dcyphr | Stress and psychological distress among SARS survivors 1 year after the outbreak


This study examined the stress and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak in 2003. During the SARS outbreak, the researchers used the 10-item Perceived Stress Scale (PSS-10) to assess SARS survivors in 2 hospitals. They evaluated the survivors 1 year later to complete the PSS-10 in 2004. They were also asked to complete the General Health Questionnaire (GHQ-12) and tests for depression, anxiety, and posttraumatic symptoms. The researchers found that SARS survivors had higher stress levels during the outbreak, which persisted 1 year later without decreasing. They also showed increased levels of depression, anxiety, and posttraumatic symptoms. 64% scored above the GHQ-12 cutoff, suggesting high incidence of mental illness. During the outbreak, healthcare worker SARS survivors had similar stress levels to non-healthcare worker SARS survivors. However, healthcare workers were more stressed and had higher rates of depression, anxiety, and posttraumatic symptoms in 2004. People should not ignore the psychological consequences of infectious diseases should not and mental health services could play an important role in treatment.


The researchers wanted to evaluate the stress level and psychological distress of healthcare worker and non-healthcare worker SARS survivors 1 year after the outbreak.


Infectious diseases are one of the biggest threats to human health, and threaten not only life but psychological health as well. The psychological consequences of SARS include higher stress levels, poor sleep, depressed mood, weepiness, nightmares, and poor concentration. However, there is little information about long-term mental health consequences in SARS survivors. After being discharged, SARS survivors face a wide range of health issues and complications, and it is possible that their psychological health might get worse. The researchers conducted a 1-year assessment of SARS survivors during and after the outbreak. They also examined if there are differences in stress between healthcare workers and non-healthcare workers who survived SARS.


Stress Levels

Average PSS-10 scores of SARS survivors were significantly higher than those of the general population, and persisted in 2004 without decreasing. PSS-10 scores were higher among female survivors. Neither education or age had an impact on PSS-10 scores.

Psychological Distress

Average scores for anxiety and depression in SARS survivors were higher than average scores for the general population. Depressive symptoms were moderate-to-severe in 36.3% of the participants, and extremely severe in 4.4% of the participants. Anxiety symptoms were moderate-to-severe in 36.7% of the participants and extremely severe in 14.4% of the participants. 64% of participants scored above the threshold on the GHQ-12, indicating a high rate of potential mental illness.

Female SARS survivors had higher scores for depression and anxiety. Female SARS survivors were more than 3 times likely to score above the GHQ threshold than male survivors, and 77.4% of female survivors scored above the GHQ-12 threshold.

Differences Between Healthcare Worker SARS Survivors and Non-Healthcare Worker SARS Survivors

During the outbreak, healthcare worker SARS survivors and non-healthcare worker SARS survivors had similar PSS-10 scores. One year after the outbreak, healthcare worker SARS survivors had higher PSS-10 scores, while non-healthcare worker SARS survivors maintained the same PSS-10 scores.

Healthcare worker SARS survivors also had higher scores for depression, anxiety, and posttraumatic stress. A greater number of healthcare worker SARS survivors scored above the GHQ-12 threshold than non-healthcare worker survivors.


SARS survivors had greater stress and psychological distress 1 year after the SARS outbreak, which failed to decrease. They were affected by a combination of stress, anxiety, long-term stress and psychological distress. Instead of improving over time, survivors’ psychological health seemed to deteriorate.

The reasons for why SARS survivors have increased mental health issues and why their mental health did not improve over time need further examination. It is possible that during the outbreak, SARS victims were trying to survive their infection and other concerns were not a priority, and these concerns resurfaced after recovery. These concerns could be related to complications of SARS and its treatment, financial concerns or stigma.

Other than PTSD, there is little understanding about the long-term impact of infectious disease. This study expanded current understanding by finding that on top of PTSD, survivors are also affected by depression, anxiety, and stress. This calls for greater attention to a wider range of mental health problems that could affect survivors after outbreaks.

Being a woman and being a healthcare worker were risk factors for deteriorating mental health in SARS survivors. Female survivors had higher stress levels, psychological distress, and more likely to have mental illness. Healthcare worker SARS survivors also had higher stress levels and psychological distress. More than 90%% of healthcare worker SARS survivors scored above the GHQ-12 cutoff, which is especially concerning. A possible explanation is that they were under a combined stress of illness and working on the frontlines. It is interesting that their stress levels increased 1 year after the outbreak. It is possible that after the outbreak, positive responses to SARS faded and healthcare workers faced greater vulnerability to psychological distress.

Psychological services could be important for rehabilitation of SARS survivors.


The researchers assessed SARS patients in 2 hospitals in Hong Kong with a questionnaire that included demographic information and the PSS-10.

One year later, the researchers assessed recovered SARS patients from the same 2 hospitals using the PSS-10, anxiety and depression assessments, and the GHQ-12.

The researchers analyzed data with SPSS. They used ANOVA to examine the associations between characteristics of the patients and measures of stress and psychological distress.