The DOI matches its Crossref record; 47 of the 50 references it cites were found in a registry or an index; 1 of the 43 sources its claims cite were checked for support.
Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease
Open accessAbstract
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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23 Not checked yet · 15 Own result · 11 Own interpretation · 7 Own method · 1 Partly supported · accuracy not yet measured
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“Posttraumatic morbidity was not associated with the three major concerns as a group.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Results > Major concerns and sources of help
plain- Asserted: passes — The authors put it forward as true.
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“Two hundred individuals (48.2%) were examined in the fever stations during the SARS outbreak.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Results > Direct Exposure to fever stations
plainn = 2- Asserted: passes — The authors put it forward as true.
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In the paper
“and planning (adjusted OR 1.51, 95% CI 1.16–1.95, P=.002) as coping measures.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
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“younger age (adjusted OR 0.97, 95% CI 0.94–0.98, P=.021)”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“increased self blame (adjusted OR 1.67, 95% CI 1.22–2.28, P=.001)”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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“Psychiatric morbidity was further associated with being seen at fever stations (adjusted OR 1.90, 95% CI 1.08–3.34, P=.026)”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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“When the three major concerns (losing control of spread of SARS, fear of contracting SARS, health concerns about family) were combined and analyzed as a group, psychiatric morbidity was significantly associated with these major concerns [OR 1.97 [1.1–3.6], P=.04) compared to the other concerns within Table 4.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Results > Major concerns and sources of help
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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: § Post-traumatic morbidity and coping · plain
“Posttraumatic morbidity was found in 107 (25.8%) respondents.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plainn = 107- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Post-traumatic morbidity and coping · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“less substance use (adjusted OR 0.74, 95% CI 0.56–0.98, P=.034)”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
What the sources say
- Not checked yetcites [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
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
The ‘Anxiety levels (STAI scores)’ section reports greater anxiety among community respondents aged 30–49. That supports an age-related association, but not the broader implication that anxiety increased with younger age generally; Table 2 does not show the youngest group consistently having the highest scores. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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It may state two separate claims as one.
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In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Results > Psychiatric morbidity and coping
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Results
plainn = 95- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Psychiatric morbidity and coping · plain
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In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Introduction
What the sources say
- Not checked yetcites [12] Low, 2005, Infectious respiratory illnesses and their impact on healthcare workers: a review, Ann Acad Med Singapore source
hedgeddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Rating instruments
What the sources say
- Not checked yetcites [27] American Psychiatric Association, 1994
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
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In the paper
“indicating the extent of psychological impact involving all areas ascertained using the scales and not limited to certain domains.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Rating instruments
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Introduction
What the sources say
- Not checked yetcites [1] Allenby, 2005, Toward inherently secure and resilient societies, Science source
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“There were no significant differences in the age and gender between participants versus nonparticipants.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Study population and design
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Rating instruments
What the sources say
- Not checked yetcites [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 yetcites [32] Phua, 2005, Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak, Acad Emerg Med source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“recall bias can still be a potential confounder although measures had been taken during the recruitment process to minimize this as much as possible.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Rating instruments
What the sources say
- Not checked yetcites [23] Goldberg, 1988
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
What the sources say
- Not checked yetcites [35] Cheng, 2004, Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS), Psychol Med source
- Not checked yetcites [36] Hawryluck, 2004, SARS control and psychological effects of quarantine, Toronto, Canada, Emerg Infect Dis source
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Introduction
What the sources say
- Not checked yetcites [13] Ruiz, 2000, Psychiatric considerations in the diagnosis, treatment, and prevention of HIV/AIDS, J Psychiatr Pract source
- Not checked yetcites [14] Maunder, 2003, The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital, Can Med Assoc J
- Not checked yetcites [16] Lee, 2007, Stress and psychological distress among Severe Acute Respiratory Syndrome (SARS) survivors 1 year after the outbreak, Can J Psychiatry source
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The association with younger age and being seen at fever stations may allow better identification of individuals at risk of developing psychological morbidities.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Participation in the survey was voluntary and the study was approved by the institutional research and ethics committee.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Rating instruments
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Abstract > Conclusion
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- Also stated in: § Discussion · hedged
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The relationship of different coping styles in those with psychological morbidity allows a better understanding of their use in these individuals.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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%.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Study population and design
plainn = 532- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
In the paper
“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”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Methods > Chronology of the local SARS outbreak and measures adopted
What the sources say
- Not checked yetcites [21]
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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,”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Introduction
What the sources say
- Not checked yetcites [3] Verghese, 2004, What is in a word?, Clin Infect Dis source
- Not checked yetcites [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 yetcites [5] Cherian, 1995, Plague in India, The Lancet source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
What the sources say
- Not checked yetcites [40] Epstein, 1998, Posttraumatic stress disorder following an air disaster: a prospective study, Am J Psychiatry source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“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].”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
What the sources say
- Not checked yetcites [32] Phua, 2005, Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak, Acad Emerg Med source
- Not checked yetcites [44] Miller, 2006, PTSD and substance-related problems: the mediating roles of disconstraint and negative emotionality, J Abnorm Psychol source
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This data, together with that of other studies, can hopefully inform the development of practical and responsive mental health programs for the community”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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.”
Citations
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Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (prompt extract-v3).
A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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