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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 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]
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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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“In our study, in accordance with the literature, the job strain score increased significantly compared to the period before the pandemic [30].”
ResultKaveh, M., Davari-tanha, F., Varaei, S., Shirali, E., Shokouhi, N., Nazemi, P., Ghajarzadeh, M., Feizabad, E., & Ashraf, M. (2021) · Journal of Obstetrics Gynecology and Cancer Research · doi:10.30699/jogcr.7.2.69 · Cited by 32
“reported that 56% of hospital staff had increased work-related stress during the SARS epidemic (19).”
BackgroundModulating Elements of Nurse Resilience in Population Care during the COVID-19 Pandemic
Sierra-García, E., Sosa-Palanca, E. M., Saus‐Ortega, C., Ruíz-Hontangas, A., Juárez‐Vela, R., & Gea-Caballero, V. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19084452 · Cited by 33
Anticipated Behaviors of Emergency Prehospital Medical Care Providers during an Influenza Pandemic
Tippett, V. C., Watt, K., Raven, S. G., Kelly, H. A., Coory, M. D., Archer, F. L., & Jamrozik, K. D. (2010) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x00007603 · Cited by 32
Impact of the 2009 influenza A(H1N1) pandemic on public health workers in the Netherlands
Vinck, L., Isken, L. D., Hooiveld, M., Trompenaars, M. E., IJzermans, J., & Timen, A. (2011) · Eurosurveillance · doi:10.2807/ese.16.07.19793-en · Cited by 31
“Previous studies have shown that, during the SARS outbreak, 53–66% of the healthcare workers had an increased workload [9,10,22].”
BackgroundResultInfluentialLiu, Y., Long, Y., Cheng, Y., Guo, Q., Liu, Y., Lin, Y., Cao, Y., Ye, L., Jiang, Y., Li, K., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.598712 · Cited by 32
Gee, S., & Skovdal, M. (2018) · Qualitative Health Research · doi:10.1177/1049732318759936 · Cited by 30
Wang, Y. Y., Duan, Z., Peng, K., Li, D., Ou, J., Wilson, A. D., Wang, N., Si, L., & Chen, R. (2020) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000851 · Cited by 30
Psychological distress among Egyptian physicians during COVID-19 pandemic
Sehsah, R., Gaballah, M. H., El‐Gilany, A., & Albadry, A. A. (2021) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-020-01624-4 · Cited by 33
Lau, J., Tan, D. H. Y., Wong, G. J., Lew, Y.-J., Chua, Y. X., Low, L. L., Ho, H.-K., Kwek, T.-S., Toh, S.-A. E. S., & Tan, K. (2021) · BMC Family Practice · doi:10.1186/s12875-021-01370-7 · Cited by 29
Self-citationYin, Q., Chen, A., Song, X., Deng, G., & Dong, W. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.607612 · Cited by 31
Li, D., Wang, Y. Y., Yu, H., Duan, Z., Peng, K., Wang, N., Zhou, Q., Hu, X., Fang, K., Wilson, A. D., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.575005 · Cited by 29
Khanam, A., Dar, S. A., Wani, Z. A., Shah, N. N., Haq, I., & Kousar, S. (2020) · Indian Journal of Psychological Medicine · doi:10.1177/0253717620933985 · Cited by 28
Coronavirus (COVID-19)-Associated Psychological Distress Among Medical Students in Iran
Moayed, M. S., Vahedian‐Azimi, A., Mirmomeni, G., Rahimi‐Bashar, F., Gohari-Moghadam, K., Pourhoseingholi, M. A., Abbasi-Farajzadeh, M., Khatibzadeh, A., Sathyapalan, T., Guest, P. C., et al. (2021) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-59261-5_21 · Cited by 28
Lyu, X., Hu, J., Xu, X., Xianyu, Y., & Dong, W. (2021) · BMC Nursing · doi:10.1186/s12912-021-00591-6 · Cited by 28
“During the SARS and MERS outbreaks, more than 50% of health care workers felt increased work stress [61], with increased negative emotions and concern about their personal safety and their families [62].”
BackgroundPortugal, L. C. L., Gama, C. M. F., Gonçalves, R., Mendlowicz, M. V., Erthal, F. S., Mocaiber, I., Tsirlis, K., Volchan, E., David, I. A., Pereira, M. G., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.752870 · Cited by 48
“In contrast, other studies have reported that altruistic acceptance of risk was not related to psychiatric symptoms among hospital employees following epidemic outbreaks and the general population (75, 76).”
