- A study from The Lancet reviewed studies reporting negative psychological effects from quarantines during past outbreaks
- Additional stressors such as financial loss, fear, and lack of supplies was found to be associated with negative psychological effects months after the quarantine ended
- Government and health officials lacking transparency related to the seriousness of a pandemic contributed to additional stress factors
The possibility of a COVID-19 quarantine has become a reality for countless people around the world. Whether it be a mandatory lockdown or travel restrictions, quarantines attempting to contain COVID-19 has disrupted the lives of billions of people around the world on some level.
The Possible Negative Effects Of A Covid-19 Quarantine
While many know the word quarantine, it is hard to grasp what exactly that entails without personally experiencing it. In response to the current COVID-19 outbreak, The Lancet conducted a study on the psychological impact of being quarantined. The study reviewed studies from past outbreaks and the reports of post-traumatic stress symptoms, confusion, and anger that at times continued months after the quarantine had ended.
When someone is placed in quarantine their entire life stops. When normal life ends additional psychological stressors typically begin and can include infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. These stressors can contribute to the negative psychological effects associated with being quarantined.
Some experts believe people with a history of mental illness are at higher risk of negative psychological effects. The study found reports of people with mental illness experiencing anxiety and anger for four to six months after being released from quarantine. Out of the studies reviewed, only one addressed the potential psychological issues that quarantines could cause for people already suffering from mental illness.
Some researching the psychological impacts have suggested the potential for long-lasting psychological effects. “Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, cause dramatic effects,” the study reads. The study was conducted in hopes of helping to provide information that could avoid some of the negative effects seen in quarantines in the past.
What We Can Learn From Past Outbreaks
In 2004, 338 hospital employees in Taiwan were quarantined for a total of nine days after being suspected of coming in contact with SARS. Staff who were quarantined were found to have acute stress disorder immediately after the quarantine ended. Staff who were quarantined were more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteriorating work performance, and reluctance to work or consideration of resignation. One of the reviewed studies noted the effect of being quarantined was a “predictor of post-traumatic stress symptoms in hospital employees even 3 years later.”
In 2008, 2,760 horse owners were quarantined in Australia during an equine influenza outbreak. During the quarantine, 34% of the horse owners reported high psychological distress during the outbreak as compared to around 12% of the Australian general population.
A reviewed study reported post-traumatic stress scores were four times higher in children who had been quarantined when compared with children not quarantined. In the same study, 27 of 98 parents quarantined reported sufficient symptoms to warrant a diagnosis of a “trauma-related mental health disorder” compared to 17 of 299 parents who were not quarantined.
Possible Exposure Quarantines
There is a difference in quarantines or at least the reason for being quarantined. General public quarantines are typically activated to attempt to contain the illness and keep it from spreading. These quarantines could include limited travel, businesses closings, and a curfew. Things become a bit more serious when you are quarantined for potentially having direct exposure to an illness. People quarantined because of close contact with SARS reported various negative responses during the quarantine period.
In 2008, 1,057 people were quarantined in Canada after potential exposure to SARS. A study found that 524 of those quarantined avoided people who were coughing or sneezing, 255 avoided crowded enclosed places and 204 avoided all public places in the weeks following the quarantine period. Another qualitative study reported several participants who described long-term behavioral changes after being quarantined, including hand washing and avoidance of crowds. For some, the return to normality took months.
Only 46 of the 1,057 people quarantined showed positive feelings. A total of 48 people reported feelings of happiness, and 43 reported feeling relief. On the negative side, 230 people reported feeling fear, 187 reported nervousness, 186 reported sadness, and 101 reported guilt. Qualitative studies identified a range of psychological responses that included confusion, fear, anger, grief, numbness, and anxiety-induced insomnia.
Three years after the SARS outbreak, two studies found that alcohol abuse and dependency symptoms were positively associated with those who were quarantined. For health-care workers, being quarantined was positively associated with avoidance behaviors, such as “minimizing direct contact with patients and not reporting to work.”
