PSYCH 3001 SUNY at Fredonia Psychological Impact of Quarantine Article Review Read the article called “The psychological impact of quarantine” and then ans

PSYCH 3001 SUNY at Fredonia Psychological Impact of Quarantine Article Review Read the article called “The psychological impact of quarantine” and then answer the questions below. You should plan to turn in a 2-3 page paper that lists your answers to these questions in order and keeps the question numbers (so it’s easy for me to read along). Please be very thorough and write clearly, using the terms from the reading without plagiarizing the reading. You should write in full sentences and paragraphs.What are the negative impacts of quarantine discussed in the study? What are the positive impacts of quarantine discussed in the study?What are some of the things that can be done to reduce the negative impact of quarantine, according to this study?While you may not be quarantined, you may still face challenges. Which of the negative impacts discussed in this study do you think might affect you the most?Are there any other challenges you anticipate that were not discussed in the study? Rapid Review
The psychological impact of quarantine and how to reduce
it: rapid review of the evidence
Samantha K Brooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, Neil Greenberg, Gideon James Rubin
Lancet 2020; 395: 912–20
Published Online
February 26, 2020
https://doi.org/10.1016/
S0140-6736(20)30460-8
Department of Psychological
Medicine, King’s College
London, London, UK
(S K Brooks PhD, R K Webster PhD,
L E Smith PhD, L Woodland MSc,
Prof S Wessely FMedSci,
Prof N Greenberg FRCPsych,
G J Rubin PhD)
Correspondence to:
Dr Samantha K Brooks,
Department of Psychological
Medicine, King’s College London,
London SE5 9RJ, UK
samantha.k.brooks@kcl.ac.uk
See Online for appendix
The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come
into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to
apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of
quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed
studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger.
Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate
information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where
quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear
rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to
altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
Introduction
Why is this Review needed?
Quarantine is the separation and restriction of movement
of people who have potentially been exposed to a contagious
disease to ascertain if they become unwell, so reducing the
risk of them infecting others.1 This definition differs from
isolation, which is the separation of people who have been
diagnosed with a contagious disease from people who
are not sick; however, the two terms are often used
interchangeably, especially in communication with the
public.2 The word quarantine was first used in Venice, Italy
in 1127 with regards to leprosy and was widely used in
response to the Black Death, although it was not until
300 years later that the UK properly began to impose
quarantine in response to plague.3 Most recently, quar­
antine has been used in the coronavirus disease 2019
(COVID-19) outbreak. This outbreak has seen entire cities
in China effectively placed under mass quarantine, while
many thousands of foreign nationals returning home
from China have been asked to self-isolate at home or
in state-run facilities.4 There are precedents for such
measures. Citywide quarantines were also imposed in
areas of China and Canada during the 2003 outbreak of
severe acute respiratory syndrome (SARS), whereas entire
villages in many west African countries were quarantined
during the 2014 Ebola outbreak.
Quarantine is often an unpleasant experience for those
who undergo it. Separation from loved ones, the loss of
freedom, uncertainty over disease status, and boredom
can, on occasion, create dramatic effects. Suicide has
been reported,5 substantial anger generated, and lawsuits
brought6 following the imposition of quarantine in
previous outbreaks. The potential benefits of mandatory
mass quarantine need to be weighed carefully against
the possible psychological costs.7 Successful use of
quarantine as a public health measure requires us to
reduce, as far as possible, the negative effects associated
with it.
Given the developing situation with coronavirus, policy
makers urgently need evidence synthesis to pro­
duce
guidance for the public. In circumstances such as these,
Key messages
• Information is key; people who are quarantined need to
understand the situation
• Effective and rapid communication is essential
• Supplies (both general and medical) need to be provided
• The quarantine period should be short and the duration
should not be changed unless in extreme circumstances
• Most of the adverse effects come from the imposition of
a restriction of liberty; voluntary quarantine is associated
with less distress and fewer long-term complications
• Public health officials should emphasise the altruistic
choice of self-isolating
912
Search strategy and selection criteria
Our search strategy was designed to inform this Review and
a second review to be published elsewhere relating to
adherence to quarantine. We searched MEDLINE, PsycINFO,
and Web of Science. The full list of search terms can be found
in the appendix. In brief, we used a combination of terms
relating to quarantine (eg, “quarantine” and “patient
isolation”) and psychological outcomes (eg, “psych” and
“stigma”). For studies to be included in this Review, they had
to report on primary research, be published in peer-reviewed
journals, be written in English or Italian (as these are the
languages spoken by the current authors), include
participants asked to enter into quarantine outside of a
hospital environment for at least 24 hours, and include data
on the prevalence of mental illness or psychological
wellbeing, or on factors associated with mental illness or
psychological wellbeing (ie, any predictors of psychological
wellbeing during or after quarantine). The initial search
yielded 3166 papers, of which 24 included relevant data and
were included in this Review. The screening process is
illustrated in the figure.
www.thelancet.com Vol 395 March 14, 2020
Rapid Review
rapid reviews are recommended by WHO.8 We undertook
a Review of evidence on the psychological impact of quar­
antine to explore its likely effects on mental health and
psychological wellbeing, and the factors that contribute
to, or mitigate, these effects. Of 3166 papers found, 24 are
included in this Review (figure). The characteristics of
studies that met our inclusion criteria are presented in
the table. These studies were done across ten countries
and included people with SARS (11 studies), Ebola (five),
the 2009 and 2010 H1N1 influenza pandemic (three),
Middle East respiratory syndrome (two), and equine
influenza (one). One of these studies related to both
H1N1 and SARS.
The psychological impact of quarantine
Five studies compared psychological outcomes for people
quarantined with those not quarantined.9,19,27,28,33 A study9
of hospital staff who might have come into contact with
SARS found that immediately after the quarantine period
(9 days) ended, having been quarantined was the factor
most predictive of symptoms of acute stress disorder. In
the same study, quarantined staff were significantly more
likely to report exhaustion, detachment from others,
anxiety when dealing with febrile patients, irritability,
insomnia, poor concentration and indecisiveness, deteri­
orating work performance, and reluctance to work
or consid­eration of resignation. In another study,33 the
effect of being quarantined was a predictor of posttraumatic stress symptoms in hospital employees even
3 years later. Approximately 34% (938 of 2760) of horse
owners quarantined for several weeks because of an
equine influenza outbreak reported high psychological
distress during the outbreak, compared with around
12% in the Australian general population.28 A study27
comparing post-traumatic stress symptoms in parents
and children quarantined with those not quarantined
found that the mean post-traumatic stress scores were
four times higher in children who had been quarantined
than in those who were not quarantined. 28% (27 of 98)
of parents quarantined in this study reported sufficient
symptoms to warrant a diagnosis of a trauma-related
mental health disorder, compared with 6% (17 of 299) of
parents who were not quarantined. Another study19 of
hospital staff examined symptoms of depression 3 years
after quar­antine and found that 9% (48 of 549) of the
whole sample reported high depressive symptoms. In
the group with high depressive symptoms, nearly
60% (29 of 48) had been quarantined but only 15% (63 of
424) of the group with low depressive symptoms had
been quarantined.
All other quantitative studies only surveyed those who
had been quarantined and generally reported a high
prevalence of symptoms of psychological distress and
disorder. Studies reported on general psychological
symptoms,22 emotional disturbance,34 depression,16 stress,15
low mood,18 irritability,18 insomnia,18 post-traumatic stress
symptoms25 (rated on Weiss and Marmar’s Impact of
www.thelancet.com Vol 395 March 14, 2020
Event Scale–Revised35), anger,20 and emotional exhaus­
tion.21 Low mood (660 [73%] of 903) and irritability
(512 [57%] of 903) stand out as having high prevalence.18
People quarantined because of being in close contact
with those who potentially have SARS25 reported various
negative responses during the quarantine period: over
20% (230 of 1057) reported fear, 18% (187) reported
nervousness, 18% (186) reported sadness, and 10% (101)
reported guilt. Few reported positive feelings: 5% (48)
reported feelings of happiness and 4% (43) reported
feelings of relief. Qualitative studies also iden­tified a range
of other psy­chological responses to quar­antine, such as
confusion,11–13,23 fear,12–15,23,24 anger,12,13 grief,29 numbness,23 and
anxiety-induced insomnia.14,15
One study compared undergraduates who had been
quarantined with those not quarantined immediately
after the quarantine period and found no significant
difference between the groups in terms of post-traumatic
stress symptoms or general mental health problems.29
However, the entire study population were undergraduate
students (who are generally young, and perhaps have
fewer responsibilities than adults who are employed
full-time) and thus it is possible that these conclusions
cannot be generalised to the wider population.
Only one study17 compared psychological outcomes
during quarantine with later outcomes and found that
during quarantine, 7% (126 of 1656) showed anxiety
symptoms and 17% (275) showed feelings of anger,
whereas 4–6 months after quarantine these symptoms
had reduced to 3% (anxiety) and 6% (anger).
