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Department of Psychiatry, All India Institute of Medical Sciences, New Delhi
Quarantine is the separation and restriction of movement of individuals who have been exposed to a contagious disease to ascertain if they become sick and to reduce the risk of infecting others.
It can be done at home setting or at government-run facilities, or even as mass quarantine for residents in a particular region.
While quarantine is a necessary preventive measure, it could be associated with several psychological challenges for those quarantined as well as their families.
Below is a brief description of the psychological effects of quarantine, as well as strategies which can be used to ensure mental well-being of those quarantined:
PSYCHOLOGICAL STRESSORS RELATED TO QUARANTINE
Frustration and boredom related to social isolation
Quarantine involves absence of usual daily routines (e.g. regular work/job, shopping, going for walk etc.)
and limited contact with others, which may cause monotony and boredom.
Fears about becoming sick and/or infecting others in family
There may be apprehensions or worries related to one’s physical health and risk of getting the illness, in addition to the fear of infecting others in the family who are caring for them. This may be particularly concerning for those with young children, pregnant women or those with elderly parents or relatives in family.
Worries about inadequate household supplies or medical care access
This may include worries pertaining to essentials like food or kitchen supplies, availability of sanitizers or
masks and limited access to routine medical care during the period of quarantine.
Lack of adequate or accurate information
The lack of clear information or confusing information can lead to uncertainty and stress among those
quarantined. Occasionally, various social platforms or internet sources may have conflicting information.
Stigma from others
Those quarantined may face some stigma from neighbours or those around them which can manifest as
being treated differently or with fear and suspicion or not being extended support from the community.
Financial loss and hardships
This is important especially for those with lower incomes or those with daily or weekly wages contingent upon work, with not enough savings to cover the period of quarantine. The possibility of continued unemployment or economic losses in the coming weeks even after quarantine is an additional source of distress.
The psychological impact of quarantine might involve anxiety, low mood, irritability, emotional exhaustion, inability to sleep and other trauma or stress-related symptoms, which could outlast the period of quarantine in vulnerable people.
PROMOTING PSYCHOLOGICAL WELL-BEING DURING QUARANTINE
Clear and accurate information provision
People who are quarantined often have catastrophic appraisals of any minor symptom in self or family members, or may have misinformation about the reasons or duration of their quarantine. Accurate information from reliable sources communicated in a clear, easy to understand language would help to allay their anxieties.
Assurance for provision of essential supplies
The quarantined households must be provided with enough supplies for their basic needs e.g. food, medications etc. Such coordination should occur at the earliest, with an assurance of continued supply for period of quarantine.
Facilitate communication with family and relatives
Ensuring a telephonic contact or internet based communication with family members or relatives is a source of support for the quarantined individual and reduces feelings of isolation. It also conveys about the health status and safety of the individual, thereby reducing the worries and fears among the loved ones. Therefore, facilitating the quarantined individuals with mobile phone/charging devices, and WiFi internet access can cut down on unwarranted panic.
Build a structured daily routine
Having a lot of unstructured time and boredom will lead to more stress and adverse psychological outcomes. People who are quarantined should be advised about maintaining a structured time table for themselves which may include fixed sleep-wake hours, working on a new hobby (e.g. music, cooking, reading, writing a poem or a daily journal), play cards or board games, telephonic interaction with loved ones etc.
Dedicated time for physical activity and relaxation
It is important to ensure some dedicated time for physical activity or yoga, or exercise in any form. The duration of such exercise may vary from 15-45 minutes, depending on one’s level of physical fitness and stamina. Additionally, it is also beneficial to engage in meditation or breathing exercises, which helps in reducing the stress.
Curtail the excessive exposure to ‘infodemic’ on social media platforms
A constant stream of news reports coming from various social media platforms and other outlets can cause anyone to feel anxious or distressed. Try to seek news updates only from reliable sources like the Government media channels or newspapers, and only at specified times during the day. Avoid listening to sources with possible rumours or fake news that may make you feel anxious.
Health-care personnel caring for quarantined individuals must take care of themselves also
Health care providers are also vulnerable to experiencing the psychological effects of quarantine, which is further compounded by the stress of caring for possibly exposed or suspected patients. It is important that health care providers must also ensure that their own needs (eating, sleeping, taking breaks at designated time, ensuring one’s family’s well-being etc) are met and that they plan ahead for the possibility that the healthcare provider may need to be quarantined separately from the family after a possible exposure.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence.Lancet. 2020;395(10227):912-920.
Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress- anxiety.html
World Health Organization: . https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf