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Quarantine can have long-lasting psychological impacts: lessons learnt from previous outbreaks

Quarantine produces negative psychological effects including post-traumatic stress symptoms, confusion and anger, according to researchers from King’s College London.

quarantine pic crop
As a means to control the current COVID-19 outbreak, many countries have asked people to isolate themselves at home or in a dedicated quarantine facility

The study, published in The Lancet, finds that these psychological impacts can be long-lasting. In the light of this, the researchers provide key messages on mitigation, particularly around the provision of information and the duration of quarantine.

As a means to control the current COVID-19 outbreak, many countries have asked people to isolate themselves at home or in a dedicated quarantine facility. UK politicians and policymakers have stated that quarantine decisions must be based on scientific evidence about the virus itself, but also the possible social and economic impacts of quarantine.

Funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Emergency Preparedness and Response, the new study has reviewed research on the psychological impact of previous disease outbreaks. Researchers analysed 24 studies, which were done across 10 countries and included people with Severe Acute Respiratory Syndrome (SARS), Ebola, H1N1 influenza, Middle East Respiratory Syndrome (MERS) and equine influenza.

The finding that these psychological effects can still be detected months or years down the line – albeit from a small number of studies – is of particular concern and indicates that measures should be put in place during the quarantine planning process to minimise these psychological impacts. – Lead author, Dr Samantha Brooks from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London

The study showed a wide range of psychological impacts from quarantine, including post-traumatic stress symptoms, depression, feelings of anger and fear, and substance misuse. Some of these, particularly post-traumatic stress symptoms, were shown to be long-standing. Those with a history of psychiatric disorder and health-care workers suffered greater psychological impacts due to quarantine, according to the research.

Lead author, Dr Samantha Brooks from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London said: ‘Going into quarantine is an isolating and often fearful experience and our study found that it has negative psychological effects. The finding that these effects can still be detected months or years down the line – albeit from a small number of studies – is of particular concern and indicates that measures should be put in place during the quarantine planning process to minimise these psychological impacts. Our research suggests that health-care workers deserve special attention from their managers and colleagues and those with pre-existing poor mental health would need extra support during quarantine.’

The research investigated the factors or stressors that were instrumental in the level of psychological impact experienced from quarantine with the aim of recommendations on minimising the effects. The study identified that longer quarantines were associated with poorer mental health.

The research showed that it is important that those in quarantine have access to up-to-date, accurate information that clearly and consistently communicates the reasons for quarantine and any changes in the quarantine plan, especially around its duration.– Contributing author, Professor Neil Greenberg from the IoPPN

Other influential factors in psychological effects were lack of basic supplies such as food, water and clothes and poor information from public health authorities around the purpose of quarantine and guidelines of actions to take. In terms of the post-quarantine period financial loss due to inability to work and stigma around the disease itself were also linked to mental health problems.

Contributing author, Professor Neil Greenberg from the IoPPN said: ‘People who are quarantined are already experiencing a high level of fear around being infected and the possibility of infecting others. When in quarantine they are often prone to catastrophic interpretations of events and an absence of accurate information can exacerbate this. Our research showed that it is important that those in quarantine have access to up-to-date, accurate information that clearly and consistently communicates the reasons for quarantine and any changes in the quarantine plan, especially around its duration. The period of quarantine should be as short as possible and the duration should not be changed unless in extreme circumstances as such changes can lead to significant impacts on mental health.’

What our research highlights are the possible unintended consequences of attempts to control the spread of the virus. We must be aware of these and put in place measures to lessen their impacts. Communication and transparency are key and voluntary quarantine, performed as an altruistic act to protect others, is always going to be associated with less severe consequences than imposed quarantine.– Contributing author Professor Sir Simon Wessely from the IoPPN and Director of the NIHR HPRU in Emergency Preparedness and Response

No previous research has compared the psychological effects of mandatory vs. voluntary quarantine but studies do indicate that highlighting the altruistic aspect of quarantine in terms of keeping others safe could make the stress and frustration of the situation easier to bear.

Contributing author Professor Sir Simon Wessely from the IoPPN and Director of the NIHR HPRU in Emergency Preparedness and Response said: ‘Health officials charged with implementing quarantine should remember that not everyone is in the same situation and people can have very different experiences of the same quarantine plan. If the quarantine experience is negative the results of our study suggest there could be long-term consequences on mental health.

‘Everyone is by now aware of the potential social and economic consequences of COVID-19, but what our research highlights are the possible unintended consequences of attempts to control the spread of the virus. We must be aware of these and put in place measures to lessen their impacts. Communication and transparency are key and voluntary quarantine, performed as an altruistic act to protect others, is always going to be associated with less severe consequences than imposed quarantine.’

The researchers highlight that the recommendations made in the review apply primarily to small groups of people in dedicated facilities and to some extent self-isolation.

The study was published in The Lancet.

This research was funded by the National Institute for Health Research (NIHR) HPRU in Emergency Preparedness and Response and in collaboration/partnership with King's College London. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or Public Health England. 

Reference: Brooks, S.K. et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet , 2020.

Contact: Franca Davenport, Interim Senior Press Officer IoPPN, franca.davenport@kcl.ac.uk