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Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak
Open accessAbstract
Healthcare workers (HCWs) found the 2003 outbreak of severe acute respiratory syndrome (SARS) to be stressful, but the long-term impact is not known.From 13 to 26 months after the SARS outbreak, 769 HCWs at 9 Toronto hospitals that treated SARS patients and 4 Hamilton hospitals that did not treat SARS patients completed a survey of several adverse outcomes.Toronto HCWs reported significantly higher levels of burnout (p = 0.019), psychological distress (p<0.001), and posttraumatic stress (p<0.001).Toronto workers were more likely to have reduced patient contact and work hours and to report behavioral consequences of stress.Variance in adverse outcomes was explained by a protective effect of the perceived adequacy of training and support and by a provocative effect of maladaptive coping style and other individual factors.The results reinforce the value of effective staff support and training in preparation for future outbreaks.S evere acute respiratory syndrome (SARS) emerged from Guangdong Province, People's Republic of China, in November 2002 and spread rapidly; transmission occurred primarily in hospitals, often to healthcare workers (HCWs).Although initially virtually no literature was available to guide expectations of how an emerging infection would affect the psychological well-being of hospital staff (1), by the summer of 2003 the acute psychological impact of SARS had been widely studied.Significant emotional distress was present in 18%-57% of HCWs (2-6) and was associated with quarantine (7), fear of contagion (6,8,9), concern for family (5,9,10), job stress (6,9), interpersonal isolation (6,9), perceived stigma (6,7,11), conscription of nonspecialists into infectious disease work (12), and attachment insecurity (10).Working in SARS-affected hospitals could have been traumatic for some HCWs (i.e., an event that "threatens an individual's life or physical integrity and involves a subjective response of fear, helplessness, or horror" [13]).Before the SARS coronavirus was identified (14-17), SARS was an infection of unknown cause, unknown mode of transmission, global spread, and high mortality, characteristics that generally increase perceived risk (18).However, although the SARS outbreak was acutely stressful, the longer term impact of SARS on HCWs is unknown.Understanding the enduring occupational and psychological effects of working during this SARS outbreak is important because it involves the well-being of large numbers of HCWs.Additionally, this information has wider relevance to health systems in planning for emerging infections, including pandemic influenza (http://www.who.int/csr/disease/influenza/inforesources/en) and the potential for bioterrorism (19).
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“Following the outbreak of severe acute respiratory syndrome in 2003, health-care workers reported chronic stress effects for months to years.4”
From COVID-19: a heavy toll on health-care workers (2021) · cites this paper as [4]
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“Such an extraordinary event will have long-term effects on mental health according to previous studies of epidemics and quarantine (Maunder et al., 2006; Brooks S. K. et al., 2020; Kisely et al., 2020).”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Maunder et al., 2006
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“However, some systematic review has been reported the hospital resources and family support as major influencing factors for nurses’ burnout.(23,25,26)”
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InfluentialPublic Health Workforce Burnout in the COVID-19 Response in the U.S.
Stone, K. W., Kintziger, K. W., Jagger, M. A., & Horney, J. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18084369 · Cited by 138
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Gilleen, J., Santaolalla, A., Valdearenas, L., Salice, C., & Fusté, M. (2021) · BJPsych Open · doi:10.1192/bjo.2021.42 · Cited by 139
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BackgroundInfluentialMaunder, R. G., Lancee, W. J., Mae, R., Vincent, L., Peladeau, N., Beduz, M. A., Hunter, J. J., & Leszcz, M. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-72 · Cited by 129
“Confidence in training and support was measured with a questionnaire derived to measure responses of health-care workers to SARS [39] that was found to predict long-term effects of SARS [13], modified to apply to influenza.”
BackgroundMethodInfluentialSelf-citationTrani, M. D., Mariani, R., Ferri, R., Berardinis, D. D., & Frigo, M. G. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.646435 · Cited by 142
“Previous studies of epidemics and quarantine suggest that such an extraordinary event will have long-term effects on mental health (Maunder et al., 2006; Kisely et al., 2020).”
