March 23, 2020

The impact of quarantine on mental health

The new reality of a global pandemic has major implications for all, particularly providers of health care - both physical and mental. The rapidity of COVID-19’s spread and impact on daily life belies how recently it began. Healthcare professionals across the world are dealing with the immediate reality of quarantine and how it affects the health and wellness of their clients, and a widespread transition to telehealth platforms has made connecting with clients even harder than ever. As such, having a working knowledge of risk factors associated with quarantine is important to ensure that this increased risk to population health and safety is mitigated.

A rapid review published this month in The Lancet provides much needed insight into some of the implications of quarantine, specifically in the context of mental health and wellness.  Researchers reviewed existing studies on quarantines in order to identify its likely effects on mental health as well as factors that could contribute to or mitigate undesirable effects. The review includes 24 different studies conducted across ten countries and included comparisons of psychological outcomes for people who were and were not quarantined as well as a surveys that focused exclusively on experiences of quarantined populations.

Most studies identified a litany of negative consequences for mental health, both during and after quarantine. Stressors during quarantine include duration of quarantine, fears of infection, frustration and boredom, inadequate supplies, inadequate information. The most significant stressors post-quarantine were financial loss and stigma from others. Among quarantined populations, the review found a high prevalence of symptoms including emotional disturbances,  depression, stress, low mood, irritability, insomnia post­-traumatic stress symptoms, anger, and emotional exhaustion. Studies on quarantine’s longer-term effects found evidence of behavioral changes such as alcohol abuse and impairments related to health anxiety after the quarantine period, particularly for health-care workers. Regarding factors that may put an individual at higher risk for negative consequences of quarantine, the review found mixed evidence for the influence of demographic characteristics like age and education, with the most notable risk factors being more specific. For example, individuals with a history of psychological illness and health-care workers seem to experience and exhibit greater consequences than the general public.

So how can you be of help during this crisis?

Results emphasize a need for healthcare professionals to mitigate the consequences of quarantine whenever possible. Providers can support existing and incoming clients by building an awareness of the influence quarantine may have on psychological wellbeing, providing accurate information about both COVID-19 and preventative health practices/policies, and maintaining effective lines of communication during and after. As the field of mental healthcare technology expands, clinicians have access to a wide range of tools to connect with patients between and during telehealth appointments. Another possibility to explore is helping clients connect with support groups or other means of building community, particularly for those most impacted by quarantine: individuals with preexisting conditions and healthcare workers. Helping clients develop and practice techniques for stress management and coping will be essential, as will individualized plans for potential triggers, behavioral changes, and the practical realities of life during and after quarantine. Clinicians can also encourage patients to recognize the altruism in measures like quarantine, as “reinforcing that [they are] helping to keep others safe, including those particularly vulnerable (such as those who are very young, old, or with pre­ existing serious medical conditions), and that health authorities are genuinely grateful to them, can only help to reduce the mental health effect and adherence in those quarantined.”

The current review both highlights the complexity of these kinds of public health crises and provides insight into ways that clinics and providers can adjust to better support their clients. There is abundant evidence that quarantine’s psychological impact is “wide­-ranging, substantial, and can be long lasting.” As the number of confirmed cases of coronavirus continues to grow in the United States, it’s clear that we are in the midst of a public health - and mental health - crisis. We all have a part to play in reducing the negative psychological consequences of COVID-19, and providers can help their patients and communities alike by integrating the mental healthcare realities of this new landscape into their practices.

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. The Lancet, 0(0).