As the response to the COVID-19 pandemic ramps up, a Lancet review examines the psychological effects of self-isolation
by Dr Shikha Gray 
Efforts are increasing daily to ‘flatten the curve’  of the COVID-19 pandemic. Authorities around the world are escalating their measures and advice to people to minimise physical contact with others and, when necessary, to self-quarantine. The expert consensus  is that this (together with hand and respiratory hygiene) is our best strategy for minimising our risk of acquiring COVID-19, and passing it on to others, especially our most vulnerable, including people with diabetes and those who have other underlying conditions or frailty.
This is an unprecedented and extraordinary situation. Social contact and freedom of movement are fundamental human needs. So, what impact will confinement during this outbreak have on our psychological well-being and how can we minimise its impact?
These questions were posed in the latest issue of The Lancet. Brooks and colleagues  reviewed 24 studies from 10 countries on the psychological effects of quarantine. The studies were initiated during past outbreaks of viral infections, e.g. severe respiratory syndrome (SARS), Ebola, H1N1 influenza. Five of the studies had non-quarantined control groups, while the rest provided descriptive insight. Here is what their research found.
What are the effects of being in quarantine?
Being in quarantine can lead people to feel many forms of distress, including:
- anxiety, stress and fear
- anger, frustration and irritability
These emotions may result from being in confinement with limited social interaction. Confinement immobilises people. It stops them from taking part in meaningful activities and routines, for example, working, socialising and shopping. Anger and frustration can stem from reduced access to food and personal supplies, as well as financial setbacks. Worries and anxieties may be about one’s own health and/or fear of infecting loved ones and others in the community.
Distress, feelings of detachment and financial losses can persist for months after quarantine. For some, it can have ripple effects, for example, causing conflicts within the family and post-traumatic stress disorder (PTSD).
Who is vulnerable to distress?
Individual factors. Those with prior mental health difficulties may be more vulnerable to feeling distressed. Possibly, also those working in healthcare and other essential services. Additionally, those who are unable to work and/or under financial strain, may be affected on an ongoing basis. Financial strain can lead to a disrupted social network, loss of leisure activities, and family conflicts.
Quarantine factors. A longer quarantine duration, inadequate supplies and inadequate information can all contribute to increased distress. Inadequate information and confusion can stem from differences in the style, approach and content of public health messages, and can lead to worry, fear and catastrophic thinking (i.e. dwelling on worst-case outcomes).
Stigma. Stigma is a very common experience. It can manifest as social rejection (e.g. withdrawal of social invitations), fear and suspicion (possibly leading to loss of work) and critical comments. Stigma can aggravate distress by leading people to avoid others, and feel anger, frustration, guilt and loneliness.
What can we do to reduce the psychological effects of quarantine?
Based on their research, the authors suggest several strategies. For example:
- keeping the quarantine period as short as possible (based on the best scientific evidence available)
- appealing to altruism (concern for the well-being of others) to validate and reinforce people’s efforts
- transparent and clear guidelines from the government and relevant authorities
They also recommend having:
- accurate information about the illness and risk for transmission
- adequate supplies to help with basic needs
- adequate resources to reduce boredom (e.g. smartphones, WiFi, books, games)
- practical techniques for coping and stress management
- virtual connections to family, friends and colleagues
- support groups post-quarantine
For healthcare workers, the authors recommend special provision of support, particularly from colleagues.