BackgroundCooper, M., Reilly, E. E., Siegel, J. A., Coniglio, K., Sadeh-Sharvit, S., Pisetsky, E. M., & Anderson, L. M. (2022) · Eating Disorders · doi:10.1080/10640266.2020.1790271 · Cited by 209
“For example, research conducted during the 2003 SARS outbreak found that healthcare workers reported substantial burnout and posttraumatic stress (Maunder et al., 2006).”
BackgroundResultZheng, L., Miao, M., & Gan, Y. (2020) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12232 · Cited by 132
“This result is consistent with the psychological effects of SARS on subjective life satisfaction (Lau et al., 2008; Maunder et al., 2006).”
ResultPredictors of poor mental health among nurses during COVID‐19 pandemic
Kim, S. C., Quiban, C., Sloan, C., & Montejano, A. S. (2020) · Nursing Open · doi:10.1002/nop2.697 · Cited by 138
“For example, 1–2 years after the SARS outbreak in Canada, frontline healthcare workers were still having higher burnout, psychological distress and post-traumatic stress disorder compared with those who did not care for SARS patients (Maunder et al., 2006).”
BackgroundLevels of stress in medical students due to COVID-19
O’Byrne, L., Gavin, B. E., Adamis, D., Lim, Y. X., & McNicholas, F. (2021) · Journal of Medical Ethics · doi:10.1136/medethics-2020-107155 · Cited by 123
GP wellbeing during the COVID-19 pandemic: a systematic review
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Attachment Relationships as Determinants of Physical Health
Maunder, R., & Hunter, J. (2008) · Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry · doi:10.1521/jaap.2008.36.1.11 · Cited by 129
Self-citationCOVID-19 Epidemic Peer Support and Crisis Intervention Via Social Media
Cheng, P., Xia, G., Pang, P., Wu, B., Jiang, W., Li, Y.-T., Wang, M., Ling, Q., Chang, X., Wang, J., et al. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00624-5 · Cited by 120
“Most people get back to baseline; however, some of them progressed into long-term mental illness, such as PTSD (Maunder et al.”
BackgroundCellini, N., Conte, F., Rosa, O. D., Giganti, F., Malloggi, S., Reyt, M., Guillemin, C., Schmidt, C., Muto, V., & Ficca, G. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.11.027 · Cited by 123
“The reduced sleep quality in this population is alarming since it can increase the susceptibility of medical staff to COVID-19 infection, therefore increase the probability of infection outbreak, and can negatively affect mental health in a population already under high stress [39].”
BackgroundZhang, X., Jiang, X., Ni, P., Li, H., Li, C., Zhou, Q., Ou, Z., Guo, Y., & Cao, J. (2021) · International Journal of Mental Health Nursing · doi:10.1111/inm.12847 · Cited by 112
“, 2020), and reported significant pressure and somatic symptoms, as well as higher levels and rate of emotional exhaustion than those observed during the SARS outbreak (Maunder et al., 2006).”
BackgroundInfluentialBrooks, S. K., Rubin, G. J., & Greenberg, N. L. (2018) · British Medical Bulletin · doi:10.1093/bmb/ldy040 · Cited by 118
Barello, S., Falcó‐Pegueroles, A., Rosa, D., Tolotti, A., Graffigna, G., & Bonetti, L. (2020) · International Journal of Public Health · doi:10.1007/s00038-020-01463-7 · Cited by 125
COVID-19-related stigmatization among a sample of Egyptian healthcare workers
Mostafa, A., Sabry, W., & Mostafa, N. S. (2020) · PLoS ONE · doi:10.1371/journal.pone.0244172 · Cited by 121
“Disease-related stigmatization was previously reported for the Autoimmune Deficiency Syndrome [23], the Middle East Respiratory Syndrome [26], and SARS [17, 27].”
BackgroundInfluentialJohns, G., Samuel, V. M., Freemantle, L., Lewis, J., & Waddington, L. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.11.026 · Cited by 121
“A study conducted one to two years post-SARS outbreak found high levels of burnout, psychological distress, and posttraumatic stress in healthcare workers (Maunder et al., 2006).”
