Quarantine, restrictions and mental health in the COVID-19 pandemic

The COVID-19 pandemic presents challenges to mental as well as physical health. In addition to the illness caused by the virus, there is growing concern over the psychiatric consequences of infection, population anxiety about the pandemic and the possible mental health effects of public health measures such as mass quarantine and restrictions. For people infected with COVID-19, preliminary evidence shows that the incidence of any psychiatric diagnosis in the 14– 90 days after COVID-19 diagnosis is 18.1%. There are, however, bi-directional associations between COVID-19 and psychiatric disorder, as having a psychiatric diagnosis in the previous year is associated with a higher risk of COVID-19 (relative risk: 1.6). This risk is independent of known physical health risk factors for COVID-19 and is consistent with previous evidence of poor access to physical health care among people with enduring mental illness, although the possibility of socioeconomic confounding remains. In the general population, 20% of people describe significant psychological distress associated with the COVID-19 pandemic, chiefly symptoms of anxiety or depression, although some estimates are higher. These problems appear to have grown as the pandemic progressed. In Ireland, an online study during mass public quarantine (27 March 2020 to 8 June 2020) asked participants to assess their depression, anxiety and stress during quarantine and to retrospectively assess their wellbeing, distress and mood prior to quarantine. Results showed that mean levels of depression, anxiety and stress rose during quarantine, with the greatest increase seen for depression. There are similar results from other countries. One Italian study looked at young adults’ mental health for each of 4 weeks during the lockdown from mid-March 2020 to mid-April 2020. This study found increases in anxiety/depression, withdrawal, somatic complaints, aggressive behaviour, rule-breaking behaviour and internalizing and externalizing problems, along with decreases in intrusive behaviour and personal strengths. The authors suggest that these findings could usefully inform the debate about the psychological impact of the COVID-19 emergency and help develop appropriate interventions to safeguard the mental well-being of young adults. Another Italian study focused on the effects of COVID-19 and quarantine measures on the lifestyles and mental health of people over the age of 60 years with mild cognitive impairment or subjective cognitive decline. In late April 2020 and early May 2020, trained psychologists conducted telephone interviews with 126 community-dwelling older adults, exploring variables related to the COVID-19 pandemic, lifestyle changes, depression, anxiety and apathy. Over one-third of this sample reported reduced physical activity and almost 70% reported an increase in idle time. Adherence to the Mediterranean diet decreased in almost one-third of respondents and just over one-third reported weight gain. Social activities were eliminated and onesixth of participants reported decreased productive and mentally stimulating activities. Mental health was also poor among this group of older adults: 19.8% were depressed, 9.5% were anxious and 9.5% were apathetic. There were significant associations between depression and living alone or having poor relations with cohabitants, and between anxiety and subjective cognitive decline, cold or flu symptoms and reduction in productive leisure activity. Overall, results showed a concerning decline in psychological well-being among Italian adults over the age of 60 with mild cognitive impairment or subjective cognitive decline. These results are not a surprise. It is already established that measures such as quarantine can have negative psychological effects that include confusion, anger and post-traumatic stress symptoms. Particular stressors include longer duration of quarantine, fears of infection, boredom, frustration, inadequate supplies or information, financial loss and stigma. Emerging