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Psychological Effects of the SARS Outbreak in Hong Kong on High-Risk Health Care Workers
Open accessAbstract
Objective: To quantify stress and the psychological impact of severe acute respiratory syndrome (SARS) on high-risk health care workers (HCWs). Method: We evaluated 271 HCWs from SARS units and 342 healthy control subjects, using the Perceived Stress Scale (PSS) to assess stress levels and a structured list of putative psychological effects of SARS to assess its psychological effects. Healthy control subjects were balanced for age, sex, education, parenthood, living circumstances, and lack of health care experience. Results: Stress levels were raised in both groups (PSS = 18) but were not relatively increased in the HCWs. HCWs reported significantly more positive (94%, n = 256) and more negative psychological effects (89%, n = 241) from SARS than did control subjects. HCWs declared confidence in infection-control measures. Conclusions: In HCWs, adaptive responses to stress and the positive effects of infection control training may be protective in future outbreaks. Elevated stress in the population may be an important indicator of future psychiatric morbidity.
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“The panic and anxiety caused by the stress response, separate from the emergency, are also common among medical staff (Maunder et al., 2003, Bai et al., 2004, Chua et al., 2004).”
From Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China (2020) · cites this paper as Chua et al., 2004
In the citing paper
“One study (Chua et al., 2004) compared HCWs with healthy controls and found that HCWs were not more stressed than controls (342) but 89% (241 of 271) of HCWs experienced negative psychological symptoms.”
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 Chua et al., 2004
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“2017), 89% of healthcare workers in high-risk situations reported psychological symptoms (Chua et al. 2004).”
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“Notably, we found higher levels of psychological distress among healthcare workers during the COVID-19 pandemic than were reported in Hong Kong (7%) and Canada (29%) during the earlier SARS outbreak [6, 29].”
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Shehada, A. K., Albelbeisi, A. H., Albelbeisi, A., Bilbeisi, A. H. E., & Afifi, A. M. E. (2021) · SAGE Open Medicine · doi:10.1177/20503121211022987 · Cited by 22
Kwon, D. H., Hwang, J., Cho, Y. W., Song, M. L., & Kim, K. T. (2020) · Journal of Sleep Medicine · doi:10.13078/jsm.200016 · Cited by 21
“이 발생했던 2004년에 캐나다의 보고에서는, 관련 의료 종사 자의 약 90%가 급성 심리 증상을 보고했다.(16) 한편 최근의 보 고에 따르면 2015년에 MERS-CoV에 대한 진료 업무를 수 행한 의료진은 수 년의 시간이 흘렀음에도 불구하고 외상후 스트레스증후군을 보일 위험이 높다는 것을 확인하였다.”
Waring, S., & Giles, S. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.629236 · Cited by 21
“Lower trust in protective measures was also associated with increased stress (53, 76) and anxiety (60) in the short-term, and burnout, psychological distress, posttraumatic stress (45), state anger, and avoidant coping (73) in the long-term.”
BackgroundResultMann, L. M., & Walker, B. R. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.09.087 · Cited by 21
Factors associated with mental health outcomes among medical residents exposed to COVID-19
Khoodoruth, M. A. S., Al-Nuaimi, S. K., Al‐Salihy, Z., Ghaffar, A., Khoodoruth, W. N. C., & Ouanes, S. (2021) · BJPsych Open · doi:10.1192/bjo.2021.12 · Cited by 21
“20 During the COVID-19 pandemic in Wuhan, China, a survey among healthcare workers showed a high prevalence of depression (50.4%), anxiety (44.6”
InfluentialHong, X., Cao, J., Wei, J., Duan, Y., Zhao, X., Jiang, J., Jiang, Y., Geng, W., & Zhu, H. (2020) · BJPsych Open · doi:10.1192/bjo.2021.32 · Cited by 22
Zhang, X., Sheng, Q., Wang, X., & Cai, C. (2021) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2021.05.007 · Cited by 20
Abdelghani, M., Hassan, M. S., Elgohary, H. M., & Fouad, E. A. (2021) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-021-00357-6 · Cited by 21
“Studies of previous pandemics and outbreaks also revealed that inadequate staff training [29], inadequate organizational support [30], frustration about the efficacy of precautionary measures [31], being less experienced [32], and lack of confidence in infection control and caring for affected medical colleagues durin…”
BackgroundSon, H. S., Kim, K., Cho, I., Lee, J., Choi, J. M., Kil, K., Kim, J.-H., Hong, Y., Ahn, M. H., & Chung, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.735016 · Cited by 25
“Moreover, studies conducted during previous pandemics, such as SARS, influenza A/H1N1, and MERS, have shown that healthcare workers exposed to these conditions are prone to psychiatric comorbidities, such as anxiety, depression, insomnia (3, 4, 7–9), acute stress disorder, or posttraumatic stress disorder (6, 10).”
