title: Population-based post-crisis psychological distress: an example from the SARS outbreak in Taiwan.
abstract: OBJECTIVE
  As a result of the severe acute respiratory syndrome (SARS) pandemic, the World Health Organization placed Taiwan on the travel alert list from May 21 to July 5, 2003. The aim of this study was to explore the post-crisis psychological distress among residents in Taiwan after the SARS epidemic.
  
  
  METHODS
  The target population consisted of a nationwide representative sample of residents aged > or = 18 years. Data were collected using computer assisted telephone interview systems by stratified random sampling according to geographic area. The survey (n = 1278) was conducted in November 2003, about 4 months after resolution of the SARS crisis in Taiwan. The maximum deviation of sampling error at the 95% confidence level was +/- 2.74%. Psychological distress was measured by a question related to subject's changes in perception of life, plus the five-item Brief Symptom Rating Scale. Multivariate logistic regression was used to examine the correlation of psychological distress.
  
  
  RESULTS
  About 9.2% of the participants reported that their perceptions of life became more pessimistic following the SARS crisis. The prevalence of psychiatric morbidity was 11.7%. Major predictors of higher levels of pessimism after the SARS epidemic included demographic factors, perception of SARS and preparedness, knowing people or having personal experiences of SARS-related discrimination, and individual worries and psychiatric morbidity. The correlates of symptomatic cases, as indicated by the five-item Brief Symptom Rating Scale, included age > or = 50 years, senior high school graduate, and worries about recurrence of SARS.
  
  
  CONCLUSIONS
  Psychological distress was significantly correlated with demographic factors and perception regarding the SARS epidemic. It is suggested that marketing of mental health education should be segmented according to age and education level, which should enhance crisis communication for newly emerging infectious diseases among community populations.
authors.affiliation: Department of Community Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
authors.forename: Eugene Yu-Chang
authors.initials: EY
authors.lastname: Peng
authors.forename: Ming-Been
authors.initials: MB
authors.lastname: Lee
authors.forename: Shang-Ta
authors.initials: ST
authors.lastname: Tsai
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Yang
authors.forename: Donald Edward
authors.initials: DE
authors.lastname: Morisky
authors.forename: Liang-Ting
authors.initials: LT
authors.lastname: Tsai
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Weng
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Lyu
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D004196:Disease Outbreaks; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D011159:Population Surveillance; D015995:Prevalence; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000523:psychology*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult