Anticipating the Psychological Consequences of COVID-19 Quarantines

How to address the negative psychological impacts of necessary public health interventions like quarantine in light of the COVID-19 pandemic.

José G. Luiggi-Hernández
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Due to the rapidly escalating threat of the COVID-19 pandemic, researchers at King’s College London undertook a review of the scientific literature on the psychological effects of quarantines. They aimed to provide information for the development of evidence-based preventative methods that would improve the short and long-term psychological distress associated with these public health measures. According to Dr. Samantha Brooks and her team:

“Quarantine is often an unpleasant experience for those who undergo it. Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects. Suicide has been reported, substantial anger generated, and lawsuits brought following the imposition of quarantine in previous outbreaks. The potential benefits of mandatory mass quarantine need to be weighed carefully against the possible psychological costs. Successful use of quarantine as a public health measure requires us to reduce, as far as possible, the negative effects associated with it.”
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Post-Quarantine Related Mental Health Issues. 

Researchers found five studies that compared psychological outcomes between people who were quarantined and people who were not. Quarantined hospital staff members were more likely to feel irritable and exhausted, became detached from others, feel anxious around people with fever, experienced poor concentration and increased indecisiveness, their performance at work was impoverished and were more likely to feel reluctant to work and consider quitting. 

For these staff, being quarantined was also found to be a predictor of meeting diagnostic criteria for severe depressive symptoms, acute stress disorder, and post-traumatic stress disorder (PTSD). PTSD was also four times higher in children who were quarantined, while 28% of their parents met diagnostic criteria for the disorder. During an Australian outbreak, those quarantined experienced higher levels of psychological distress than the general population.

Non-comparative survey research found high levels of general psychological symptoms, emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger, and emotional exhaustion. People quarantined due to SARS reported high levels of fear, nervousness, sadness, and guilt, and low levels of happiness or relief. Qualitative (or interview-based) research found similar results, adding confusion, numbness, and anxiety-induced insomnia to the rest of the identified symptoms. 

The findings of another study might suggest that anxiety and anger symptoms might be partially reduced 3-6 months after the quarantine. Yet others found that being quarantined could predict PTSD and alcohol abuse even 3-years after the event. Many also developed avoidant behaviors such as lowering direct contact with patients, not reporting to work, avoiding people who were coughing and sneezing, avoiding crowded enclosed spaces and avoiding all public spaces week after the event. People who had histories of psychiatric diagnosis previous to quarantines were more likely to experience anger and anxiety months after no longer being quarantined.

Stressors During Quarantines. 

Further findings on the stressors that influenced psychological distress during quarantines were found. Frustration out of not having basic supplies during the quarantine was associated with anxiety and anger months after being released. Additionally, people reported feeling confused out of not having enough clear information and perceiving a lack of transparency and negligence from coordinated public health institutions. 

Quarantines of longer duration were associated with worsened mental health – specifically, they experienced post-traumatic stress symptoms, avoidance behaviors, and anger. For those who feared infecting others were more worried about their physical symptoms during the quarantine, and continued feeling worry months after the event. Finally, Being separated from others and breaking their routines, people began feeling boredom, frustration, and a sense of isolation. 

Stressors Post-Quarantine. 

The main stressors that people experienced after being quarantined found in the literature were financial loss and stigma. Those quarantined are unable to work, and as outbreaks occur without warning, they cannot prepare for the financial blow they could experience. This has long-term effects, as the socioeconomic distress negatively impacts psychological well being, as people experience financial-related anxiety and anger long after the quarantine is over.

In some cases, anger arose from not receiving financial support post-quarantine or support that was insufficient or untimely. People with lower incomes were more likely to experience long-term depressive and post-traumatic symptoms – which is consistent with study findings highlighting the relationship between un- and underemployment and depression and suicidality. For people quarantined because of exposure to- or infection with – Ebola experienced the effects of stigma as others distanced themselves from them out of fear of contagion.  

Recommendations

Quarantines are often necessary public health interventions, as they prevent the increased incidence of new and lethal illnesses, but additional practices, measures, and interventions can buffer their adverse psychological effects. After analyzing the available data, the researchers recommended reducing the length of quarantines as much as possible, providing as much necessary clear, timely information as possible, reducing boredom and increasing communication as much it is possible to do so due to contemporary forms of technology such as mobile electronic devices and the internet.

Provide additional mental health services to health professionals as literature finds they are more at risk of developing long-term emotional distress after quarantines due to being at higher risk of exposure. Finally, policies should aim to address the financial issues and effects of stigma ahead of time by educating the public about the disease and providing economic support for those affected.  

This study provides us useful information on what we can expect from measures being taken to control the COVID-19 pandemic. By anticipating the effects of quarantine and developing guidelines to address these issues, we can prepare as citizens, researchers, and health providers. 

