The impact of self-isolation on psychological wellbeing and how to reduce it: a systematic review

Abstract

Self-isolation is a public health measure used to prevent the spread of infection, and which can have an impact on the psychological wellbeing of those going through it. It is likely that self-isolation will be used to contain future outbreaks of infectious disease. We synthesised evidence on the impact of home self-isolation on psychological wellbeing of the general public during the COVID-19 pandemic. This systematic review was registered on PROSPERO (CRD42022378140). We searched Medline, PsycINFO, Web of Science, Embase, and grey literature (01 January 2020 to 13 December 2022). Our definition of wellbeing included adverse mental health outcomes and adaptive wellbeing. Studies that investigated isolation in managed facilities, children, and healthcare workers were excluded. We followed PRISMA and synthesis without meta-analysis (SWiM) guidelines. We extracted data on the impact of self-isolation on wellbeing, and factors associated with and interventions targeting wellbeing during self-isolation. We included 36 studies (most were cross sectional, two were longitudinal cohort studies, three assessed interventions, and five were qualitative). The mode quality rating was high-risk. Depressive and anxiety symptoms were most investigated. Evidence for an impact of self-isolation on wellbeing was often inconsistent in quantitative studies, although qualitative studies consistently reported a negative impact on wellbeing. However, people with pre-existing mental and physical health needs consistently reported increased symptoms of mental ill health during self-isolation. Studies reported modifiable stressors that have been reported in previous infectious disease contexts, such as inadequate support, poor coping strategies, inadequate and conflicting information, and the importance of regular contact from trusted healthcare professionals. However, interventions targeting psychological wellbeing were rare and evaluative studies of these had high or very high risk of bias. When implementing self-isolation directives, public health officials should prioritise support for more vulnerable individuals who have pre-existing mental or physical health needs, lack support, or who are facing significant life stressors. Clinicians can play a key role in identifying and supporting those most at risk. Focus should be directed toward interventions that address loneliness, worries, and misinformation, whilst monitoring and identifying individuals in need of additional support.