Two studies reported on longer-term effects of quar­
antine. 3 years after the SARS outbreak, alcohol abuse or
3163 records identified from database search
3 from hand search
266 duplicates
2900 titles and abstracts screened
2848 excluded after screening titles and abstracts
as they did not meet the inclusion criteria
52 full texts screened
28 full-text articles excluded
10 population not quarantined
6 quarantined in hospital wards
5 psychological effect not discussed
4 isolation because of psychological
disorder
2 review article
1 not peer-reviewed
24 citations included
Figure: Screening profile
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Rapid Review
dependency symptoms were positively associated with
having been quarantined in health-care workers.32 In a
multivariate analysis,32 after controlling for demographic
factors, having been quarantined and having worked in
a high-risk location were the two types of exposure signifi­
cantly associated with these outcomes (for quarantine:
unadjusted mean ratio 0·45; 95% CI 1·02–2·65).
After quarantine, many participants continued to
engage in avoidance behaviours. For health-care workers,20
being quarantined was significantly and positively asso­
ciated with avoidance behaviours, such as minimising
direct contact with patients and not reporting to work. A
study25 of people quarantined because of potential SARS
contact noted that 54% (524 of 1057) of people who had
Country
Design
Participants
Quarantine period
Measures
Bai et al (2004)9
Taiwan
Cross-sectional
338 hospital staff
9 days because of contact with
suspected SARS cases
Study-specific survey;
SARS-related stress survey
composed of acute stress
disorder criteria according to the
DSM-IV and related emotional
and behavioural changes
Blendon et al
(2004)10
Canada
Cross-sectional
501 Canadian residents
Length unclear; exposure to
SARS
Study-specific survey
Braunack-Mayer
et al (2013)11
Australia
Qualitative
56 school community
members
Length unclear; H1N1 influenza
Interview
Caleo et al (2018)12
Sierra Leone
Mixed methods
Length unclear; entire village on Interview
1161 residents of a rural
village; 20 of whom took part restricted movement because of
Ebola
in an interview study
Cava et al (2005)13
Canada
Qualitative
21 Toronto residents
5–10 days because of SARS
contact
Desclaux et al
(2017)14
Senegal
Qualitative
70 Ebola contact cases
21 days because of Ebola contact Interview
DiGiovanni et al
(2004)15
Canada
Mixed methods
1509 Toronto residents
Duration of quarantine was the
difference between the
incubation period of SARS
(taken as 10 days) and the time
that had elapsed since their
exposure to a SARS patient
Interviews, focus groups,
and telephone polls
Hawryluck et al
(2004)16
Canada
Cross-sectional
129 Toronto residents
Median of 10 days because of
potential SARS exposure
IES-R to assess post-traumatic
stress and CES-D to assess
depression
Jeong et al (2016)17
South Korea
Longitudinal
1656 residents of four
regions in Korea
2 weeks because of contact
with MERS patients
GAD-7 to assess anxiety and
STAXI-2 to assess anger
Lee et al (2005)18
Hong Kong
(Special
Administrative
Region, China)
Mixed methods
903 residents of Amoy
Gardens (the first officially
recognised site of
community outbreak of
SARS in Hong Kong) took
surveys; 856 of whom were
not diagnosed with SARS;
2 of whom were interviewed
Length unclear; residents of a
SARS outbreak site
Study-specific survey
Liu et al (2012)19
China
Cross-sectional
549 hospital employees;
104 (19%) of whom had
been quarantined
Length unclear; home or work
quarantine because of potential
SARS contact
CES-D to assess depressive
symptoms and IES-R to assess
post-traumatic stress symptoms
Marjanovic et al
(2007)20
Canada
Cross-sectional
333 nurses
Length unclear; SARS exposure
MBI-GS to assess burnout;
STAXI-2 to assess anger;
six study-specific questions to
assess avoidance behaviour
Maunder et al
(2003)21
Canada
Observational
Health-care workers (sample
size unavailable)
10 days voluntary quarantine
because of potential SARS
contact
Observations of health-care staff
Mihashi et al
(2009)22
China
Retrospective
cross-sectional
187 printing company
workers, university faculty
members and their families,
and non-medicine students
Length unclear; citywide
isolation because of SARS
GHQ-30 to assess psychological
disorders
Pan et al (2005)23
Taiwan
Observational
12 college students
Length unclear; asked to limit
interactions outside the home
because of potential SARS
contact
Observations of a support group
for home-quarantined students
Interview
(Table continues on next page)
914
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Rapid Review
Country
Design
Participants
Quarantine period
Measures
(Continued from previous page)