 

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Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N., and Rudin, G.J. (2020). The psychological impact of quarantine and how to reduce it: a rapid review of the evidence. Lancet, 395, p.912–20 (Link)

19 COMMENTS

  1. Ironic. Stigma and loss of income is what I got from seeking “mental health.”

    I am wondering how all those who attend community mental centers are doing. I’m sure the already marginalized “consumers” miss the time spent with the few friends they have. Especially since so many live alone. 🙁

    Calling a friend who’s still in the “mental illness system.” Hard to leave as I know too well.

  2. Having everyone quarantined at once feels less traumatic than hospitalization. We are all together in our isolation this time. This research can help understand and support the long term effects of psych “quarantine”. I am grateful to sleep in my own bed, have wifi, privacy and use the phone. Thinking of everyone everywhere with love, but especially those in psych hospital and others who are isolated without family and the comforts of home.

  3. Not to be flippant…I understand this is not the point of the article and that the emotional distress of being quarantined due to Covid 19 can be profound… but I couldn’t help but think of all the parallels there are to the experience of being committed to a psych ward. Stigma, lack of clear communication, boredom, lack of necessary supplies, fear of being contagious…anger, PTSD. It kind of makes me sorry for the whole world.

  4. This is really disturbing to me, considering that I’ve lived most of my life this way, involuntarily.

    I’m referring to being alone. As I read into the article more, it seems they are talking about people placed in a sort of … concentration camp? I don’t think this article makes it clear. Googling quarantine brings up references to things like “isolation” and “staying home”, but also being locked away…

    • Yes, I feel the same way, Jeffrey. This is how I’ve lived most of my life also, through no choice I made. Abandoned by family and friends, people were always putting up “boundaries” so they wouldn’t have to deal with my “severe mental illness”. No one but me ever wondered if the “help” I was getting was the thing that was making my life unbearable.
      I guess it gives us a kind of strength in situations like this. Quarantine? Yes, I can do that. I’ve been doing it voluntarily or involuntarily most of my life. Voluntarily is when I “took the hint” that I don’t belong.
      And now I live most of my life in quotation marks.

  5. Well covid-19 effects are perfect then, for psychiatry to medicate all the “symptoms”, that were not covid-19.

    It seems then that isolation in psych wards are not “mentally healthy”
    Nor are nursing homes. Nor prisons.
    But the agitation and restlessness needs drugs, not activity. More drugs please.

  6. Well quarantine isn’t so bad as long as you are not on a psych ward. And have enough toilet paper. If you haven’t there are reasonable substitutions. Kleenex, paper towels, napkins, pharma ads, CBT workbooks, the DSM…If you are looking for the latter you will want to watch for the label that says “not soft enough to cushion the blow of landing in abject poverty”. If it says that you know you have the right brand!

      • I hated doing stuff like that when I was in hospital. I remember they made me draw up a list of pros and cons over being involved with someone I was dating trying to get me to break up with them. Meanwhile, I’m there because I was having bad reactions to pills and I knew that was the problem. It was almost like you had a drug overdose and instead of being given medical help, they ask you to fill out a Cosmo dating questionnaire before they’ll do anything, only when you’re done, they still do nothing.

        • It’s like being in a bad nightmare. Regular medical care can be much like it.
          It’s the go around, and what lies at the very heart of this garbage is their lack of competence, their lack of rationality in the face of their fears of their knowledge that they do not “know” after all.
          It is never about the “patient”. Even if a patient or prisoner act nuts, at the heart is their own inability to admit.
          It is liberating to understand that it was never about you or me.

          • Don’t even get me started about how horrible regular medical health care is where I am…Three people I know recently lost loved ones in the regular “health care” system here, all of them with really serious medical issues, left too long to be seen, or given such horrible treatment that a two year old could have done a better job…

  7. The “mental health” workers are always looking for business. Anyone who is distressed by the entire world being quarantined will now be claimed to be “mentally ill.” Just like anyone who was distressed by 9/11/2001 was claimed to be “mentally ill.”

    Distressing events don’t cause distress according to the “mental health” workers, they believe all distress is caused by “chemical imbalances” in people’s brains. Despite the fact that their “chemical imbalance theory of mental illness” was debunked decades ago.

  8. Just read an article in a journal of neuro-science how they think they found a bio marker for depression. Is this a real neurological condition they plan on actually fixing?

    Heck no! Just an excuse to dole out more of the same poison that damages neuron receptors. Only now they’re hopeful for an excuse to force happy people to take the same old crap they’ve been handing out with for 30 years.

    “We don’t know how SSRIs work. We just know that they always do. Because the consumers tell us so. If they don’t say the meds are working we keep them locked up till they do.”

    How can anyone be that dumb? “Depression is the leading cause of disability.” Yet in order to get that disability check approved you need proof that you’re taking standard “treatments.” Hence SSRI drugs do not prevent disability from depression.

    How can respected neuro scientists mix up cause and effect so thoroughly?

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