|Ahead of print publication
Impact of quarantine on lifestyle and psychological state of people during the COVID-19 pandemic
Mithun Sharma1, Vivek Anand1, Vijay Bhaskar1, Arun Kumar Yadav1, Surinder Kumar2, Swati Bajaj1
1 Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 DADH Amritsar, India
|Date of Submission||22-Mar-2021|
|Date of Decision||10-May-2021|
|Date of Acceptance||17-Nov-2021|
Department of Community Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Objectives: The objective of the study was to assess impact of quarantine on lifestyle behavior and the psychological state of persons during the COVID-19 pandemic. Study Design: This study was a cross-sectional study. Methods: A questionnaire-based cross-sectional study was conducted among 216 persons quarantined during the COVID-19 pandemic at home or in selected facilities set up by various tertiary care hospitals and administrative authorities in various parts of India. The questionnaire was distributed among participants using electronic media. Psychological state during quarantine was assessed using the DASS 21 questionnaire. Results: Out of 57.4% of responders who gave a history of physical exercise before quarantine, 52.7% reported a reduction in physical activity. 18.5% of study participants brought about dietary changes towards healthy diet during quarantine, while 24.5% took up some new activities or hobbies. 62.9% of respondents reported any degree of psychological stress (depression, stress, or anxiety) during the quarantine. Conclusions: Quarantine impacted psychological state of individuals and brought about changes in lifestyle with both positive attributes such as dietary modification toward healthy diet or negative attributes such as reduction in physical activity. IEC activities have a positive impact in terms of reducing negative attributes and increasing the compliance toward quarantine.
Keywords: Compliance, COVID-19, lifestyle changes, psychological state, quarantine
|How to cite this URL:|
Sharma M, Anand V, Bhaskar V, Yadav AK, Kumar S, Bajaj S. Impact of quarantine on lifestyle and psychological state of people during the COVID-19 pandemic. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=337070
| Introduction|| |
Quarantine is the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, reducing the risk of them infecting others. Quarantine was used for the first time in Italy in the 12th century to leprosy and again in Italy during the black death outbreak in the 14th century. In the 17th century, it was used in the UK during the plague outbreak. In the recent past, many people have been placed in quarantine during the SARS outbreak of 2003 and the Ebola outbreak of 2014. The current COVID-19 pandemic has witnessed a large number of people being quarantined across countries to contain the spread of this disease, perhaps the most the world has ever seen.
The quarantine can be difficult because of various factors like separation from family (for those not quarantined at home) or inability to go for work, leading to financial burden. Some may see it as a loss of freedom because of the restrictions imposed. These factors can adversely affect the psychological state of an individual undergoing quarantine., Fear of getting infected and the stigma surrounding quarantine also influence the psychological state adversely during quarantine., On the other hand, the quarantine time may move individuals to pursue their long-lost hobbies or inculcate a feeling to learn or do something novel and productive. For those quarantined at home, it may provide them with quality time to spend with family. However, available literature is sparse about the impact of quarantine in India.
Time in the quarantine may also impact the lifestyle among those quarantined. Although there is lack of evidence available on the effects of quarantine on lifestyle changes, studies on people in home isolation during lockdown suggest that people tend to adopt unfavorable changes in terms of diet and physical activity when confined to home.,
These factors may impact individuals' compliance toward quarantine and the overall success of quarantine in slowing the spread of COVID19. Educating the people undergoing quarantine about various facets of disease and its mode of spread can go a long way in ensuring quarantine's overall success.
Hence, we conducted a study to assess the impact of quarantine on the lives of people in terms of changes in lifestyle, psychological state during quarantine, their compliance toward quarantine and role of IEC activities in increasing their compliance, and reducing fear and stigma related to quarantine.
| Methods|| |
A questionnaire-based cross-sectional study was conducted among persons quarantined during the COVID-19 pandemic, either due to recent travel history or as contacts of positive cases, at home or in selected facilities set up by various tertiary care hospitals and administrative authorities in various parts of India. Data was collected for 4 months, and a total of 216 participants consented to the study in this period. All individuals who reported to the selected facilities and advised quarantine for 14 days (at facility or home) were included in the study.
