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Severe Acute Respiratory Syndrome–Related Psychiatric and Posttraumatic Morbidities and Coping Responses in Medical Staff Within a Primary Health Care Setting in Singapore

J Clin Psychiatry 2004;65(8):1120-1127

Background: Severe acute respiratory syndrome (SARS) is a major new infectious disease of this century that is unique in its high morbidity and concentration in health care settings. We aimed to determine the level of psychological impact and coping styles among the medical staff in a primary health care setting.

Method: Using a structured questionnaire, we conducted a cross-sectional survey of the doctors and nurses working within a public, primary health care setting in mid-July 2003. The main outcome measures were rates of psychiatric morbidity, level of posttraumatic stress symptoms, and coping strategies.

Results: The response rate was 92.0%. Of the 277 respondents (91 doctors and 186 nurses), psychiatric morbidity and posttraumatic morbidity were found in 20.6% and 9.4%, respectively. Both psychiatric and posttraumatic morbidities were associated with higher scores on coping efforts including self-distraction, behavioral disengagement, social support, venting, planning, and self-blame (all p < .001), but not with direct exposure factors such as contact with suspected SARS patients or working in fever rooms/tentages. Multivariate analysis showed that psychiatric morbidity was associated with posttraumatic morbidity (p = .02) and denial (p = .03), whereas posttraumatic morbidity was associated with younger age (p = .007), being married (p = .02), psychiatric morbidity (p = .02), self-distraction (p = .02), behavioral disengagement (p = .01), religion (p = .003), less venting (p = .04), less humor (p = .04), and less acceptance (p = .02).

Conclusion: SARS-related psychiatric and posttraumatic morbidities were present in the medical staff within a primary health care setting. Specific coping efforts, age, and marital status, not direct exposure factors, were associated with psychological morbidity. These findings provide possible foci for early identification and psychological support.