Given the recent COVID-19 Pandemic, it is an appropriate time to review the research on the psychological impact quarantines. Quarantines differ from isolation. Quarantines restrict people who are potentially exposed to the contagion in order to protect others. Isolation separates those who have been infected by the contagion to protect those who have not. Here I will discuss quarantines.
In Lancet on March 14thof 2020, Brooks et al. (2020) published a review of 24 psychological studies of quarantine. They reviewed research from outbreaks of SARS, Ebola, H1N1, Middle East respiratory syndrome, and equine influenza. They suggested that the collective benefits of quarantine must be calculated along with the potential psychological costs when deciding to mandate quarantine. This should apply to both mandated quarantine and self-quarantine.
One study of hospital staff found quarantine was more predictive of stress disorders than staff who had not been quarantined. Compared to non-quarantined staff, quarantined staff had increased exhaustion, detachment, anxiety, irritability, and worse concentration after their quarantine. Another study showed that quarantine predicted post-traumatic stress symptoms in quarantined hospital staff three years later. A separate study found post-traumatic symptoms increased post-quarantine for both children and parents, with a 400% increase in symptoms for quarantined children over non-quarantined children.
A study of college students found no differences on post-traumatic symptoms or mental health problems between quarantined and non-quarantined students. This is good news for college students in a quarantine!
One study of 1656 quarantined individuals found small percentages of anxiety (7%) and anger (17%) during the quarantine, but the symptoms nearly disappeared 4-6 months later (3% anxiety, 6% anger).
Three years after SARS, healthcare workers who had been quarantined were more likely to abuse alcohol.
In general, quarantine does change behavior. After a quarantine, people are more likely to avoid people who are coughing or sneezing, avoid crowded places that are enclosed, and avoid all public spaces for several weeks.
A history of psychiatric illness increases the level of quarantine related anxiety 4-6 months post-quarantine.
Overall, here is what you can expect to experience in a quarantine.
--The longer the quarantine, the worse the deterioration in mental health, post-traumatic stress symptoms, and anger. Avoidance behaviors increase with length of quarantine.
--Increased sense of boredom, frustration, and sense of isolation.
--If supplies are inadequate, this increases frustration during the quarantine and predicts increased anxiety and anger 4-6 months post-quarantine.
--If information from health officials in inadequate, fear increases. Individuals who perceive compliance with the quarantine as difficult are the most likely to experience post-traumatic stress symptoms after the quarantine.
--The more financial loss the person experiences from the quarantine, the more anger, anxiety and other psychological disorder symptoms they experience months later. This disproportionately affects lower income people more than higher income people.
--Quarantined people report experiencing stigma in their local neighborhoods if they have been targeted for mandated quarantine. They face withdrawn social invitations, fear, and criticism. This is increased when media coverage features dramatic negative headlines, which occurred during the SARS outbreak.
Based on the research, the top two things you can do during a quarantine to reduce the psychological impact:
--Frame it as an altruistic act that helps other people.
--Remain active in your social network.
A quarantine highlights one of the most important elements of social media—social connection that can occur remotely. Take advantage of your social media and stay connected. It’s the best thing you can do for yourself in a quarantine AND it helps other people, which helps you too!
Reference
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020), The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, 395, 912-920.