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      Long-term psychiatric morbidities among SARS survivors

      research-article
      , F.H.K.C.Psych., F.H.K.A.M. (psychiatry), M.R.C.Psych. (UK), D.C.Psyc. R.C.P. & S. (Irel), M.Sc. Epidemiology and Biostatistics (CUHK) a , b , * , , M.D., F.R.C.P. a , c , , F.H.K.C.Psych., F.H.K.A.M. (psychiatry), M.R.C.Psych. (UK) b , , F.H.K.C.Psych., F.H.K.A.M. (psychiatry), M.R.C.Psych. (UK) b , , F.H.K.A.M. (Medicine), M.R.C.P. (UK) a , c
      General Hospital Psychiatry
      Elsevier Inc.
      Severe acute respiratory syndrome, SARS survivors, Cohort, Psychiatric, Post-traumatic stress disorder

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          Abstract

          Objective

          Severe acute respiratory syndrome (SARS) was the first massive infectious disease outbreak of the 21st century. However, it is unlikely that this outbreak will be the last. This study aimed to evaluate the long-term psychiatric morbidities in survivors of SARS.

          Method

          This is a cohort study designed to investigate psychiatric complications among SARS survivors treated in the United Christian Hospital 30 months after the SARS outbreak. Psychiatric morbidities were assessed by the Structured Clinical Interview for DSM-IV, the Impact of Events Scale–Revised and the Hospital Anxiety and Depression Scale. Functional outcomes were assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey.

          Results

          Ninety subjects were recruited, yielding a response rate of 96.8%. Post-SARS cumulative incidence of DSM-IV psychiatric disorders was 58.9%. Current prevalence for any psychiatric disorder at 30 months post-SARS was 33.3%. One-fourth of the patients had post-traumatic stress disorder (PTSD), and 15.6% had depressive disorders.

          Conclusion

          The outbreak of SARS can be regarded as a mental health catastrophe. PTSD was the most prevalent long-term psychiatric condition, followed by depressive disorders. Our results highlight the need to enhance preparedness and competence of health care professionals in detecting and managing the psychological sequelae of future comparable infectious disease outbreaks.

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          Most cited references26

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          Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers.

          To quantify stress and the psychological impact of severe acute respiratory syndrome (SARS) on high-risk health care workers (HCWs). We evaluated 271 HCWs from SARS units and 342 healthy control subjects, using the Perceived Stress Scale (PSS) to assess stress levels and a structured list of putative psychological effects of SARS to assess its psychological effects. Healthy control subjects were balanced for age, sex, education, parenthood, living circumstances, and lack of health care experience. Stress levels were raised in both groups (PSS = 18) but were not relatively increased in the HCWs. HCWs reported significantly more positive (94%, n = 256) and more negative psychological effects (89%, n = 241) from SARS than did control subjects. HCWs declared confidence in infection-control measures. In HCWs, adaptive responses to stress and the positive effects of infection control training may be protective in future outbreaks. Elevated stress in the population may be an important indicator of future psychiatric morbidity.
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            Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.

            We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.
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              Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton Rating Scale of Depression.

              The aim of this study was to validate the Chinese-Cantonese version of the Hospital Anxiety and Depression Scale (HADS) and to compare it with the Hamilton Rating Scale of Depression (HRSD) as a screening tool for depressive disorders in general hospital in-patients. The Chinese-Cantonese version of the HADS was administered to general hospital in-patients seen on a consultation basis, and psychiatric diagnoses were made according to DSM-III-R. The subjects were further rated independently with the HRSD. The Chinese-Cantonese version of the HADS was found to have good internal consistency and external validity, with favourable sensitivity and specificity for screening for psychiatric disorders. However, its performance was marginally inferior to that of the HRSD. The scale also performed poorly in identifying major depression. The HADS has limitations with regard to identification of depressive disorders. However, despite its shortcomings, it remains one of the best paper-and-pencil tests for screening psychiatric disorders in the medically ill.
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                Author and article information

                Contributors
                Journal
                Gen Hosp Psychiatry
                Gen Hosp Psychiatry
                General Hospital Psychiatry
                Elsevier Inc.
                0163-8343
                1873-7714
                15 April 2009
                July-August 2009
                15 April 2009
                : 31
                : 4
                : 318-326
                Affiliations
                [a ]Integrated Post-SARS Clinic, United Christian Hospital, Kowloon, Hong Kong
                [b ]Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong
                [c ]Department of Medicine and Geriatrics, United Christian Hospital, Kowloon, Hong Kong
                Author notes
                [* ]Corresponding author. Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong. Fax: +852 35135505. ucmakwc1@ 123456ha.org.hk
                Article
                S0163-8343(09)00047-4
                10.1016/j.genhosppsych.2009.03.001
                7112501
                19555791
                d7a36053-272b-4d8d-b3bb-dd8eb2a91ab3
                Copyright © 2009 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 16 August 2008
                : 2 March 2009
                Categories
                Article

                severe acute respiratory syndrome,sars survivors,cohort,psychiatric,post-traumatic stress disorder

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