title: Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease.
abstract: OBJECTIVE
  The psychological and coping responses of the noninfected community towards infectious disease outbreaks are relatively understudied. This cross-sectional study sought to determine the prevalence of severe acute respiratory syndrome (SARS)-related psychiatric and posttraumatic morbidities and associated coping styles within the general population visiting community health care services.
  
  
  METHODS
  It was conducted on individuals attending community polyclinics in Singapore within the first week of July 2003, 16 weeks after the first national outbreak of SARS. The General Health Questionnaire-28, Impact of Event Scale-Revised, and Brief COPE were used to determine the prevalence rates of psychiatric and posttraumatic morbidities and employed coping strategies respectively.
  
  
  RESULTS
  The overall response rate was 78.0%. Of the 415 community health care setting respondents, we found significant rates of SARS-related psychiatric (22.9%) and posttraumatic morbidities (25.8%). The presence of psychiatric morbidity was associated with the presence of high level of posttraumatic symptoms [adjusted odds ratio (OR) 2.26, 95% confidence interval (CI) 1.24-4.13, P=.008]. Psychiatric morbidity was further associated with being seen at fever stations (adjusted OR 1.90, 95% CI 1.08-3.34, P=.026), younger age (adjusted OR 0.97, 95% CI 0.94-0.98, P=.021), increased self blame (adjusted OR 1.67, 95% CI 1.22-2.28, P=.001), less substance use (adjusted OR 0.74, 95% CI 0.56-0.98, P=.034) and posttraumatic morbidity was associated with increased use of denial (adjusted OR 1.31, 95% CI 1.04-1.67, P=.024), and planning (adjusted OR 1.51, 95% CI 1.16-1.95, P=.002) as coping measures.
  
  
  CONCLUSIONS
  These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.
authors.affiliation: Department of Adult Psychiatry, Woodbridge Hospital/ Institute of Mental Health, Singapore, Singapore. kang_sim@imh.com.sg
authors.forename: Kang
authors.initials: K
authors.lastname: Sim
authors.forename: Yiong
authors.initials: Y
authors.lastname: Huak Chan
authors.forename: Phui Nah
authors.initials: PN
authors.lastname: Chong
authors.forename: Hong Choon
authors.initials: HC
authors.lastname: Chua
authors.forename: Shok
authors.initials: S
authors.lastname: Wen Soon
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003153:Community Health Services; D003430:Cross-Sectional Studies; D003717:Denial, Psychological; D004196:Disease Outbreaks; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D012846:Singapore / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires