title: Stress and psychological distress among SARS survivors 1 year after the outbreak.
abstract: OBJECTIVE
  Our study examined the stress level and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak.
  
  
  METHODS
  During the SARS outbreak in 2003, we used the 10-item Perceived Stress Scale (PSS-10) to assess SARS survivors treated in 2 major hospitals (non-health care workers, n = 49; health care workers, n = 30). We invited SARS survivors from the same hospitals (non-health care workers, n = 63; health care workers, n = 33) to complete the PSS-10 again in 2004. At that time, they were also asked to complete the General Health Questionnaire (GHQ-12) and measures of depression, anxiety, and posttraumatic symptoms. PSS-10 scores were also obtained from matched community control subjects during the outbreak (n = 145) and again in 2004 (n = 112).
  
  
  RESULTS
  SARS survivors had higher stress levels during the outbreak, compared with control subjects (PSS-10 scores = 19.8 and 17.9, respectively; P < 0.01), and this persisted 1 year later (PSS-10 scores = 19.9 and 17.3, respectively; P < 0.01) without signs of decrease. In 2004, SARS survivors also showed worrying levels of depression, anxiety, and posttraumatic symptoms. An alarming proportion (64%) scored above the GHQ-12 cut-off that suggests psychiatric morbidity. During the outbreak, health care worker SARS survivors had stress levels similar to those of non-health care workers, but health care workers showed significantly higher stress levels in 2004 (PSS-10 score = 22.8, compared with PSS-10 score = 18.4; P < 0.05) and had higher depression, anxiety, posttraumatic symptoms, and GHQ-12 scores.
  
  
  CONCLUSIONS
  One year after the outbreak, SARS survivors still had elevated stress levels and worrying levels of psychological distress. The situation of health care worker SARS survivors is particularly worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an important role in rehabilitation.
authors.affiliation: Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Lee
authors.forename: Josephine G W S
authors.initials: JG
authors.lastname: Wong
authors.forename: Grainne M
authors.initials: GM
authors.lastname: McAlonan
authors.forename: Vinci
authors.initials: V
authors.lastname: Cheung
authors.forename: Charlton
authors.initials: C
authors.lastname: Cheung
authors.forename: Pak C
authors.initials: PC
authors.lastname: Sham
authors.forename: Chung-Ming
authors.initials: CM
authors.lastname: Chu
authors.forename: Poon-Chuen
authors.initials: PC
authors.lastname: Wong
authors.forename: Kenneth W T
authors.initials: KW
authors.lastname: Tsang
authors.forename: Siew E
authors.initials: SE
authors.lastname: Chua
mesh_terms: D000293:Adolescent; D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004196:Disease Outbreaks; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000523:psychology*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data*; D013997:Time Factors