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Individual-level interventions for reducing occupational stress in healthcare workers
Tamminga, S. J., Emal, L. M., Boschman, J. S., Levasseur, A., Thota, A. B., Ruotsalainen, J. H., Schelvis, R. M. C., Nieuwenhuijsen, K., & van der Molen, H. F. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002892.pub6 · Cited by 148
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“As demonstrated by studies on previous outbreaks [40,41], some of the medical workers during the SARS-CoV-2 pandemic may be at risk for post-traumatic stress disorder, which also appears to be connected with prolonged hypothalamic–pituitary–adrenal (HPA) axis overactivity [42,43].”
BackgroundInfluentialFeingold, J. H., Peccoralo, L. A., Chan, C. C., Kaplan, C. A., Kaye‐Kauderer, H., Charney, D. S., Verity, J., Hurtado, A., Burka, L., Syed, S., et al. (2020) · Chronic Stress · doi:10.1177/2470547020977891 · Cited by 117
“Hospital staff at sites that treated SARSinfected patients in 2003 reported higher symptoms of burnout, psychological distress, and posttraumatic stress 13-26months after the outbreak, compared with those at sites that did not treat SARS patients.(9) Early data from the COVID-19 pandemic found that among 1,257 Chinese…”
ResultKhajuria, A., Tomaszewski, W., Liu, Z., Chen, J., Mehdian, R., Fleming, S. S., Vig, S., & Crawford, M. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06279-6 · Cited by 121
“Studies from the 2003 SARS pandemic reported higher levels of depression [12], anxiety [13], posttraumatic stress disorder (PTSD) [14], burnout [15] and stress [10] amongst HCWs, with symptoms persisting up to 1 year after the pandemic [10] and nursing staff reporting the worst outcomes [16].”
BackgroundXu, H., Stjernswärd, S., & Glasdam, S. (2021) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2021.100037 · Cited by 112
“…nurses had a higher prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) during and after pandemics (Martikainen et al., 2002, Maunder et al., 2004, Maunder et al., 2006, Chong et al., 2004, Bai et al., 2004, Verma et al., 2004, Barello et al., 2020, Grace et al., 2005).”
BackgroundLiu, S., Yang, L., Zhang, C., Xu, Y., Cai, L., Ma, S., Wang, Y., Cai, Z., Du, H., Li, R., et al. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.03.014 · Cited by 122
Nurses’ Mental Health and Well-Being: COVID-19 Impacts
Stelnicki, A. M., Carleton, R. N., & Reichert, C. (2020) · Canadian Journal of Nursing Research · doi:10.1177/0844562120931623 · Cited by 111
Insomnia and stress of physicians during COVID-19 outbreak
Abdulah, D. M., & Musa, D. H. (2020) · Sleep Medicine X · doi:10.1016/j.sleepx.2020.100017 · Cited by 105
“The urgent appropriate strategies are required to strengthen the HCWs against mental health issues [22].”
BackgroundInfluentialPaiano, M., Jaques, A. E., Nacamura, P. A. B., Salci, M. A., Radovanovic, C. A. T., & Carreira, L. (2020) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2020-0338 · Cited by 113
“Among the risk factors mentioned are high-risk exposures(42), quarantine during the outbreak(33), living alone(43), having an infected family member/friend(7), being a nurse(42), feel forced to care for infected patients due to work position(44), stigmatization/social isolation(42), overwork(42) and inadequate psychia…”
BackgroundHendrickson, R. C., Slevin, R. A., Hoerster, K. D., Chang, B. P., Sano, E., McCall, C. A., Monty, G. R., Thomas, R. G., & Raskind, M. A. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07252-z · Cited by 102
Hammond, N. E., Crowe, L., Abbenbroek, B., Elliott, R. M., Tian, D. H., Donaldson, L., Fitzgerald, E., Flower, O. J., Grattan, S., Harris, R. D., et al. (2020) · Australian Critical Care · doi:10.1016/j.aucc.2020.12.004 · Cited by 109
Attachment Relationships as Determinants of Physical Health
Maunder, R., & Hunter, J. (2022) · Psychodynamic Psychiatry · doi:10.1521/pdps.2022.50.2.360 · Cited by 103
Self-citationFarhoudian, A., Baldacchino, A., Clark, N. C., Gerra, G., Ekhtiari, H., Dom, G., Mokri, A., Sadeghi, M., Nematollahi, P., Demasi, M., et al. (2020) · Basic and Clinical Neuroscience Journal · doi:10.32598/bcn.11.covid19.1 · Cited by 107
“In a study conducted on frontline staff involved in the Severe Acute Respiratory Syndrome (SARS) epidemic, it was found that they had high levels of burnout, psychological distress, and posttraumatic stress (Maunder et al., 2006).”