ResultCarvalho, E., Castro, P., León-Castelao, E., del Rı́o, A., Crespo, F., Trigo, L., Fernández, S., Trilla, A., Varela, P., & Nicolas, J. M. (2018) · Nursing in Critical Care · doi:10.1111/nicc.12396 · Cited by 27
Hajebi, A., Abbasinejad, M., Zafar, M., Hajebi, A., & Taremian, F. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.891430 · Cited by 31
Teo, I., Nadarajan, G. D., Ng, S., Bhaskar, A., Sung, S. C., Cheung, Y. B., Pan, F. T., Haedar, A., Gaerlan, F. J., Ong, S. F., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116380 · Cited by 30
Depression, anxiety, and stress among Iranian nurses in COVID-19 care wards
Sharifi, A., Fallahi‐Khoshknab, M., Mohammadi, S., Nasrabadi, M. Z., Jamshidi, Z., Aghabeygi-Arani, M., Mirzaei, N., Fallahi‐Khoshknab, N., & Rasooli, P. (2022) · BMC Psychology · doi:10.1186/s40359-022-00911-8 · Cited by 27
Chen, H., Wang, B., Cheng, Y., Muhammad, B., Li, S., Miao, Z., Wan, B., Abdul, M., Zhao, Z., Geng, D., et al. (2020) · Neurobiology of Stress · doi:10.1016/j.ynstr.2020.100261 · Cited by 26
“Consistent with our conclusion, coping styles and working stress were also found to be critical mediators for the development of mental problems during SARS epidemic (Koh et al., 2005; Maunder, 2003; Maunder et al., 2006; Sim et al., 2004; Styra et al., 2008).”
Mental Health of Medical Workers in COVID-19 Pandemic: Restrictions and Barriers
Badrfam, R., Zandifar, A., & Arbabi, M. (2020) · Journal of Research in Health Sciences · doi:10.34172/jrhs.2020.16 · Cited by 26
Watt, K., Tippett, V. C., Raven, S. G., Jamrozik, K. D., Coory, M. D., Archer, F. L., & Kelly, H. A. (2010) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x00007597 · Cited by 25
Saddik, B. A., Elbarazi, I., Temsah, M.-H. A., Sharif‐Askari, F. S., Kheder, W., Hussein, A., Najim, H., Bendardaf, R., Hamid, Q. A., & Halwani, R. (2021) · International Journal of Public Health · doi:10.3389/ijph.2021.1604369 · Cited by 25
“Similarly, in a large-scale study of 10,511 HCWs, 49% experienced social stigmatization Int J Public Health | Owned by SSPH+ | Published by Frontiers November 2021 | Volume 66 | Article 16043698 and 31% ostracism by family members during the SARS outbreak in Singapore [47].”
BackgroundFumagalli, S., Borrelli, S., Ornaghi, S., Vergani, P., & Nespoli, A. (2022) · Women and Birth · doi:10.1016/j.wombi.2022.04.011 · Cited by 25
A year after COVID‐19: Its impact on nurses' psychological well‐being
Aloweni, F. B. A. B., Ayre, T. C., Teo, I., Tan, H. K., & Lim, S. H. (2022) · Journal of Nursing Management · doi:10.1111/jonm.13814 · Cited by 27
“…of getting COVID-19 was assessed by the item “I feel that my job puts me at great risk of exposure to COVID-19,” whereby the responses ranged from “strongly agree” to “strongly disagree” on a 6-point Likert scale, which was subsequently recoded into either “agree” or “disagree” (Koh et al., 2005).”
BackgroundWorsening of pre-existing psychiatric conditions during the COVID-19 pandemicPreprint
Gobbi, S., Płomecka, M. B., Ashraf, Z., Radziński, P., Neckels, R., Lazzeri, S., Dedić, A., Bakalović, A., Hrustić, L., Skórko, B., et al. (2020) · medRxiv · doi:10.1101/2020.05.28.20116178 · Cited by 25
Impact of COVID-19 on paramedicine students: A mixed methods study
Williams, B. A., King, C. A., Shannon, B., & Gosling, C. M. (2021) · International Emergency Nursing · doi:10.1016/j.ienj.2021.100996 · Cited by 23
Bekele, F., & Hajure, M. (2021) · SAGE Open Medicine · doi:10.1177/20503121211012512 · Cited by 25
Slama, H., Kefi, H. E., Taamallah, K., Stambouli, N., Baffoun, A., Samoud, W., Bechikh, C., Oumaya, A., Lamine, K., Hmida, M. J., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.622830 · Cited by 25
Nissan, D., Weiss, G., Siman‐Tov, M., Spitz, A., Bodas, M., Shenhar, G., & Adini, B. B. (2021) · Research in Nursing & Health · doi:10.1002/nur.22165 · Cited by 25
Rolin, S. N., Flis, A. E., & Davis, J. J. (2021) · Psychology & Neuroscience · doi:10.1037/pne0000257 · Cited by 24
Metadata
- 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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