What Are the Psychological Effects of a Quarantine?

New research surveys the challenges and consequences of this form of seclusion.

Posted Mar 29, 2020

Given the exponential spread of COVID-19, President Trump wanted to order a quarantine for the New York region before recommending a “strong travel advisory.” But what are the psychological effects of a quarantine? One woman who was quarantined for 14 days with her husband after being on a cruise ship with infected passengers told the CBC, “Now I know what an inmate must feel like.”

Clearly, being apart from (most) others and in isolation for the good of society can take a significant toll. In response to the pandemic, psychologist Samantha Brooks of Kings College London and her colleagues conducted a “rapid review” of the literature on the psychological effects of being quarantined. The following is a brief and selective summary of their paper as published in the Lancet.

Predictors of psychological impact before quarantine:

• Having a psychiatric history was associated with anxiety and anger four to six months after being released from quarantine. Moreover, quarantined health-care workers showed more severe symptoms of post-traumatic stress compared to quarantined members of the general public.

Stressors during quarantine:

  • Longer periods of quarantine were associated with post-traumatic stress symptoms, avoidance, and anger.
  • Participants feared for their own health and/or fears of infecting others.
  • Participants felt frustrated and bored during quarantine, due to confinement, loss of regular routine, and diminished social and physical contact with others.
  • Having inadequate basic supplies (eg, food, water, clothes, or accommodation) during quarantine led to frustration, and was linked to anger and anxiety four to six months after release.
  • Having inadequate information, including clarity around actions to undertake, the purpose of the quarantine, and different levels of risk proved stressful.

Stressors after quarantine:

• Financial loss due to the inability to work created serious economic hardship, with enduring psychological impacts.  In particular, anger and anxiety persisted for months after quarantine.

• Stigma was prominently reported. Participants experienced rejection and avoidance by others, and were treated with fear and suspicion.

What can be done to offset the psychological consequences of a quarantine?

• Keep a quarantine as short as possible but “scientifically reasonable.” Studies showed that the longer the quarantine, the poorer the psychological outcomes tended to be.

• Give people as much information as possible. Quarantined individuals feared being infected or infecting others. Thus, making sure that people quarantined have a firm understanding of the disease and the purpose of the quarantine is key.

• Provide adequate supplies quickly, and have back up plans for what to do if those in quarantine are running out of them.

• Decrease boredom and improve communication. Clear guidelines on coping and stress management should be provided.  In addition, remaining connected to one’s social network — even remotely — helps guard against immediate anxiety and long-lasting distress. Furthermore, public health officials should be clear with those in quarantine about what to do if they have any symptoms.

• Health-care workers need special treatment. They often experience stigma and should be supported by their colleagues.

Altruism works better than compulsion. Reminders that a quarantine keeps others safe, and that health officials are grateful to people for quarantining is recommended. It helps to increase adherence and decrease negative mental health effects of the quarantine.

Be well and stay safe!

References

Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395: 912-20

Quarantine diary: Repatriated cruise ship passenger documents life at CFB Trenton. https://www.cbc.ca/news/canada/ottawa/quarantine-diary-ottawa-1.5511654