Opinion: The psychological cost of lockdown

As the focus of the national effort remains firmly on reducing the number of cases of COVID-19 and helping those who need to access care, the mental health implications of the UK quarantine are not yet the top priority. Richard Dawson draws on a comprehensive review of previous epidemics to see what the psychological cost might be

One of the most positive aspects of the coronavirus health crisis is the amount of public information and personal advice available to people for how to look after your mental health in such difficult times.

From business leaders sharing best practice on working from home to healthcare providers publishing guidance on how to reduce health anxiety and stress, such an outpouring of opinion and commentary has helped foster a sense of community spirit and solidarity.

That shared sense of responsibility is particularly important when it comes to adhering to Government instructions on staying at home.

But in the weeks and months ahead, the lasting impact on many people’s mental health may become more apparent.

Numerous studies have found that social distancing, self-isolation and quarantine measures inflict a heavy psychological cost that can persist long after the immediate threat posed by infection has subsided.

Giving people as much information as possible, as the Government is trying to do, can reduce that psychological cost. But, if previous epidemics are anything to go by, the cost will still be significant.

A review of the psychological impact of quarantine released by The Lancet at the end of February compiled studies about epidemics such as SARS, MERS, H1N1 Influenza and Ebola.

While the results varied on a case-by-case basis, most studies reported a range of negative psychological effects associated with quarantine measures, some of which lasted much longer than others.

The kinds of psychological effects ranged from low mood, irritation and stress through to emotional disturbances, depression and post-traumatic stress disorder (PTSD).

Many of these effects were most prevalent during the quarantine period but long-term behavioural changes were also observed.

In the case of a group of health-care workers surveyed three years after the SARS outbreak, for example, alcohol abuse or dependency was positively associated with having been quarantined.

Similarly, a study of people quarantined because of potential SARS contact noted that 54 per cent avoided people who were coughing or sneezing, 26 per cent avoided crowded enclosed spaces and 21 per cent avoided all public spaces in the weeks following quarantine being lifted.

Other long-term behavioural changes included vigilant handwashing and avoidance of crowds. For some, the review claims the return to normality was delayed by many months.

Things which were most likely to cause people stress during quarantine were fears of infection, frustration and boredom, inadequate supplies, poor information and the duration of the quarantine itself.

Post quarantine stressors were typically concerns about financial loss through being unable to work or having professional life interrupted and stigma from others.

The severity of the mental health consequences of quarantine set out above reinforce the importance of a strong mitigation strategy as we grapple with the psychological fallout of this pandemic.

The UK is into its third week of quarantine and it is widely expected that the Government will extent this next Monday (April 13), given that the number of new infections is still rising.

The Lancet review notes that a big part of mitigating negative mental health outcomes is giving people as much information as possible and on this front, the proliferation of public information and personal advice that we have seen should stand us in good stead.

The other obvious thing is to keep the quarantine period as short as possible. But the Government is hamstrung given the scale of the epidemic in the UK and the need to slow down transmission to protect people and the NHS.

With the UK potentially facing many weeks in isolation and months of social-distancing measures, there is no easy way of reducing the psychological impact.

The growing body of information and advice will have a positive effect, but it is likely that we will still see a large increase in the number of people presenting with mental health problems.

That is why a cross-party group of MPs and peers recently appealed to the Health Secretary Matt Hancock to provide funding to mental health charities providing vital support.

In her historic remarks on Sunday night (April 5), the Queen appealed to quintessential British attributes of self-discipline, good-humoured resolve and fellow-feeling, claiming that “those who come after us will say that the Britons of this generation were as strong as any.”

Keeping that historical perspective at the forefront of our minds will bring some comfort to many. But we must make sure, as a community, we continue to support each other through the inevitable worry that comes with not knowing when this thing will end. It will.