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Impact on health care workers employed in high-risk areas during the Toronto SARS outbreak
Open accessAbstract
Background A number of publications focusing on health care workers (HCWs) during a severe acute respiratory syndrome (SARS) outbreak have suggested that HCWs experienced psychological distress, particularly increased levels of posttraumatic stress symptomatology (PTSS). Factors contributing to increased distress in HCWs working in high-risk areas treating patients with SARS have not been fully elucidated. The goal of this study was to quantify the psychological effects of working in a high-risk unit during the SARS outbreak.Methods HCWs in a Toronto hospital who worked in high-risk areas completed a questionnaire regarding their attitude toward the SARS crisis along with the Impact of Event Scale-Revised, which screens for PTSS. The comparison group consisted of clinical units that had no contact with patients infected with SARS.Results Factors that were identified to cause distress in the 248 respondent HCWs were the following: (a) perception of risk to themselves, (b) impact of the SARS crisis on their work life, (c) depressive affect, and (d) working in a high-risk unit. In addition, HCWs who cared for only one SARS patient in comparison to those caring for multiple SARS patients experienced more PTSS.Conclusions As expected, HCWs who were working in high-risk units experienced greater distress. Contrary to expectations, HCWs who experienced greater contact with SARS patients while working in the high-risk units were less distressed. This suggests that HCW experience in treating patients infected with SARS may be a mediating factor that could be amenable to intervention in future outbreaks.
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“and PTSD (Maunder et al., 2004; Styra et al., 2008; Wu et al., 2009).”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Styra et al., 2008
In the citing paper
“PTSD (Bukhari et al., 2016; Styra et al., 2008; Tang et al., 2017; Wu et al., 2009; Wu et al., 2008; Arpacioglu et al., 2020)”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Styra et al., 2008
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“Feelings of social rejection or isolation and higher impact of the outbreak on daily life (Styra et al., 2008) increased the likelihood of developing PTSD”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Styra et al., 2008
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“Similarly, in Toronto, Canada, caring for patients with SARS or those suspected of having SARS increased the incidence of work-related anxiety among frontline healthcare workers (Styra et al., 2008).”
BackgroundZhou, Z., Yuan, T., Tao, X.-B., Huang, L. J., Zhan, Y., Gui, L.-L., Li, M., Liu, H., & Li, X.-D. (2022) · World Journal of Psychiatry · doi:10.5498/wjp.v12.i2.338 · Cited by 11
Vaughan, A. D., Moran, C. B., Pearce, L. D. R., & Hearty, L. (2016) · Journal of Workplace Behavioral Health · doi:10.1080/15555240.2016.1195693 · Cited by 10
“, 2008), relief services (Simons, Gaher, Jacobs, Meyer, & Johnson-Jimenez, 2005), journalism and mass communication (Feinstein, Owen, & Blair, 2002), health care (Styra et al., 2008), and social work services (Bride, 2007).”
BackgroundInfluentialBell, V., & Wade, D. M. (2020) · medRxiv · doi:10.1101/2020.04.28.20082669 · Cited by 9
Health Risks Related to COVID‐19, Psychological Distress and Perceived Productivity
Park, S., & Koch, M. (2023) · British Journal of Management · doi:10.1111/1467-8551.12751 · Cited by 8
Rice, E. N., Xu, H., Wang, Z., Webb, L. E., Thomas, L. E., Kadhim, E. F., Nunes, J. C., Adair, K. C., & O'Brien, E. C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0293392 · Cited by 9
“Past studies in other pandemic settings, including the severe acute respiratory syndrome (SARS) outbreak in 2003, reported increased PTSD symptoms among HCWs [8, 9].”
ResultFond-Harmant, L., Kane, H., Baumgart, J. G., Rusch, E., Breton, H., el-Hage, W., Deloyer, J., Lebas, M.-C., Marazziti, D., Thome, J., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261818 · Cited by 7
Response of US psychiatric programs to the COVID-19 pandemic and the impact on trainees
Durns, T. A., Gethin-Jones, T., Monson, E. T., & O’Donohoe, J. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03286-x · Cited by 8
Basavegowda, M., Umeshchandra, S. M., Duraisamy, P., Thimmulappa, R. K., Manivasagan, M. S., Mallaiah, C., Madhu, J. V., Yogeeshwaran, V. V., Vishwanath, N., Rudramuniyappa, V. K., et al. (2023) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_573_23 · Cited by 9
Risk, Covid-19 and hospital care in Mexico City: Are we moving toward a new medical practice?
