CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Psychological Effects of Quarantine
During the Coronavirus Outbreak:
What Public Health Leaders Need to Know
Quarantine is defined as thebroadly serve the public good, it is
While quarantine can broadly serve
separation of individuals who
also associated with psychologicalmay have been exposed to anchallenges for those quarantined,
the public good, it is also associatedinfectious disease from the rest
their loved ones, and the healthcarewith psychological challenges for thoseof the population to determine if
workers caring for them. Much
quarantined, their loved ones, and thethey are ill and to reduce their riskof the weight of professional,of infecting others. During theadministrative, political, andhealthcare workers caring for them.
coronavirus (COVID-19) outbreak,programmatic factors of quarantine
quarantine has been used as a public
rests upon public health leaders.
health strategy to reduce disease transmission. COVID-19
This fact sheet describes some of the factors especiallyquarantine efforts have ranged from the mass quarantine
relevant to senior public health officials, such as local, state,of entire cities in China, to isolation in government-runand tribal health authorities, as they consider their roles infacilities, to self-isolation at home. While quarantine canthe range of psychological effects related to quarantine.
Stressors of Quarantine and their Psychological
Effects
Quarantine can expose individuals to stressors
both during and after the quarantine period and may
result in adverse acute and long-term psychologicaloutcomes. Effects of quarantine can include symptomsof posttraumatic stress, anxiety, and depression, andresponses such as fear, anger/irritability, insomnia,fatigue, detachment and avoidance behaviors, impaired
concentration, and diminished work performance. Moreinformation on the nature of stressors during and after
quarantine, as well as guidance on how to provide care that
promotes mental wellbeing, can be found in the resources
section of this document.
Tasks for Public Health Leaders (Specific toPsychological Effects and Factors)
1. Gather and utilize knowledge and expertise —Behavioral health factors in disasters and other extreme
events is a very specialized area within the behavioral
sciences. Public health leaders are encouraged to seek
such expertise within their own systems as well as fromleaders in academia and other governmental entities.
Once identified, strategies are needed to ensure theintegration of their expertise into decision-making
processes used by public health leaders.
2. Monitor psychological effects — Psychological impact
varies greatly depending on the nature of the event,
event stage, geography, and other factors. In addition,these effects frequently change over time as a functionof threat status and the impact of intervention efforts.
Effective monitoring of impact and adaptation ofstrategies will help ensure that efforts are focused wheremost needed. These effects are experienced by diverse
individuals such as those quarantined, their families,
health and behavioral health care providers, and others.
3. Assist in resource identification, provision,operations, adaptability, and integration — Leaders
are frequently the seekers and gatekeepers of resource
acquisition and deployment. They also play a central
role in ensuring that resources are appropriately
targeted and integrated with other related efforts.
Integration of efforts and resources across professional
cultures and organizational structures is critical tooptimal programs, especially in potentially complex
and controversial strategies, such as quarantine. At aminimum, in quarantine situations, important systems
include behavioral health, public health, medical
Continued

services, social services, education systems, medical
examiners, and faith communities.
4. Integrate public health efforts with behavioral healthservices and systems — While integration of allsystems is important, integration of public health andbehavioral health systems is especially important. In
many jurisdictions, they exist in the same governmentalsystems. Integration begins in the preparedness
phase of events and should continue in the response
and recovery phases. Encourage behavioral healthintegration in the considerations to initiate quarantine.
Continue this integration through operation, closedown, and follow-up periods.
Tasks of Public Health Leaders (More Broadly)
1. Lead — Public health leaders have the opportunity,and even responsibility, to lead within public healthcommunities and structures, across organizationallines, and up and down the organizational chart.
Effective leadership in all of these domains will enhance
the probability of programmatic success.
2. Consider workforce factors — Quarantine of exposed
healthcare workers will impact both those exposed,
but also the systems in which they work as increased
demand for services intersects with decreased capacity
due to loss of quarantined workers. The workforce
providing services in the case of quarantine (as well asother adverse public health events) are at both generaland behavioral health risk. Remain attentive to theneeds of all workers. Take positive steps to combat
stigma toward exposed and potentially exposedworkers. Also pay attention to fatigue and overwork
in the remaining workforce. A central role of publichealth leaders is to motivate, protect, and promote
the workforce. Part of that role is to acknowledge,validate, and respond to the psychological needs of theworkforce and their families.
3. Seek behavioral health subject matter expertise —Public health leaders typically do not personally possess
content in expertise in the wide and diverse areas
required to do their jobs. It is incumbent on publichealth leaders, as noted earlier, to have easy access to
those with content expertise in this specialized area of
behavioral health.

4. Engage political leadership — Disasters of all
types draw the attention of political leaders. Publichealth leaders should be prepared to explain needs
and strategies to political leaders in ways that areunderstandable and support the mission. They should
be prepared to anticipate questions and concerns andhave credible responses ready. Political factors changeover time, so leaders should be prepared to adapt tothese changes.
5. Communication (general) — Communication is partof every function for all leaders, including public healthleaders. This is true at all times, even when a crisis is
not at hand. Skills in how to communicate effectively
and strategies to establish and maintain effective
communications are critical.
6. Communication (risk and crisis) — In a crisis or whencommunicating health risk, special skills and training
are helpful. Public health leaders are encouraged towork with communications professionals and takeadvantage of established guidance (e.g., the CDC’s
Crisis and Emergency Risk Communication Manual).
Effective communication, especially in novel andcomplex situations such as quarantines, are behavioral
health interventions. They can reduce community
distress as well as enhance adherence with behavioral
health and other health recommendations.
Resources
Centers for Disease Control and Prevention (CDC) Crisisand Emergency Risk Communication (CERC) Manual:https://emergency.cdc.gov/cerc/manual/index.asp
Center for the Study of Traumatic Stress (CSTS):https://www.cstsonline.org/resources/resource-master-list/
coronavirus-and-emerging-infectious-disease-outbreaksresponseBrooks, SK et al. The psychological impact of quarantine
and how to reduce it: rapid review of the evidence. The
Lancet. Published online February 26, 2020.
https://www.thelancet.com/journals/lancet/article/PIIS01406736(20)30460-8/fulltext#%20

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org