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Cited by 414COVID-19 and Mental HealthPosttraumatic Stress Disorder ResearchMental Health Treatment and Access

Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease

Open access
Sim, Kang, Huak Chan, Yiong, Chong, Phui Nah, Chua, Hong Choon, Wen Soon, Shok·2010·Journal of Psychosomatic Research
DOI 10.1016/j.jpsychores.2009.04.004PMC PMC7094450
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Abstract

Objective The psychological and coping responses of the noninfected community towards infectious disease outbreaks are relatively understudied. This cross-sectional study sought to determine the prevalence of severe acute respiratory syndrome (SARS)-related psychiatric and posttraumatic morbidities and associated coping styles within the general population visiting community health care services.Methods It was conducted on individuals attending community polyclinics in Singapore within the first week of July 2003, 16 weeks after the first national outbreak of SARS. The General Health Questionnaire-28, Impact of Event Scale-Revised, and Brief COPE were used to determine the prevalence rates of psychiatric and posttraumatic morbidities and employed coping strategies respectively.Results The overall response rate was 78.0%. Of the 415 community health care setting respondents, we found significant rates of SARS-related psychiatric (22.9%) and posttraumatic morbidities (25.8%). The presence of psychiatric morbidity was associated with the presence of high level of posttraumatic symptoms [adjusted odds ratio (OR) 2.26, 95% confidence interval (CI) 1.24-4.13, P=.008]. Psychiatric morbidity was further associated with being seen at fever stations (adjusted OR 1.90, 95% CI 1.08-3.34, P=.026), younger age (adjusted OR 0.97, 95% CI 0.94-0.98, P=.021), increased self blame (adjusted OR 1.67, 95% CI 1.22-2.28, P=.001), less substance use (adjusted OR 0.74, 95% CI 0.56-0.98, P=.034) and posttraumatic morbidity was associated with increased use of denial (adjusted OR 1.31, 95% CI 1.04-1.67, P=.024), and planning (adjusted OR 1.51, 95% CI 1.16-1.95, P=.002) as coping measures.Conclusion These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.

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Crossref · 10.1016/j.jpsychores.2009.04.004

Cites

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Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Posttraumatic morbidity was not associated with the three major concerns taken as a group.

    “Posttraumatic morbidity was not associated with the three major concerns as a group.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Two hundred respondents (48.2%) were examined at fever stations during the SARS outbreak.

    “Two hundred individuals (48.2%) were examined in the fever stations during the SARS outbreak.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Posttraumatic morbidity was associated with increased use of planning as a coping measure (adjusted OR 1.51, 95% CI 1.16-1.95, P=.002).

    “and planning (adjusted OR 1.51, 95% CI 1.16–1.95, P=.002) as coping measures.”
    Quote in the paperSubstantial claim
  • Findingown data

    Psychiatric morbidity was associated with younger age (adjusted OR 0.97, 95% CI 0.94-0.98, P=.021).

    “younger age (adjusted OR 0.97, 95% CI 0.94–0.98, P=.021)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Psychiatric morbidity was associated with increased self blame as a coping measure (adjusted OR 1.67, 95% CI 1.22-2.28, P=.001).

    “increased self blame (adjusted OR 1.67, 95% CI 1.22–2.28, P=.001)”
    Quote in the paperSubstantial claim
  • May combine two claims. 17
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    Total GHQ scores correlated positively with IES-R total scores (rs=0.34) and with the intrusion (rs=0.35), avoidance (rs=0.28) and hyperarousal (rs=0.37) subscale scores, all P<.001.

    “The total GHQ scores were also correlated with the IES-R total (r s=0.34, P<.001) and mean intrusion (r s=0.35, P<.001), avoidance (r s= 0.28, P<.001), and hyperarousal (r s=0.37, P<.001) subscale scores.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among the 415 community health care respondents, the prevalence of SARS-related psychiatric morbidity was 22.9% (95 participants).

    “Of the 415 community health care setting respondents, we found significant rates of SARS-related psychiatric (22.9%) and posttraumatic morbidities (25.8%).”
    • Also stated in: § Psychiatric morbidity and coping · plain
      “Psychiatric morbidity was reported in 95 (22.9%) participants.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Factors that could contribute to complex psychosocial responses, such as personality variables, cognitive appraisal mechanisms, and past trauma, were not examined in this study.

