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.
Highlights
Quarantine and isolation are main containment strategies intended to help protect the public by preventing the spread of contagious diseases
Quarantine, per definition, is used for persons that may have been exposed to the disease, while isolation is used for contagious persons that require separation from persons who are not infected
In spite of this cautionary remark, our results provide compelling evidence for increased adverse mental health outcomes in isolated or quarantined individuals
Summary
Quarantine and isolation are main containment strategies intended to help protect the public by preventing the spread of contagious diseases. Both strategies primarily refer to a restriction of movement and limitation of personal contacts [1]. Findings from previous research pointed towards an increased risk for negative psychological outcomes, such as depression and anxiety, through isolation [2,3,4]. Quarantined persons may be at heightened risk for adverse mental health outcomes. A rapid review by Brooks et al reported increased negative psychological outcomes including post-traumatic stress symptoms, confusion, and anger in persons under quarantine [5].
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