The Impact of Self-Isolation on Psychological Wellbeing and How to Reduce It: a Systematic Review

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. ### Competing Interest Statement LES, RA, and GJR were participants of the UK Scientific Advisory Group for Emergencies or its subgroups. GJR advised the UK Office for National Statistics on its work relating self isolation, papers relating to this work were considered as part of the review. All authors co-authored papers that were considered during the review process. RA is an employee of the UK Health Security Agency. AFM, SKB, RD, MVS, and NG report no competing interests. ### Funding Statement This study was funded by the Research England Policy Support Fund 2022-23 (from the allocation to Kings College London). AFM, LES, SKB, RA and GJR are supported by the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, Kings College London and the University of East Anglia. The views expressed are those of the authors and not necessarily those of the NIHR, UKHSA or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data used were in the public domain, therefore ethical approval was not required. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No novel data were collected as part of this study. All data are already publicly available.