    “other factors that could potentially contribute to the complex psychosocial responses of an individual such as personality variables, cognitive appraisal mechanisms, and past trauma were not examined in this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Safeguarding the psychological wellbeing of the community through practical mental health programs is crucial because it would help prevent or ameliorate disruption of health care delivery in the community during outbreaks.

    “better safeguarding of the psychological wellbeing of the community with practical mental health programs is crucial as it would help to prevent or ameliorate any disruption of health care delivery in the community during such outbreaks [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Low, 2005, Infectious respiratory illnesses and their impact on healthcare workers: a review, Ann Acad Med Singapore source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Posttraumatic morbidity was determined using the DSM-IV criteria for posttraumatic stress disorder (more than 1 re-experiencing symptom, more than 3 avoidance symptoms, and more than 2 arousal symptoms).

    “traumatic morbidity was determined by using the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder (>1 re-experiencing symptoms, >3 avoidance symptoms, and >2 arousal symptoms) [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] American Psychiatric Association, 1994

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  • May combine two claims.

    Interpretationown data

    The elevated scores across all subscales indicate that the psychological impact involved all areas ascertained by the scales and was not limited to certain domains.

    “indicating the extent of psychological impact involving all areas ascertained using the scales and not limited to certain domains.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Some participants visiting primary health care centers may have been self-selected or worried well and more predisposed to developing psychiatric morbidity.

    “it is possible that some of the participants who visited primary heath care centers may be self selected or worried well and who were more predisposed to the development of psychiatric morbidity.”
    Quote in the paperNot a substantial claim

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    Study design and conductcitation

    The three outcome measures were selected because they are self-reported scales that are easy to administer and widely used in studies evaluating psychiatric morbidity and posttraumatic stress.

    “All the three outcome measures were chosen as they were self-reported scales, easy to administer, and widely used in studies to evaluate psychiatric morbidity and posttraumatic stress [25], [29].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Silver, 2002, Nationwide longitudinal study of psychological responses to September 11, JAMA source

      Not checked in the free run.

    • cites [29] Tjemsland, 1998, Posttraumatic distress symptoms in operable breast cancer III: status one year after surgery, Breast Cancer Res Treat source

      Not checked in the free run.

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    Premisecitation

    Psychological morbidities occurring in a substantial proportion of the community can impair the daily functioning of affected individuals, with immediate social and economic consequences such as lost job productivity and financial hardship.

    “such psychological morbidities occurring in a substantial proportion of the community can impact on the daily functioning of these affected individuals with immediate social and economic consequences such as lost job productivity and financial hardship [1].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Allenby, 2005, Toward inherently secure and resilient societies, Science source

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    Study design and conductown data

    Participants and nonparticipants did not differ significantly in age or gender.

    “There were no significant differences in the age and gender between participants versus nonparticipants.”
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    Study design and conductcitation

    Participants were instructed to rate their symptoms and coping measures specifically with respect to their SARS experiences, following methods used in other studies.

    “The participants had all been instructed to rate their symptoms and coping measures based on their experiences specifically with respect to SARS akin to similar methods used in other studies [16], [32].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [16] Lee, 2007, Stress and psychological distress among Severe Acute Respiratory Syndrome (SARS) survivors 1 year after the outbreak, Can J Psychiatry source

      Not checked in the free run.

    • cites [32] Phua, 2005, Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak, Acad Emerg Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Recall bias remains a potential confounder even though measures were taken during recruitment to minimize it as much as possible.

    “recall bias can still be a potential confounder although measures had been taken during the recruitment process to minimize this as much as possible.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Using the conventional GHQ binary scoring method, a total GHQ-28 score of 5 or above indicates a case of psychiatric morbidity.

    “Using the conventional GHQ binary scoring method (range 0–28), a total GHQ score of 5 and above is indicative of a case of “psychiatric morbidity” [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Goldberg, 1988

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    Premisecitation

    Previous reports have documented high levels of anxiety and depression among SARS survivors (35%), quarantined individuals (31%), and nurses (38.5%).

    “This is in agreement with previous reports which have also documented high levels of anxiety, depression amongst survivors of SARS (35%) [35], quarantined individuals (31%) [36], and nurses (38.5%) [34].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [35] Cheng, 2004, Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS), Psychol Med source

      Not checked in the free run.

