Long-term Psychological and Occupational Effects of Providing Hospital Healthcare During SARS Outbreak

Overview

Journal Emerg Infect Dis

Specialty Infectious Diseases

Date 2007 Mar 1

PMID 17326946

Citations 534

Authors

Robert G Maunder

William J Lancee

Kenneth E Balderson

Jocelyn P Bennett

Bjug Borgundvaag

Susan Evans

Christopher M B Fernandes

David S Goldbloom

Mona Gupta

Jonathan J Hunter

Linda McGillis Hall

Lynn M Nagle

Clare Pain

Sonia S Peczeniuk

Glenna Raymond

Nancy Read

Sean B Rourke

Rosalie J Steinberg

Thomas E Stewart

Susan VanDeVelde-Coke

Georgina G Veldhorst

Donald A Wasylenki

Affiliations

Soon will be listed here.

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.

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References

Fraley R, Waller N, Brennan K . An item response theory analysis of self-report measures of adult attachment. J Pers Soc Psychol. 2000; 78(2):350-65. DOI: 10.1037//0022-3514.78.2.350. View

Maunder R, Lancee W, Nolan R, Hunter J, Tannenbaum D . The relationship of attachment insecurity to subjective stress and autonomic function during standardized acute stress in healthy adults. J Psychosom Res. 2006; 60(3):283-90. DOI: 10.1016/j.jpsychores.2005.08.013. View

Aiken L, Clarke S, Sloane D . Hospital staffing, organization, and quality of care: cross-national findings. Int J Qual Health Care. 2002; 14(1):5-13. DOI: 10.1093/intqhc/14.1.5. View

Kessler R, Andrews G, Colpe L, Hiripi E, Mroczek D, Normand S . Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002; 32(6):959-76. DOI: 10.1017/s0033291702006074. View

Aiken L, Clarke S, Sloane D, Sochalski J, Silber J . Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002; 288(16):1987-93. DOI: 10.1001/jama.288.16.1987. View

Peiris J, Lai S, Poon L, Guan Y, Yam L, Lim W . Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003; 361(9366):1319-25. PMC: 7112372. DOI: 10.1016/s0140-6736(03)13077-2. View

Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M . The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003; 168(10):1245-51. PMC: 154178. View

Drosten C, Gunther S, Preiser W, van der Werf S, Brodt H, Becker S . Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003; 348(20):1967-76. DOI: 10.1056/NEJMoa030747. View

Rota P, Oberste M, Monroe S, Nix W, Campagnoli R, Icenogle J . Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003; 300(5624):1394-9. DOI: 10.1126/science.1085952. View

10.

Kuiken T, Fouchier R, Schutten M, Rimmelzwaan G, van Amerongen G, van Riel D . Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome. Lancet. 2003; 362(9380):263-70. PMC: 7112434. DOI: 10.1016/S0140-6736(03)13967-0. View

11.

Yehuda R . Risk and resilience in posttraumatic stress disorder. J Clin Psychiatry. 2004; 65 Suppl 1:29-36. View

12.

Nickell L, Crighton E, Tracy C, Al-Enazy H, Bolaji Y, Hanjrah S . Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ. 2004; 170(5):793-8. PMC: 343853. DOI: 10.1503/cmaj.1031077. View

13.

Chan A, Huak C . Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med (Lond). 2004; 54(3):190-6. PMC: 7107861. DOI: 10.1093/occmed/kqh027. View

14.

Bai Y, Lin C, Lin C, Chen J, Chue C, Chou P . Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55(9):1055-7. DOI: 10.1176/appi.ps.55.9.1055. View

15.

Horowitz M, WILNER N, Alvarez W . Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979; 41(3):209-18. DOI: 10.1097/00006842-197905000-00004. View

16.

Horowitz M . Stress-response syndromes: a review of posttraumatic and adjustment disorders. Hosp Community Psychiatry. 1986; 37(3):241-9. DOI: 10.1176/ps.37.3.241. View

17.

Slovic P . Perception of risk. Science. 1987; 236(4799):280-5. DOI: 10.1126/science.3563507. View

18.

Yank G, Barber J, Hargrove D, Whitt P . The mental health treatment team as a work group: team dynamics and the role of the leader. Psychiatry. 1992; 55(3):250-64. DOI: 10.1080/00332747.1992.11024598. View

19.

Mikulincer M, Florian V, Weller A . Attachment styles, coping strategies, and posttraumatic psychological distress: the impact of the Gulf War in Israel. J Pers Soc Psychol. 1993; 64(5):817-26. DOI: 10.1037//0022-3514.64.5.817. View

20.

Maunder R, Lancee W, Rourke S, Hunter J, Goldbloom D, Balderson K . Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto. Psychosom Med. 2004; 66(6):938-42. DOI: 10.1097/01.psy.0000145673.84698.18. View