The effects of disease severity, use of corticosteroids and social factors on neuropsychiatric complaints in severe acute respiratory syndrome (SARS) patients at acute and convalescent phases

Abstract

Severe disease, high dose corticosteroids and being health care workers were independent predictors of neuropsychiatric complaints in both acute and convalescent phases.

Was SARS a mental health catastrophe?

“…What are we to make of this report? The first thing to note is that these results are consistent with previous studies that have reported persistent psychological symptoms in 41-65% of SARS survivors [2][3][4], although the previous studies were not designed to diagnose psychiatric illness. The finding that SARS patients who were healthcare workers are at increased risk of PTSD (40.7%) is also consistent with one previous report [2] and with the finding that healthcare workers who cared for SARS patients but were not infected continued to experience substantial psychological distress [5], if not mental illness [6], 1-2 years after the outbreak.…”

Long-term psychiatric morbidities among SARS survivors

“…Finally, there is emerging evidence concerning the role of neuroendocrine, neurostruc-tural and neuroimmunological disturbances in psychiatric disorders such as depression and PTSD [32,42,43]. Hence, we cannot exclude the possibility that either neurobiological disturbances brought about by high-dose steroid treatment, inflammation secondary to SARS infection or the direct effect of the virus on the central nervous system caused various neuropsychological consequences [44,45].…”

Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors

“…Risk factor analysis can improve the detection of hidden psychiatric complications. Previous reported predictors of acute psychiatric complications include sociodemographic variables [e.g., being a health care worker (HCW)] [11][12][13]; illness-related variables [e.g., the severity of disease and the administration of high-dose corticosteroids [11], lowest level of arterial oxygen saturation (SaO 2 ) during hospitalisation] [14]; and psychosocial variables including social support, cognitive appraisal and coping style [13,15]. There are various methodological problems with these studies, including high attrition rates, the use of convenience sampling methods and the use of selfadministered questionnaires as the primary measuring instrument.…”