Longitudinal assessment of community psychobehavioral responses during and after the 2003 outbreak of severe acute respiratory syndrome in Hong Kong
Abstract
BACKGROUND: In previous literature, the stability and temporal evolution of psychobehavioral responses to an outbreak remained undefined, because of the exclusively cross-sectional nature of such study designs. METHODS: Using random-digit dialing, we sampled 4481 Hong Kong residents in 6 population-based surveys that were conducted at different times during and after the 2003 outbreak of severe acute respiratory syndrome (SARS). RESULTS: Respondents' State-Trait Anxiety Inventory score (range, 10-40) showed a decreasing temporal trend, from a high mean value of 24.8 during the peak of the Amoy Gardens outbreak to a postepidemic mean baseline value of 14.5. Those who perceived a higher likelihood of contracting or dying of SARS had significantly higher anxiety scores. Female respondents, individuals aged 30-49 years, and individuals with only a primary education or less were predisposed to greater anxiety. There was a positive dose-response gradient between anxiety level and uptake of personal protective measures. Males respondents, individuals at the extremes of age, and individuals with lower educational levels were less likely to engage in self-protective behavior. The presence of symptoms was the only consistent predictor for greater use of health services. There was remarkable stability in the magnitude and the direction of associations between predictors and outcomes over time. CONCLUSIONS: Our findings can assist in modifying public service announcements in the future, which should be tailored to psychobehavioral surveillance intelligence to achieve the desired behavioral outcomes. Future research should explore the use of more-sophisticated techniques, including structural equation modeling and game-theoretical frameworks, to analyze population psychology and behavior, and it should integrate such findings with transmission dynamics modeling.
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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.”
From Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease (2010) · cites this paper as [41]
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- Authors
- Leung, G. M., Ho, L.-M., Chan, S. K. K., Ho, S.-Y., Bacon-Shone, J., Choy, R. Y. L., Hedley, A. J., Lam, T.-H., & Fielding, R.
- Affiliations
- University of Hong Kong (HK)
- Department of Health (CN)
- Corresponding author
- Leung, Gabriel M.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-06-15
- Volume
- 40
- Issue
- 12
- Pages
- 1713-1720
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2162709512
- Cited by
- 377
- References
- 27
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 9 · 2023: 18 · 2022: 52 · 2021: 115 · 2020: 89 · 2018: 2 · 2017: 1 · 2016: 7 · 2015: 11 · 2014: 6 · 2013: 3 · 2012: 8
- FWCI
- 3.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Social Sciences › Sociology and Political Science › Risk Perception and Management
- Keywords
- SARS, SARS epidemic, anxiety, temporal trends, self-protective behavior, health care utilization, perceived infection risk, sociodemographic predictors, public service announcements, Hong Kong
- MeSH terms
- Adult, Aged, Anxiety, Disease Outbreaks, Female, Hong Kong, Humans, Health Knowledge, Attitudes, Practice, Longitudinal Studies, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, 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.
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