Understanding, compliance and psychological impact of the SARS quarantine experience
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SUMMARY: This study examines a cohort of persons quarantined during the 2003 SARS outbreak in Canada and describes their understanding of, difficulties and compliance with, and the psychological impact of the quarantine experience. A mailed questionnaire was administered to 1912 eligible adults and included the Impact of Events Scale – Revised (IES-R) to assess symptoms of post-traumatic stress disorder (PTSD). Self-reported compliance with all required quarantine measures was low (15·8±2·3%), although significantly higher when the rationale for quarantine was understood (P=0·018). Health-care workers (HCW) experienced greater psychological distress, including symptoms of PTSD (P<0·001). Increasing perceived difficulty with compliance, HCW, longer quarantine and compliance with quarantine requirements were significant contributors to higher IES-R scores. The low compliance with quarantine requirements introduces concerns about the effectiveness of quarantine as a public health measure. Improvements in compliance and reduced psychological distress may be possible by minimizing duration, revising requirements, and providing enhanced education and support.
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During the SARS, Ebola and MERS epidemics, higher levels of psychopathology were reported, especially in anxiety and stress-related disorders.
“During the Severe Acute Respiratory Syndrome (SARS) epidemic in early 2000, to Ebola and the Middle East Respiratory Syndrome (MERS), in which quarantine was one of the essential public health measures to break the transmission, higher levels of psychopathology were also reported, especially in anxiety and stress-related disorders [65,66,67].”
From Relationships between psychopathology, psychological process variables, and sociodemographic variables and comparison of quarantined and non-quarantined groups of malaysian university students in the covid-19 pandemic (2021) · cites this paper as [66]
The Abstract and Discussion (page numbers unavailable) report psychological distress, worry, nervousness, and PTSD symptoms among adults quarantined during the 2003 SARS outbreak. The paper does not establish elevated rates of diagnosed anxiety or stress-related disorders, and its findings concern SARS quarantine rather than the Ebola or MERS epidemics. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStudies of the SARS epidemic found that people who had to quarantine had more symptoms of depression and post-traumatic stress disorder.
“These findings echo those from studies of previous epidemics such as the epidemic of severe acute respiratory syndrome (SARS), during which individuals who had to quarantine experienced increases in symptoms of depression and post-traumatic stress disorder.6, 7, 8, 9”
From Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study (2021) · cites this paper as [7]
Eleven articles highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.
“Eleven articles from various geographical and disease contexts highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.22–25,27–32,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
People in or after quarantine experienced emotional distress including annoyance, anxiety, boredom, disappointment, life dissatisfaction, fear of infection, isolation, loneliness and mistrust.
“Among people in or after quarantine, some experienced emotional distress, including: annoyance,32 anxiety,25,29 boredom,23,25,32 disappointment and life dissatisfaction,24,32,35 fear of infection,23,25,30,34 isolation,23,25,32 loneliness25,32 and mistrust.31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
Female and older (>65 years old) respondents were more likely to accept the use of mass quarantine.
“and that female and older (>65 years old) respondents were more likely to accept the use of mass quarantine.32,33”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
Nine studies stressed how mass quarantine aggravated inequalities in individuals' access to, understanding of, and actions on prevention and control of infections.
“Nine studies stressed how mass quarantine aggravated inequalities in individuals’ access to, understanding of, and actions on prevention and control of infections.21,23–26,31–34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
Being health care workers was predictive of correct knowledge of quarantine.
“Two studies of SARS confinement reported that being health care workers was predictive of correct knowledge of quarantine”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
The review found negative psychological impacts of mass quarantine, such as low life satisfaction, emotional isolation and fear of infection.
“Consistent with previous studies,10,36,37 our review presents a range of negative psychological impacts of mass quarantine, such as low life satisfaction, emotional isolation and fear of infection.23–25,30,32,34,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
In two studies of the SARS outbreak in Toronto, Canada, 10.0-25.7% of surveyed respondents experienced reduced or no payment due to missing work.
“In two studies of the SARS outbreak in Toronto, Canada, 10.0–25.7% of surveyed respondents experienced reduced or no payment due to missing work.22,32”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [32]
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- Authors
- REYNOLDS, D. L., GARAY, J. R., DEAMOND, S. L., MORAN, M. K., GOLD, W., & STYRA, R.
- Affiliations
- University of Toronto (CA)
- Durham Region Health Department (CA)
- University Health Network (CA)
- Corresponding author
- REYNOLDS, D. L.
- Venue
- Epidemiology and Infection
- Publisher
- Cambridge University Press (CUP)
- Published
- 2007-07-30
- Volume
- 136
- Issue
- 7
- Pages
- 997-1007
- ISSN
- 0950-2688 (ISSN-L)
- 1469-4409
- PMC
- PMC2870884
- OpenAlex
- W1986605986
- Cited by
- 895
- References
- 17
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 28 · 2023: 90 · 2022: 181 · 2021: 295 · 2020: 261 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 4
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epidemiology and Infection (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- SARS, quarantine, quarantine compliance, post-traumatic stress disorder, psychological distress, healthcare workers, public health measures, quarantine duration
- MeSH terms
- Adult, Aged, Aged, 80 and over, Canada, Disease Outbreaks, Female, Health Personnel, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Patient Compliance, Quarantine, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Cohort Studies, Disease Transmission, Infectious, Comprehension, Severe Acute Respiratory Syndrome
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