SARS control and psychological effects of quarantine, Toronto, Canada
Open accessAbstract
As a transmissible infectious disease, severe acute respiratory syndrome (SARS) was successfully contained globally by instituting widespread quarantine measures. Although these measures were successful in terminating the outbreak in all areas of the world, the adverse effects of quarantine have not previously been determined in a systematic manner. In this hypothesis-generating study supported by a convenience sample drawn in close temporal proximity to the period of quarantine, we examined the psychological effects of quarantine on persons in Toronto, Canada. The 129 quarantined persons who responded to a Web-based survey exhibited a high prevalence of psychological distress. Symptoms of posttraumatic stress disorder (PTSD) and depression were observed in 28.9% and 31.2% of respondents, respectively. Longer durations of quarantine were associated with an increased prevalence of PTSD symptoms. Acquaintance with or direct exposure to someone with a diagnosis of SARS was also associated with PTSD and depressive symptoms.
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Social distancing was previously proven to trigger negative mental health consequences, including intensified anxiety and depression.
“Moreover, social distancing was previously proven to trigger negative mental health consequences, including intensified anxiety and depression38,39.”
From Mindfulness-based online intervention increases well-being and decreases stress after Covid-19 lockdown (2022) · cites this paper as [38]
The Discussion reports that quarantine can result in psychological distress, including depressive symptoms, and the Results describe anxiety among some respondents. But this study of people quarantined during SARS does not prove that social distancing generally causes increased anxiety and depression; the authors describe their findings as hypotheses requiring further exploration. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSocial distancing has been proven to trigger negative mental health consequences, including intensified anxiety and depression and/or apathy and hypersensitivity, and can exacerbate mental illness.
“social distancing has been proven to trigger negative mental health consequences, including intensified anxiety and depression [9,10] and/or apathy and hypersensitivity; it is especially worrisome that it can also exacerbate mental illness [11,12].”
From Examining the associations between psychological flexibility, mindfulness, psychosomatic functioning, and anxiety during the covid-19 pandemic: A path analysis (2020) · cites this paper as [9]
The Discussion (page unavailable) reports PTSD and depressive symptoms among people quarantined during the Toronto SARS outbreak; the Results also describe anxiety associated with quarantine measures. The study does not prove that social distancing causes these outcomes, and it does not establish apathy, hypersensitivity, or exacerbation of pre-existing mental illness. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDuring 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 [65]
The Results (Psychological Impact of Quarantine) report PTSD and depressive symptoms among people quarantined during SARS, and the Discussion identifies PTSD as an anxiety disorder. The paper does not address Ebola or MERS, so it supports the SARS portion of the cited statement, not the claim across all three epidemics. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrevious reports have documented high levels of anxiety and depression among SARS survivors (35%), quarantined individuals (31%), and nurses (38.5%).
“This is in agreement with previous reports which have also documented high levels of anxiety, depression amongst survivors of SARS (35%) [35], quarantined individuals (31%) [36], and nurses (38.5%) [34].”
From Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease (2010) · cites this paper as [36]
Studies 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 [6]
Similar mental health effects were seen in past containment efforts during SARS in 2003, the 2009 swine flu pandemic, and the 2014-2016 Ebola epidemic.
“similar mental health effects were seen in past containment efforts during infectious disease outbreaks, such as the severe acute respiratory syndrome (SARS) in 2003 [2, 3], the 2009 swine flu pandemic [4, 5], and the 2014–2016 Ebola epidemic [6].”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [3]
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 [27]
The result on PTSD and depression from Hawryluck et al. was prone to reporting bias as the survey response rate was <1%.
“Nevertheless, this result was prone to reporting bias as the survey response rate was <1%27; confirmation of psychiatric disorders required further clinical diagnosis, on which data were not available.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [27]
Hawryluck et al. reported that around one-third of respondents suffered from symptoms of post-traumatic stress disorder and depression (28.9% and 31.2%, respectively).
“Hawryluck et al.27 reported that around one-third of respondents suffered from symptoms of post-traumatic stress disorder and depression (28.9% and 31.2%, respectively).”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [27]
Mass quarantine-induced mobility restrictions impacted every step of the food supply chain, including production, transportation, access and storage.
“Mass quarantine-induced mobility restrictions impacted every step of the food supply chain, including production,29 transportation,24,29,30 access22–24,27,29,31,34 and storage.23,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [27]
Participants from three studies of the SARS outbreak in Toronto stressed that authorities did not provide clear and consistent messages on why, how and how long to enact quarantine, and that they were unable to contact designated public health staff.
“Participants from three studies of the SARS outbreak in Toronto stressed that authorities did not provide clear and consistent messages on why, how and, how long to enact quarantine, and that they were unable to contact designated public health staff.23,25,27”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [27]
Identifying trustworthy information became challenging for the public due to diverse and unverified sources as well as heightened uncertainty during disease outbreaks.
“In addition, identifying trustworthy information became challenging for the public due to diverse and unverified sources as well as heightened uncertainty during disease outbreaks.23,25,27”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [27]
Communication inequalities are often compounded by poor information governance across authorities during outbreaks, such as non-justified decision-making, inconsistent instructions and non-synchronized implementation of mass quarantine.
“Often, communication inequalities are compounded by poor information governance across authorities during outbreaks, such as non-justified decision-making, inconsistent instructions and non-synchronized implementation of mass quarantine.23,25,27,51”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [27]
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- Authors
- Hawryluck, L., Gold, W. L., Robinson, S., Pogorski, S., Galea, S., & Styra, R.
- Affiliations
- New York Academy of Medicine (US)
- ASK Information Technologies, Toronto, Ontario, Canada;
- Corresponding author
- Styra, Rima
- Venue
- Emerging Infectious Diseases
- Published
- 2004-07
- Volume
- 10
- Issue
- 7
- Pages
- 1206-1212
- ISSN
- 1080-6040 (ISSN-L)
- 1080-6059
- PMC
- PMC3323345
- OpenAlex
- W2170812681
- Cited by
- 1,929
- References
- 23
- Citations by year
- 2026: 10 · 2025: 46 · 2024: 75 · 2023: 183 · 2022: 358 · 2021: 645 · 2020: 512 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 5 · 2015: 5 · 2014: 2 · 2013: 4 · 2012: 4
- FWCI
- 15.58
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Emerging infectious diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion, public-domain)
- Funders
- University Health Network
- University of Toronto
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- SARS, quarantine, psychological distress, post-traumatic stress disorder, depression, quarantine duration
- MeSH terms
- Adolescent, Adult, Aged, Canada, Communicable Disease Control, Depression, Disease Outbreaks, Humans, Health Knowledge, Attitudes, Practice, Middle Aged, Quarantine, Stress Disorders, Post-Traumatic, Communicable Diseases, Emerging, Severe Acute Respiratory Syndrome, Severe acute respiratory syndrome-related coronavirus
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