Health-care workers have been found to suffer from more severe symptoms of post-traumatic stress disorder than the general public following a quarantine. It was found that health-care workers felt “greater stigmatization than the general public, exhibited more avoidance behaviors after quarantine, reported greater lost income.”
Psychologically, health-care workers reported “substantially more anger, annoyance, fear, frustration, guilt, helplessness, isolation, loneliness, nervousness, sadness, worry, and were less happy.” It was also noted that health-care workers were “substantially more likely to think they had SARS and to be concerned about infecting others.”
Multiple factors play into the negative psychological effects of being quarantined. Three studies found longer durations of quarantine were associated with poorer mental health. Eight studies found fear of infection or infecting loved ones were higher in those quarantined.
Fears escalated if the quarantined person showed any physical symptoms related to the illness and contributed to psychological symptoms several months after the quarantine ended. One study found those extremely concerned about being infected or infecting loved ones tended to be pregnant women and parents of young children.
Participants felt distressed from the confinement, loss of normal daily routines, and reduced social and physical contact with others. The lack of contact frequently caused boredom, frustration, and a sense of isolation from the rest of the world. The frustration commonly grew due to not being able to take part in day-to-day activities.
There were several stressors that were found associated with psychological effects in life after quarantine. Having inadequate supplies during a quarantine is a common source of frustration that is associated with anxiety and anger four to six months after release. Some participants said a lack of regular prescriptions and medical care was an issue. Along with all the personal psychological challenges one faces during quarantine, government response—or a lack thereof—has been found to add to negative psychological effects.
Poor Government Response Has Shown Negative Psychological Effects In Some
Four studies found public health authorities had insufficient supplies during quarantines. Participants from the four studies reported receiving their masks and thermometers either late or not at all. Food, water, and other items “were only intermittently distributed.” Food supplies commonly took a long time to arrive. Public health authorities in Toronto were praised for their quick delivery of medical kits during the SARS outbreak. However, that praise faded after those quarantined received no groceries or other supplies necessary for daily living.
Along with a lack of supplies, another stressor was found to be poor information from public health authorities. After the Toronto SARS epidemic, some participants believed much of the confusion was caused by “differences in style, approach, and content of various public health messages because of poor coordination between the multiple jurisdictions and levels of government involved.” A lack of understanding of the different levels of risks was one of the biggest factors in extreme fear. Participants claimed to have noticed a lack of transparency from health and government officials in regards to the level of severity of the pandemic.
Financial loss while quarantined was found to be a major stressor that often continued after being released from quarantine. Several studies found the financial loss resulting from a quarantine “created serious socioeconomic distress and was found to be a risk factor for symptoms of psychological disorder and both anger and anxiety several months after quarantine.”
In 2018, 1,161 people in Sierra Leone were quarantined after it was believed they were exposed to Ebola. Some of those quarantined felt the financial assistance that came was either insufficient or came too late. Government compensation helped relieve some of the financial stress caused by being quarantined during the SARS outbreak in Toronto. However, those who were not financially “well-off” struggled after the government reimbursement was slow to arrive. Those with an income lower than CAD $40,000 showed significantly higher amounts of post-traumatic stress and depression.
Across multiple studies, the stigma that comes from others from being quarantined often continued even after the outbreak had been contained. “Quarantined participants were significantly more likely to report stigmatization and rejection from people in their local neighborhoods, suggesting that there is stigma specifically surrounding people who had been quarantined,” the study reads. Participants across several studies reported people “avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments.”
More quarantines appear to be unavoidable at this point in the COVID-19 outbreak. Quarantines are necessary at times for the benefit of the general public but leave the burden of ensuring they are short-lived and properly supplied on health authorities. Supplies have been a major concern across the globe throughout the COVID-19 outbreak, especially now that panic purchasing has led to issues even getting toilet paper around the world. A lack of basic resources before a quarantine is typically not ideal, and will likely add stressors to future areas subject to a COVID-19 quarantine.