title: Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers.
abstract: OBJECTIVE
  To assess the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak.
  
  
  METHODS
  At the peak of the 2003 SARS outbreak, we assessed health care workers in 2 acute care Hong Kong general hospitals with the Perceived Stress Scale (PSS-10). One year later, we reassessed these health care workers with the PSS-10, the 21-Item Depression and Anxiety Scale (DASS-21), and the Impact of Events Scale-Revised (IES-R). We recruited high-risk health care workers who practised respiratory medicine and compared them with nonrespiratory medicine workers, who formed the low-risk health care worker control group.
  
  
  RESULTS
  In 2003, high-risk health care workers had elevated stress levels (PSS-10 score = 17.0) that were not significantly different from levels in low-risk health care worker control subjects (PSS-10 score = 15.9). More high-risk health care workers reported fatigue, poor sleep, worry about health, and fear of social contact, despite their confidence in infection-control measures. By 2004, however, stress levels in the high-risk group were not only higher (PSS-10 score = 18.6) but also significantly higher than scores among low-risk health care worker control subjects (PSS-10 score = 14.8, P < 0.05). In 2004, the perceived stress levels in the high-risk group were associated with higher depression, anxiety, and posttraumatic stress scores (P < 0.001). Posttraumatic stress scores were a partial mediator of the relation between the high risk of exposure to SARS and higher perceived stress.
  
  
  CONCLUSIONS
  Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety. Front-line staff could benefit from stress management as part of preparation for future outbreaks.
authors.affiliation: Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: Grainne M
authors.initials: GM
authors.lastname: McAlonan
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Lee
authors.forename: Vinci
authors.initials: V
authors.lastname: Cheung
authors.forename: Charlton
authors.initials: C
authors.lastname: Cheung
authors.forename: Kenneth W T
authors.initials: KW
authors.lastname: Tsang
authors.forename: Pak C
authors.initials: PC
authors.lastname: Sham
authors.forename: Siew E
authors.initials: SE
authors.lastname: Chua
authors.forename: Josephine G W S
authors.initials: JG
authors.lastname: Wong
mesh_terms: D000328:Adult; D004196:Disease Outbreaks; D005239:Fear; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000523:psychology*; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors