Characteristics of the included articles
Among 1364 citations retrieved from searching the databases and additional sources, 771 unique records were screened after removing 593 duplicate records (Figure 1). At the end of full-text screening, a total of eight reviews were included in this umbrella review (Table 2) [32–39].
Table 2: Characteristics of the articles included in this review
Authors/ Sources
|
Name and timeframe of databases searched
|
Number and types of primary studies
|
Country or locations of the primary studies
|
Sample size and characteristics
|
Morgan et al. (2009)
[32]
|
MEDLINE,
PubMed, Google Scholar, and additional sources; 1970 -
2008
|
7 studies on mental health outcomes; 5
cohort studies, 2 cross-sectional and series interviews
|
Not specified
|
Sample size ranged from 8 to 43; participants in 7 selected studies; most (n =
6) studies recruited hospitalized patient populations, one study included both patients and providers
|
Abad et al. (2010)
[33]
|
MEDLINE and CINAHL; 1966 -
2009
|
8 cohort studies and 7 case-control studies
|
Not specified
|
Sample size ranged from 16 to 156; most studies had adult participants; two studies recruited children; samples were recruited from hospital wards
|
Barratt et al. (2011)
[34]
|
MEDLINE, CINAHL,
PsycINFO, and Cochrane Library Databases; 1990 -
2010
|
Studies were qualitative (n = 7), cohort (n = 7), cross- sectional (n = 6), case studies (n = 2), and
review (n = 1)
|
Most studies were from the UK (n = 6) followed by the US (n = 4), Hong Kong (n = 1), and Canada (n = 1)
|
Sample size ranged from 7 to 300; samples were recruited from different clinical settings
|
Gammon and Hunt (2018)
[35]
|
PubMed and Applied Social Sciences Index and Abstracts (ASSIA); 1990 -
2017
|
Not specified
|
Not specified
|
Sample size ranged from 13 to 41 among studies reporting sample sizes; participants were recruited from different hospital wards
|
Gammon et al. (2019)
[36]
|
MEDLINE and Applied Social Sciences Index and Abstracts (ASSIA); 1990 -
2017
|
14; only one study was cohort-based; most studies were cross-sectional, and 10 studies had qualitative design
|
Most studies were from the UK (n = 6), followed by the US (n = 2), Sweden (n = 2), and one study each from the Netherlands, New Zealand, Ireland, and Brazil
|
Sample size ranged from 1 to 528; most studies recruited patients and providers from clinical settings, whereas two samples included nursing students
|
Brooks et al. (2020)
[37]
|
MEDLINE,
PsycINFO, Web of Science; timeframe not specified
|
25; Cross sectional (n
= 11), qualitative (n = 7), longitudinal (n = 1), observational (n = 2), mixed methods (n
= 3), psychological evaluation (n = 1)
|
Most studies were conducted in Canada (n = 8) and China (n = 4); two studies each from Taiwan, Australia, South Korea, and Liberia; one study each from Sierra Leone, Senegal, Hong Kong, and Sweden; one study has participants
both from the US and Canada
|
Sample size ranged from 10 to 6231; diverse samples including patients, providers, students, institutional stakeholders, and community members were recruited
|
Purssell et al. (2020)
[38]
|
Embase, MEDLINE, and
PsycINFO; from the inception of the databases till December, 2018
|
26; cohort (n = 12), case-control (n = 6), cross sectional (n = 4), and quasi- experimental (n = 2) studies
|
Most studies were from the US (n = 14), followed by the UK (n = 3), Canada (n = 3), and one study each from Spain, Turkey, Netherlands, Singapore, France, and one study had participants both
from the US and Canada
|
Sample size ranged from 14 to 9684; patients were recruited from diverse clinical settings
|
Sharma et al. (2020)
[39]
|
Embase, PubMed, and Google Scholar; studies published till March, 2019
|
7; cohort (n = 4), quasi- experimental (n = 2), not specified (n = 1)
|
Not specified
|
Sample size ranged from 16 to 148; participants were recruited from diverse clinical settings
|
Table 3: Different conditions of quarantine/isolation and associated mental health outcomes
Authors/ Sources
|
Type and reasons for quarantine, isolation or other measures to infection prevention
|
Mental health impacts
|
Morgan et al. (2009)
[32]
|
Contact precaution; Multiple Drug Resistant Organisms (MDROs)
|
