Report Summary: The Psychological Impact of Quarantine and How to Reduce It

Quarantines and other social distancing measures are a vital means for slowing the spread of pathogens like the SARS-CoV-2 virus causing the current COVID-19 pandemic. But they are difficult. Studies of people placed under quarantine for other epidemics over the past 20 years have shown that they can suffer from a wide range of psychological effects like depression, anxiety, and post-traumatic stress symptoms. Clear and constant information from authorities about the nature of the disease and the reasons for the quarantine is the best way to dispel these psychological effects.

The Psychological Impact of Quarantine and How to Reduce It. Rapid Review of the Evidence Samantha K Brooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, Neil Greenberg and Gideon James Rubin, The Lancet, 2020
The Psychological Impact of Quarantine and How to Reduce It. Rapid Review of the Evidence Samantha K Brooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, Neil Greenberg and Gideon James Rubin, The Lancet, 2020

Content Summary

Recommendation
Take-Aways
Summary
About the Authors

Recommendation

The COVID-19 pandemic has spread around the globe, putting much of the world’s population in quarantine. Whether told to self-isolate, shelter in place, or stay within a hundred meters of home, this is an unfamiliar and uncomfortable situation for most. Smaller groups of people have been in similar circumstances over the past 20 years, and people can learn from the studies of how they fared while they were in quarantine and after they emerged. These studies are invaluable if people want to know what their next few months will likely look like.

Take-Aways

  • Quarantine can have substantial and wide-ranging negative psychological effects.
  • There are many different stressors during quarantine, and they can last beyond the quarantine period.
  • Officials can take measures to make mandatory quarantines as bearable as possible.

Summary

Quarantine can have substantial and wide-ranging negative psychological effects.
Large swaths of the world’s Western population are now in some form of quarantine to control COVID-19, and many in Asia are just emerging. This social distancing measure is essential to curb the effects of this pandemic, but it’s trying – and the psychological costs are quite real.

“This outbreak has seen entire cities in China effectively placed under mass quarantine, while many thousands of foreign nationals returning home from China have been asked to self-isolate at home or in state-run facilities.”

Psychologists at University College London have reviewed studies of how people fared when they were put under quarantine in the recent past, primarily because of the Ebola outbreak in West Africa in 2014 and the SARS outbreak in China and Canada in 2003. Their review found that those placed under quarantine were more likely to experience a wide range of negative psychological effects, including acute stress disorder, exhaustion, irritability, insomnia, post-traumatic stress symptoms, depression, fear, sadness, numbness, grief, confusion, anxiety and detachment from others.

[Editor’s note: Coronavirus disease 2019 (COVID-19) is an infectious viral respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as “the novel coronavirus.”]

There are many different stressors during quarantine, and they can last beyond the quarantine period.
It was not clear if there were any demographic or individual predictors of who might be the most psychologically affected by quarantine. Health workers did seem to suffer the most and to retain behaviors like avoiding public spaces and co-workers even months after the quarantine was over. A history of psychiatric illness was also associated with retaining anger and anxiety for months after the quarantine was lifted.

“Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects.”

The stressors during quarantine are manifold, and people get more stressed the longer the quarantine lasts. People worry about getting sick themselves, and about passing the infection on to their families. They feel bored and unmoored without their standard routines, and often feel isolated. They worry about their finances, especially if the quarantine means that they are unable to work. A lot of people, notably health workers, worry about the stigma they will experience when the quarantine is lifted. Unfortunately, their worry has proven to be justified. Many people quarantined during the Ebola epidemic reported that others avoided them, treated them suspiciously, and made disparaging comments to them after they emerged.

People also get very stressed by a lack of supplies and a lack of information. A lack of clear guidance from public health officials left people in quarantine fearful, confused and resentful.

Officials can take measures to make mandatory quarantines as bearable as possible.
The key takeaway from this literature review is that information is essential. People under quarantine need clear, rapid and constant communication from their leaders about the disease circulating and about the purpose of the quarantine.

“If quarantine is essential, then our results suggest that officials should take every measure to ensure that this experience is as tolerable as possible for people.”

Public officials can stress the altruistic nature of the quarantine since people fare better when they feel that their sacrifices are voluntary and for the greater good rather than feeling like their freedoms are being restricted. Households also need adequate supplies. Governments should coordinate the distribution of food and medical supplies in advance, and should have reallocation and conservation plans in place to make sure that resources don’t run out.

About the Authors

Samantha K. Brooks, Rebecca K. Webster, Louise E. Smith, Lisa Woodland, Simon Wessely, Neil Greenberg, and Gideon James Rubin are in the Department of Psychological Medicine at King’s College London, where they work on the impact of disasters on distress and psychological health disorders, and how people perceive potential health risks.

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