Martínez, R. M. (2021) · Revista de Ciencias Sociales y Humanidades · doi:10.20983/noesis.2022.1.2 · Cited by 6
Ali, M. J. (2020) · Indian Journal of Ophthalmology · doi:10.4103/ijo.ijo_1753_20 · Cited by 7
Preventing Absenteeism and Promoting Resilience Among Health Care Workers In Biological Emergencies
Lesperance, A. M., & Miller, J. S. (2009) · doi:10.2172/974987 · Cited by 7
“After the SARS epidemic, researchers in Taiwan (Chen et al. 2007), Hong Kong (Chua et al. 2004), Singapore (Koh et al. 2005), and Canada (Maunder 2004, McAlonan et al. 2007, Styra et al. 2008) all documented significant stress, anxiety, and depression among healthcare workers.”
BackgroundMental health care of medical workers during COVID-19 pandemic
Yuryeva, L. (2020) · Medicni perspektivi · doi:10.26641/2307-0404.2020.4.221224 · Cited by 6
Caballero‐Domínguez, C. C., Ospino, G. A. C., & Campo‐Arias, A. (2021) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211066385 · Cited by 6
“This situation implies perceiving the virus as a threat to survival (Styra et al., 2008).”
BackgroundUlusoy, S., & Çelik, Z. (2022) · Psychiatry and Clinical Psychopharmacology · doi:10.5152/pcp.2022.21248 · Cited by 7
COVID-19 pandemic experience of diagnostic radiographers: A Singapore survey
Afif, A. M., Razak, H. A., & Choong, A. (2023) · Journal of medical imaging and radiation sciences · doi:10.1016/j.jmir.2023.01.010 · Cited by 7
“Medical staff and nurses were said to be the most impacted [13 , 14 , 15 , 16 , 17] .”
Backgroundvan der Noordt, M., Proper, K. I., Loef, B., Boot, C. R. L., Kroese, F. M., de Bruin, M., & van Oostrom, S. H. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1224112 · Cited by 7
Influencing Factors of Acute Stress Disorder Among Frontline Nurses in Wuhan, China
Liu, S., Xu, R., & Liu, L. (2021) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20210324-03 · Cited by 5
Halperin, O., Noble, A., Yakov, G., Raz, I., & Liebergall‐Wischnitzer, M. (2022) · Journal of Nursing Management · doi:10.1111/jonm.13710 · Cited by 6
“(Interviewee 1) Experience from the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak and early reports related to Covid-19 revealed that health care professionals experienced considerable anxiety, stress and fear (Lai et al., 2020; Styra et al., 2008).”
BackgroundВячеславович, Б. Е., Novikov, D. E., & Efremov, A. A. (2021) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro2021121031104 · Cited by 5
Family medicine research assistants’ experiences during COVID‐19 pandemic: A qualitative study
Aksoy, H., Başer, D. A., Fi̇dancı, İ., Arsava, E. Y., & Cankurtaran, M. (2020) · International Journal of Clinical Practice · doi:10.1111/ijcp.13975 · Cited by 5
Challenges of Mental Health in Medical Staffs during COVID-19 Outbreak: A Systematic Review
Rakhshan, M., Hakimi, H., Mousazadeh, N., & Dorri, S. (2023) · Medicina Clínica Práctica · doi:10.1016/j.mcpsp.2022.100361 · Cited by 4
Naharro, E. M. G., Fernández‐Sáez, J., Sillero, A. S., Tolo, P., & Ponce‐Blandón, J. A. (2025) · Healthcare · doi:10.3390/healthcare13030236 · Cited by 4
“These conditions can evolve into depression, panic attacks, PTSD, psychotic symptoms, and even suicide [12], especially in quarantined patients, who tend to experience higher levels of psychological stress [2,7].”
