Coping with quarantine (and social distancing)
Quarantine is a preventative measure aimed at slowing the spread of an infectious disease. People who may have been exposed to a contagion are isolated on the chance that they could pass the infection on to others. Courtesy of SARS, equine flu and the particularly horrifying ebola epidemic in West Africa, researchers have had ample opportunities this century to study the impact of quarantine on mental health.
At first glance, the news is not good: anxiety, depression and even PTSD have been reported post-quarantine. In some cases the negative impacts have been long-lasting. However, researchers have also identified ways of reducing the mental health repercussions of preventative isolation. This is must-have knowledge for everyone during a time of widespread social distancing. (In a hurry? Jump to ways to protect mental health during quarantine and social distancing by clicking here.)
Social distancing differs from quarantine in that it is an across-the-board approach that the general public are asked (and at times, required) to undertake regardless of whether they’ve been exposed to the infection. Flouting social distancing requirements can have negative consequences, for example large fines. However, social distancing is generally less restrictive than quarantine. (See the ABC’s reports on the distressing conditions some Australians have experienced in quarantine this year to get a sense of the difference.) Still, there are many similarities between the two preventative measures.
Like people in quarantine, people asked to practice social distancing may have to endure separation from loved ones, dramatically reduced social interactions, loss of freedom, uncertainty over disease status and boredom. According to the authors of a timely new research paper on the psychological impacts of quarantine, these frustrations hit some people very hard.
Understanding the mental health risks of quarantine can help us come to terms with some of the psychological challenges we might face whilst practicing social distancing. Below, we summarise the results of the review mentioned above, which was published in early 2020 and funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with Public Health England, and in collaboration with the University of East Anglia and Newcastle University.
What are the mental health impacts of quarantine?
During quarantine, and immediately afterwards, people describe many negative psychological states including low mood, irritability, depression, anxiety, stress, insomnia and anger.
Health workers are at higher risk of becoming infected. Perhaps for this reason, they seem particularly prone to poor mental health during and after quarantine, specifically:
- Detachment from others;
- Poor concentration and indecisiveness;
- Deteriorating work performance; and
- Reluctance to work.
Some of the negative repercussions of quarantine may last months or even years.
People might avoid crowds or maintain vigilant handwashing practices for many months after quarantine. One study conducted three years after the SARS pandemic found higher rates of alcohol abuse and dependency amongst people who were quarantined compared to people who retained freedom of movement. Post-traumatic stress disorder (PTSD) has also been reported following quarantine.
Are some people more prone to ill-effects than others?
The evidence is mixed as to whether some people are more vulnerable than others to the negative impacts of quarantine. However, it’s likely that being a health care worker is a risk factor for greater harm, as is having a history of psychiatric illness.
Do particular practices worsen the mental health outcomes?
There’s good evidence that specific aspects of quarantine cause problems. For instance, outcomes tend to be worse when:
- Quarantine lasts for a long time, the end date keeps shifting, or duration is unknown;
- The person in quarantine has a strong fear of infection;
- The person in quarantine says that they feel frustrated and bored, have lost their usual routine;
- When quarantine results in less social and physical contact than usual, causing a sense of isolation;
- People in quarantine don’t understand its value and importance for the wider community;
- People face stigma when they emerge from quarantine; and
- There is inadequate or contradictory information from health authorities.
It’s also been shown that long-term negative impacts of quarantine are more likely when quarantined folk are provided with inadequate supplies. People do better psychologically, and recover their equilibrium more quickly, when they know that they have the medication, food, water and clothes they need to get by.
Post quarantine, some people will face serious financial stress due to a loss of income and employment opportunities. Financial pressures can increase psychological distress and may lead to perceptions of injustice – a known risk factor for mental and physical ill-health.
Quarantine and other isolating preventative measures should be as short as possible, in line with medical advice.
The altruistic value of quarantine and social distancing should be emphasised. People cope better when they understand that their isolation is keeping other people safe. However, it’s important that authorities ensure that the families of those in quarantine are protected – you can’t expect people to benefit the community at the expense of their children’s health, for example.
Authorities (including leaders in the workplace) should also provide reassuring, realistic, clear and consistent information about the significance of symptoms, and risks of passing on the infection. People do better when they understand what is happening and why. There should also be clear lines of communication for the public and workforce to ask questions about fears, symptoms and the reasons behind preventative measures.
Financial support makes sense, especially for people with lower household incomes.
People in isolation should be encouraged to talk to friends, family and colleagues. Prioritising socialising and communication can protect against long term distress. This applies to those practicing social distancing too – stay in touch with loved ones as much as you can.
For those in quarantine, staying busy is a good idea. Work can help keep emotions stable and brains active. Employers who enable workers to work remotely during quarantine can help stave off boredom, as well as avoid some of the negative financial consequences of enforced, unexpected time off work. However, it needs to be understood and accepted that the high levels of stress many people feel during quarantine will likely impact productivity.
Following routines and staying busy is good for people practicing social distancing too but the same productivity proviso applies. Workers suddenly based in the home office may face new responsibilities on top of their normal workload – for example, the need to home school children during working hours. Employers who are supportive and accommodating of this split focus should see less burnout and stress.
Governments and employers can help combat stigma by providing accurate information about the disease and the reasons for quarantine.
Finally, people need to be confident that they will have adequate supplies for basic needs and medical treatment.
For more information, see Brooks, Sam & Webster, Rebecca & Smith, Louise & Woodland, Lisa & Wessely, Simon & Greenberg, Neil & Rubin, Gideon. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 395. doi: 10.1016/S0140-6736(20)30460-8.