BackgroundSkoda, E.-M., Teufel, M., Stang, A., Jöckel, K., Junne, F., Weismüller, B., Hetkamp, M., Musche, V., Dinse, H., Dörrie, N., et al. (2020) · Journal of Public Health · doi:10.1093/pubmed/fdaa124 · Cited by 100
Britt, T. W., Shuffler, M. L., Pegram, R., Xoxakos, P., Rosopa, P. J., Hirsh, E., & Jackson, W. (2020) · Applied Psychology · doi:10.1111/apps.12304 · Cited by 119
Burnout and the challenges facing pharmacists during COVID-19: results of a national survey
Johnston, K., O’Reilly, C. L., Scholz, B., Georgousopoulou, E. N., & Mitchell, I. (2021) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-021-01268-5 · Cited by 95
“Data from the SARS epidemic supports this finding and suggests that longterm psychological burden is not related to whether a health professional cared directly for a patient with the virus [50, 51].”
BackgroundUsing Rapid Design Thinking to Overcome COVID-19 Challenges in Medical Education
Thakur, A., Soklaridis, S., Crawford, A., Mulsant, B., & Sockalingam, S. (2020) · Academic medicine : journal of the Association of American Medical Colleges · doi:10.1097/acm.0000000000003718 · Cited by 73
“25,26 Although, understandably, the current focus is on controlling and acutely managing the COVID-19 pandemic, supporting HCPs and community members to build resilience and coping strategies is imperative.”
BackgroundGao, F., Guo, R., Ma, Q., Li, Y., Wang, W., Fan, Y., Ju, Y., Zhao, B., Gao, Y., Li, Q., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.02.024 · Cited by 92
“…Disorders 303 (2022) 187–195 symptoms in FHWs, which is consistent with a previous study that reported significantly higher post-traumatic stress from 13 to 26 months after the severe acute respiratory syndrome (SARS) outbreak in healthcare workers who treated SARS patients (Maunder et al., 2006).”
Kim, S. C., Sloan, C., Montejano, A. S., & Quiban, C. (2021) · Nursing Reports · doi:10.3390/nursrep11010004 · Cited by 102
“Compared with the pre-lockdown period, students reported higher stress (median [IQR]; 16 [13, 18] vs.”
BackgroundValidation of the Impact of Event Scale With Modifications for COVID-19 (IES-COVID19)
Vanaken, L., Scheveneels, S., Belmans, E., & Hermans, D. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00738 · Cited by 100
“Notably, these trauma-related stress symptoms persisted over time and were still present 13 to 26 months after the outbreak (8).”
BackgroundLuo, Y., Chua, C. R., Xiong, Z., Ho, R., & Ho, C. S. H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.565098 · Cited by 93
Nijland, J. W. H. M., Veling, W., Lestestuiver, B., & van Driel, C. M. G. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.706527 · Cited by 91
Mental health issues impacting pharmacists during COVID-19
Elbeddini, A., Wen, C. X., Tayefehchamani, Y., & To, A. (2020) · Journal of Pharmaceutical Policy and Practice · doi:10.1186/s40545-020-00252-0 · Cited by 96
The psychological impact of COVID-19 pandemic on physicians in Saudi Arabia: A cross-sectional study
Sulais, E. A., Mosli, M. H., & AlAmeel, T. (2020) · Saudi Journal of Gastroenterology · doi:10.4103/sjg.sjg_174_20 · Cited by 88
“Previous studies have shown that a quarantine for ten days and more is a predictor of negative psychological outcomes,[7,9,11,13] It is noteworthy that the majority of physicians enrolled in our study (86.”
