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 - PubMed (original) (raw)

Meta-Analysis

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

Steven W H Chau et al. BMC Public Health. 2021.

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.

Keywords: Covid-19; Healthcare workers; Infectious disease; Mental health; Post-traumatic stress disorder; SARS.

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Conflict of interest statement

The authors have had no financial relationships in the previous 3 years with any organisations that might have an interest in the submitted work. The authors have no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1

Fig. 1

PRISMA flowchart of the review

Fig. 2

Fig. 2

Forest plots of pooled estimates of prevalence of mental health outcomes among SARS survivors. a Forest plot of pooled estimate of prevalence of probable or clinically diagnosed anxiety disorder among SARS patients in post-recovery period; b Forest plot of pooled estimate of prevalence of probable or clinically diagnosed depressive disorder among SARS patients in post-recovery period; c Forest plot of pooled estimate of prevalence of post-traumatic stress disorder (PTSD) among SARS patients in post-recovery period. Note: *Prevalence calculated from mean and standard deviation using Monte Carlo simulation

Fig. 3

Fig. 3

Forest plots of pooled estimates of health-related quality of life measures of SARS survivors. a Forest plot of pooled estimate of mean of 36-item Short Form Survey (SF-36) mental health domain among SARS patients in > 6 months post-discharge; b Forest plot of pooled estimate of mean of SF-36 role emotional domain among SARS patients in > 6 months post-discharge; c Forest plot of pooled estimate of mean of SF-36 role social functioning among SARS patients in > 6 months post-discharge

Fig. 4

Fig. 4

Forest plots of pooled estimates of prevalence of mental health outcomes among healthcare workers of SARS-affected regions. a Forest plot of pooled estimate of prevalence of probable PTSD among healthcare workers; b Forest plot of pooled estimate of prevalence of probable depression among healthcare workers; c Forest plot of pooled estimate of prevalence of significant psychological distress among healthcare workers. Note: *Prevalence calculated from mean and standard deviation using Monte Carlo simulation

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