The Psychological Impact Of Quarantine And How To Reduce It
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counselor Education
CEUs available at: https://www.allceus.com/member/cart/index/product/id/1268/c/
Objectives
Based on The psychological impact of quarantine and how to reduce it: rapid review of the literature
~ Review the effects of quarantine
~ Explore ways to mitigate these effects
Intro
~ Quarantine means the separation and restriction of movement of people who have potentially been exposed to a contagious disease
~ However, during a contagious outbreak like influenza, SARS, H1N1, Ebola etc., many people choose to voluntarily restrict their movement to prevent getting ill
~ Many of the principles we will discuss here also apply to extended “sheltering in place” which people experience after hurricanes or blizzards.
Stressors During Quarantine
~ Those quarantined for more than 10 days showed significantly higher post-traumatic stress symptoms
~ Fears about own health or getting sick and infecting others (which continued for several months post-quarantine)
~ Hypervigilance to any symptoms of illness
~ High risk populations (pregnant women, parents of young children and the elderly showed negative rumination)
Short Term Problems
~ Separation from loved ones
~ Detachment from others
~ Loss of freedom
~ Loss of routine
~ Lack of access to basic supplies
~ Uncertainty over status of the situation
~ Financial losses due to inability to work and stock market
~ Dependence on family members to provide financial assistance during quarantine caused conflicts
~ Those who live at or below 300% of the poverty level showed greatest stress in response to financial losses
Short Term Reactions
~ In the case of potential exposure, acute stress disorder (34% vs. 12%)
~ Exhaustion
~ Anxiety when around people who are sick
~ Irritability
~ Anger
~ Insomnia
~ Poor concentration
~ Indecisiveness
~ Deteriorating work performance
~ Reluctance to go to into public and consideration of resignation from work
Short Term Effects
~ Confusion and a perception of lack of transparency about the severity of the problem can be created due to differences in style, approach, and content of various public health messages because of poor coordination between the multiple jurisdictions and levels of government involved.15
~ Lack of clarity about the different levels of risk causes participants to fear (and ruminate on) the worst
~ Stigma continued long after the outbreak had been contained for those perceived to be at high risk, who had been sick or exposed
~ Avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments
~ Stigma could lead to disenfranchisement of minority groups as families under quarantine often belonged to different ethnic groups, tribes, or religions
~ General education about the disease and the rationale for quarantine and public health information provided to the general public can be beneficial to reduce stigma
~ Detailed information targeted at schools and workplaces might also be useful.
~ Media reporting contributes to stigma and trauma due to their dramatic headlines and fear 36
~ Public health officials must provide rapid, clear messages delivered effectively for the entire affected population to promote accurate understanding of the situation.
~ Mandatory Public Broadcasts
~ Social Media
~ Single point of contact website (i.e. CDC)
Longer Term Effects
~ 3 years after the SARS outbreak, alcohol abuse or dependency symptoms were positively associated with having been quarantined or worked with high risk populations.32
~ After quarantine, many participants continued to engage in avoidance behaviors such as minimizing direct contact with patients and not reporting to work.
~ 54% of people who had been quarantined continued to avoid and were anxious around people who were coughing or sneezing
~ 26% avoided crowded enclosed places
~ 21% avoided all public spaces in the months following the quarantine period.
Longer Term Effects
~ Longer-term behavioral changes after the quarantine period, included
~ continued vigilant handwashing
~ avoidance of crowds
~ Lack of access to basic supplies was associated with continued anxiety and anger 4–6 months after release
Interventions
~ Provide a unified public message about what is happening, safety measures that are being undertaken, emergency plans, the likelihood of deterioration of the situation and how long it will continue.
~ Providing meaningful activities while in quarantine.
~ Ensure basic supplies (such as food, water, and medical supplies) are available.
~ Reinforcing the sense of altruism and safety.
~ Those involved with public safety and healthcare are in uniquely dangerous positions and require additional organizational support and “disaster planning” to mitigate risk
~ Health officials charged with implementing quarantine, who often have reasonable job security, should also remember that not everyone is in the same situation.
Summary
~ 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 or available (i.e. online shopping)
~ 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 freedom
~ Voluntary quarantine is associated with less distress and fewer long-term complications
~ Public health officials should emphasise the altruistic choice of self-isolating