Psychological impact on SARS survivors: Critical review of the English language literature

Severe acute respiratory syndrome (SARS) has been labelled a mental health catastrophe, an infectious atypical pneumonia condition that spread to 29 countries in 2002/2003, infecting over 8,000 people, 774 of whom died. A literature search on electronic databases, including MEDLINE, PsycINFO, CINAHL, and Cochrane Library was used to conduct a critical review of the English language literature on the psychological impact of SARS for survivors. Twenty original studies pertaining to the psychological experience of patients revealed prominent symptoms: in the acute and early recovery stages, psychotic symptomatology, fear for survival, and fear of infecting others; across all timeframes, stigmatization, reduced quality of life, and psychological distress; posttraumatic stress symptoms were prevalent across all stages post-SARS. Health care workers with SARS were found to be at increased risk. Limitations within many studies restrict the optimal usefulness of the findings. Studies included in our review consistently reported high rates of emotional distress among survivors, persisting for years postinfection. Recommendations to enhance comparability across studies for future outbreaks were proposed.Keywords: SARS, psychological, posttraumatic stress disorder, health care workers, infectious diseasesResumeLe syndrome respiratoire aigu severe (SRAS) a ete qualifie de catastrophe de sante mentale. Cette pneumonie atypique infectieuse s'est repandue dans 29 pays en 2002-2003, infectant plus de 8000 personnes, parmi lesquelles 774 en sont mortes. Une recherche a ete effectuee au moyen des bases de donnees electroniques MEDLINE, PsycINFO, CINAHL et la Cochrane Library, en vue d'un resume critique des articles en anglais sur les repercussions psychologiques du SRAS sur les survivants. Vingt etudes originales sur l'experience psychologique de patients ont revele les symptomes dominants suivants : dans les stades aigus et au debut du retablissement, on note des symptomes psychotiques, la peur pour la survie, la peur d'infecter autrui; a tous les stades, on note la stigmatisation, une qualite de vie amoindrie, la detresse psychologue; a tous les stades apres le retablissement, on note des symptomes de stress post-traumatique. Les travailleurs de la sante ayant eu le SRAS presentaient des risques plus eleves. Les limites de nombre des etudes restreignent l'utilite optimale des resultats. Les etudes utilisees dans notre revue de litterature rapportaient systematiquement de hauts taux de troubles emotifs parmi les survivants, lesquels persistaient des annees apres l'infection. Des recommandations sont formulees en vue d'ameliorer la comparabilite des etudes advenant de nouvelles poussees.Mots-cles : SRAS, psychologie, syndrome de stress posttraumatique, travailleurs de la sante, maladies infectieuses.After its first emergence in Asia in November 2002, severe acute respiratory syndrome (SARS) spread throughout several parts of the world and was finally contained by July 2003. This epidemic, with its rapid spread and high mortality rate, generated considerable panic and anxiety around the globe (Campbell, 2006). The origin of SARS was traced to a novel strain of the corona-virus that causes flu-like symptoms, which for many sufferers escalated into clinical pneumonia. In 29 countries, 8,096 individuals were infected, and a wide range of severity was reported, from asymptomatic infection to severe illness and death. Between 20% and 25% of SARS patients became critically ill, requiring intensive care, and ^10%, or 774 individuals, died worldwide (World Health Organization, 2004). In the few studies reviewed to date that pertain to the psychological impact on SARS survivors, high rates of emotional distress were reported, including anxiety, depression, fearfulness, and stigmatization (Chan et al., 2003; Cheng & Wong, 2005; Tsang, Scudds, & Chan, 2004; Zhang, Liu, & He, 2004). However, because most of these studies looked at the period covering the acute phase of the illness and up to 6 months postinfection, we know very little about the longer-term psychological effects of SARS, and we know even less about how the psychological effects of SARS changed over time. …