title: Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn?
abstract: BACKGROUND
  Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism.
  
  
  METHODS
  We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics.
  
  
  RESULTS
  From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%).
  
  
  CONCLUSIONS
  During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.
authors.affiliation: Department of Community, Occupational and Family Medicine (MD3), Faculty of Medicine, National University of Singapore, Singapore. cofhead@nus.edu.sg
authors.forename: David
authors.initials: D
authors.lastname: Koh
authors.forename: Meng Kin
authors.initials: MK
authors.lastname: Lim
authors.forename: Sin Eng
authors.initials: SE
authors.lastname: Chia
authors.forename: Soo Meng
authors.initials: SM
authors.lastname: Ko
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.forename: Vivian
authors.initials: V
authors.lastname: Ng
authors.forename: Ban Hock
authors.initials: BH
authors.lastname: Tan
authors.forename: Kok Seng
authors.initials: KS
authors.lastname: Wong
authors.forename: Wuen Ming
authors.initials: WM
authors.lastname: Chew
authors.forename: Hui Kheng
authors.initials: HK
authors.lastname: Tang
authors.forename: Winston
authors.initials: W
authors.lastname: Ng
authors.forename: Zainal
authors.initials: Z
authors.lastname: Muttakin
authors.forename: Shanta
authors.initials: S
authors.lastname: Emmanuel
authors.forename: Ngan Phoon
authors.initials: NP
authors.lastname: Fong
authors.forename: Gerald
authors.initials: G
authors.lastname: Koh
authors.forename: Chong Teck
authors.initials: CT
authors.lastname: Kwa
authors.forename: Keson Beng-Choon
authors.initials: KB
authors.lastname: Tan
authors.forename: Calvin
authors.initials: C
authors.lastname: Fones
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D004196:Disease Outbreaks / Q000517:prevention & control; D004644:Emotions; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000523:psychology*; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016526:Workload