The questionnaire was distributed among participants using electronic media. It covered aspects of lifestyle change, the psychological state during quarantine, compliance, risk perception, and stigma towards quarantine.
Individuals who were engaging for at least 30 min of physical activity, including Yoga (not including daily household chores) for at least 5 days a week were taken as positive for physical activity. Those consuming alcohol in any quantity for at least once a week and those smoking at least 1 cigarette per day were taken as positives for respective habits. Increase in fruits and/or vegetables consumption or decrease in the consumption of junk food during quarantine was taken as dietary modification towards a healthy diet. In contrast, increased intake of processed or junk or oily food during quarantine was taken as dietary modification toward an unhealthy diet. Taking up any hobby which the people were not pursuing for the last 3 years including physical activity for those who were not doing it before or learning a new skill was taken as taking up a new skill/hobby.
Psychological state during quarantine was assessed using the DASS 21 questionnaire. The DASS-21 is a set of three self-report scales designed to measure the emotional states of depression, anxiety, and stress. Each of the three scales contains seven items divided into subscales with similar content. People with any degree of depression, anxiety, or stress (or combination of any of these) present were taken as positives for the presence of psychological stress. Questions such as regular thought of acquiring the disease at any point during quarantine, risk/fear due to death/sickness of colleagues/known after exposure to COVID-19, or isolation from family and friends and feeling of getting ignored by friends or family were used to assess the risk perception and stigma related to quarantine, respectively. Compliance was assessed in terms of willingness to complete the full duration of quarantine and perceiving quarantine as an essential tool to stop the spread of the disease.
IEC activities were carried out for people on 1st day for all and then regular follow-up activities for those quarantined at the facility by lectures and distribution of educational pamphlets and by means of electronic media for those quarantined at home. Educating about the basics of disease in terms of symptoms, its mode of prevention, and how to stop its spread were the core elements covered under these activities. The study participants were also assessed about risk perception, stigma and compliance towards quarantine following completion of IEC activities.
Data were entered in MS Excel and analyzed in IBM Statistical Package for Social Sciences version 23 (SPSS, IBM, Chicago, IL, USA) using appropriate statistical tools. The P = 0.05 was taken as significant. Ethical clearance was obtained from the institutional ethics committee letter number IEC/2020 dt 27 Nov 2020.
| Results|| |
The study conducted among 216 participants with distribution as per age, sex, socioeconomic status, marital status, profession, and current residence is listed in [Table 1] along with location and reason for quarantine. Out of 57.4% of responders who gave a history of physical exercise before quarantine, 52.7% reported a reduction in physical activity. Interestingly, 52.6% of smokers reported cutting down on smoking, while 49.2% of participants who consumed alcohol had a reduction in alcohol consumption. Nearly 18.5% of study participants brought about dietary changes toward healthy diet during quarantine, whereas 24.5% took up some new activities or hobbies [Table 2]. Physical activity and alcohol intake were significantly reduced in facility-based quarantine, and dietary modification towards a healthy diet was increased considerably in home-quarantined individuals.
|Table 2: Comparison of lifestyle changes, psychological state and change in compliance and perceived risk and stigma with sex, profession, place and reason for quarantine (n=216)|
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Furthermore, 62.9% of respondents reported any degree of psychological stress (depression, stress, or anxiety) during the quarantine. It was significantly higher in those quarantined at the facility (76.3%) than those at home (31.2%). Nearly 72.6% of the respondents had higher risk perception with frequent thought of getting infected during quarantine, whereas 24.5% felt stigma attached to being quarantined, which reduced to 57.9% and 18%, respectively, following assessment after completion of IEC activities with the maximum reduction being found among women and minimum among doctors. Approximately 75% of respondents were willing to complete the entire duration of quarantine and 68.9% thought of quarantine as a useful tool to reduce the spread of disease which improved to 93% and 87.5%, respectively, following IEC activities with a maximum increase found among nonmedicos and minimum among doctors.
| Discussion|| |
This study presents the data from an online survey from various parts of India, assessing changes in lifestyle and psychological state during home and facility-based quarantine as a result of COVID 19. Our study's findings in terms of reduction of physical activity were consistent with the findings of studies by Ammar et al. and Castañeda-Babarro et al. assuming restrictions and home confinement to be similar to home quarantine. A similar reduction during COVID pandemic was also observed in a community-based cross-sectional study was done in Kuwait by Husain W and Ashkanani F. The reduction in physical activity in this study may be due to participants' engagement in activities such as running/jogging in the park or going to the gym that they couldn't continue after being quarantined due to space constraints or lack of equipment. Another reason could be people thinking about it as a temporary arrangement and resuming physical activity once released from quarantine. The study also revealed that this reduction is even more in people quarantined at the facility, which could be because of more restrictions and space constraints at the facility as compared to home. However, we did find 14.3% of study participants with no history of doing regular physical exercise before took up regular physical activity as part of starting a new skill/activity using mobile-based applications. Interestingly, a study by Ding et al. showed a surge in online searches for home-based exercises during the lockdown period; however, with overall reduction in proportion of physical activity, it did not translate to action in this study among those quarantined or in studies, among people confined to home.
A study done by Chodkiewicz et al. in July 2020 among 443 individuals on alcohol consumption during the COVID 19 pandemic in Poland reported 30% of participants with change in drinking habit pattern during lockdown with 14% consuming more, while 16% consuming less while this study reported 20% change in drinking habit pattern with 4% consuming more and 16% consuming less during quarantine. Similar reduction in alcohol consumption found by Ammar et al. and Scarmozzino and Visioli is consistent with our study, with greater reduction among those at the facility as compared to home. It is difficult to ascertain whether this reduction in alcohol consumption was voluntary or due to restrictions imposed.
A total of 18.5% of study participants reported modified diet patterns toward healthy diet by increasing consumption of fruits and vegetables, almost similar (21%) to that found in the study by Scarmozzino and Visioli. The study also reported 23.5% increase in consumption of junk food and processed food in contrast to just 3.2% in our study. It may be because the majority of people in our study were quarantined at the facility where they got food as per fixed menu and there was little scope for them consuming outside food which is evident from the fact that a significantly higher number of people increased junk food consumption in our study at home than those at the facility.
The psychological state during quarantine in this study assessed using DASS 21 scale reported 62.9% of individuals with any degree of psychological stress in terms of depression, stress, or anxiety. Many studies have shown similar findings highlighting the negative effect of quarantine on psychological state.,, The psychological impact in this study is less than what was found by Mazza et al. in Italian population where on an average 73% people experienced psychological stress which may be due to a significant number of female participants (71.6%) as compared to the present study (16.7%) and also Italy was facing the worst phase of the pandemic at the time of the study. Various previous studies, in the past have reported an association between female gender and increased psychological stress. The study also revealed significantly low psychological stress among those present in home quarantine as compared to facility quarantine, which may be due to the positive influence of living with family and friends during quarantine compared to living alone or with strangers in the facility.
Overall compliance toward quarantine was found high in our study as 75% of people wanted to complete the entire duration of quarantine at the beginning and 72% of people perceived risk of getting infected during quarantine, and 24% felt stigmatized during quarantine. Cava et al. reported that during the SARS outbreak, compliance toward quarantine was more in people with high risk perception, while Person et al. reported that stigma among people during SARS outbreak had adverse impact on compliance of people toward following general measures advised by authorities to slow the spread of infectious diseases, for example, early reporting of disease. This can also hold true for people in quarantine as stigma among them may lead to nonreporting of any symptoms, potentially leading to outbreaks among quarantined people specially those at the facility making quarantine ineffective. We found risk perception in our study to be significantly more in contacts similar to that found by Cava et al. A new finding revealed in our study was that it was significantly more among those at the facility. This could be another reason for the increased psychological stress found among them. Stigma was also perceived by a significantly higher number of contacts as compared to those with a history of travel. A relatively large percentage (69%) of people at the start of our study perceived quarantine as important to stop the spread of disease which could be because of the general awareness created about COVID-19 by the government through mass media, electronic media, etc. Overall, risk perception and stigma decreased, and compliance towards quarantine increased among people toward the end of quarantine which could be because of the IEC activities carried out during quarantine, and this change was more among those at facility.
There are some limitations in the present study. First, a causal association could not be assessed of depression, anxiety and stress or lifestyle behaviours with the quarantine during pandemic. Second, online recruitment of study subjects is prone to selection bias. Furthermore, a significant number of study participants were health-care workers or those working with hospital which can affect the study outcome.
| Conclusions|| |
The findings of the study suggest that quarantine brought about changes in lifestyle behavior and psychological state, but further research is needed to ascertain whether these changes were for short term or had long-term impact as well. The study also reported increased vulnerability toward the negative attributes during quarantine among groups such as those quarantined at the facility and contacts of confirmed cases. It is also suggested that IEC activities have a positive impact in terms of reducing risk perception and stigma and increasing the compliance toward quarantine which will make quarantine more effective to serve its intended purpose.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rosen G. A History of Public Health. New York: M.D. Publications; 1958. p. 68.
Newman KL. Shutt up: Bubonic plague and quarantine in early modern England. J Soc Hist 2012;45:809-34.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al
. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.
Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep 2015;9:547-53.
Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al
. The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry 2009;54:302-11.
Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, et al
. A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: Immediate psychological responses and associated factors. Int J Environ Res Public Health 2020;17:3165.
Cava MA, Fay KE, Beanlands HJ, McCay EA, Wignall R. Risk perception and compliance with quarantine during the SARS outbreak. J Nurs Scholarsh 2005;37:343-7.
Person B, Sy F, Holton K, Govert B, Liang A; National Center for Inectious Diseases/SARS Community Outreach Team. Fear and stigma: The epidemic within the SARS outbreak. Emerg Infect Dis 2004;10:358-63.
Ammar A, Brach M, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, et al
. Effects of COVID-19 home confinement on eating behaviour and physical activity: Results of the ECLB-COVID19 international online survey. Nutrients 2020;12:1583.
Scarmozzino F, Visioli F. COVID-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample. Foods 2020;9:675.
Bauerle Bass S, Burt Ruzek S, Ward L, Gordon TF, Hanlon A, Hausman AJ, et al
. If you ask them, will they come? Predictors of quarantine compliance during a hypothetical avian influenza pandemic: Results from a statewide survey. Disaster Med Public Health Prep 2010;4:135-44.
Castañeda-Babarro A, Arbillaga-Etxarri A, Gutiérrez-Santamaría B, Coca A. Physical activity change during COVID-19 confinement. Int J Environ Res Public Health 2020;17:6878.
Husain W, Ashkanani F. Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: A community-based cross-sectional study. Environ Health Prev Med 2020;25:61.
Ding D, Del Pozo Cruz B, Green MA, Bauman AE. Is the COVID-19 lockdown nudging people to be more active: A big data analysis. Br J Sports Med 2020;54:1183-4.
Chodkiewicz J, Talarowska M, Miniszewska J, Nawrocka N, Bilinski P. Alcohol consumption reported during the COVID-19 pandemic: The initial stage. Int J Environ Res Public Health 2020;17:4677.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al
. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:1729.
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr 2020;33:e100213.
[Table 1], [Table 2]