Mental health effects of infection containment strategies: quarantine and isolation—a systematic review and meta-analysis

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Abstract

Due to the ongoing COVID-19 pandemic, an unprecedented number of people worldwide is currently affected by quarantine or isolation. These measures have been suggested to negatively impact on mental health. We conducted the first systematic literature review and meta-analysis assessing the psychological effects in both quarantined and isolated persons compared to non-quarantined and non-isolated persons. PubMed, PsycINFO, and Embase databases were searched for studies until April 22, 2020 (Prospero Registration-No.: CRD42020180043). We followed PRISMA and MOOSE guidelines for data extraction and synthesis and the Newcastle–Ottawa Scale for assessing risk of bias of included studies. A random-effects model was implemented to pool effect sizes of included studies. The primary outcomes were depression, anxiety, and stress-related disorders. All other psychological parameters, such as anger, were reported as secondary outcomes. Out of 6807 screened articles, 25 studies were included in our analyses. Compared to controls, individuals experiencing isolation or quarantine were at increased risk for adverse mental health outcomes, particularly after containment duration of 1 week or longer. Effect sizes were summarized for depressive disorders (odds ratio 2.795; 95% CI 1.467–5.324), anxiety disorders (odds ratio 2.0; 95% CI 0.883–4.527), and stress-related disorders (odds ratio 2.742; 95% CI 1.496–5.027). Among secondary outcomes, elevated levels of anger were reported most consistently. There is compelling evidence for adverse mental health effects of isolation and quarantine, in particular depression, anxiety, stress-related disorders, and anger. Reported determinants can help identify populations at risk and our findings may serve as an evidence-base for prevention and management strategies.

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Stress and Health: Psychological, Behavioral, and Biological Determinants

Neil Schneiderman, Gail Ironson, Scott D Siegel (2005)

Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual's biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.

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Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China

Han Xiao, Yan Yan Zhang, Desheng Kong … (2020)

Background From the end of December 2019, coronavirus disease 2019 (COVID-19) began to spread in central China. Social capital is a measure of social trust, belonging, and participation. This study aimed to investigate the effects of social capital on sleep quality and the mechanisms involved in people who self-isolated at home for 14 days in January 2020 during the COVID-19 epidemic in central China. Methods Individuals (n=170) who self-isolated at home for 14 days in central China, completed self-reported questionnaires on the third day of isolation. Individual social capital was assessed using the Personal Social Capital Scale 16 (PSCI-16) questionnaire. Anxiety was assessed using the Self-Rating Anxiety Scale (SAS) questionnaire, stress was assessed using the Stanford Acute Stress Reaction (SASR) questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Path analysis was performed to evaluate the relationships between a dependent variable (social capital) and two or more independent variables, using Pearson’s correlation analysis and structural equation modeling (SEM). Results Low levels of social capital were associated with increased levels of anxiety and stress, but increased levels of social capital were positively associated with increased quality of sleep. Anxiety was associated with stress and reduced sleep quality, and the combination of anxiety and stress reduced the positive effects of social capital on sleep quality. Conclusion During a period of individual self-isolation during the COVID-19 virus epidemic in central China, increased social capital improved sleep quality by reducing anxiety and stress.

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Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence

Md Mahbub Hossain, Abida Sultana, Neetu Purohit (2020)

OBJECTIVES Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases. METHODS We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population. RESULTS Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes. CONCLUSIONS This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.

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Author and article information

Contributors

Andreas Heinz: andreas.heinz@charite.de

Journal

Journal ID (nlm-ta): Eur Arch Psychiatry Clin Neurosci

Journal ID (iso-abbrev): Eur Arch Psychiatry Clin Neurosci

Title: European Archives of Psychiatry and Clinical Neuroscience

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0940-1334

ISSN (Electronic): 1433-8491

Publication date (Electronic): 6 October 2020

Publication date PMC-release: 6 October 2020

Pages: 1-12

Affiliations

[1 ]Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany

[2 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Department of Psychiatry and Psychotherapy, , University of Cologne Medical School, ; Cologne, Germany

[3 ]GRID grid.7468.d, ISNI 0000 0001 2248 7639, Berlin School of Mind and Brain, ; Berlin, Germany

[4 ]GRID grid.455089.5, Bernstein Center of Computational Neuroscience Berlin, ; Berlin, Germany

Article

Publisher ID: 1196

DOI: 10.1007/s00406-020-01196-x

PMC ID: 7538183

PubMed ID: 33025099

SO-VID: b27b1201-dcec-479d-98b0-23168b368cfe

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 17 June 2020

Date accepted : 17 September 2020

Funding

Funded by: Charité (3093)

Open Access :

Open Access funding enabled and organized by Projekt DEAL. This study was supported in part by the Collaborative Research Centre TRR 265 (CRC-TRR 265). Henrik Walter has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 777084. This publication reflects only the authors' view and the European Commission is not responsible for any use that may be made of the information it contains.

Mental health effects of infection containment strategies: quarantine and isolation—a systematic review and meta-analysis

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Novel Coronavirus Disease COVID-19

Most cited references 24

Stress and Health: Psychological, Behavioral, and Biological Determinants

Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China

Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence

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