    • cites [36] Hawryluck, 2004, SARS control and psychological effects of quarantine, Toronto, Canada, Emerg Infect Dis source

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    • cites [34] Su, 2007, Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak, J Psychiatr Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most research on psychological responses to infectious disease outbreaks has been conducted on affected individuals, health care workers combating the illness, and survivors, so data on the larger noninfected community are needed.

    “most of the research on the psychological responses to infectious disease outbreaks were conducted on either affected individuals such as in the case of HIV/AIDS [13], health care workers working to combat the illness such as in the case of SARS [14], [15], and survivors of SARS [16].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] Ruiz, 2000, Psychiatric considerations in the diagnosis, treatment, and prevention of HIV/AIDS, J Psychiatr Pract source

      Not checked in the free run.

    • cites [14] Maunder, 2003, The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital, Can Med Assoc J

      Not checked in the free run.

    • cites [16] Lee, 2007, Stress and psychological distress among Severe Acute Respiratory Syndrome (SARS) survivors 1 year after the outbreak, Can J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is also possible that individuals with posttraumatic symptoms are inherently more predisposed to using denial as a coping measure in the first place.

    “Alternatively, it is also possible that those with posttraumatic symptoms may be inherently more predisposed to using denial as a coping measure in the first place.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The multivariate logistic regression models adjusted for age, marital status, psychiatric or posttraumatic caseness, consultation at fever stations, and the 14 coping strategies.

    “Covariates entered in the multivariate logistic regression models included age, marital status, psychiatric, or posttraumatic “caseness,” consultation at fever stations, and the 14 coping strategies).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The associations with younger age and with being seen at fever stations may allow better identification of individuals at risk of developing psychological morbidities.

    “The association with younger age and being seen at fever stations may allow better identification of individuals at risk of developing psychological morbidities.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Participation in the survey was voluntary and the study was approved by the institutional research and ethics committee.

    “Participation in the survey was voluntary and the study was approved by the institutional research and ethics committee.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.

    “These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.”
    • Also stated in: § Discussion · hedged
      “These findings could potentially inform the formulation of much needed mental health awareness programs for the community who may face similar disease outbreaks in the future.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    The relationship of different coping styles in those with psychological morbidity allows a better understanding of their use in these individuals.

    “The relationship of different coping styles in those with psychological morbidity allows a better understanding of their use in these individuals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The association of psychiatric morbidity with younger age is consistent with the authors' study of health care workers and with Leung et al.'s finding that greater anxiety was associated with younger age in the community.

    “Our finding of an association of psychiatric morbidity with younger age is consistent with the results of our study on health care workers [31] as well as the study by Leung et al. [41] who found that greater anxiety was associated with younger age within the community.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] Sim, 2004, Severe acute respiratory syndrome-related psychiatric and posttraumatic morbidities and coping responses in medical staff within a primary health care setting in Singapore, J Clin Psychiatry source

      Not checked in the free run.

    • cites [41] Leung, 2005, Longitudinal assessment of community psychobehavioral responses during and after the 2003 outbreak of severe acute respiratory syndrome in Hong Kong, Clin Infec Dis source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Of 532 eligible individuals approached, 415 agreed to participate, giving an overall response rate of 78.0%.

    “Of the 532 eligible individuals approached, 415 agreed to participate giving a response rate of 78.0%.”
    • Also stated in: § Results · plain
      “The overall response rate was 78.0%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Infection control measures rapidly implemented at the primary health care level during SARS included personal protective equipment for health care workers, regular temperature monitoring, health declaration forms, audits of infection control, and fever stations to isolate and manage febrile individuals within the polyclinics.

    “infection control measures that were rapidly implemented included the use of the personal protective equipment amongst the health care workers attending to patients including those presenting with a febrile illness, regular temperature monitoring, filling of health declaration forms, regular audit of infection control measures, and the setting up of fever stations to isolate and manage individuals”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21]

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  • May combine two claims.

    Premisecitation

    Psychosocial responses to infectious disease outbreaks are variable, ranging from anxiety, shame, and misestimation of survival and infection likelihood, to flight from the outbreak, excessive precautionary measures, and increased demand for health care services during shortages.

    “Psychosocial responses towards such infectious disease outbreaks are variable and can range from feelings of anxiety, a sense of shame, failure or weakness of the individual and society [3], and an underestimation of likelihood of survival, an overestimation of likelihood of infection [4] to a sudden flight from the outbreak [5], an excessive and inappropriate adoption of precautionary measures,”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Verghese, 2004, What is in a word?, Clin Infect Dis source

      Not checked in the free run.

