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History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002–2003 Severe Acute Respiratory Syndrome (SARS) outbreak

History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002–2003 Severe Acute Respiratory Syndrome (SARS) outbreak
History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002–2003 Severe Acute Respiratory Syndrome (SARS) outbreak

Background: The aims of this systematic review and meta-analysis are to examine the prevalence of adverse mental health outcomes, both short-term and long-term, among SARS patients, healthcare workers and the general public of SARS-affected regions, and to examine the protective and risk factors associated with these mental health outcomes. Methods: We conducted a systematic search of the literature using databases such as Medline, Pubmed, Embase, PsycInfo, Web of Science Core Collection, CNKI, the National Central Library Online Catalog and dissertation databases to identify studies in the English or Chinese language published between January 2003 to May 2020 which reported psychological distress and mental health morbidities among SARS patients, healthcare workers, and the general public in regions with major SARS outbreaks. Results: The literature search yielded 6984 titles. Screening resulted in 80 papers for the review, 35 of which were included in the meta-analysis. The prevalence of post-recovery probable or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) among SARS survivors were 19, 20 and 28%, respectively. The prevalence of these outcomes among studies conducted within and beyond 6 months post-discharge was not significantly different. Certain aspects of mental health-related quality of life measures among SARS survivors remained impaired beyond 6 months post-discharge. The prevalence of probable depressive disorder and PTSD among healthcare workers post-SARS were 12 and 11%, respectively. The general public had increased anxiety levels during SARS, but whether there was a clinically significant population-wide mental health impact remained inconclusive. Narrative synthesis revealed occupational exposure to SARS patients and perceived stigmatisation to be risk factors for adverse mental health outcomes among healthcare workers, although causality could not be determined due to the limitations of the studies. Conclusions: The chronicity of psychiatric morbidities among SARS survivors should alert us to the potential long-term mental health complications of covid-19 patients. Healthcare workers working in high-risk venues should be given adequate mental health support. Stigmatisation against patients and healthcare workers should be explored and addressed. The significant risk of bias and high degree of heterogeneity among included studies limited the certainty of the body of evidence of the review.

Covid-19, Healthcare workers, Infectious disease, Mental health, Post-traumatic stress disorder, SARS
1471-2458
Chau, Steven W.H.
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Wong, Oscar W.H.
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Ramakrishnan, Rema
d7595f07-824e-47d7-b6f3-48ca5d7dd3d1
Chan, Sandra S.M.
97b7af7e-72ae-4285-a606-1acde3a6276c
Wong, Evelyn K.Y.
8be8fece-baf7-488c-93c8-da609539610b
Li, Pinky Y.T.
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Raymont, Vanessa
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Elliot, Kathryn
7868a3b8-4039-4c07-ab9e-c098f85b74b4
Rathod, Shanaya
b4dddbe5-e4aa-4069-bd03-20cd6332639c
Delanerolle, Gayathri
ad2cf9bf-da2b-4f15-bc5d-ffbceb77786a
Phiri, Peter
bdcad679-98c5-47c5-a7ad-15865f1e880e
Chau, Steven W.H.
9725ca64-f3fe-4eb3-8502-1b923d0cabb7
Wong, Oscar W.H.
a674bfd2-6061-4847-82ea-9503625c9841
Ramakrishnan, Rema
d7595f07-824e-47d7-b6f3-48ca5d7dd3d1
Chan, Sandra S.M.
97b7af7e-72ae-4285-a606-1acde3a6276c
Wong, Evelyn K.Y.
8be8fece-baf7-488c-93c8-da609539610b
Li, Pinky Y.T.
13a1ac73-b5eb-4c5d-99f0-29cada6bd533
Raymont, Vanessa
86a66987-dc0e-48f1-bbe1-49b982409223
Elliot, Kathryn
7868a3b8-4039-4c07-ab9e-c098f85b74b4
Rathod, Shanaya
b4dddbe5-e4aa-4069-bd03-20cd6332639c
Delanerolle, Gayathri
ad2cf9bf-da2b-4f15-bc5d-ffbceb77786a
Phiri, Peter
bdcad679-98c5-47c5-a7ad-15865f1e880e

Chau, Steven W.H., Wong, Oscar W.H., Ramakrishnan, Rema, Chan, Sandra S.M., Wong, Evelyn K.Y., Li, Pinky Y.T., Raymont, Vanessa, Elliot, Kathryn, Rathod, Shanaya, Delanerolle, Gayathri and Phiri, Peter (2021) History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002–2003 Severe Acute Respiratory Syndrome (SARS) outbreak. BMC Public Health, 21 (1), [670]. (doi:10.1186/s12889-021-10701-3).

