SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review

SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review Read the article called “The psychological impact of quarantine” and then answer the questions below. You should plan to turn in a 2-3 page paper that lists your answers to these questions in order and keeps the question numbers (so it’s easy for me to read along). Please be very thorough and write clearly, using the terms from the reading without plagiarizing the reading. You should write in full sentences and paragraphs. SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review What are the negative impacts of quarantine discussed in the study? What are the positive impacts of quarantine discussed in the study? What are some of the things that can be done to reduce the negative impact of quarantine, according to this study? While you may not be quarantined, you may still face challenges. Which of the negative impacts discussed in this study do you think might affect you the most? Are there any other challenges you anticipate that were not discussed in the study? impact_.pdf Rapid Review The psychological impact of quarantine and how to reduce it: rapid review of the evidence Samantha K Brooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, Neil Greenberg, Gideon James Rubin Lancet 2020; 395: 912–20 Published Online February 26, 2020 https://doi.org/10.1016/ S0140-6736(20)30460-8 Department of Psychological Medicine, King’s College London, London, UK (S K Brooks PhD, R K Webster PhD, L E Smith PhD, L Woodland MSc, Prof S Wessely FMedSci, Prof N Greenberg FRCPsych, G J Rubin PhD) Correspondence to: Dr Samantha K Brooks, Department of Psychological Medicine, King’s College London, London SE5 9RJ, UK [email protected] See Online for appendix The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable. Introduction Why is this Review needed? Quarantine is the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, so reducing the risk of them infecting others.1 This definition differs from isolation, which is the separation of people who have been diagnosed with a contagious disease from people who are not sick; however, the two terms are often used interchangeably, especially in communication with the public.2 The word quarantine was first used in Venice, Italy in 1127 with regards to leprosy and was widely used in response to the Black Death, although it was not until 300 years later that the UK properly began to impose quarantine in response to plague.3 Most recently, quar­ antine has been used in the coronavirus disease 2019 (COVID-19) outbreak. This outbreak has seen entire cities in China effectively placed under mass quarantine, while many thousands of foreign nationals returning home from China have been asked to self-isolate at home or in state-run facilities.4 There are precedents for such measures. Citywide quarantines were also imposed in areas of China and Canada during the 2003 outbreak of severe acute respiratory syndrome (SARS), whereas entire villages in many west African countries were quarantined during the 2014 Ebola outbreak. SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review Quarantine is often an unpleasant experience for those who undergo it. Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects. Suicide has been reported,5 substantial anger generated, and lawsuits brought6 following the imposition of quarantine in previous outbreaks. The potential benefits of mandatory mass quarantine need to be weighed carefully against the possible psychological costs.7 Successful use of quarantine as a public health measure requires us to reduce, as far as possible, the negative effects associated with it. Given the developing situation with coronavirus, policy makers urgently need evidence synthesis to pro­ duce guidance for the public. In circumstances such as these, Key messages • Information is key; people who are quarantined need to understand the situation • Effective and rapid communication is essential • Supplies (both general and medical) need to be provided • The quarantine period should be short and the duration should not be changed unless in extreme circumstances • Most of the adverse effects come from the imposition of a restriction of liberty; voluntary quarantine is associated with less distress and fewer long-term complications • Public health officials should emphasise the altruistic choice of self-isolating 912 Search strategy and selection criteria Our search strategy was designed to inform this Review and a second review to be published elsewhere relating to adherence to quarantine. We searched MEDLINE, PsycINFO, and Web of Science. The full list of search terms can be found in the appendix. In brief, we used a combination of terms relating to quarantine (eg, “quarantine” and “patient isolation”) and psychological outcomes (eg, “psych” and “stigma”). For studies to be included in this Review, they had to report on primary research, be published in peer-reviewed journals, be written in English or Italian (as these are the languages spoken by the current authors), include participants asked to enter into quarantine outside of a hospital environment for at least 24 hours, and include data on the prevalence of mental illness or psychological wellbeing, or on factors associated with mental illness or psychological wellbeing (ie, any predictors of psychological wellbeing during or after quarantine). The initial search yielded 3166 papers, of which 24 included relevant data and were included in this Review. The screening process is illustrated in the figure. www.thelancet.com Vol 395 March 14, 2020 Rapid Review rapid reviews are recommended by WHO.8 We undertook a Review of evidence on the psychological impact of quar­ antine to explore its likely effects on mental health and psychological wellbeing, and the factors that contribute to, or mitigate, these effects. Of 3166 papers found, 24 are included in this Review (figure). The characteristics of studies that met our inclusion criteria are presented in the table. These studies were done across ten countries and included people with SARS (11 studies), Ebola (five), the 2009 and 2010 H1N1 influenza pandemic (three), Middle East respiratory syndrome (two), and equine influenza (one). One of these studies related to both H1N1 and SARS. The psychological impact of quarantine Five studies compared psychological outcomes for people quarantined with those not quarantined.9,19,27,28,33 . SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review A study9 of hospital staff who might have come into contact with SARS found that immediately after the quarantine period (9 days) ended, having been quarantined was the factor most predictive of symptoms of acute stress disorder. In the same study, quarantined staff were significantly more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteri­ orating work performance, and reluctance to work or consid­eration of resignation. In another study,33 the effect of being quarantined was a predictor of posttraumatic stress symptoms in hospital employees even 3 years later. Approximately 34% (938 of 2760) of horse owners quarantined for several weeks because of an equine influenza outbreak reported high psychological distress during the outbreak, compared with around 12% in the Australian general population.28 A study27 comparing post-traumatic stress symptoms in parents and children quarantined with those not quarantined found that the mean post-traumatic stress scores were four times higher in children who had been quarantined than in those who were not quarantined. 28% (27 of 98) of parents quarantined in this study reported sufficient symptoms to warrant a diagnosis of a trauma-related mental health disorder, compared with 6% (17 of 299) of parents who were not quarantined. Another study19 of hospital staff examined symptoms of depression 3 years after quar­antine and found that 9% (48 of 549) of the whole sample reported high depressive symptoms. In the group with high depressive symptoms, nearly 60% (29 of 48) had been quarantined but only 15% (63 of 424) of the group with low depressive symptoms had been quarantined. All other quantitative studies only surveyed those who had been quarantined and generally reported a high prevalence of symptoms of psychological distress and disorder. Studies reported on general psychological symptoms,22 emotional disturbance,34 depression,16 stress,15 low mood,18 irritability,18 insomnia,18 post-traumatic stress symptoms25 (rated on Weiss and Marmar’s Impact of www.thelancet.com Vol 395 March 14, 2020 Event Scale–Revised35), anger,20 and emotional exhaus­ tion.21 Low mood (660 [73%] of 903) and irritability (512 [57%] of 903) stand out as having high prevalence.18 People quarantined because of being in close contact with those who potentially have SARS25 reported various negative responses during the quarantine period: over 20% (230 of 1057) reported fear, 18% (187) reported nervousness, 18% (186) reported sadness, and 10% (101) reported guilt.SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review Few reported positive feelings: 5% (48) reported feelings of happiness and 4% (43) reported feelings of relief. Qualitative studies also iden­tified a range of other psy­chological responses to quar­antine, such as confusion,11–13,23 fear,12–15,23,24 anger,12,13 grief,29 numbness,23 and anxiety-induced insomnia.14,15 One study compared undergraduates who had been quarantined with those not quarantined immediately after the quarantine period and found no significant difference between the groups in terms of post-traumatic stress symptoms or general mental health problems.29 However, the entire study population were undergraduate students (who are generally young, and perhaps have fewer responsibilities than adults who are employed full-time) and thus it is possible that these conclusions cannot be generalised to the wider population. Only one study17 compared psychological outcomes during quarantine with later outcomes and found that during quarantine, 7% (126 of 1656) showed anxiety symptoms and 17% (275) showed feelings of anger, whereas 4–6 months after quarantine these symptoms had reduced to 3% (anxiety) and 6% (anger). Two studies reported on longer-term effects of quar­ antine. 3 years after the SARS outbreak, alcohol abuse or 3163 records identified from database search 3 from hand search 266 duplicates 2900 titles and abstracts screened 2848 excluded after screening titles and abstracts as they did not meet the inclusion criteria 52 full texts screened 28 full-text articles excluded 10 population not quarantined 6 quarantined in hospital wards 5 psychological effect not discussed 4 isolation because of psychological disorder 2 review article 1 not peer-reviewed 24 citations included Figure: Screening profile 913 Rapid Review dependency symptoms were positively associated with having been quarantined in health-care workers.32 In a multivariate analysis,32 after controlling for demographic factors, having been quarantined and having worked in a high-risk location were the two types of exposure signifi­ cantly associated with these outcomes (for quarantine: unadjusted mean ratio 0·45; 95% CI 1·02–2·65). After quarantine, many participants continued to engage in avoidance behaviours. For health-care workers,20 being quarantined was significantly and positively asso­ ciated with avoidance behaviours, such as minimising direct contact with patients and not reporting to work. A study25 of people quarantined because of potential SARS contact noted that 54% (524 of 1057) of people who had Country Design Participants Quarantine period Measures Bai et al (2004)9 Taiwan Cross-sectional 338 hospital staff 9 days because of contact with suspected SARS cases Study-specific survey; SARS-related stress survey composed of acute stress disorder criteria according to the DSM-IV and related emotional and behavioural changes Blendon et al (2004)10 Canada Cross-sectional 501 Canadian residents Length unclear; exposure to SARS Study-specific survey Braunack-Mayer et al (2013)11 Australia Qualitative 56 school community members Length unclear; H1N1 influenza Interview Caleo et al (2018)12 Sierra Leone Mixed methods Length unclear; entire village on Interview 1161 residents of a rural village; 20 of whom took part restricted movement because of Ebola in an interview study Cava et al (2005)13 Canada Qualitative 21 Toronto residents 5–10 days because of SARS contact Desclaux et al (2017)14 Senegal Qualitative 70 Ebola contact cases 21 days because of Ebola contact Interview DiGiovanni et al (2004)15 Canada Mixed methods 1509 Toronto residents Duration of quarantine was the difference between the incubation period of SARS (taken as 10 days) and the time that had elapsed since their exposure to a SARS patient Interviews, focus groups, and telephone polls Hawryluck et al (2004)16 Canada Cross-sectional 129 Toronto residents Median of 10 days because of potential SARS exposure IES-R to assess post-traumatic stress and CES-D to assess depression Jeong et al (2016)17 South Korea Longitudinal 1656 residents of four regions in Korea 2 weeks because of contact with MERS patients GAD-7 to assess anxiety and STAXI-2 to assess anger Lee et al (2005)18 Hong Kong (Special Administrative Region, China). SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review Mixed methods 903 residents of Amoy Gardens (the first officially recognised site of community outbreak of SARS in Hong Kong) took surveys; 856 of whom were not diagnosed with SARS; 2 of whom were interviewed Length unclear; residents of a SARS outbreak site Study-specific survey Liu et al (2012)19 China Cross-sectional 549 hospital employees; 104 (19%) of whom had been quarantined Length unclear; home or work quarantine because of potential SARS contact CES-D to assess depressive symptoms and IES-R to assess post-traumatic stress symptoms Marjanovic et al (2007)20 Canada Cross-sectional 333 nurses Length unclear; SARS exposure MBI-GS to assess burnout; STAXI-2 to assess anger; six study-specific questions to assess avoidance behaviour Maunder et al (2003)21 Canada Observational Health-care workers (sample size unavailable) 10 days voluntary quarantine because of potential SARS contact Observations of health-care staff Mihashi et al (2009)22 China Retrospective cross-sectional 187 printing company workers, university faculty members and their families, and non-medicine students Length unclear; citywide isolation because of SARS GHQ-30 to assess psychological disorders Pan et al (2005)23 Taiwan Observational 12 college students Length unclear; asked to limit interactions outside the home because of potential SARS contact Observations of a support group for home-quarantined students Interview (Table continues on next page) 914 www.thelancet.com Vol 395 March 14, 2020 Rapid Review Country Design Participants Quarantine period Measures (Continued from previous page) Pellecchia et al (2015)24 Liberia Qualitative 432 (focus groups) and 30 (interviews) residents of neighbourhoods with incidence of Ebola 21 days because neighbourhoods had epidemiological incidence of Ebola Interviews and focus groups Reynolds et al (2008)25 Canada Cross-sectional 1057 close contacts of potential SARS cases Mean 8·3 days; range 2–30 days because of contact with potential SARS cases IES-7 to assess post-traumatic stress symptoms Robertson et al (2004)26 Canada Qualitative 10 health-care workers 10 days home quarantine, or continually wearing a mask in the presence of others, or required to attend work but had to travel in their own vehicle and wear a mask, because of SARS exposure Interviews Sprang and Silman (2013)27 USA and Canada Cross-sectional 398 parents Length unclear; lived in areas severely affected by H1N1 or SARS PTSD-RI Parent Version and PCL-C Taylor et al (2008)28 Australia Cross-sectional 2760 horse owners or those involved in horse industry Several weeks because of equine K10 to assess distress influenza Wang et al (2011)29 China Cross-sectional 419 undergraduates 7 days; non-suspected H1N1 influenza cases SRQ-20 to assess general mental health and IES-R to assess post-traumatic stress Wester and Giesecke (2019)30 Sweden Qualitative 12: six health-care workers who worked in west Africa during the Ebola outbreak and one close contact for each of them 3 weeks because of working in west Africa during the Ebola crisis Interview Wilken et al (2017)31 Liberia Qualitative 16 residents of villages who were quarantined 21 days because of living in a village in which someone had died of Ebola Interview Wu et al (2008, 2009)32,33 China Cross-sectional 549 hospital employees Length unclear; either because of SARS diagnosis, suspected SARS, or having had direct contact with SARS patients 7 questions adapted from NHSDA to assess alcohol dependence and abuse; IES-R to assess post-traumatic stress symptoms; CES-D to assess depression Yoon et al (2016)34 South Korea Psychological evaluation by professionals 6231 Korean residents Length unclear; placed in quarantine because of MERS Questions such as ‘for the last 2 weeks or after being in quarantine, do you feel depressed or hopelessness? Do you feel loss of interest in any part of your life?’ SARS=severe acute respiratory syndrome. DSM-IV=Diagnostic and Statistical Manual of Mental Disorders-IV. IES-R=Impact of Event Scale-Revised. CES-D=Center for Epidemiologic Studies Depression scale. MERS=Middle East respiratory syndrome-related coronavirus. SUNY at Fredonia PSYCH 3001 Psychological Impact of Quarantine Article Review GAD-7=Generalised Anxiety Disorder-7. STAXI-2=State-Trait Anger Expression Inventory. MBI-GS= Maslach Burnout Inventory-General Survey. GHQ-30=General Health Questionnaire-30. IES-7=International Education Standard-7. PTSD-RI=Post-Traumatic Stress Disorder Reaction Index. PCL-C=PTSD Checklist-Civilian version. K10= Kessler 10 Psychological Distress Scale. SRQ-20=Self-Reporting Questionnaire-20. NHSDA=National Household Survey on Drug Abuse. Table: Study characteristics been quar­antined avoided people who were coughing or sneezing, 26% (255) avoided crowded enclosed places, and 21% (204) avoided all public spaces in the weeks following the quarantine period. A qualitative study13 reported that several participants described long-term behavioural changes after the quarantine period, such as vigilant handwashing and avoidance of crowds and, for some, the return to normality was delayed by many months. Prequarantine predictors of psychological impact There was mixed evidence for whether participant characteristics and demographics were predictors of www.thelancet.com Vol 395 March 14, 2020 the psychological impact of quarantine. A study28 of horse owners quarantined because of equine influenza identified several characteristics associated with negative psycho­logical impacts: younger age (16–24 years), lower levels of formal educational qualifications, female gender, and having one child as opposed to no children (although having three or more children appeared somewhat protective). However, another study16 suggested that demographic factors such as marital status, age, educa­ tion, living with other adults, and having children were not associated with psychological outcomes. Having a history of psychiatric illness was associated with experiencing anxiety and anger 4–6 months after 915 Rapid Review release from quarantine.17 Health-care workers25 who had been quarantined had more severe symptoms of posttraumatic stress than members of the general public who had been quarantined, scoring significantly higher on all dimensions. 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