    • cites [4] Koh, 2005, Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn?, Med Care source

      Not checked in the free run.

    • cites [5] Cherian, 1995, Plague in India, The Lancet source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Being seen at fever stations may reinforce a sense of vulnerability and threat of infection, and this may interact with younger age to produce more severe stress symptoms.

    “psychiatric morbidity was associated with being seen at fever stations which may reinforce the sense of vulnerability and threat of infection, and this can interact with the younger age to produce more severe stress symptoms [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Epstein, 1998, Posttraumatic stress disorder following an air disaster: a prospective study, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The use of self blame may reflect an underlying sense of frustration and guilt related to responsibility attribution and interpersonal reactions, which can in turn contribute to psychiatric morbidity.

    “The use of self blame may reflect an underlying sense of frustration and guilt related to responsibility attribution and interpersonal reactions which can, in turn, contribute to psychiatric morbidity [42], [43].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [42] Shaver, 1986, On causality, responsibility, and self-blame: a theoretical note, J Pers Soc Psychol source

      Not checked in the free run.

    • cites [43] Karasawa, 2001, Anger vs guilt: inference of responsibility attribution and interpersonal reactions, Psychol Rep source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The finding of less substance use is in line with a previous local study of coping responses of emergency room staff but contrary to previous studies that noted increased substance use in individuals facing stress.

    “The less use of substance in our study is in line with a previous local study of coping responses of staff within an emergency room setting [32] but is contrary to the findings of some previous studies [44], [45], which had noted increased substance use in individuals facing stress.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [32] Phua, 2005, Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak, Acad Emerg Med source

      Not checked in the free run.

    • cites [44] Miller, 2006, PTSD and substance-related problems: the mediating roles of disconstraint and negative emotionality, J Abnorm Psychol source

      Not checked in the free run.

    • cites [45] Waldrop AE, Back SE, Verduin ML, Brady KT. Triggers for cocaine and alcohol use in the presence and absence of posttraumatic stress disorder. Addict Behav, Published online: 24 July 2006. doi:10.1016/j.addbeh.2006.06.001. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    This data, together with that of other studies, can inform the development of practical and responsive mental health programs for the community.

    “This data, together with that of other studies, can hopefully inform the development of practical and responsive mental health programs for the community”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The lower GHQ scores in the affected domain indicate a negative impact on the social functioning of these individuals, underlining the need to address community psychosocial responses in situation-specific mental health programs for infectious disease outbreaks.

    “This has negative impact on the social functioning of the individuals as evidenced by the lower scores on the same affected domain in GHQ, thus underlining the need to address the community psychosocial responses in any situation-specific mental health program related to an infectious disease outbreak.”
    Quote in the paperSubstantial claim
30 of 30

  • The paper relies on this without support.

    The risk of future infectious disease outbreaks remains real.

    “Access to appropriate psychological assistance in the community is important as the risk of future outbreaks remains real.”
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Authors
Sim, K., Huak Chan, Y., Chong, P. N., Chua, H. C., & Wen Soon, S.
Affiliations
  • Institute of Mental Health (SG)
  • National Healthcare Group (SG)
Corresponding author
Sim, Kang
ORCID
Sim, Kang
Venue
Journal of Psychosomatic Research
Publisher
Elsevier BV
Published
2010-02
Volume
68
Issue
2
Pages
195-202
ISSN
0022-3999 (ISSN-L)
DOI
10.1016/j.jpsychores.2009.04.004
PMC
PMC7094450
OpenAlex
W2008408902
Cited by
414
References
50
Citations by year
2026: 3 · 2025: 7 · 2024: 23 · 2023: 63 · 2022: 77 · 2021: 122 · 2020: 114 · 2018: 1 · 2012: 1
FWCI
1.41
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Psychosomatic Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Healthcare Group
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
SARS, infectious disease outbreaks, post-traumatic stress, psychiatric morbidity, coping strategies, community mental health, self-blame, denial, community-based care
MeSH terms
Adaptation, Psychological, Adult, Community Health Services, Cross-Sectional Studies, Denial, Psychological, Disease Outbreaks, Female, Health Surveys, Humans, Male, Mental Health, Middle Aged, Surveys and Questionnaires, Singapore, Stress Disorders, Post-Traumatic, Stress, Psychological, Prevalence, Odds Ratio, Severe Acute Respiratory Syndrome

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