Story at a glance
- The Lancet recently published a review paper about the psychological effects of being in quarantine.
- Studies on past outbreaks of SARS, MERS and Ebola can give insight to what could happen with COVID-19.
- Although the paper makes some general recommendations, it’s no substitute for talking to a medical professional if you are experiencing psychological trauma.
With much of the U.S. under stay-at-home orders or in quarantine due to the COVID-19 pandemic, mental health has become an important topic for all of us. In a recent review published in The Lancet, researchers summarize studies that have focused on the psychological impacts of being in quarantine and the potential long-term effects.
While we hope that reading about this topic can be therapeutic and helpful, it’s not a replacement for medical attention. At the end of this article, you’ll find a list of resources for mental health and seeking professional care.
The Lancet paper reviews several studies that look into the psychological effects of being in quarantine. Some studies compared people who were put into quarantine with others who were not. The research spans past epidemics of SARS, MERS and Ebola virus.
After the quarantine and disease event, several studies show that people generally reported symptoms of psychological distress and disorder. In one study of MERS, participants showed signs of psychological disorders, anger and anxiety months after quarantine. A study comparing parents and children who were put in quarantine versus those who were not found that post-traumatic stress scores were four times higher in children who had been quarantined than children who weren’t.
Some studies focused specifically on health care workers. “Health care workers who had been quarantined had more severe symptoms of post traumatic stress than members of the general public who had been quarantined,” write the authors. "Health-care workers also felt greater stigmatisation than the general public, exhibited more avoidance behaviours after quarantine, reported greater lost income, and were consistently more affected psychologically: they reported substantially more anger, annoyance, fear, frustration, guilt, helplessness, isolation, loneliness, nervousness, sadness, worry, and were less happy.”
The studies suggest that the long-term effects like post-traumatic stress in health care workers could potentially last for years after the event. For example, this study found that previously quarantined health care workers showed signs of alcohol abuse or dependency three years after the SARS outbreak.
Many participants in the studies also suffered social stigma of being quarantined. “Participants in several studies reported that others were treating them differently: avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments,” write the authors. In the current COVID-19 pandemic, people of Asian descent are subject to such social stigma and acts of racism, especially in the U.S.
“Historically, contagion anxiety has been ‘hijacked’ by prior, often longstanding prejudices, discriminatory practices, and structural stigma,” according to the American Psychiatric Association. They recommend monitoring personal behavior and offering myth-busting information when hearing comments from others.
It is important to note that these studies generally had small sample sizes, and few examined both quarantined and not-quarantined groups of people. It’s difficult to make direct comparisons among the studies, and we should be careful about generalizing to larger populations.
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What can be done overall
The authors provide some general recommendations like giving people as much information as possible, administer adequate supplies and give special attention to health care workers.
Not only are we concerned about getting people as much information as possible, but that information should be accurate and timely and come with a clear message. Supplies are currently a significant struggle for U.S. governors all over the country. And while health care workers are being applauded now, will we be able to continue to give them the mental health support they need a year or two from now?
After 9/11, there was a health care and compensation act for people who lived, worked or attended school near the World Trade Center during the event. Potentially, a similar initiative may be necessary for health care and other affected workers from the COVID-19 pandemic.
So what can we do? For those of us in our homes — doing the right thing — there are ways we can try to keep ourselves in the best possible head space.
Reduce boredom: Find new ways to fill your time and engage your mind. If you are someone who thrives on making progress, start a new project or a hobby or take an online class. There are courses on Coursera, MIT Open Courseware and Harvard. YouTube is host to millions of videos where you can learn nearly anything in the world, so you could pick up that ukulele again and strum yourself to peace and calm.
Stay connected virtually: Reach out to friends and family. Don’t just catch up, have a structured conversation, perhaps answer the 36 questions to fall in love. Take this chance to get deeper with each other. Here’s a list of ideas of ways to gather online with friends. For example, you can get some friends together for a trivia night. NYC Trivia League is streaming their trivia nights four days a week over Instagram Live. You can also play some board games online.
Altruism is better than compulsion: The research studies covered in The Lancet paper weren’t designed to tell us if voluntary or mandatory quarantines have different effects on well-being. But knowing that keeping yourself in quarantine could keep others safe may make a stressful situation easier to bear.
None of these recommendations are a substitute for seeking professional medical help when you need it. Please see below for additional resources.
Mental Health Resources
Pandemic mental health page from the Centers for Disease Control and Prevention (CDC)
American Psychiatric Association resource page has a lot of information about the crisis for the general public and for psychiatrists
National helpline from the Substance Abuse and Mental Health Services Administration
Resources from the Suicide Prevention Resource Center, with articles for parents and caregivers, community leaders, American Indians and Alaska Natives
The National Council for Behavioral Health page with links to additional resources like loans for small business and other emergency grants
Free mental health sessions from Real in New York State
List of therapists by state available for virtual sessions during the pandemic
TED Connects talk with psychologist Susan David
An online course about managing your mental health during the COVID-19 pandemic
Another course about the coronavirus and epidemiology from Johns Hopkins University
Kind Campaign on Instagram with some solutions and strategies
For up-to-date information about COVID-19, check the websites of the Centers for Disease Control and Prevention and the World Health Organization. For updated global case counts, check this page maintained by Johns Hopkins University.
You can follow Chia-Yi Hou on Twitter.
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