Quarantine can have lasting psychological effects, but it is necessary

It all began in the mid-14th century, when the ghost of the Black Death flew over Europe. The disease struck the Genoese, who began to spread it in the ports where they docked. Venice, which at the time was an important commercial epicenter, was struck by the disease, so it began to leave ships coming from infected ports anchored for 40 days. Thus the word quarantine appeared, although Hippocrates had spoken much earlier about preventive isolation.

A long time has passed since then, but today the shadow of COVID-19 has reactivated that protocol on a large scale. Whole Chinese cities have been placed in strict quarantine, the northern Italian regions are isolated and thousands of people around the world have self-isolated themselves in their homes.

Separating and restricting the movement of those who may have been exposed to a contagious disease, to determine if they will get sick and reduce the risk of infecting others, has been shown to be an effective containment measure to prevent the spread of infectious diseases. But it can also have a heavy and lasting psychological impact on some people.

The emotional price of quarantine

Quarantine can be a very tough experience. To the separation from the people we love, the inability to move freely and the radical change in our habits are added boredom and uncertainty about the course of the disease.

Researchers at King's College London analyzed the results of 24 studies conducted in 10 countries in which quarantine measures were applied to control outbreaks of diseases such as Severe Acute Respiratory Syndrome (SARS), Ebola, H1N1 influenza, Middle Eastern Respiratory (MERS) and Equine Flu.

The findings, published in The Lancet , indicate that the most common problems associated with quarantine are post-traumatic stress and depression , which can last up to three consecutive years. Another study conducted at Columbia University found that some people resort to maladaptive strategies such as substance abuse to address these problems.

The emotional state also suffers. Sadness, irritability, fear, anger and guilt are the most common emotions. However, quarantine doesn't affect everyone equally. People with a history of psychiatric disorders and healthcare professionals suffer a much greater psychological impact.

Samantha Brooks, lead author of the study, says: “Going into quarantine is a lonely and often frightening experience. Our study found that it has negative psychological effects. The fact that these effects last for months or even years is of particular concern and indicates that appropriate measures must be put in place during the quarantine planning process to minimize the psychological impact. "

What is it that stresses us most in quarantine?

We don't all experience quarantine in the same way and not all quarantines are the same. Some factors can aggravate the psychological effects of isolation:

• Too long periods of isolation. Quarantines of more than 10 days usually cause more negative emotional states and the psychological repercussions are greater, according to a study conducted at the University of Ontario . An extension of the quarantine, however short, can greatly exacerbate frustration and dismay.

• Insufficient information. One of the most stressful factors for people in quarantine is limited information on the purpose of isolation or not having clear guidelines to follow. Being isolated creates a passive situation that is very difficult to manage. If we don't have reliable information, catastrophic thoughts take over and we fall into a dangerous vicious circle of negativity.

• Frustration and boredom. Confinement, loss of routine, and reduced social contact are some of the most distressing factors for people in quarantine, which end up generating frustration and irritability.

• Lack of basic necessities such as food and medicines. During a period of confinement, people cannot provide the basic necessities they need, so the lack of these or not having a regular supply further exacerbates the feeling of loss of control.

Another study published in the journal Comprehensive Psychiatry revealed that being exposed to traumatic situations before quarantine, in addition to perceiving a high risk of getting sick , increases the chances of suffering a stronger emotional impact that will last longer.

Once the quarantine is over, the economic losses due to the inability to work, as well as the social stigma that may have been generated around the disease, also affect our mental health.

How to mitigate the psychological impact of quarantine?

During major infectious disease outbreaks, quarantine can be a necessary preventive measure, but it is also important to be aware of the psychological effects to try to alleviate them - as much as possible - especially if we are vulnerable.

There are many factors beyond our control, such as the length of the quarantine and the information we receive. But there are other factors we can influence to mitigate the psychological effects of isolation.

As Viktor Frankl said: "When all objectives have been snatched from us, what remains is the last of human freedoms: the ability to choose personal attitude in the face of a series of circumstances".

- Prepare psychologically for what is to come

Centuries ago, Seneca, the Roman philosopher, warned us that: "The unexpected has overwhelming effects, adding to the weight of the disaster." That is why the Stoics encouraged to prepare for the worst in the best way. It means that we must be aware that sooner or later boredom, irritability, worry and anguish will knock on our door. Then, stress management techniques such as transcendental meditation will be our best allies.

- Stop catastrophic thoughts by focusing on our strength

Having a lot of free time is fertile ground for catastrophic thoughts to arise. Fear of disease and its consequences can become a double-edged sword that develops a hypervigilant attitude, making us exaggerate the symptoms and imagine the worst possible scenario. Attempting to consciously stop those thoughts generates the rebound effect . Taking refuge in happy memories or future plans is a good way to evoke them. Seneca said, “There are more things that can frighten us than crush us; we suffer more often in the imagination than in reality. "

- Find an altruistic sense in him

The feeling that other people will benefit from our situation can make quarantine easier to endure. Indeed, the psychological impact of a chosen quarantine will be much less than that of enforced isolation. Therefore, it means making sense of what is happening to us and understanding that isolation is helping to protect others, including the people we love, but also those who are particularly vulnerable. It is about being aware and responsible.

- Feel connected

Feeling connected is also essential for dealing with quarantine. Activating our social network through the phone or social networks allows us to keep in touch and not feel alone. A study conducted at Chung Yuan Christian University revealed that participating in support groups after quarantine facilitates the connection and exchange of similar experiences by making us feel useful and important.

There is no doubt that a quarantine not only disrupts our routine but also takes away the feeling of control and creates confusion and helplessness. In that state we are emotionally vulnerable. But we can choose the attitude with which we will face it, and this matters a lot.

Sources:

Brooks, S. et. Al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet ; S0140-6736 (20) 30460-8

Liu, X. et. Al. (2012) Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry ; 53 (1): 15-23.

Wu, P. et. Al. (2008) Alcohol abuse / dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol ; 43 (6): 706-712.

Pan, P. et. Al. (2005) A Support Group for Home-Quarantined College Students Exposed to SARS: Learning from Practice. The Journal for Specialists in Group Work ; 30 (4): 363-374.

Hawryluck, L. et. Al. (2004) SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis ; 10 (7): 1206-1212.