COVID‐19, which first emerged in December 2019, 1 has caused a global pandemic. 2 Quarantine/isolation is an effective measure to control virus transmission, but may have negative effects on mental health. 3 At present, there are few studies on the relation between mental health and quarantine/isolation during the COVID‐19 outbreak.
The study was conducted online through the Wenjuanxing platform (Online Survey Platform) from 14 to 21 February 2020. In total, 14 505 participants aged at least 18 years provided informed consent to participate. Depression, anxiety, and stress symptoms were assessed using the Chinese version of the Depression, Anxiety, and Stress Scale (the severity of the symptoms was divided into five grades: normal, mild, moderate, severe, and extremely severe). 4 Participants reported whether they had been in isolation/quarantine during the pandemic. If participants reported that they had been isolated due to COVID‐19 infection, suspected COVID‐19 infection, close contact with people with suspected/confirmed infection, or arrival/return from a severely affected area, they were assigned to the medically isolated subgroup. Participants who responded that they had quarantined, but who did not meet the criteria for the medically isolated subgroup, were assigned to the self‐reported quarantine subgroup. This study was approved by the Ethics Committee of Shenzhen Kangning Hospital.
Of the 14 505 participants, 7.2%, 19.9%, and 72.9% reported medical isolation, self‐reported quarantine, and no isolation/quarantine, respectively, in the male sample; and 3.5%, 21.3%, and 75.2% reported medical isolation, self‐reported quarantine, and no isolation/quarantine, respectively, in the female sample (Table S1). Of the participants who reported medical isolation, 38.2%, 48.9%, and 30.1% reported severe and above depression, anxiety, and stress, respectively. These rates are higher than those for the self‐reported quarantine and the no isolation/quarantine subgroups. Logistic regression further showed that no isolation/quarantine was protective against mental health problems compared with medical isolation (Table 1). These results suggest that medical isolation may affect mental health, which is in accord with previous studies.5, 6 Because medical isolation means confirmed/suspected infection, or close contact with those people, or from severely affected areas, such individuals might be understandably upset and worried about their health and prognosis. Many medically isolated people experience fear due to their higher risk of infection, 7 anxiety concerning insufficient supplies, loneliness and boredom due to decreased communication with others, 6 and fear or anger about negative news and rumors on the Internet. 5
Table 1.
Rates of various symptoms for the different isolation/quarantine status groups and unadjusted logistic regression results
| Symptoms (dependent variable) | Isolation/quarantine status | N | n (%, 95%CI) | UOR (95%CI) |
|---|---|---|---|---|
| Severe and above depression symptoms | No reported isolation/quarantine | 10 786 | 806 (7.5, 7.0–8.0) | Reference |
| Self‐reported quarantine | 3012 | 244 (8.1, 7.2–9.1) | 1.091 (0.940–1.267) | |
| Medical isolation | 707 | 270 (38.2, 34.7–41.8) | 7.650 (6.468–9.048) | |
| Severe and above anxiety symptoms | No reported isolation/quarantine | 10 786 | 1180 (10.9, 10.4–11.5) | Reference |
| Self‐reported quarantine | 3012 | 381 (12.6, 11.5–13.9) | 1.179 (1.042–1.334) | |
| Medical isolation | 707 | 346 (48.9, 45.3–52.6) | 7.802 (6.653–9.150) | |
| Severe and above stress symptoms | No reported isolation/quarantine | 10 786 | 621 (5.8, 5.3–6.2) | Reference |
| Self‐reported quarantine | 3012 | 189 (6.3, 5.5–7.2) | 1.096 (0.926–1.296) | |
| Medical isolation | 707 | 213 (30.1, 26.9–33.6) | 7.058 (5.896–8.449) |
CI, confidence interval; UOR, unadjusted odds ratio.
The medically isolated subgroup reported severe and above depression rates of 48.7% (isolation periods of ≤1 week), 46.8% (isolation periods of 1–2 weeks), and 22.1% (isolation periods of >2 weeks). The corresponding rates of severe and above anxiety and stress in this subgroup, respectively, were 57.7%, 56.1%, and 35.6%, and 44.9%, 38.0%, and 13.8% (Tables S2–S4). Logistic regression showed that the adjusted odds of severe and above depression (Table S2) and stress (Table S4) were significantly lower among individuals in isolation for >2 weeks (odds ratio = 0.419 and 0.278) versus ≤1 week. Given the long incubation period of COVID‐19, 8 people who had medically isolated for more than 2 weeks reported fewer psychological problems, perhaps because they realized the decreasing likelihood that they were infected. Although these rates significantly decreased with time (especially stress), they remained high after 2 weeks. Longer isolation may be associated with worse psychological outcomes due to chronic stress and negative emotions. 9
Furthermore, the results suggest significantly higher rates of psychological problems (severe and above depression, anxiety, or stress symptoms) in participants aged 18–29 years (vs ≥30 years), in frontline anti‐epidemic workers (vs students and other occupations), in people with a middle school education or lower (vs ≥college‐educated), in people who had paid little attention to epidemic information (≤6 times/day vs ≥7 times/day), and in people who felt nervous about having sufficient supplies (vs no nervousness) during medical isolation among the medically isolated group (Tables S2–S4). These findings provide a reference for effective interventions, such as focusing on frontline workers and relatively young and low‐educated individuals; ensuring the accuracy of information disseminated; and providing basic living security. Several of these precautions have been recommended by psychiatrists. 10 Interestingly, isolating individuals who received basic supplies from the service department during the outbreak (vs those who did not) reported more severe and above psychological problems among the medically isolated group (Tables S2–S4). This finding may be because the provision of supplies indicates a greater risk of COVID‐19 infection, and, as a result, more severe psychological problems.
In summary, these findings demonstrate that medically isolated individuals during the COVID‐19 outbreak experienced high rates of psychological problems, especially in the early days of isolation. The psychological problems of medically isolating individuals must be addressed.
Disclosure statement
The authors declare no conflict of interest.
Supporting information
Table S1. Demographic characteristics of the participants.
Table S2. Prevalence and distribution of severe and above depression symptoms and relevant factors among the medically isolated group.
Table S3. Prevalence and distribution of severe and above anxiety symptoms and relevant factors among the medically isolated group.
Table S4. Prevalence and distribution of severe and above stress symptoms and relevant factors among the medically isolated group.
Acknowledgments
This project was supported by the Medjaden Academy & Research Foundation for Young Scientists (COVID‐19‐MJA20200309), Sanming Project of Medicine in Shenzhen (SZSM201612079), Shenzhen Key Medical Discipline Construction Fund (SZXK042), and Guangdong Provincial High‐Level Clinical Key Specialties (SZGSP013).
Contributor Information
Jianping Lu, Email: szlujianping@126.com.
Jianbo Liu, Email: liujianbo@csu.edu.cn.
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Associated Data
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Supplementary Materials
Table S1. Demographic characteristics of the participants.
Table S2. Prevalence and distribution of severe and above depression symptoms and relevant factors among the medically isolated group.
Table S3. Prevalence and distribution of severe and above anxiety symptoms and relevant factors among the medically isolated group.
Table S4. Prevalence and distribution of severe and above stress symptoms and relevant factors among the medically isolated group.