Psychosocial effects of social distancing during coronavirus infections: integrative review

Rocha, Daniel de Macêdo; Silva, Joyce Soares e; Abreu, Ingrid Moura de; Mendes, Priscila Martins; Leite, Hilda Dandara Carvalho Santos; Ferreira, Maria do Carmo Santos

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Review Article • Acta Paul Enferm. 34 • 2021 • https://doi.org/10.37689/acta-ape/2021AR01141 copy

Psychosocial effects of social distancing during coronavirus infections: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the literature regarding the psychosocial effects of isolation and social distancing measures adopted as strategy for the prevention and control of coronavirus infections.

Methods:

Integrative review of the literature based on the theoretical framework proposed by Whittemore and Knafl and conducted on seven databases: MEDLINE, SCOPUS, Embase, Web of Science, LILACS, IBECS and BDENF. The sample consisted of 14 primary studies, with no time or language restriction and the analysis was descriptive. The level of evidence classification was used to characterize the studies.

Results:

Psychosocial repercussions of isolation and social distancing measures were frequent in different countries, with a negative impact on mental health and quality of life. Psychological impairments included mood instability, high levels of anxiety, stress, frustration, loneliness, anger and altered sleep patterns. Factors related to the prolonged duration of the measure, possibilities of contagion, economic instability, lack of knowledge and the uncertainties related to the disease were associated with psychological distress.

Conclusion:

Isolation and social distancing measures contribute to the epidemiological control of outbreaks, epidemics and pandemics of coronavirus; however, they compromise the population's mental health. The duration of the measure, the possibilities of contagion, fear and financial instability were determining factors for the degree of psychological distress.

Keywords
Social isolation; Mental health; Stress, psychological; Coronavirus infections; Coronavirus

Database	Search expressions
MEDLINE	(((((((“Social Isolation”[Mesh]) OR (Social Isolation)) OR (Social detachment)) OR (Detachment)) OR (Quarantine)) OR (Community restraint)) AND (((((((((((“Cost of Illness”[Mesh]) OR “Mental Health”[Mesh]) OR (Mental Health)) OR (Cost of Illness)) OR (Burden of Illness)) OR (Cost of Disease)) OR (Cost of Sickness)) OR (Costs of Disease)) OR (Disease Cost)) OR (Disease Costs)) OR (Sickness Cost))) AND ((((((“Coronavirus Infections”[Mesh]) OR (Coronavirus Infections)) OR (Infections, Coronavirus)) OR (MERS (Middle East Respiratory Syndrome))) OR (Middle East Respiratory Syndrome)) OR (COVID-19))
SCOPUS	( TITLE-ABS-KEY ( social AND isolation ) OR TITLE-ABS-KEY ( social AND detachment ) OR TITLE-ABS-KEY ( detachment ) OR TITLE-ABS-KEY ( quarantine ) OR TITLE-ABS-KEY ( community AND restraint ) ) AND ( TITLE-ABS-KEY ( cost AND of AND illness ) OR TITLE-ABS-KEY ( mental AND health ) OR TITLE-ABS-KEY ( burden AND of AND illness ) OR TITLE-ABS-KEY ( cost AND of AND disease ) OR TITLE-ABS-KEY ( cost AND of AND sickness ) OR TITLE-ABS-KEY ( costs AND of AND disease ) OR TITLE-ABS-KEY ( disease AND cost ) OR TITLE-ABS-KEY ( disease AND costs ) OR TITLE-ABS-KEY ( sickness AND cost ) ) AND ( TITLE-ABS-KEY ( coronavirus AND infections ) OR TITLE-ABS-KEY ( mers ) OR TITLE-ABS-KEY ( middle AND east AND respiratory AND syndrome ) OR TITLE-ABS-KEY ( covid-19 ) )
Embase	(social AND isolation OR (social AND detachment) OR detachment OR quarantine OR (community AND restraint)) AND (cost AND of AND illness OR (mental AND health) OR (burden AND of AND illness) OR (cost AND of AND disease) OR (cost AND of AND sickness) OR (costs AND of AND disease) OR (disease AND cost) OR (disease AND costs) OR (sickness AND cost)) AND (coronavirus AND infections OR (infections, AND coronavirus) OR (mers AND middle AND east AND respiratory AND syndrome) OR (middle AND east AND respiratory AND syndrome) OR ‘covid 19')
Web of Science	TS=((Social Isolation) OR (Social detachment) OR (Detachment) OR (Quarantine) OR (Community restraint)) AND TS=((Cost of Illness) OR (Mental Health) OR (Burden of Illness) OR (Cost of Disease) OR (Cost of Sickness) OR (Costs of Disease) OR (Disease Cost) OR (Disease Costs) OR (Sickness Cost)) AND TS=((Coronavirus Infections) OR (Infections, Coronavirus) OR (MERS (Middle East Respiratory Syndrome)) OR (Middle East Respiratory Syndrome) OR (COVID-19))
LILACS, BDENF and IBECS	(mh:(Isolamento Social OR Distanciamento social OR Distanciamento OR Quarentena OR Contenção comunitária)) AND (mh:(Efeitos Psicossociais da Doença OR Saúde Mental OR Carga da Doença OR Custo da Doença OR Fardo da Doença OR Ônus da Doença )) AND (mh:(Infecções por Coronavirus OR COVID-19 OR Doença por Coronavírus 2019-nCoV OR Infecção pelo Coronavírus 2019-nCoV OR Infecções por Coronavírus))

Leading author, year and location	Objective	Design and LE	Psychosocial effects and associated factors
Xiao H⁽¹⁶16. Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) Outbreak in January 2020 in China. Med Sci Monit. 2020;26:e923921.⁾ 2020 China	To investigate the effects of social capital on sleep quality and the mechanisms involved in people who self-isolated during the COVID-19 epidemic.	Quantitative 2C	Anxiety, stress and altered sleep pattern Financial impact.
Wang Y⁽¹⁷17. Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med. 2020;30:1–10.⁾ 2020 China	To assess psychological states and related factors during the COVID-19 epidemic	Cohort 2B	Anxiety and depression Fear of contagion
Roy D⁽¹⁸18. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatry; 2020; 51:102083.⁾ 2020 India	To assess knowledge, attitude, anxiety and mental healthcare needs during the coronavirus pandemic.	Observational 2C	Anxiety, insomnia and paranoia Little knowledge about the disease, concern and fear due to the information published on social media.
Lei L⁽¹⁹19. Lei L, Huang X, Zhang S, Yang J, Yang L, Xu M. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020;26:e924609.⁾ 2020 China	Assess the prevalence and associated factors of anxiety and depression during the COVID-19 quarantine.	Observational 2C	High level of anxiety and depression Fear of contagion, low income and education, lack of psychological support and concern about being infected.
Yuan S⁽²⁰20. Yuan S, Liao Z, Huang H, Jiang B, Zhang X, Wang Y, et al. Comparison of the indicators of psychological stress in the population of hubei province and non-endemic provinces in china during two weeks during the coronavirus disease 2019 (COVID-19) outbreak in February 2020. Med Sci Monit. 2020;26:e923767.⁾ 2020 China	To compare the emotional state, somatic responses, sleep quality and behavior of people during social isolation	Observational 2C	Anxiety, poor sleep quality and stress.
Koolaee AK⁽²¹21. Koolaee AK. Living in home quarantine: analyzing psychological experiences of college students during Covid-19 pandemic. J Military Med. 2020;22(2):130–8.⁾ 2020 Iran	To analyze the psychological experiences of university students in domestic quarantine.	Qualitative 2C	Obsessive-compulsive behaviors and negative emotions. Fear of contamination, financial and social concerns and concert with family health.
Lee SM⁽²²22. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;87:123–7.⁾ 2018 South Korea	To assess the immediate stress and psychological impact experienced in quarantine during the Middle East Respiratory Syndrome (MERS).	Quantitative 2C	Symptoms of post-traumatic stress disorder. Fear of contamination and high mortality.
Kim HC⁽²³23. Kim HC, Yoo SY, Lee BH, Lee SH, Shin HS. Psychiatric findings in suspected and confirmed middle east respiratory syndrome patients quarantined in hospital: a retrospective chart analysis. Psychiatry Investig. 2018;15(4):355–60.⁾ 2018 South Korea	To assess psychiatric complications or risk factors for depression in patients quarantined with MERS.	Observational 2C	Depression and other psychiatric symptoms. Lack of knowledge about the disease and financial losses.
Jeong H⁽²⁴24. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38:e2016048.⁾ 2016 South Korea	To examine the prevalence of anxiety and anger symptoms in self-isolated people during the MERS epidemic	Quantitative 2C	Anxiety and anger Prolonged isolation, insufficient food supplies, financial losses, and a history of psychiatric illnesses.
Yoon MK⁽²⁵25. Yoon MK, Kim SY, Ko HS, Lee MS. System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. Int J Ment Health Syst. 2016;10(1):51.⁾ 2016 South Korea	To report the case of a proactive community-based intervention in South Korea.	Case report 4	Psychological difficulties and emotional instabilities. Prolonged quarantine.
Mihashi M⁽²⁶26. Mihashi M, Otsubo Y, Yinjuan X, Nagatomi K, Hoshiko M, Ishitake T. Predictive factors of psychological disorder development during recovery following SARS outbreak. Health Psychol. 2009;28(1):91–100.⁾ 2009 Japan	To investigate strategies for broad mass isolation during outbreaks of infectious diseases.	Quantitative 2C	Emotional instability Income reduction, eating restrictions, restriction of social life and clinical symptoms.
Hawryluck L⁽²⁷27. Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–12.⁾ 2004 Canada	To understand the psychological effects in people quarantined during recent SARS outbreaks.	Quantitative 2C	Symptoms of post-traumatic stress disorder. Long duration of the measure, little knowledge about the disease and direct exposure to someone with a diagnosis.
Robertson E⁽²⁸28. Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatry. 2004;49(6):403–7.⁾ 2004 Canada	To examine the psychosocial effects on health workers quarantined due to SARS.	Qualitative 2C	Fear and frustration Loss of intimacy and social contact, conflict resulting from simultaneous roles, fear of infecting vulnerable family members and friends.
Maunder R⁽²⁹29. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168(10):1245–51.⁾ 2003 Canada	To describe the psychological and occupational impact of the SARS outbreak in a large hospital in the first 4 weeks.	Observational 2C	Anxiety, insomnia, fear, loneliness, boredom and anger. Fear of spreading the disease to family and friends, presence of clinical symptoms, uncertainty and stigma.

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[1] Corresponding author Daniel de Macêdo Rocha, E-mail: daniel_m.rocha@outlook.com.br