REDUCING THE PSYCHOLOGICAL IMPACT OF QUARANTINE
Clinical psychologist Jacqui Maguire discusses a review of research on selfisolation and looks at mental health risk factors both during and after isolation.
In New Zealand we are experiencing an unprecedented national response to the global Covid-19 pandemic. Self-isolation is a favoured tool public health officials are using to help prevent community transmission of the virus, in an attempt to ‘‘flatten the curve’’.
In February the Department of Psychological Medicine, King’s College London, completed a rapid review of the research examining the impact of quarantine (self-isolation) on wellbeing and mental health. The review strongly indicates that quarantine can have significant and long-lasting impacts on individuals. Restricting people’s liberty is therefore not a decision to be made lightly.
The Government has made a decision that the negative impact of exponential Covid-19 spread is greater than potential psychological risks. We must therefore use this research to ensure we optimise the mental health and wellbeing outcomes for people who will need to quarantine.
The rapid review identified 3166 papers that investigated the impact of quarantine on wellbeing and mental health. From this pool, 24 papers met criteria centring on individuals quarantined during the outbreaks of Sars, Ebola, H1N1 (swine flu) and an equine influenza outbreak.
Findings from this review identified that quarantine can have significant and long-lasting psychological impact on individuals, including but not restricted to: fatigue, stress, depression, insomnia, irritability, concentration difficulties, detachment from others and symptoms akin to post-traumatic stress. For example, in a study of 903 individuals quarantined in Hong Kong during the Sars outbreak, 73 per cent of the subjects experienced low mood and 57 per cent experienced irritability.
In a separate study, focused on hospital staff in Taiwan during the Sars outbreak, quarantine was the highest predictor of acute stress disorder.
As a cohort, health workers appear at highest risk of psychological harm following quarantine, with stigma, shame, fear and avoidance of work identified as precipitators and outcomes.
Conclusions have been drawn that those with pre-existing mental illnesses may also be at risk and require extra care during quarantine. No other clear demographic differentials have been identified.
What appears critically important from this review is understanding the risk factors during and after quarantine.
During quarantine: Risk factors and protective actions
Duration: Quarantine periods should be kept as short as possible and all effort should be taken to prevent the extension of quarantine.
Fear of contagion: Clear information given to those in quarantine about how they keep their family members or housemates safe can significantly reduce individuals’ worry and anxiety. This has been shown as particularly important for pregnant women and those with young children.
Inconsistent and inadequate communication – including with loved ones and public health officials. Consistent and frequent messaging from our director-general of health, the Government and public health workers is protective. Ensuring those in quarantine have a good understanding of the disease in question, and the reasons for quarantine, should be a priority.
Boredom and frustration: Lack of routine, social interactions and inability to participate in usual daily activities are stressors. Providing clear stress management techniques is deemed helpful. Engaging in activities that provide a sense of purpose, employers enabling flexible work from home and staying connected via social media and video apps is encouraged.
Lack of supplies: Though we are being urged to resist panic-buying, it is important all households have a quarantine plan in place, either by ensuring the provision of general household and medical supplies, or establishing a network of supporters. This is especially important if you are located in a region without home delivery, or medical supplies are required. A backup network is also recommended. For example, if your household is quarantined, who can deliver your groceries? If they become unwell, who is your second in line?
An individual’s mindset during quarantine affects wellbeing and mental health. Those who take an altruistic approach, focusing on how their self-isolation is protecting vulnerable members of their community, fare psychologically better.
Post-quarantine
Financial stress: Financial loss during quarantine has been linked to socioeconomic distress, and can lead to persistent anger and anxiety. Low-income households and those with vulnerable positions (casual workers or those in the tourism sector) are at particular risk.
While we wait for the Government’s economic relief package to be announced, there is opportunity for the community to support those affected. Ensuring you have your neighbour’s phone number and checking in on them is a good starting position. Delivering cooked meals and general household supplies at the front door of a house in quarantine is also helpful.
Stigma: Following quarantine individuals across several studies reported that others were treating them differently, ‘‘avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments’’.
Reduction of stigma will require a multipronged approach:
■ Continuation of general education about Covid-19 for the public.
■ Clear information and support for employers.
■ Reduction (and monitoring) of fearmongering in the media and on social networks. Education and support for leaders with team members who are reintegrating into the workforce.
■ Support for individuals re-integrating into the workforce/community.
When in uncharted waters, it is important our decisions and behaviours are underpinned by the available evidence base. While the Government and public health have clear requirements to reduce the psychological impact of quarantine (clear messaging, constant contact, reduction of quarantine extensions where possible, financial aid), we also have a community responsibility.
Appropriately preparing for a 14-day quarantine (having a household plan, stocking reasonable provisions and medical supplies), educating ourselves with available information from reputable sources, employing stress management techniques, self-isolating if unwell, frequent hand washing, restraint from physical contact with others and halting the spread of fearmongering propaganda is within our control.
Employers also have a responsibility to, where possible, employ flexi-working and positive reintegration into the workforce.
New Zealanders are resilient and caring. We have already seen that in the past year after the March 15 mosque shootings and the Whakaari/ White Island tragedy. If we can be prepared and calm, we can work together to protect the wellbeing and mental health of those who need to quarantine.
Jacqui Maguire is a registered clinical psychologist and regular media contributor. She is passionate about using psychological science to support Kiwis to thrive.