title: Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak.
abstract: OBJECTIVE
  During the 2003 severe acute respiratory syndrome (SARS) outbreak, health care workers (HCWs) experienced unusual stressors. The study hospital introduced psychosocial interventions to help HCWs. This study aimed to examine the coping strategies adopted by the emergency department (ED) HCWs who cared for the SARS patients.
  
  
  METHODS
  In November 2003, a self-administered questionnaire of physicians and nurses was conducted in the hospital ED that is the national SARS screening center in Singapore. Data collected included demographics and responses to these instruments: 1) the Coping Orientation to Problems Experienced (COPE) to assess coping strategies, 2) the Impact of Event Scale (IES) to measure psychological reactions, and 3) the General Health Questionnaire 28 (GHQ 28) to measure psychiatric morbidity.
  
  
  RESULTS
  Thirty-eight of 41 (92.7%) physicians and 58 of 83 (69.9%) nurses responded. The respondents reported a preference for problem-focused and emotion-focused coping measures. The physicians chose humor as a coping response significantly more frequently (p < 0.001) than nurses, scoring 9.61/16 (95% CI = 8.52 to 10.69), compared with the nurses' score of 7.05/16 (95% CI = 6.28 to 7.83). The Filipino HCWs turned to religion as a coping response significantly more frequently (p < 0.001) than the non-Filipino HCWs, scoring 14.38/16 (95% CI = 13.33 to 15.42), compared with 9.93/16 (95% CI = 9.00 to 10.87) for the non-Filipinos. Psychiatric morbidity was 17.7% on the IES and 18.8% on the GHQ 28, with the trend for physicians to report lower psychiatric morbidity.
  
  
  CONCLUSIONS
  With a supportive hospital environment, ED HCWs chose adaptive coping in response to the outbreak and reported low psychiatric morbidity. Physicians chose humor and Filipinos chose turning to religion as their preferred responses. Psychosocial interventions to help HCWs need to take these preferences into account.
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. phuadh@yahoo.com
authors.forename: D H
authors.initials: DH
authors.lastname: Phua
authors.forename: H K
authors.initials: HK
authors.lastname: Tang
authors.forename: K Y
authors.initials: KY
authors.lastname: Tham
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D004635:Emergency Medicine; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D012067:Religion; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000628:therapy; D012846:Singapore / Q000453:epidemiology; D013315:Stress, Psychological / Q000208:ethnology / Q000517:prevention & control; D014925:Wit and Humor as Topic; D000078329:Workforce