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SARS Patients Experience Mental Health Decline

Canada-The many survivors of the 2003 epidemic severe acute respiratory syndrome (SARS) recovered physically but many suffered lingering mental health problems, according to a new study.

The epidemic Severe Acute Respiratory syndrome (SARS) became a global epidemic in 2003. Most cases were in Asia, and the largest concentration of North American cases occurred in Toronto, Ontario," it killed 800 people around the world, including 44 in Toronto. Severe acute respiratory symptom, caused by a coronavirus, attacked the lungs of those who were infected.

"The longer-term physical and psychological consequences of SARS were not reported until recently." Most Investigations of the disease have focused on lung function, distance walked in six minutes and health-related quality of life, but a one-year followup study of 117 SARS survivors has found 51 of them needed mental health services.

Catherine M. Tansey, M.Sc., University Health Network, Toronto, and colleagues, evaluated 117 SARS survivors from Toronto who were discharged from the hospital in 2003. Patients were evaluated three, six and 12 months after leaving the hospital by undergoing a physical examination, a six-minute walk test, a lung function test, a chest X-ray and quality-of-life measures and reporting how often they saw a physician.

General health, vitality and social functioning remained below the normal range one year after discharge from the hospital. Many patients returned to work part-time, increasing their workload over the first two months while 23 patients returned to work full-time with no need for a modified schedule. At one year, 17 percent of patients had not returned to work, and a further 9 percent had not returned to their pre-SARS level of work.

Dr. Margaret Herridge, a critical care doctor at Toronto's University Health Network, and her colleagues report their findings in Monday's issue of the Archives of Internal Medicine.

"These data may help to highlight the needs of patients and caregivers during and after an epidemic, the potential benefit of a family-centred approach to followup care, and the importance of exploring strategies to minimize the psychological burden of an epidemic illness as part of future pandemic-planning initiatives

Survivors used health care services frequently the first year after hospitalization. "Psychiatric evaluation accounted for the greatest number of visits," the authors write. "Of the patients, 74 percent saw their primary care physician a median of five times. Infectious disease specialists assessed 72 percent of patients, mostly in the first three months after discharge." Caregiver surveys showed a decline in the mental health of caregivers, which was caused by reported lifestyle interference and loss of control.

The study noted that some of these patients were heavy users of mental health services during their recovery period; 51 required 668 visits to psychiatrists or psychologists.

Vicki McKenna, first vice-president of the Ontario Nurses Association, said some nurses remain off the job because of the emotional trauma they experienced.

"They have anxiety disorders such as panic attacks. It's a general feeling that they have even just driving by a hospital. They have an overwhelming sense of panic and fear," she said

The SARS patients experienced acute social stigmatization and loss of anonymity due to relentless media coverage, along with difficulties coping with quarantine and isolation, and overwhelming fear for their physical health and endangering their loved ones.

The study was supported by the Ontario Thoracic Society and Canadian Institutes of Health Research.


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