Risk Perception and Impact of Severe Acute Respiratory Syndrome (SARS) on Work and Personal Lives of Healthcare Workers in Singapore: What Can We Learn?
Abstract
INTRODUCTION: Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism. METHOD: We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics. RESULTS: From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%). CONCLUSION: During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.
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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,”
From Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease (2010) · cites this paper as [4]
Stigmatisation, social rejection, and lower levels of social support were risk factors for stress among healthcare workers during viral outbreaks.
“In addition, stigmatisation (Koh et al., 2005), social rejection (Park et al., 2018), and lower levels of social support were identified as risk factors for stress (Xiao 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 Koh et al., 2005
Managers are essential to mitigate stigmatization, especially among healthcare workers who have to be quarantined.
“and stigmatization (Koh et al., 2005), especially among those HCWs who have to be quarantined.”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Koh et al., 2005
HCWs often found themselves working under high levels of physical and psychological stress, sometimes attributed to work conditions.
“HCWs often found themselves working under high levels of physical and psychological stress (Koh et al., 2005), sometimes attributed to work conditions (Zhang et al., 2020b).”
From The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review (2020) · cites this paper as Koh et al., 2005
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- Authors
- Koh, D., Lim, M. K., Chia, S. E., Ko, S. M., Qian, F., Ng, V., Tan, B. H., Wong, K. S., Chew, W. M., Tang, H. K., Ng, W., Muttakin, Z., Emmanuel, S., Fong, N. P., Koh, G., Kwa, C. T., Tan, K. B.-C., & Fones, C.
- Affiliations
- National University of Singapore (SG)
- National University Hospital (SG)
- Singapore General Hospital (SG)
- KK Women's and Children's Hospital (SG)
- NHG Polyclinics (SG)
- Corresponding author
- Koh, David
- Lim, Meng Kin
- Chia, Sin Eng
- Qian, Feng
- Ng, Vivian
- Fong, Ngan Phoon
- ORCID
- Venue
- Medical Care
- Published
- 2005-07
- Volume
- 43
- Issue
- 7
- Pages
- 676-682
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2031239563
- Cited by
- 454
- References
- 21
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 15 · 2023: 45 · 2022: 73 · 2021: 131 · 2020: 104 · 2019: 1 · 2018: 4 · 2017: 7 · 2016: 3 · 2015: 3 · 2014: 3 · 2012: 7
- FWCI
- 9.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- SARS, healthcare workers, risk perception, occupational anxiety, occupational stress, personal protective measures, social stigma, ostracism, work-life impact, infection control policy, bioterrorism preparedness
- MeSH terms
- Adaptation, Psychological, Adult, Disease Outbreaks, Emotions, Female, Health Personnel, Humans, Male, Surveys and Questionnaires, Singapore, Logistic Models, Workload, Severe Acute Respiratory Syndrome
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