Patients expressed feeling neglected, isolated, angry (p < .037), depression (up to 77%, p value ranged from < .01 to < .001), anxiety (p < .001), low self-esteem (p < .005), perception of less control (p <
.001); less patient-provider contact was reported
|
Abad et al. (2010)
[33]
|
Isolation; multiple infectious conditions including VRE, MRSA, HAI, MDRO, SARS, and mixed infections
|
Most studies reported higher scores from 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 lesser
time with isolated patients compared to the controls
|
Barratt et al. (2011)
[34]
|
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, negative emotions
|
Gammon and Hunt (2018)
[35]
|
Source isolation; MRSA, TB, and other non- specified infections
|
Participants experienced limited visiting, lack of attention and lesser interaction with providers, and disruption of routine. Also, 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. Moreover, studies have found many
psychosocial issues were attributable to the primary cause(s) of hospitalization
|
Gammon et al. (2019)
[36]
|
Source isolation; MRSA and other non- specified infectious conditions
|
Patients reported a lack of control and feeling lonely in isolation, which lead 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’. Also, patients reported suboptimal patient-provider communication, lack of understanding facial expression due to masks, and procedures which provoked anxiety and stresses of isolation
|
Brooks et al. (2020)
[37]
|
Quarantine; SARS (n = 15), Ebola (n = 5), H1N1 influenza (n = 3), MERS (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 crowd 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). Also, the healthcare providers 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 after 3 years of quarantine period
|
Purssell et al. (2020)
[38]
|
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)
[39]
|
Isolation precaution; MRSA, MDROs, and other infections
|
The pooled mean difference estimates for Hospital Anxiety and Depression Scales (HADS)-A was - 1.4 (p = .15) and that for HADS-D was - 1.85 (p = .09) for anxiety and depression, respectively. Most studies (n = 6) reported negative effects in psychological burden scales in the empirical analysis
|
These reviews have been published between 2009 and 2020, whereas most (number of reviews, n = 5) reviews were published since 2018. These reviews used different scholarly sources ranging from 2 to 4 databases. The number of primary studies in those reviews, which ranged from 7 to 26. Most reviews included cohort studies (n = 6; number/range of primary studies in each review, s = 1 to 12), followed by cross-sectional studies ( n = 5, s = 2 to 11), qualitative studies (n = 3, s = 2 to 10), case-control studies (n = 1, s = 6), quasi-experimental studies (n = 2, s = 2), case studies (n = 1, s = 2), mixed method studies (n = 1, s = 2), reviews (n = 1, s = 1), and psychological evaluation (n = 1, s = 1). In quality assessment (Appendix 1), three reviews were found to have high quality [36,38,39], whereas most (n = 5) studies had a medium quality [32–35,37].
Characteristics of the study populations
The reviews had included primary studies ranging from case studies with one sample to larger samples like 9,648. Three reviews did not specify the origin of the primary studies [32,33,35]; among the remaining reviews, most of the primary studies were from the US, UK, and Canada, whereas fewer studies were conducted in Sweden, Australia, Netherlands, South Korea, Senegal, New Zealand, Ireland, Brazil, Liberia, Turkey, France, Spain, Sierra Leone, Hong Kong, Taiwan, China, and Singapore [34,36–39]. Most reviews recruited primary studies conducted in healthcare settings. For example, Gammon and colleagues reviewed 14 studies with samples ranging from 1 to 528 [36], whereas Purssell and colleagues reviewed 26 studies with samples ranging from 14 to 9,648 [38]. Both reviews evaluated studies that recruited participants from clinical settings, including healthcare providers and clinical students. In contrast, a review by Brooks and colleagues included studies that recruited participants, including patients, providers, students, institutional stakeholders, and community members from diverse settings [37].
Infectious diseases or conditions for quarantine and isolation
Different types of measures for infection prevention and associated causes were reported across reviews (Table 3). Abad and colleagues evaluated studies focusing on isolation [33], whereas three studies specified source isolation across the primary studies [34–36]. Moreover, three reviews focused on contact precaution or isolation [32,38,39]. One study by Brooks and colleagues emphasized on primary studies conducted on quarantine [37].
Several infectious agents or conditions were found to be associated with quarantine or isolation across the study populations. Methicillin-resistant Staphylococcus aureus (MRSA) was the most commonly reported (number of reviews, n =6) reason for isolating the patients [33–36,38,39]. Moreover, four reviews reported Multi-drug resistant organisms (MDRO) as the primary reason for isolation [32,33,38,39]. Several reviews reported Severe acute respiratory syndrome (SARS) (n = 3) and Vancomycin-resistant Enterococcus (VRE) (n = 2) as reasons for isolation [33,34,37]. Other infectious agents or conditions associated with isolation or quarantine included Healthcare- associated infections (HAI), tuberculosis, Ebola, H1N1 influenza, equine influenza, and Middle East Respiratory Syndrome (MERS) [33,35,37].
Mental health outcomes of quarantine and isolation
Reviews reported a high burden of mental health conditions among individuals who experienced isolation or quarantine [36,37,39]. For example, Gammon and colleagues found 33% of the participants who had undergone source isolation had poor mental health status [36]. Among specific mental health outcomes, all reviews reported a high prevalence of anxiety among study participants [32–39]. For example, Purssell and colleagues found the pooled standardized mean difference for anxiety was 1.45 (95% CI 0.56 to 2.34) among participants who experienced contact precaution and isolation [38].
Six reviews reported varying levels of depression among the study participants [33–35,37–39]. For example, Sharma and colleagues found the pooled mean difference estimates for Hospital Anxiety and Depression Scale (HADS-D) AS -1.85 (p = .09) [39], whereas Purssell and colleagues found the pooled mean difference as 1.28 (95% CI 0.47 to 2.09) for depression among the study participants [38]. Four reviews reported anger and irritability among the study participants [32– 34,37]. For example, a review found up to 57% of the participants reported irritability alongside other mental conditions following the quarantine [37]. Psychological distress associated with suboptimal patient-provider communication was reported in four reviews [32,33,35,36]. Moreover, four reviews found varying levels of stress among the study participants who experienced quarantine or isolation [34–37].
Several psychosocial conditions affected the mental health and wellbeing of the individuals during and after quarantine or isolation. Three reviews found the participants perceived social exclusion or felt neglected [32,34,35]. Often, psychological and emotional disturbances were reported by the affected individuals, as found in three reviews [34,35,37]. Stigmatization was reported in three reviews, which impacted the mental health and wellbeing among the study participants [34–36]. For example, Gammon and colleagues found 32% of MRSA carriers reported stigma, among which 14% of the participants reported ‘clear stigma’ and 42% reported ‘suggestive for stigma’ [36].
Quarantine and isolation for infection prevention also impacted the mental health and wellbeing among healthcare providers [36,37]. For example, Brooks and colleagues found several mental health conditions among the healthcare providers who worked under quarantine, which included 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 after three years of quarantine period [37]. Moreover, the mental health of informal caregivers was affected due to quarantine and isolation. Brooks and colleagues reported 28% of parents of children who were quarantined had trauma-related mental disorders, which was higher than comparison parents who had a prevalence of 6% for the same condition [37].
Several other mental disorders and psychological conditions were found across study populations, which included low self-esteem [32,33,35], mood disorders [35,37], fear [33,37], guilt [37],
loneliness [33–36], boredom [33,34], feeling a lack of control [34–36], insomnia [37], posttraumatic stress disorders [37], perceived dirtiness [35], vigilant handwashing [37], and avoiding crowds and social gatherings even after quarantine or isolation [37]. One study in the review by Abad and colleagues reported a few participants acknowledged privacy and freedom during isolation, whereas remaining studies reported higher scores from depression, anxiety, anger-hostility, fear, loneliness, boredom, and low self-esteem [33].