The impact of quarantine

Ricardo Sáinz, Chief Medical Officer, views on the future impact of COVID-19 in Mental Health Disorders

Ricardo Sáinz, Chief Medical Officer, views on the future impact of COVID-19 in Mental Health Disorders

Introduction

As the world shuts down to fend-off the COVID-19 outbreak, our attention is immediately directed from us towards those on the front lines, our healthcare workers, and the most vulnerable, our elders. 

Our healthcare workers, police, and armed forces face, not only the intrinsic threat of the infection to their health but also exposure to the devastating effects of the disease on others. These are worsened by other widespread circumstantial factors, such as the lack of resources available to fight the virus (i.e., PPE, ICU beds, staff, funding, etc.). 

And yet, little thought is being given to another group of extremely vulnerable people:  those currently suffering from mental disorders. This group of people will suffer greatly as a result of the imposed quarantine, and once the dust of the physical damage done by the COVID-19 in the general population settles, we will realize the devastating impact it has had on them.

To structure my thoughts, I will summarise this extremely helpful paper first: The psychological impact of quarantine and how to reduce it: rapid review of the evidence and will subsequently extrapolate the authors’ conclusions to the different diagnostic categories in the DSM-V

 

The impact of quarantine

In this recent review, Brooks et al. noted that health­care workers who had been quarantined had more severe symptoms of posttraumatic stress than members of the general public who had been quarantined, and also felt greater stigmatisation than the general public. They exhibited more avoidance behaviours after quarantine, reported greater lost income, and were consistently more affected psychologically as they reported substantially more anger, annoyance, fear, frustration, guilt, helplessness, isolation, loneliness, nervousness, sadness, worry, and less happiness in general. 

The impact, they said, was likely to depend on a variety of factors during quarantine, such as:

  • Duration of quarantine: Longer durations of quarantine were associated with poorer mental health, specifically, post­traumatic stress symptoms, avoidance behaviours, and anger.
  • Fears of infection: Fear of being infected or infecting others may lead to depression, anxiety, and, in some cases, suicide.
  • Frustration and boredom: Exacerbated if unable to perform usual day-to-day activities or take part in social networking activities.
  • Inadequate supplies: Associated with frustration and anger 4-6 months after release.
  • Inadequate information: Lack of clarity about the different levels of risk, perceived lack of transparency from health and government officials about the severity of the pandemic, and perceived difficulty with complying with quarantine protocols was a significant predictor of post­traumatic stress symptoms in one of the studies reviewed.

And, on some other factors post-quarantine, like:

  • Finances:  Financial loss as a result of quarantine created serious socio-economic distress and was found to be a risk factor for symptoms of psychological disorders and both anger and anxiety several months after quarantine.
  • Stigma:  Infected people suffering stigmatisation as a result of being perceived as guilty, dangerous, different, or a combination of these.

Brooks and colleagues recommend the following to mitigate the impact of quarantine in healthy individuals:

  • Keep it as short as possible
  • Give people as much information as possible
  • Provide adequate supplies
  • Reduce boredom and improve communication
  • Altruism
  • Pay special attention to at-risk groups

 

The psychological impact of quarantine on individuals with pre-existing mental health disorders

These patients are most likely to be under the supervision of a mental health professional. They will face forced distancing from their usual healthcare structures, as well as the effect of isolation on their mental health disorders.

  • Neurodevelopmental Disorders
  • Schizophrenia Spectrum and Other Psychotic Disorders
  • Catatonia
  • Bipolar and Related Disorders
  • Depressive Disorders
  • Anxiety Disorders
  • Obsessive-Compulsive and Related Disorders
  • Trauma- and Stressor-Related Disorders
  • Dissociative Disorders
  • Somatic Symptom and Related Disorders
  • Feeding and Eating Disorders
  • Elimination Disorders
  • Sleep-Wake Disorders
  • Sexual Dysfunctions
  • Disruptive, Impulse-Control, and Conduct Disorders
  • Substance-Related and Addictive Disorders
  • Neurocognitive Disorders
  • Personality Disorders
  • Paraphilic Disorders
  • Other Mental Disorders

 

To read the full article click here: My views on the future impact of COVID-19 in Mental Health Disorders

Dr Ricardo Sáinz Fuertes

LMS MSc MRCPsych PhD
Chief Medical Officer

 

REFERENCES

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8

 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 74–85ISBN 978-0-89042-555-8.