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FILLERS: Andrew C F Hui Medicine in the time of SARS BMJ 2003; 326: 1067 [Full text]

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Psychological effects of SARS on health-care workers in Hong Kong

Grainne McAlonan, Grainne M McAlonan1* MB BS PhD, Siew E Chua1 MRCPsych, Vinci Cheung1 MPhil, Charlton Cheung1 BSc, Josephine GWS Wong1 MRCPsych, Khai-meng Choy3 BM BCh, Michael MC Wong1 MRCPsych, Kenneth WT Tsang2 FRCP.   (5 June 2003)

Psychological effects of SARS on health-care workers in Hong Kong 5 June 2003
Grainne McAlonan, Assistant Professor Department of Psychiatry, The University of Hong Kong, NCB 222, Queen Mary Hospital,Pokfulam Rd, HK., Grainne M McAlonan1* MB BS PhD, Siew E Chua1 MRCPsych, Vinci Cheung1 MPhil, Charlton Cheung1 BSc, Josephine GWS Wong1 MRCPsych, Khai-meng Choy3 BM BCh, Michael MC Wong1 MRCPsych, Kenneth WT Tsang2 FRCP. Send response to journal: Re: Psychological effects of SARS on health-care workers in Hong Kong	Dear Sir, In response to Hui 2003 description of how SARS has changed the way we practice medicine today (1), we report results on the psychological effects experienced by health-care workers in Hong Kong (HCWs) and how they perceive the risks of SARS transmission. HCWs have now to regard all patients as potential SARS and observe strict infection control measures. Many have been redeployed to SARS units, avoid family and even fallen ill. Psychological problems in HCWs might well undermine infection control standards and stress impacts upon clinical performance (2). Our psychological health questionnaire was designed to be brief, confidential and self-administered (to minimize cross infection when used on SARS wards). It examines beliefs about SARS transmission and risks, assesses stress using the Perceived Stress Scale (PSS-10) (3) and allows quantification of negative and positive psychological responses to the outbreak. 106 (88%) of 120 subjects (34 HCWs, 32 adult psychiatric out- patients, and 40 healthy individuals) successfully completed a pilot in the Department of Psychiatry. The groups were balanced for male to female ratio, but the HCWs had more education and the healthy individuals were older. No HCWs had taken care of SARS patients but had significantly more had SARS-diagnosed friends or colleagues (n=5). HCWs reported the highest number of very likely routes of transmission compared with the other 2 groups. This number positively correlated with the number of PSS- rated stress items (Spearman's rho 0.25, p <0.05). Most surprising however, HCWs (HCW=9.9%, patients=15.9%, healthy individuals=10.3%) ranked lowest for negative psychological effects of the SARS problem (such as depressed mood, poor sleep, avoiding social contact, wanting to escape, worry about family finance). Conversely, HCWs (17.6%), patients (14.9%), and healthy individuals (8.5%) reported positive psychological effects (feeling lucky, a sense of unity) and social coping responses (concern for others and hygiene) to the SARS problem. We conclude that the questionnaire is feasible for self-administration, and that the range of negative psychological effects reported is likely to be more marked in HCWs on SARS wards and their patients. We plan to examine whether measures, such as confident implementation of infection control, can offset this. We also found positive psychological responses in HCWs which appear to be protective in nature and studies are underway to examine these in greater detail. References 1) Hui CFA. Medicine in the time of SARS. BMJ 326, 1067 2) Shelledy DC, Mikles SP, May DF, Youtsey JW. Analysis of job satisfaction, burnout, and intent of respiratory care practitioners to leave the field or the job. Respir Care 1992; 37:46-60. 3) Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385-396. Acknowledgement We warmly thank staff of Western Psychiatric Centre and our colleagues in the Department of Psychiatry for their support of this study. Competing interests:   None declared