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

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.

COVID-19 restrictions and age-specific mental health—U.S. probability-based panel evidence

“…A large literature investigates the psychological effects of large-scale health shocks (SARS, MERS) or disasters (natural and non), especially post-traumatic stress disorders (PTSD) [ 9 – 11 ]. Very few studies in the literature investigate the age effects separately, and the relation between age and mental health outcomes in these studies is ambiguous.…”

Fear, Anxiety, Stress, and Depression of novel coronavirus (COVID-19) pandemic among patients and their healthcare workers

“…March-April (14). These results can also be linked to post-SARS 2003 outbreak findings, which showed that among SARS survivors, the prevalence of post-recovery likely or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) was 19%, 20%, and 28%, respectively (15). These findings are in contrast with those of a similar report on HCWs and the psychological effects of the SARS 2003 pandemic, which discovered that high-risk HCWs had elevated stress levels.…”

“…March-April (14). These results can also be linked to post-SARS 2003 outbreak findings, which showed that among SARS survivors, the prevalence of post-recovery likely or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) was 19%, 20%, and 28%, respectively (15).…”

Mental health risk factors during the first wave of the COVID-19 pandemic

“…7,8 Past and present comparisons Experience from recent epidemics (2002)(2003)(2004) severe acute respiratory syndrome and 2015 Middle East respiratory syndrome outbreaks) shows that imposed distancing measures were accompanied by increased symptoms of depression, anxiety and post-traumatic stress disorder. [9][10][11][12] As for the COVID-19 pandemic, researchers expect the impact on mental health to be wide-ranging, substantial and possibly long-lasting. 13 Shi et al, 14 in a Chinese population-based study, described a high prevalence of mental health symptoms, with rates of 27.9% for depression, 31.6% for anxiety and 29.2% for insomnia.…”