Long-term Psychological and Occupational Effects during SARS Outbreak
Long-term Psychological and Occupational Effects during SARS Outbreak
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.
Severe 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, 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 and was associated with quarantine, fear of contagion, concern for family, job stress, interpersonal isolation, perceived stigma, conscription of nonspecialists into infectious disease work, and attachment insecurity.
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"). Before the SARS coronavirus was identified, SARS was an infection of unknown cause, unknown mode of transmission, global spread, and high mortality, c haracteristics that generally increase perceived risk. 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. Although healthcare work during the SARS outbreak and during an influenza pandemic will differ in key respects, SARS experience provides the most extensive information available about the effects on HCWs of a large-scale infectious outbreak. The objective of the Impact of SARS Study was to assess the long-term psychological and occupational impact of SARS outbreak on HCWs and to identify personal and systemic factors that increase vulnerability.
Abstract and Introduction
Abstract
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.
Introduction
Severe 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, 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 and was associated with quarantine, fear of contagion, concern for family, job stress, interpersonal isolation, perceived stigma, conscription of nonspecialists into infectious disease work, and attachment insecurity.
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"). Before the SARS coronavirus was identified, SARS was an infection of unknown cause, unknown mode of transmission, global spread, and high mortality, c haracteristics that generally increase perceived risk. 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. Although healthcare work during the SARS outbreak and during an influenza pandemic will differ in key respects, SARS experience provides the most extensive information available about the effects on HCWs of a large-scale infectious outbreak. The objective of the Impact of SARS Study was to assess the long-term psychological and occupational impact of SARS outbreak on HCWs and to identify personal and systemic factors that increase vulnerability.