Mental Health of Healthcare Personnel during Quarantine for Infectious Epidemic--Real-time Data
Halbreich, U. M., & Meng, F. (2020) · Acta Scientific Neurology · doi:10.31080/asne.2020.03.0184 · Cited by 3
“Most current discussions and recommendations are based on retrospective recollections and post-hoc impressions or outside inquiries [9-14].”
BackgroundMental health of physicians in Croatia during the COVID-19 pandemic
Begić, D., Korajlija, A. L., & Jokić‐Begić, N. (2020) · Liječnički vjesnik · doi:10.26800/lv-142-7-8-32 · Cited by 5
Choudhary, A., Ranjan, J. K., Sharma, P., & Asthana, H. S. (2022) · Contributions to economics · doi:10.1007/978-3-030-89996-7_15 · Cited by 4
Fowlis, N., Barnett, N. L., Banks, S., & Jubraj, B. (2022) · European Journal of Hospital Pharmacy · doi:10.1136/ejhpharm-2021-003164 · Cited by 4
Miele, R. (2022) · Journal of Contemporary Ethnography · doi:10.1177/08912416221131512 · Cited by 4
dos Santos, H. M. M., Fontes, C. J. F., & Lima, D. D. S. (2022) · Debates em Psiquiatria · doi:10.25118/2763-9037.2022.v12.410 · Cited by 4
Preparedness of ICU networks for pandemics
Florio, G., Zanella, A., & Pesenti, A. M. (2020) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000792 · Cited by 4
SARS-Cov-2 Damage on the Nervous System and Mental Health
Boulkrane, M. S., Ilina, V. S., Melchakov, R., Arisov, M., Fedotova, J., Gozzo, L., Drago, F., Lu, W., Sarapultsev, A., Tseilikman, V., et al. (2021) · Current Neuropharmacology · doi:10.2174/1570159x19666210629151303 · Cited by 5
“Medical workers may experience stress from providing direct care to patients with COVID-19 knowing someone who became ill or died from this disease or from having to undergo quarantine or isolation [132,133].”
BackgroundPerceived Stress and Quality of Sleep among Health-Care Staff Working in a Dedicated COVID Hospital
Devarakonda, R., Nagari, N., Bobdey, S., Yadav, A. K., Kumar, S., Anand, V. R., & Kaushik, S. K. (2022) · Journal of Marine Medical Society · doi:10.4103/jmms.jmms_27_21 · Cited by 5
Nyanfor, S. S., & Xiao, S. (2020) · doi:10.21203/rs.3.rs-18672/v1 · Cited by 6
Çelik, F., & Dağlı, R. (2021) · Düzce Tıp Fakültesi Dergisi · doi:10.18678/dtfd.915010 · Cited by 4
“DASS-21 Depression Anxiety Stress 6 (2-16) 4 (2-10) 12 (7-17) 4 (2-8) 2 (0-6) 8 (4-12) 0.”
BackgroundInfluentialKumari, K., Chaudhary, K., Chhabra, S., Bhatia, P. K., Kamal, M., Kishan, R., Verma, M., & Kumar, A. (2022) · Journal of Anaesthesiology Clinical Pharmacology · doi:10.4103/joacp.joacp_291_21 · Cited by 3
Metadata
- Authors
- Styra, R., Hawryluck, L., Robinson, S., Kasapinovic, S., Fones, C., & Gold, W. L.
- Affiliations
- University Health Network (CA)
- National University Hospital (SG)
- Corresponding author
- Styra, Rima
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2008-02
- Volume
- 64
- Issue
- 2
- Pages
- 177-183
- ISSN
- 0022-3999 (ISSN-L)
- PMC
- PMC7094601
- OpenAlex
- W2054049746
- Cited by
- 280
- References
- 42
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 8 · 2023: 23 · 2022: 41 · 2021: 98 · 2020: 79 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 4 · 2015: 2 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 3.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- SARS, healthcare workers, posttraumatic stress symptoms, psychological distress, occupational stress, patient contact, risk perception, depressive affect
- MeSH terms
- Adult, Canada, Catchment Area, Health, Demography, Disease Outbreaks, Employment, Factor Analysis, Statistical, Female, Health Personnel, Health Status, Humans, Male, Occupational Diseases, Surveys and Questionnaires, Risk Factors, Occupational Exposure, Severe Acute Respiratory Syndrome
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