Impact on health care workers employed in high-risk areas during the Toronto SARS outbreak

Rima Styra, Laura Hawryluck, Susan Robinson, Sonja Kasapinovic, Calvin Fones, Wayne L Gold, Rima Styra, Laura Hawryluck, Susan Robinson, Sonja Kasapinovic, Calvin Fones, Wayne L Gold

Abstract

Background: A number of publications focusing on health care workers (HCWs) during a severe acute respiratory syndrome (SARS) outbreak have suggested that HCWs experienced psychological distress, particularly increased levels of posttraumatic stress symptomatology (PTSS). Factors contributing to increased distress in HCWs working in high-risk areas treating patients with SARS have not been fully elucidated. The goal of this study was to quantify the psychological effects of working in a high-risk unit during the SARS outbreak.

Methods: HCWs in a Toronto hospital who worked in high-risk areas completed a questionnaire regarding their attitude toward the SARS crisis along with the Impact of Event Scale-Revised, which screens for PTSS. The comparison group consisted of clinical units that had no contact with patients infected with SARS.

Results: Factors that were identified to cause distress in the 248 respondent HCWs were the following: (a) perception of risk to themselves, (b) impact of the SARS crisis on their work life, (c) depressive affect, and (d) working in a high-risk unit. In addition, HCWs who cared for only one SARS patient in comparison to those caring for multiple SARS patients experienced more PTSS.

Conclusions: As expected, HCWs who were working in high-risk units experienced greater distress. Contrary to expectations, HCWs who experienced greater contact with SARS patients while working in the high-risk units were less distressed. This suggests that HCW experience in treating patients infected with SARS may be a mediating factor that could be amenable to intervention in future outbreaks.

References

    1. Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, for the National Microbiology Laboratory, Canada, and the Canadian Severe Acute Respiratory Syndrome Study Team Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348:1995–2005.
    1. Booth M, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA. Clinical features and short-term outcomes of 144 patients with SARS in the Greater Toronto Area. JAMA. 2003;289:2801–2809.
    1. Public Health Agency of Canada, SARS (severe acute respiratory syndrome) outbreak period, .
    1. Muller MP, Richardson SE, McGeer A, Dresser L, Raboud J, Mazzulli T. Early diagnosis of SARS: lessons from the Toronto SARS outbreak. Eur J Clin Microbiol Infect Dis. 2006;25:230–237.
    1. Ofner-Agnostini M, Gravel D, McDonald LC, Lem M, Sarwal S, McGeer A. Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series. Infect Control Hosp Epidemiol. 2006;27:473–478.
    1. World Health Organization WHO issues consensus document on the epidemiology of SARS. Wkly Epidemiol Rec. 2003;78:373–375.
    1. Caputo KM, Byrick R, Chapman MG, Orser BJ, Orser BA. Intubation of SARS patients: infection and perspectives of healthcare workers. Can J Anaesth. 2006;53:122–129.
    1. Muller MP, McGeer A. Febrile respiratory illness in the intensive care unit setting: an infection control perspective. Curr Opin Crit Care. 2006;12:37–42.
    1. Hall LM, Angus J, Peter E, O'Brien-Pallas L, Wynn F, Donner G. Media portrayal of nurses' perspectives and concerns in the SARS crisis in Toronto. J Nurs Scholarsh. 2003;35:211–216.
    1. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–1994.
    1. Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T. SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004;10:251–255.
    1. Christian MD, Loutfy M, McDonald LC, Martinez KF, Ofner M, Wong T. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis. 2004;10:287–293.
    1. Varia M, Wilson S, Sarwal S, McGeer A, Gournis E, Galanis E. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169:285–292.
    1. Koh D, Lim MK, Chia SE, Ko SM, Qian F, Ng V. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn? Med Care. 2005;43:676–682.
    1. Nickell LA, Crighton EJ, Tracy CS, Al-Enazy H, Bolaji Y, Hanjrah S. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ. 2004;170:793–798.
    1. Maunder RG, Lancee WJ, Rourke S, Hunter JJ, Goldbloom D, Balderson K. Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto. Psychosom Med. 2004;66:938–942.
    1. Bai Y, Ling CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004;55:1055–1057.
    1. Ho SM, Kowng-Lo RS, Mak CW, Wong JS. Fear of severe acute respiratory syndrome (SARS) among health care workers. Consult Clin Psychol. 2005;73:344–349.
    1. Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34:1197–1204.
    1. Wong TW, Yau JKY, Chan CLW, Kwong RSY, Ho SMY, Lau CC, Lau FL, Lit CH. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med. 2005;12:13–18.
    1. Chan AOM, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med. 2004;54:190–196.
    1. Chua SE, Cheung V, Cheung C, Cheung C, McAlonan GM, Wong JWS. Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers. Can J Psychiatry. 2004;49:391–393.
    1. Chen CS, Wu HY, Yang P, Yen CF. Psychological distress of nurses in Taiwan who worked during the outbreak of SARS. Psychiatr Serv. 2005;56:76–79.
    1. Weiss D, Marmar C. The Impact of Event Scale—Revised. In: Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. Guilford; New York: 1997. pp. 399–441.
    1. Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale—Revised. Behav Res Ther. 2003;41:1489–1496.
    1. Ford JD, Campbell KA, Storzbach D, Binder LM, Anger WK, Rohlman DS. Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service. Psychosom Med. 2001;63:842–849.
    1. Beaton R, Murphy S, Johnson C, Pike K, Corneil W. Coping responses and posttraumatic stress symptomatology in urban fire service personnel. J Trauma Stress. 1999;12:293–308.
    1. Lai TJ, Chang CM, Connor KM, Lee LC, Davidson JR. Full and partial PTSD among earthquake survivors in rural Taiwan. J Psychiatr Res. 2004;38:313–322.
    1. Stein MB, Walker JR, Hazen AL, Forde DR. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry. 1997;154:1114–1119.
    1. Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struening EL. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry. 2001;158:1467–1473.
    1. Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10:1206–1212.
    1. Feinstein A, Owen J, Blair N. A hazardous profession: war, journalists and psychopathology. Am J Psychol. 2002;159:1570–1575.
    1. Folkman S, Laxarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50:571–579.
    1. Schwarzer R. Taylor & Francis; Washington, DC: 1992. Self-efficacy: thought control of action.
    1. Bandura A. Prentice-Hall; Englewood Cliffs, NJ: 1985. Social foundations of thought and action: a social cognitive theory.
    1. Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav. 1978;19:2–21.
    1. The SARS Commission Report, vol. 1, 2, 3, 4, and 5 , 2006.
    1. Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004;185:127–133.
    1. Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002;346:108–114.
    1. Nortje CR, Moller CB, Andre AT. Judgment of risk in traumatized and nontraumatized emergency medical service personnel. Psychol Rep. 2004;95:1119–1128.
    1. Bibring E. The mechanisms of depression. In: Greenacre P, editor. Affective disorders. International Press; New York: 1953. pp. 19–26.

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