BackgroundResultPredictors of Burnout in Healthcare Workers during the COVID-19 Pandemic
Cotel, A., Golu, F., Stoian, A. P., Dimitriu, M. C. T., Socea, B., Cirstoveanu, C. G., Daviţoiu, A. M., Jacotă‐Alexe, F., & Oprea, B. (2021) · Healthcare · doi:10.3390/healthcare9030304 · Cited by 97
“After the 2003 outbreak of SARS, healthcare workers from hospitals that treated SARS patients reported higher levels of burnout than hospital employees who had not treated such patients [10].”
BackgroundCOVID-19 Outbreak Can Change the Job Burnout in Health Care Professionals
Liu, X., Chen, J., Wang, D., Li, X., Wang, E., Jin, Y., Ma, Y., Yu, C. J., Luo, C., Zhang, L., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.563781 · Cited by 88
“It is worth noting that previous studies had shown a long-term psychological and occupational effects of SARS (severe acute respiratory syndrome coronavirus) that it could even significantly increase the level of burnout among health care workers who cared for SARS patients compared to those who did not after 13 to 26…”
ResultVyas, K. J., Delaney, E. M., Webb-Murphy, J. A., & Johnston, S. L. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00473 · Cited by 80
Maunder, R., Heeney, N. D., Kiss, A., Hunter, J., Jeffs, L. P., Ginty, L., Johnstone, J., Loftus, C., & Wiesenfeld, L. A. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2021.04.012 · Cited by 86
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Yıldırım, D., & Yıldız, C. Ç. (2022) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000511 · Cited by 95
Lee, J., & Kang, S. J. (2019) · Nursing and Health Sciences · doi:10.1111/nhs.12652 · Cited by 82
The Effect of COVID-19 Anxiety on General Health: the Role of COVID-19 Coping
Yıldırım, M., Akgül, Ö., & Geçer, E. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-020-00429-3 · Cited by 93
Addressing Postpandemic Clinician Mental Health
Schwartz, R., Sinskey, J. L., Anand, U., & Margolis, R. D. (2020) · Annals of Internal Medicine · doi:10.7326/m20-4199 · Cited by 86
“Studies of previous pandemics demonstrate heightened distress in health care workers more than 2 years after the event (7).”
BackgroundClinical Characteristics of COVID-19 Infection in Newborns and Pediatrics: A Systematic Review.
Panahi, L., Amiri, M., & Pouy, S. (2020) · Archives of Academic Emergency Medicine · doi:10.22037/aaem.v8i1.634 · Cited by 80
Zhang, H., Shi, Y., Jing, P., Zhan, P., Fang, Y., & Wang, F. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113541 · Cited by 83
Advancement in COVID‐19 detection using nanomaterial‐based biosensors
Truong, P. L., Yin, Y., Lee, D., & Ko, S. H. (2023) · Exploration · doi:10.1002/exp.20210232 · Cited by 81
Burnout in Hospital-Based Healthcare Workers during COVID-19
Maunder, R., Heeney, N. D., Strudwick, G., Shin, H. D., O’Neill, B. G., Young, N., Jeffs, L. P., Barrett, K. A., Bodmer, N. S., Born, K. B., et al. (2021) · doi:10.47326/ocsat.2021.02.46.1.0 · Cited by 87
Self-citationLou, N. M., Montreuil, T. C., Feldman, L. S., Fried, G. M., Lavoie‐Tremblay, M., Bhanji, F., Kennedy, H., Kaneva, P. A., & Harley, J. M. (2021) · Journal of Continuing Education in the Health Professions · doi:10.1097/ceh.0000000000000365 · Cited by 82
“By contrast, a lack of early access to support (eg, time and access to therapy, hobbies such as gym, and family and friends) can restrict the adoption of adaptive copingmechanisms and their deployment inmanaging stress, which can result in psychological distress and carry longlasting consequences.(9) Therefore, social…”
BackgroundZürcher, S. J., Kerksieck, P., Adamus, C., Burr, C., Lehmann, A. I., Huber, F. K., & Richter, D. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.560389 · Cited by 88
Kreh, A., Brancaleoni, R., Magalini, S., Chieffo, D. P. R., Flad, B., Ellebrecht, N., & Juen, B. H. (2021) · PLoS ONE · doi:10.1371/journal.pone.0249609 · Cited by 86
Magill, E., Siegel, Z., & Pike, K. M. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000274 · Cited by 77
“management (9, 23, 62, 78), and evidence-based data analysis methods (21, 61, 67, 90).”
BackgroundInfluentialCOVID-19: a new work-related disease threatening healthcare workers
Godderis, L., Boone, A., & Bakusic, J. (2020) · Occupational Medicine · doi:10.1093/occmed/kqaa056 · Cited by 82
“found that doctors providing healthcare during a pandemic face a substantially higher risk of developing long-term mental health problems due to chronic stress or traumatic experiences [9].”
BackgroundGupta, B., Sharma, V., Kumar, N., & Mahajan, A. (2020) · JMIR Public Health and Surveillance · doi:10.2196/24206 · Cited by 80
“outbreaks wherein HCWs reported high levels of fear of contagion and transmitting infection to their family members, in addition to emotional disturbance, uncertainty, and stigmatization [33-37].”
Biber, J. E., Ranes, B. M., Lawrence, S., Malpani, V., Trinh, T. T., Cyders, A., English, S., Staub, C. L. H., McCausland, K. L., Kosinski, M. R., et al. (2022) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-022-00467-6 · Cited by 81
“Evidence from previous epidemics shows that outbreaks can negatively impact the short and long-term mental health of HCWs significantly [2].”
BackgroundMoral and mental health challenges faced by maternity staff during the COVID-19 pandemic.
Horsch, A., Lalor, J., & Downe, S. M. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000629 · Cited by 74
“In turn, this may lead to reduced working hours and increased turnover (Maunder et al., 2006).”
BackgroundFlexman, A. M., Abcejo, A. S., Avitsian, R., Sloovere, V. D., Highton, D., Juul, N., Li, S., Meng, L., Paisansathan, C., Rath, G. P., et al. (2020) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0000000000000691 · Cited by 74
Maiorano, T., Vagni, M., Giostra, V., & Pajardi, D. (2020) · Sustainability · doi:10.3390/su12219004 · Cited by 85
Insomnia, Perceived Stress, and Family Support among Nursing Staff during the Pandemic Crisis
Tselebis, A., Lekka, D., Sikaras, C., Tsomaka, E., Tassopoulos, A., Ilias, Ι., Bratis, D., & Pachi, A. (2020) · Healthcare · doi:10.3390/healthcare8040434 · Cited by 80
Bell, V., & Wade, D. M. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01990-x · Cited by 77
“One cross-sectional study conducted at two time points and sampling from the same clinical teams found high levels of self-reported poor mental health for high exposure workers one year after high-exposure work (Maunder et al., 2006) although a study on a subsample of participants using a structured interview assessme…”
BackgroundResultInfluentialBurnout and peritraumatic distress of healthcare workers in the COVID-19 pandemic
Jang, Y., You, M., Lee, H., Lee, M., Lee, Y., Han, J.-O., & Oh, J. H. (2021) · BMC Public Health · doi:10.1186/s12889-021-11978-0 · Cited by 82
“The higher prevalence of emotional exhaustion could be attributed to long-term COVID-19 work participation, having to work in a risky workplace, and continuous presence of COVID-19 related tasks [15, 17].”
BackgroundResultInfluentialChau, S. W. H., Wong, O. W. H., Ramakrishnan, R., Chan, S. S. M., Wong, E. K.-Y., Li, P. Y. T., Raymont, V., Elliot, K., Rathod, S., Delanerolle, G., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-10701-3 · Cited by 81
“The study by Lancee et al., which captured a subset of the sample of the study by Maunder et al. (2006), also reported a low rate of PTSD (1.5”
BackgroundResultInfluentialSleep disturbances among physicians during COVID-19 pandemic
Alnofaiey, Y. H., Alshehri, H. A., Alosaimi, M. M., Alswat, S. H., Alswat, R. H., Alhulayfi, R. M., Alghamdi, M. A., & Alsubaie, R. M. G. M. M. A. M. M. (2020) · BMC Research Notes · doi:10.1186/s13104-020-05341-6 · Cited by 72
Toh, W. L., Meyer, D., Phillipou, A., Tan, E. J., Rheenen, T. E. V., Neill, E., & Rossell, S. L. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113822 · Cited by 75
“In the long-term, HCWs reported increased post-traumatic stress, psychological distress and burnout (Maunder et al., 2006).”
BackgroundSchneider, J., Talamonti, D., Gibson, B., & Forshaw, M. J. (2021) · Journal of Health Psychology · doi:10.1177/13591053211012759 · Cited by 80
“In turn, burnout was greater in the presence of jobrelated stress, poor hospital resources, and poor support from family and friends (Kim and Choi, 2016), as well as maladaptive coping techniques and a perceived lack of support from others, including fellow hospital staff, more generally (Maunder et al., 2006).”
BackgroundMaunder, R., Heeney, N. D., Hunter, J., Strudwick, G., Jeffs, L. P., Ginty, L., Johnstone, J., Kiss, A., Loftus, C., & Wiesenfeld, L. A. (2022) · Journal of Occupational Medicine and Toxicology · doi:10.1186/s12995-022-00352-4 · Cited by 75
“In particular, after the 2003 outbreak of severe acute respiratory syndrome (SARS) had resolved, healthcare workers in affected hospitals reported a range of stress effects that continued to be significantly elevated compared to workers in non-affected hospitals for as long as they were followed, which was 18–24 month…”
BackgroundSelf-citationLi, J., Xu, J., Zhou, H., You, H., Wang, X., Li, Y., Liang, Y., Li, S., Ma, L., Zeng, J., et al. (2021) · BMC Public Health · doi:10.1186/s12889-020-10146-0 · Cited by 74
Fader, A. N., Huh, W. K., Kesterson, J. P., Pothuri, B., Wethington, S. L., Wright, J. D., Bakkum-Gamez, J. N., Soliman, P. T., Sinno, A., Leitão, M. M., et al. (2020) · Gynecologic Oncology · doi:10.1016/j.ygyno.2020.06.001 · Cited by 69
Zhao, Y.-J., Jin, Y., Rao, W., Li, W., Zhao, N., Cheung, T. C. C., Ng, C. H., Wang, Y. Y., Zhang, Q., & Xiang, Y. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.016 · Cited by 71
Tzeng, N.-S., Chung, C.-H., Chang, C.-C., Chang, H.-A., Kao, Y.-C., Chang, S.-Y., & Chien, W.-C. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-01021-y · Cited by 63
Si̇s Çeli̇k, A., & Kılınç, T. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2022.101637 · Cited by 68
The evolved developmental niche in childhood: Relation to adult psychopathology and morality
Narvaez, D. F., Wang, L., & Cheng, Y. (2016) · Applied Developmental Science · doi:10.1080/10888691.2015.1128835 · Cited by 81
“Lack of secure attachment generally indicates some habitual form of dysphoria in social relationships and is related to the use of non-social means for mood improvement, such as eating, smoking, and the use of substances like alcohol or drugs (Maunder, Lancee, et al., 2006).”
Intensive Care Unit Preparedness During Pandemics and Other Biological Threats
Maves, R. C., Jamros, C., & Smith, A. G. (2019) · Critical Care Clinics · doi:10.1016/j.ccc.2019.06.001 · Cited by 68
“much of the risk to HCWs is a direct result of their actual work and not a general risk to their community; as such, training and institutional precautions need to be implemented to both protect staff and reduce absenteeism.(22,23)”
BackgroundHlubocky, F. J., Symington, B. E., McFarland, D. C., Gallagher, C. M., Dragnev, K. H., Burke, J. M., Lee, R. T., El-Jawahri, A. R., Popp, B., Rosenberg, A. R., et al. (2021) · JCO Oncology Practice · doi:10.1200/op.20.00937 · Cited by 68
Gupta, S., Prasad, A. S., Dixit, P. K., Padmakumari, P., Gupta, S. K., & Abhisheka, K. (2020) · Medical Journal Armed Forces India · doi:10.1016/j.mjafi.2020.07.006 · Cited by 66
“In another study assessing the association between distress and job role, nurses were found to have higher distress levels during the SARS outbreak.(21) In a”
BackgroundCOVID-19 Pandemic: Looking After the Mental Health of Our Healthcare Workers
Choudhury, T. R., Dębski, M., Wiper, A., Abdelrahman, A., Wild, S., Chalil, S., More, R. S., Goode, G., Patel, B., & Abdelaziz, H. K. (2020) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001907 · Cited by 67
“Various factors that contribute to such heightened psychological stress have been described including interpersonal isolation, fear of contagion (81% in our survey), quarantine, stigma, concern for family, and non-infectious specialty workers being drafted on to infectious wards.(10) Particularly, in an infectious out…”
BackgroundCoronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor
Canestrari, C., Bongelli, R., Fermani, A., Riccioni, I., Bertolazzi, A., Muzi, M., & Burro, R. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.601574 · Cited by 67
The impact of oxidative stress damage induced by the environmental stressors on COVID-19
Bakadia, B. M., Boni, B. O. O., Ahmed, A. A. Q., & Yang, G. (2020) · Life Sciences · doi:10.1016/j.lfs.2020.118653 · Cited by 66
“Indeed, a year after the 2003 epidemic, caregivers caring for infected patients had shown an increased prevalence of burnout, symptoms of PTSD, and psychological distress [47].”
Kelsey, E. A., West, C. P., Cipriano, P. F., Peterson, C., Satele, D., Shanafelt, T., & Dyrbye, L. N. (2021) · AJN, American Journal of Nursing · doi:10.1097/01.naj.0000798056.73563.fa · Cited by 65
Umbetkulova, S., Kanderzhanova, A., Foster, F., Stolyarova, V., & Cobb-Zygadlo, D. (2023) · Evaluation & the Health Professions · doi:10.1177/01632787231165076 · Cited by 71
“Furthermore, some studies indicate that acute mental health issues experienced by healthcare professionals may have long-term psychological effects (Maunder et al., 2006).”
BackgroundGuidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic
Geerts, J. M., Kinnair, D., Taheri, P. A., Abraham, A., Ahn, J. M., Atun, R. A., Barberia, L., Best, N. J., Dandona, R., Dhahri, A. A., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.20295 · Cited by 77
Elshami, W., Akudjedu, T. N., Abuzaid, M., David, L. R., Tekin, H. O., Cavlı, B., & Issa, B. A. (2020) · Radiography · doi:10.1016/j.radi.2020.09.016 · Cited by 65
Metadata
- Authors
- Maunder, R., Lancee, W., Balderson, K., Bennett, J., Borgundvaag, B., Evans, S., Fernandes, C., Goldbloom, D., Gupta, M., Hunter, J., McGillis Hall, L., Nagle, L., Pain, C., Peczeniuk, S., Raymond, G., Read, N., Rourke, S., Steinberg, R., Stewart, T., VanDeVelde-Coke, S., Veldhorst, G., & Wasylenki, D.
- Affiliations
- Mount Sinai Hospital (CA)
- Scarborough Health Network (CA)
- Sunnybrook Health Science Centre (CA)
- University of Toronto (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Maunder, Robert
- Lancee, William
- Bennett, Jocelyn
- Borgundvaag, Bjug
- Goldbloom, David
- Hunter, Jonathan
- Pain, Clare
- Steinberg, Rosalie
- Stewart, Thomas
- ORCID
- Venue
- Emerging Infectious Diseases
- Published
- 2006
- Volume
- 12
- Issue
- 12
- Pages
- 1924-1932
- ISSN
- 1080-6040 (ISSN-L)
- PMC
- PMC3291360
- OpenAlex
- W1985834457
- Cited by
- 1,109
- References
- 44
- Citations by year
- 2026: 16 · 2025: 33 · 2024: 47 · 2023: 121 · 2022: 223 · 2021: 335 · 2020: 259 · 2019: 12 · 2018: 8 · 2017: 5 · 2016: 6 · 2015: 4 · 2014: 1 · 2013: 5
- FWCI
- 6.15
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Emerging infectious diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (67807)
- 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, burnout, psychological distress, post-traumatic stress, occupational stress, coping styles, staff training and support, hospital staff well-being, stigma, working time reduction, insecure attachment, risk perception, 2003 SARS outbreak
- MeSH terms
- Adult, Data Collection, Disease Outbreaks, Female, Humans, Male, Ontario, Personnel, Hospital, Regression Analysis, Severe Acute Respiratory Syndrome, Severe acute respiratory syndrome-related coronavirus
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