containment

The psychological stress of confinement

Experts make recommendations to reduce containment anxiety

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On March 6, the results of a national survey on the degree of psychological distress of the Chinese population following the Covid-19 epidemic was published in the specialist journal General Psychiatry. Eight days later, the prestigious medical journal The Lancet also published a review of the literature on the psychological impact of quarantine and ways to alleviate it.
While the President of the Republic Emmanuel Macron announced on Monday evening a tightening of measures to limit the impact of Covid-19 and the Minister of the Interior Christophe Castaner confirmed the implementation of a mechanism inspired by Spain or Italy, this work provides us with key elements to better identify the deleterious effects of this type of provisions and to establish the measures to be taken to circumscribe them.

Here's what you need to remember.

Recommendations based on Chinese data

The Chinese survey on the degree of psychological distress, conducted among the general population in 36 provinces, autonomous regions or municipalities, collected 52,730 responses. These were obtained through an online self-administered self-administered questionnaire, exploring with validated tools the frequency of anxiety, depression, avoidance behaviours and physical symptoms in the past week.

The authors show that 35% of respondents (35.27% men and 64.73% women) reported moderate psychological stress and 5.14% reported severe stress. The analysis also indicates that women show a higher degree of psychological distress than men. We also learn that this distress is more prevalent among individuals aged 18 to 30 years or those over 60 years of age. Finally, migrant workers are the group most at risk, while the psychological distress score is, not surprisingly, highest in the epicentres of the epidemic.

Accordingly, the authors of the study suggest the following recommendations:

  • pay attention to the specific needs of vulnerable groups such as young people aged 18 to 30, the elderly and migrant workers;

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  • to set up support and accompaniment services such as those put in place in situations of major disasters ;

  • deploy targeted interventions to reduce psychological stress and prevent future mental health problems.

Identify stressors during and after containment

The editors of the Lancet journal have been looking at the psychological impact of containment and what measures can be implemented to reduce its negative effects. The summary note was written on the basis of 3166 articles published and reviewed by scientific committees. 24 studies with scientific soundness were selected. They concern 10 countries and mainly include the SARS (11), Ebola (5) and influenza A (H1N1) viruses (3).

Documented analysis of the results of these studies indicates that the duration of confinement itself is a stressor: a duration of more than 10 days is predictive of post-traumatic symptoms, avoidance behaviours and anger. The authors also identified the following stressors during the confinement period:

  • physical symptoms: these increase the fear of infection and anxiety (including several months after the episode);

  • Fear for pregnant women of both becoming infected and passing on the virus to their unborn child;

  • the fear of mothers with young children being infected or transmitting the virus;

  • boredom, frustration and feelings of isolation caused by confinement and reduced physical and social contact;

  • shortcomings in the distribution of basic necessities;

  • inadequate information from public health authorities on good practice, and confusion about the purpose of containment;

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  • lack of clarity on risk levels ;

  • the lack of transparency on the severity of the pandemic;

  • the lack of clear protocols and guidelines for conduct.

Stress doesn't stop after confinement ends. Indeed, these studies also list a number of stressors that continue to be present once the situation returns to "normal":

  • the economic consequences of loss of income leading to socio-economic distress, causing anger and anxiety in the months following confinement ;

  • overall socio-economic distress;

  • the loss of business relationships;

  • the high fragility of the self-employed;

  • the even greater precariousness of the most economically fragile people working in jobs that cannot be carried out by teleworking ;

  • the difficulties of returning to work;

  • Tension in couples related to the types of professional activities more or less at risk for each partner;

  • Stigmatization of people who are dangerous to spread or come from an overexposed area.

The recommendations recommended by the experts

The 24 studies summarized in the Lancet identify a number of measures to be put in place to limit the effects of these various stressors. These include the creation of support services to assist people suffering from anxiety and depression.

It should also be kept in mind that the duration of confinement has an impact on stressors, and has a demoralizing effect. During confinement, it is important to reduce boredom and feelings of social isolation. Several solutions are possible:

  • Set up toll-free numbers to reduce isolation;

  • Helping broken families stay in touch;

  • Set up a toll-free number staffed by health professionals to answer questions from people with symptoms that worry them and reassure the public;

  • Create online support and discussion groups on the experience of confinement;

  • Promote communication that focuses more on altruism than an obsession;

  • Thank and encourage people who are in a confinement situation to reinforce adherence and compliance with confinement measures while informing them about prevention measures.

This global literature review suggests that it is essential to make containment as acceptable as possible to all, by meeting the specific needs of the most disadvantaged populations. Indeed, if the experience of confinement is experienced as negative, the consequences will affect not only the individuals who undergo it, but also the health system that organises it and the public policies that prescribe it.

It is not just about money, as illustrated by the educational literature produced by the World Health Organization, the Atlanta CDC and other sources to equip citizens, families and individuals to deal with containment. Among the examples available, let's look at tips for managing stress in children related to Covid-19.

Identifying Children's Stress: Tips for Parents

The Atlanta CDC has produced several fact sheets and mini-guides for adults, families and children themselves.

As a parent, it is important to identify changes in your children's attitudes and behaviours. These can be reactive manifestations of stress. Some of the things to watch out for include:

  • Excessive crying or irritability in young children;

  • The return of bed-wetting;

  • Excessive worry or sadness;

  • Irritability and impulsivity in adolescents;

  • Difficulty paying attention and concentrating;

  • Avoidance of activities that used to give them pleasure;

  • Unexplained headaches or body aches and pains;

  • Use of alcohol, tobacco or other drugs.

To help your children and teenagers, here are several tips:

  • Take some time to discuss the Covid-19 outbreak with them;

  • Answer their questions in a factual and understandable way;

  • Reassure them that they're safe;

  • Tell them it's okay if they feel overwhelmed;

  • Share with them your strategies for dealing with your own stress, so that they can learn from you;

  • Limit your family's exposure to media coverage;

  • Try to set up and maintain routines, including schedules for school activities at home and for your children's leisure time;

  • Be a role model for them;

  • Maintain contact with friends and family members.

Other practical guides also provide guidance on how to deal with the period of release from containment. Indeed, this period can generate mixed emotions: relief mixed with worries, fears, anger, guilt about one's work performance during the confinement period, etc.

In conclusion, it is important to implement strategies for the psychosocial support of containment-related measures in order to make containment as acceptable as possible.
This means taking a public health approach that combines collective decision making with empathetic, caring, population-centred interventions. The population is made up of individuals who need to feel that they count as unique and singular subjects in the concern of public health authorities.

It is a difficult exercise, but if all the players share the tasks and coordinate, we can do it. At theUniversity of Patients-Sorbonne, we ourselves are volunteering to contribute to this, as are many associations that already have solid experience of epidemics.

Catherine Tourette-TurgisDirector of the Master in Therapeutic Education at the Sorbonne University, Researcher at the CNAM, Sorbonne University

This article is republished from The Conversation editorial partner of UP' Magazine. Read theoriginal paper.

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