BackgroundCOVID-19: Mental Health Prevention and Care for Healthcare Professionals
Rolling, J., Mengin, A. C., Palacio, C., Mastelli, D., Fath, M., Gras, A., Hunolstein, J. V., Schroder, C. M., & Vidailhet, P. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.566740 · Cited by 24
“Our first clinical observations (feeling of fear, acute stress, sleep disorders, anxiety, sense of rejection) are consistent with the results of previous studies on epidemics such as SARS (3–6) and with the first Chinese publications for COVID-19 (13–15).”
BackgroundInfluentialRoldán-Merino, J. F., Hurtado‐Pardos, B., Molina-Raya, L., Bande, D., Casas, I., & Farrés‐Tarafa, M. (2022) · Nursing Open · doi:10.1002/nop2.1207 · Cited by 20
“Many studies evaluating the psychological impact of the similar situations, such as the outbreak of Severe Acute Respiratory Syndrome (SARS) of 2003 on healthcare workers working during the epidemic, have been published (Chua et al., 2004; Maunder et al., 2006; McAlonan et al., 2007).”
BackgroundFear of COVID-19 Scale for Hospital Staff in Regional Hospitals in Mexico: A Survey StudyPreprint
García-Reyna, B., Castillo-García, G. D., Barbosa-Camacho, F. J., Cervantes-Cardona, G. A., Cervantes-Pérez, E., Torres-Mendoza, B. M., Fuentes-Orozco, C., Pintor-Belmontes, K. J., Guzmán-Ramírez, B. G., Hernández-Bernal, A., et al. (2020) · doi:10.21203/rs.3.rs-34065/v1 · Cited by 20
“In the COVID–19 crisis, health care professionals are expected to perceive a high amount of stress due to the overall lack of preparation, infrastructure, and personal protective equipment (Chua et al., 2004; Maunder et al., 2003; Pfefferbaum & North, 2020) .”
BackgroundVillalba-Arias, J., Estigarribia, G., Bogado, J. A., Méndez, J., Núñez, S. D. T., González, I., Castaldelli-Maia, J. M., Ventriglio, A., & Torales, J. C. (2020) · Medicina Clínica y Social · doi:10.52379/mcs.v4i3.156 · Cited by 19
“2020;4(3):93-97 97 issues and psychological distress among healthcare workers is mandatory (23).”
BackgroundResultInfluentialYiğitoğlu, G. T., Yılmaz, A., & Yılmaz, H. (2021) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2021.07.001 · Cited by 19
“Some published research reveals that healthcare staff developed negative psychological reactions to 2003 SARS pandemic (Chua et al., 2004; Maunder et al., 2003).”
Bodys-Cupak, I. E., Czubek, K., & Grochowska, A. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.814176 · Cited by 21
“During the SARS pandemic in 2003, fear of infection was reported to have had negative psychological effects (Bai et al., 2004; Chua et al., 2004; Lee et al., 2007), so it seems appropriate to conduct research to determine the best ways to ensure safety and counteract PTSD (post-traumatic stress disorder).”
BackgroundRajasekaran, K. (2020) · doi:10.22541/au.158931657.76546679 · Cited by 19
Psychological impact of COVID‐19 on hospital workers in nursing care hospitals
Yang, S., Kwak, S. G., & Chang, M. C. (2020) · Nursing Open · doi:10.1002/nop2.628 · Cited by 18
“During the 2003 outbreak of SARS, hospital employees reported high levels of anxiety, stress and depression (Lee et al., 2007; Wu et al., 2009) and 89% of healthcare workers reported psychological symptoms (e.g. worry over personal health and fear of social contact) (Chua et al., 2004).”
