When quarantines occur across a large population, policy options for public health departments or clinical providers are limited. However, when they occur in smaller outbreaks, it is theoretically possible to provide emotional support during isolation or mental health intervention on clinical follow-up following isolation. Our findings suggest that it would be prudent to add contact with a caseworker who can provide emotional support as an adjunct to routine contact tracing and quarantine verification activities.
Specifically, we find that a positive test result and self-isolation, particularly among those who believe that they are infected with COVID-19, is associated with a large increase in risk of clinical depression. Mental health assessment—which is typically conducted using a PHQ-2 screen—is therefore important on clinical follow-up. When resources are limited, clinical follow-up might be targeted to the highest risk group—those with a positive test result.
A number of behavioral techniques exist to manage quarantine in isolation. These range from medication or relaxation practices to providing more human interaction through video conferencing. Something as simple providing those in quarantine with a list of online resources for emotional support, human connection, and relaxation practices could plausibly help those facing quarantine (6). Another option would be to allow people to quarantine with pets if they are in countries that utilize quarantine centers (7).
Previous studies have found high rates of depression associated with experiences of quarantine and critical illness (8, 9). To the extent possible, those who test positive for COVID-19 should receive clinical follow up for mental health assessment, ideally while under self-isolation. Healthcare workers providing mental health assessment is a public health priority, especially during the COVID-19 pandemic. Our study identifies a unique population, those that test positive for COVID-19 and report being in isolation, that may benefit from critical mental healthcare.