibited more post-traumatic stress symptoms than those quarantined for less than 10 days. Not having supplies like food, water, clothing, shelter, or medication was associated with symptoms of anxiety and anger, even when assessed four to six months after the experience. A lack of clarity, information, and transparency from health and government officials about risks and guidelines appeared related to post-traumatic stress symptoms. A lack of information also appeared to lead to the development of catastrophic fears about symptoms and risks.
After quarantines, stressors that appeared to increase the potential for psychological problems included financial losses and stigmatization. Financial distress was associated with increases in anger and anxiety, and individuals with lower incomes experienced significantly higher levels of post-traumatic and depressive symptoms than those with lower incomes; a temporary loss of income is likely to be more problematic for those with lower incomes. Stigma was reported to be a major problem for individuals who had experienced quarantine; there were reports of rejection and negative treatment from neighbors, employers, and family members. Stigma caused some quarantined individuals to avoid seeking help for other subsequent illnesses.
Recommendations to Reduce the Psychological Impacts of Quarantine
Although the study’s authors stated clearly that there is much that remains unknown about the effects of quarantine, they provided some suggestions that may mitigate adverse psychological impacts:
Quarantines are designed to save lives, but the King’s College rapid review suggests they may unfortunately also result in lasting psychological problems, including post-traumatic, depressive, and anxiety symptoms. The authors argue that working to make a quarantine experience as manageable as possible may help to eliminate or reduce negative psychological impacts:
This can be achieved by: telling people what is happening and why, explaining how long it will continue, providing meaningful activities for them to do while in quarantine, providing clear communication, ensuring basic supplies (such as food, water, and medical supplies) are available, and reinforcing the sense of altruism that people should, rightly, be feeling. (p. 919)
Are you starting to feel the effects of quarantine, or, are you looking to be proactive in preventing the symptoms of trauma and stress?
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Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wesseley, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet, 395: 912-920. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext
World Health Organization. (2017). Rapid reviews to strengthen health policy and systems: A practical guide. https://www.who.int/alliance-hpsr/resources/publications/rapid-review-guide/en/