BackgroundПандемии и суицид: идеальный шторм и момент истины
Любов, Е. Б., Zotov, P. B., & Сергеевич, П. Б. (2020) · Суицидология · doi:10.32878/suiciderus.20-11-01(38)-3-38 · Cited by 18
Amer, S. A. A. M., Fouad, A., El-Samahy, M., Hashem, A. A., Saati, A. A., Sarhan, A. A., & Anani, M. M. (2021) · Journal of Primary Care & Community Health · doi:10.1177/21501327211027432 · Cited by 17
Psychological impacts of the COVID-19 pandemic on medical students in the United States of America
Zhang, Y., Geddes, J., Kanga, F. H., & Himelhoch, S. S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114595 · Cited by 17
What Can We Learn From the Past? Pandemic Health Care Workers’ Fears, Concerns, and Needs: A Review
Duffy, C. C., Bass, G. A., Fitzpatrick, G., & Doherty, E. M. (2020) · Journal of Patient Safety · doi:10.1097/pts.0000000000000803 · Cited by 18
Psychiatric distress in family caregivers of patients with COVID-19
Jafari‐Oori, M., Ebadi, A., Moradian, S. T., Jafari, M., Dehi, M., & Fard, F. G. (2021) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2021.07.005 · Cited by 18
Lee, H.-A., Ahn, M. H., Byun, S., Lee, H., Kweon, Y., Chung, S., Shin, Y., & Lee, K. (2021) · Journal of Korean Medical Science · doi:10.3346/jkms.2021.36.e325 · Cited by 17
Ahn, M. H., Shin, Y. W., Suh, S., Kim, J. H., Kim, H. J., Lee, K.-U., & Chung, S. (2020) · doi:10.31234/osf.io/9nxth · Cited by 63
Anxiety Levels among Polish and Turkish Dentists during the COVID-19 Pandemic
Olszewska-Czyż, I., & Sözkes, S. (2022) · Healthcare · doi:10.3390/healthcare10020357 · Cited by 16
Santa-Cruz, J., Moran, L., Tovar, M. A., Peinado, J., Cutipé, Y., Ramos, L., Astupillo, A., Rosler, M., Raviola, G. J., Lecca, L. W., et al. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.36 · Cited by 16
Anxiety and depression due to 2019 SARS-CoV-2 among frontier healthcare workers in Kenya
Onchonga, D., Ngetich, E., Makunda, W., Wainaina, P., Njuguna, D. W., & Prémusz, V. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06351 · Cited by 16
Chan, W. C. H., Woo, R. K. W., Kwok, D. K.-S., Yu, C. T. K., & Chiu, L. M.-H. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091211057043 · Cited by 16
“There have been more than 204 million confirmed cases worldwide.1 In Hong Kong (HK), by August 11, 2021, more than 12 000 confirmed cases and 212 deaths were reported.2 The outbreak of COVID-19 has caused substantial pressure on healthcare workers.3 Globally, 23% of healthcare workers have experienced symptoms of depr…”
BackgroundBeckstein, A. S., Chollier, M., Kaur, S., & Ghimire, A. R. (2022) · SAGE Open · doi:10.1177/21582440221100455 · Cited by 20
“In fact, for workers who dealt with the previous SARS outbreak, social support, previous training, and greater knowledge and competence about reducing the spread of the virus was associated with less distress (Chen et al., 2006; Chua et al., 2004; Maunder et al., 2006).”
BackgroundCOVID-19 pandemic: the impact on Canada’s intensive care units
Gibney, R. T. N., Blackman, C., Gauthier, M., Fan, E., Fowler, R., Johnston, C., Katulka, R. J., Marcushamer, S., Menon, K., Miller, T., et al. (2022) · FACETS · doi:10.1139/facets-2022-0023 · Cited by 19
Metadata
- Authors
- Chua, S. E., Cheung, V., Cheung, C., McAlonan, G. M., Wong, J. W., Cheung, E. P., Chan, M. T., Wong, M. M., Tang, S. W., Choy, K. M., Wong, M. K., Chu, C. M., & Tsang, K. W.
- Affiliations
- Queen Mary Hospital (CN)
- Hospital Authority (HK)
- United Christian Hospital (CN)
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2004-06
- Volume
- 49
- Issue
- 6
- Pages
- 391-393
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- OpenAlex
- W2131841402
- Cited by
- 462
- References
- 10
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 13 · 2023: 36 · 2022: 74 · 2021: 164 · 2020: 132 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 1 · 2013: 1 · 2012: 1
- FWCI
- 7.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Queen Mary University of London
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
- Keywords
- SARS, healthcare workers, psychological stress, psychological impact, infection control, infection control training, psychiatric morbidity, outbreak response, Hong Kong
- MeSH terms
- Adult, Disease Outbreaks, Fatigue, Female, Health Personnel, Hong Kong, Humans, Male, Occupational Diseases, Prospective Studies, Surveys and Questionnaires, Risk Factors, Health Behavior, Occupational Exposure, Severe Acute Respiratory Syndrome
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