Record type: Article

Abstract

Background: The aims of this systematic review and meta-analysis are to examine the prevalence of adverse mental health outcomes, both short-term and long-term, among SARS patients, healthcare workers and the general public of SARS-affected regions, and to examine the protective and risk factors associated with these mental health outcomes. Methods: We conducted a systematic search of the literature using databases such as Medline, Pubmed, Embase, PsycInfo, Web of Science Core Collection, CNKI, the National Central Library Online Catalog and dissertation databases to identify studies in the English or Chinese language published between January 2003 to May 2020 which reported psychological distress and mental health morbidities among SARS patients, healthcare workers, and the general public in regions with major SARS outbreaks. Results: The literature search yielded 6984 titles. Screening resulted in 80 papers for the review, 35 of which were included in the meta-analysis. The prevalence of post-recovery probable or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) among SARS survivors were 19, 20 and 28%, respectively. The prevalence of these outcomes among studies conducted within and beyond 6 months post-discharge was not significantly different. Certain aspects of mental health-related quality of life measures among SARS survivors remained impaired beyond 6 months post-discharge. The prevalence of probable depressive disorder and PTSD among healthcare workers post-SARS were 12 and 11%, respectively. The general public had increased anxiety levels during SARS, but whether there was a clinically significant population-wide mental health impact remained inconclusive. Narrative synthesis revealed occupational exposure to SARS patients and perceived stigmatisation to be risk factors for adverse mental health outcomes among healthcare workers, although causality could not be determined due to the limitations of the studies. Conclusions: The chronicity of psychiatric morbidities among SARS survivors should alert us to the potential long-term mental health complications of covid-19 patients. Healthcare workers working in high-risk venues should be given adequate mental health support. Stigmatisation against patients and healthcare workers should be explored and addressed. The significant risk of bias and high degree of heterogeneity among included studies limited the certainty of the body of evidence of the review.

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More information

Accepted/In Press date: 24 March 2021
Published date: 7 April 2021
Additional Information: Funding Information: This study was partly supported by NIHR RCF allocation to Southern Health NHS Foundation Trust and Oxford Brain Health Clinical Trials Unit. All of the study sponsors had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the paper for publication. Funding Information: The authors acknowledge support from Southern Health NHS Foundation Trust and Oxford Brain Health Clinical Trials Unit. This paper is part of the multifaceted EPIC project that is sponsored by Southern Health NHS Foundation Trust and in collaboration with the University of Oxford’s Oxford Brain Health Clinical Trials Unit and Department of Psychiatry, The Chinese University of Hong Kong. We thank Ms. Daisy Cheung for her very helpful comments and suggestions. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Covid-19, Healthcare workers, Infectious disease, Mental health, Post-traumatic stress disorder, SARS

Identifiers

Local EPrints ID: 450815
URI: http://eprints.soton.ac.uk/id/eprint/450815
ISSN: 1471-2458
PURE UUID: 75e692fc-4cc1-423e-9e19-2dc247376e34

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Date deposited: 12 Aug 2021 16:31
Last modified: 26 Apr 2022 19:52

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Contributors

Author: Steven W.H. Chau
Author: Oscar W.H. Wong
Author: Rema Ramakrishnan
Author: Sandra S.M. Chan
Author: Evelyn K.Y. Wong
Author: Pinky Y.T. Li
Author: Vanessa Raymont
Author: Kathryn Elliot
Author: Shanaya Rathod
Author: Gayathri Delanerolle
Author: Peter Phiri

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