Table 3.

Mental health outcomes in different conditions of quarantine and isolation

Study	Type and reasons for quarantine, isolation, or other measures for infection prevention	Mental health impacts
Morgan et al., 2009 [40]	Contact precaution; MDROs	Patients expressed feeling neglected, isolated, angry (p=0.037), depression (up to 77%, p-values ranged from < 0.01 to < 0.001), anxiety (p<0.001), low self-esteem (p<0.01), perception of less control (p<0.001); less patient-provider contact was reported
Abad et al., 2010 [41]	Isolation; multiple infectious conditions including VRE, MRSA, healthcare-associated infections, MDRO, SARS, and mixed infections	Most studies reported higher scores for depression, anxiety, anger-hostility, fear, loneliness, boredom, and low self-esteem; One study reported higher freedom and privacy perceived by the patients; higher anxiety scores were associated with history of mental illness; Most studies found that providers visited less frequently and spent less time with isolated patients compared to the controls
Barratt et al., 2011 [42]	Source isolation; VRE, MRSA, SARS, and mixed infections	Studies reported stress, anxiety, depression, loneliness, anger, neglect, abandonment, boredom, stigmatization, low sense of control and self-esteem, and negative emotions
Gammon et al., 2018 [43]	Source isolation; MRSA, tuberculosis, and other non-specified infections	Participants experienced limited visiting, lack of attention and lesser interaction with providers, and disruption of routine; Additionally, feelings of loneliness, abandonment, social exclusion, stigmatization, anxiety, depression, mood changes, stress, negative effects on coping and psychological functioning, low self-esteem and sense of control, emotional problems, anger, perceived feeling of dirtiness, and a lack of clarity on the isolation process were reported; Moreover, studies have found that many psychosocial issues were attributable to the primary cause(s) of hospitalization
Gammon et al., 2019 [28]	Source isolation; MRSA and other non-specified infectious conditions	Patients reported a lack of control and feeling lonely in isolation, which led to a perceived state of social exclusion; Along with poor mental health (33%), about 32% of MRSA carriers reported stigma; of these, 14% reported “clear stigma” and 42% reported “suggestive for stigma”; Patients also reported suboptimal patient-provider communication, lack of understanding facial expression due to masks, and procedures that provoked anxiety and stresses of isolation
Brooks et al., 2020 [29]	Quarantine; SARS (n=15), Ebola (n=5), H1N1 influenza (n=3), Middle East Respiratory Syndrome (n=2), and equine influenza (n=1)	Patients reported general psychological problems, emotional disturbance, depression, stress, low mood (up to 73%), irritability (up to 57%), anger, guilt, nervousness, sadness, fear, numbness, vigilant handwashing and avoidance of crowds even after quarantine period; The parents and children who were quarantined had higher prevalence of trauma-related mental disorders (28% parents had such symptoms compared to 6% control parents); Healthcare providers also reported acute stress disorder, exhaustion, detachment, anxiety, depression, irritability, insomnia, poor concentration, deterioration of work performance, alcohol use, avoidance behavior, and posttraumatic stress-related symptoms even 3 yr after the quarantine period
Purssell et al., 2020 [44]	Contact precaution and isolation; MRSA and MDROs	The pooled standardized mean difference was 1.28 (95% CI, 0.47 to 2.09) for depression and 1.45 (95% CI, 0.56 to 2.34) for anxiety among the study participants
Sharma et al., 2020 [45]	Isolation precaution; MRSA, MDROs, and other infections	The pooled mean difference estimates for HADS-A was -1.4 (p=0.15) and that for HADS-D was -1.85 (p= 0.09) for anxiety and depression, respectively; Most studies (n=6) reported negative effects on psychological burden scales in the empirical analysis

MDROs, multiple drug-resistant organisms; VRE, vancomycin-resistant Enterococcus; MRSA, methicillin-resistant Staphylococcus aureus; SARS, Severe Acute Respiratory Syndrome; CI, confidence interval; HADS, Hospital Anxiety and Depression Scales.