Staying well during self-isolation

Norman Swan: Self-isolation measures will help us reduce the spread of the SARS-CoV-2 virus, but they will also mean less contact with friends, families, school or workplaces. For some that could bring about feelings of anxiety, low mood or disconnection. A review of the evidence just published in the Lancet has looked at the psychological impact of quarantine and how we can reduce that impact. To unpack the findings we are joined by Dr Melanie Taylor, an Associate Professor in Organisational Psychology at Macquarie University. Welcome to the Health Report, Melanie.

Melanie Taylor: Hello, nice to be here.

Norman Swan: So what did this review actually do?

Melanie Taylor: So this was a group of well-known researchers from the UK who published this paper in the Lancet four weeks ago, and they did a systematic review of the literature around the psychological impacts of quarantine. So they were looking at what those potential mental health and psychological well-being impacts could be and what contributes to those. And so they looked at around 3,000 papers, narrowed that down to 24 that they looked at in detail to come up with their findings.

Norman Swan: I'm amazed there's 3,000 studies into this issue, that's incredible. You've done one yourself and we will come to your study in a minute. What were your findings?

Melanie Taylor: So really they found that, as you would expect, that usually there are negative psychological consequences of this, it's not a natural state for us to be in. And indeed, most of this quarantine was around some fairly serious infections such as Ebola and MERS and things like that. So they found that the longer the quarantine duration, the worse the outcomes were. If people had concerns about the infection itself, the fears around about, that also contributed. The frustration and boredom of actually being in quarantine, having issues around inadequate supplies, food and medications, and of course inadequate information. And then alongside that, things like financial loss and stigma.

Norman Swan: Stigma? Talk to me about stigma.

Melanie Taylor: Well, I think in the context here they were looking at SARS in particular at the time and MERS, and so there is the idea that people are unclean who have had these diseases and survived and maybe are still infectious in some way. So I think in those diseases they were looking at in these particular research papers, those were the types of things they were finding.

Norman Swan: And what sort of psychological effects were they, what were people experiencing?

Melanie Taylor: So, often…in this paper they talked about PTSD in some areas, I'm not sure that's so relevant perhaps at the moment for us, but a lot of the impacts were stress-related type things, so anxiety and depression, people being more irritable, unable to sleep, so insomnia, anger and frustration, emotional exhaustion as well.

Norman Swan: More and more, particularly in the United States they talk about shelter in place. Did it make a difference whether you were quarantined by yourself or with your family?

Melanie Taylor: That would have had an effect. I don't think it was a major part of the studies I was reading. In this case I guess a lot of the people they were talking about specifically were being separated as individuals and isolated, and so therefore there was that increased lack of contact with loved ones directly.

Norman Swan: And what about your mental well-being, your mental health before you were quarantined? Was that a predictor of outcome here?

Melanie Taylor: Yes, so this paper in its review looked at the sorts of things that might relate to either coping particularly well or particularly badly. And one of the main predictors (again, probably not surprisingly) is if you already have some sort of mental health issue, you're a fairly isolated person, those sorts of things would impact on how you coped with these situations.

Norman Swan: So your social supports, how many people you can call upon in your life to come and help you out. You've done your own study in this, in fact it was analysed in this paper, and it was into equine influenza. I'd forgotten that we'd had an equine influenza epidemic in Australia, that was about 10, 12 years ago.

Melanie Taylor: That's right, yes, back in 2007. So my paper in the context of this review was unusual because in equine influenza horses were quarantined on properties but people weren't, but we were finding at that point that people were self-quarantining, they were separating themselves because there was this stigma around having that on your property. So people were separating themselves.

Norman Swan: I see, so it didn't make the jump from horses to humans.

Melanie Taylor: No, so they weren't frightened about themselves in the context of this, but they did have real serious concerns about their animals and their livelihoods, so in some ways there are some good analogies going on now really in terms of being concerned about others, in this case we are talking about animals but it was very much about loved and special animals that were important to their recreation or their networks and their social worlds as well.

Norman Swan: And it was quite a decent sized study.

Melanie Taylor: Yes, we had over 2,000 horse owners, and they were really interested to take part and tell us about their experiences. And so I was looking at not just the behaviours and the hygiene that they had to operate at this point in time, but also looking at emotional and social implications of quarantining, and indeed the closing down of that industry.

Norman Swan: So it was a bit like foot-and-mouth disease, the farms had to be isolated.

Melanie Taylor: Yes, and in fact…

Norman Swan: And humans could spread the disease, therefore they had to stay on their own farm.

Melanie Taylor: Yes, that's right, and in fact it was foot-and-mouth disease and Ovine Johne's were the only diseases I could find where they had similar social impacts of both the control and the disease itself.

Norman Swan: And what did you find were the impacts?

Melanie Taylor: Well, I was particularly interested to look at psychological distress. So this is not a clinical diagnosis but it was a screening of anxiety and depression that could lead to mental health issues down the line. And so my study was trying to look at that, and we had great information from the public health surveys in New South Wales to compare to the general population. So I was able to see that younger people in particular were struggling more than older people, that people, children, were struggling a bit more, and obviously people who had their financial interest in the equine industry, again was finding it more difficult to cope at that point in time.

Norman Swan: So if your income was threatened, that was an additional stressor.

Melanie Taylor: Yes, definitely, it definitely comes out.

Norman Swan: So how similar do you think this is to what we going to go through now? So some people are in quarantine because they've had a contact with somebody with COVID-19, coming in from overseas. But increasingly we are going to be asked to stay at home more and more and not go out very much at all, apart from to go to the shops to get our food. And of course our income is being threatened for many people, usually casual income, our businesses are being threatened, it's going to be pretty dire. What's your prediction here from the research that's going to affect people with the COVID-19 pandemic?

Melanie Taylor: Obviously the major impacts will be I guess this freezing of time one way or another, however you tend to look at it. So, yes, as you said, the financial impacts are massive. The duration of the potential lockdown, again, we are fairly uncertain about what the duration is.

Norman Swan: And uncertainty is not good for mental health well-being.

Melanie Taylor: Definitely not. And one of the important things psychologically is having an idea of how long you've got to keep this up for. If we know where we are heading to roughly, what we've got to prepare for, that makes it a lot more easy to at least work out ways to manage that.

Norman Swan: Is there an evidence base for solutions here that people can actually pick up and do at home?

Melanie Taylor: I mean, there are aspects to this, and again, some of this is around fear of the actual disease itself. So we have had good information about what you can do to help reduce your risk of catching this, and obviously the social distancing, hygiene have been clearly articulated. But also just thinking of ways to deal with the things you can foresee. So if you're at home with the children, you have to have ways to keep them occupied and think about those sorts of things, so there's a range of things you can do.

Norman Swan: And presumably celebrate the good things and maybe celebrate them online with your friends via a screen.

Melanie Taylor: Yes, and I think this is where it becomes so sad. We have a lot of acknowledgement of the financial impacts, and rightly so of course. But I think that whole freezing of time, depending where you sit and what stage of life you're at, there's so many sad things about that, there are losses going on all over that are small when you look at them from the outside, but big to people. So we've got the HSC students and those missing out on the last years of schooling where they've got a lot of social things and lots of I guess achievements that have come up from being part of school…

Norman Swan: So, challenges for us all to meet as a community and help each other out. Melanie, thank you very much for joining us.

Melanie Taylor: You're welcome.

Norman Swan: Melanie Taylor is Associate Professor of Organisational Psychology at Macquarie University. There are several online assistance programs to help and you can always call Beyond Blue for advice on 1300 224 636, and there is Lifeline too on 13 11 14.