Pellecchia et al
(2015)24
Liberia
Qualitative
432 (focus groups) and
30 (interviews) residents of
neighbourhoods with
incidence of Ebola
21 days because
neighbourhoods had
epidemiological incidence of
Ebola
Interviews and focus groups
Reynolds et al
(2008)25
Canada
Cross-sectional
1057 close contacts of
potential SARS cases
Mean 8·3 days; range 2–30 days
because of contact with
potential SARS cases
IES-7 to assess post-traumatic
stress symptoms
Robertson et al
(2004)26
Canada
Qualitative
10 health-care workers
10 days home quarantine, or
continually wearing a mask in
the presence of others, or
required to attend work but had
to travel in their own vehicle
and wear a mask, because of
SARS exposure
Interviews
Sprang and Silman
(2013)27
USA and
Canada
Cross-sectional
398 parents
Length unclear; lived in areas
severely affected by H1N1 or
SARS
PTSD-RI Parent Version and
PCL-C
Taylor et al (2008)28 Australia
Cross-sectional
2760 horse owners or those
involved in horse industry
Several weeks because of equine K10 to assess distress
influenza
Wang et al (2011)29
China
Cross-sectional
419 undergraduates
7 days; non-suspected H1N1
influenza cases
SRQ-20 to assess general mental
health and IES-R to assess
post-traumatic stress
Wester and
Giesecke (2019)30
Sweden
Qualitative
12: six health-care workers
who worked in west Africa
during the Ebola outbreak
and one close contact for
each of them
3 weeks because of working in
west Africa during the Ebola
crisis
Interview
Wilken et al (2017)31 Liberia
Qualitative
16 residents of villages
who were quarantined
21 days because of living in a
village in which someone had
died of Ebola
Interview
Wu et al (2008,
2009)32,33
China
Cross-sectional
549 hospital employees
Length unclear; either because
of SARS diagnosis, suspected
SARS, or having had direct
contact with SARS patients
7 questions adapted from
NHSDA to assess alcohol
dependence and abuse; IES-R to
assess post-traumatic stress
symptoms; CES-D to assess
depression
Yoon et al (2016)34
South Korea
Psychological
evaluation by
professionals
6231 Korean residents
Length unclear; placed in
quarantine because of MERS
Questions such as ‘for the last
2 weeks or after being in
quarantine, do you feel depressed
or hopelessness? Do you feel loss
of interest in any part of your life?’
SARS=severe acute respiratory syndrome. DSM-IV=Diagnostic and Statistical Manual of Mental Disorders-IV. IES-R=Impact of Event Scale-Revised. CES-D=Center for
Epidemiologic Studies Depression scale. MERS=Middle East respiratory syndrome-related coronavirus. GAD-7=Generalised Anxiety Disorder-7. STAXI-2=State-Trait Anger
Expression Inventory. MBI-GS= Maslach Burnout Inventory-General Survey. GHQ-30=General Health Questionnaire-30. IES-7=International Education Standard-7.
PTSD-RI=Post-Traumatic Stress Disorder Reaction Index. PCL-C=PTSD Checklist-Civilian version. K10= Kessler 10 Psychological Distress Scale. SRQ-20=Self-Reporting
Questionnaire-20. NHSDA=National Household Survey on Drug Abuse.
Table: Study characteristics
been quar­antined avoided people who were coughing or
sneezing, 26% (255) avoided crowded enclosed places,
and 21% (204) avoided all public spaces in the weeks
following the quarantine period. A qualitative study13
reported that several participants described long-term
behavioural changes after the quarantine period, such as
vigilant handwashing and avoidance of crowds and, for
some, the return to normality was delayed by many
months.
Prequarantine predictors of psychological impact
There was mixed evidence for whether participant
characteristics and demographics were predictors of
www.thelancet.com Vol 395 March 14, 2020
the psychological impact of quarantine. A study28 of
horse owners quarantined because of equine influenza
identified several characteristics associated with negative
psycho­logical impacts: younger age (16–24 years), lower
levels of formal educational qualifications, female gender,
and having one child as opposed to no children (although
having three or more children appeared somewhat
protective). However, another study16 suggested that
demographic factors such as marital status, age, educa­
tion, living with other adults, and having children were
not associated with psychological outcomes.
Having a history of psychiatric illness was associated
with experiencing anxiety and anger 4–6 months after
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Rapid Review
release from quarantine.17 Health-care workers25 who had
been quarantined had more severe symptoms of posttraumatic stress than members of the general public
who had been quarantined, scoring significantly higher
on all dimensions. Health-care workers also felt greater
stigmatisa…
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