Spring 2003 was not a good time for the Chang Gung Memorial Hospital in
southern Taiwan. It admitted its first patient with severe acute respiratory
syndrome (SARS) in late April. After that, 79 patients and hospital workers
became infected, including five physicians. One of the physicians died on May
Hospital staff set up computers outside the Chang Gung Memorial Hospital
in Kaohsiung, Taiwan, during the 2003 SARS epidemic. A Taiwanese psychiatrist
was ready to meet the mental health challenges to patients and staff. See
story on page 22.
© SAM YEH/Staff/Getty Images
However, Mian-Yoon Chong, M.D., Ph.D., chair of psychiatry at the hospital,"
was ready for the challenge of the SARS epidemic," he told
Psychiatric News. "It was because I had been involved in trauma
and disaster work and research before. [For instance] in the devastating
earthquake of September 21, 1999 in Taiwan.... I was one of the first
psychiatrists involved in the rescue work."
So, in addition to organizing his hospital staff into teams to help
hospital workers deal with the SARS epidemic, Chong realized that the
situation was an excellent one to learn how SARS affects health care workers.
At his own expense, he and some of his colleagues decided to study as many
health care workers in the hospital as possible to find out how they were
Their study took place from May 12, 2003 to June 27, 2000—the period
when the hospital was officially declared as having a serious SARS infection.
All staff working at the hospital at this time were invited to participate. A
questionnaire was distributed at all work stations in the hospital and also
over the Internet, to which all hospital workers had free access.
The questionnaire was composed of three parts—basic demographic
questions and questions about SARS exposure; the Impact of Event Scale; and
the Chinese Health Questionnaire.
The Impact of Event Scale is used to assess the frequency of intrusive and
avoidance phenomena in response to a specific stressful life event. The scale
has demonstrated extensive reliability and validity and is often used in
trauma research. The Chinese Health Questionnaire is a screening instrument
used to assess psychiatric morbidity in the Chinese community. It inquires
about anxiety, depression, poor family relationships, somatic symptoms, and
Of the approximately 2,500 workers eligible for the study, 1,257 completed
the questionnaires. The respondents included physicians, nurses, health
administrative workers, pharmacists, technicians, respiratory therapists, and
some other professionals. The researchers then separated respondents'
reactions into those that occurred during the first half of the study, when
the situation was chaotic and the SARS infection was escalating, and during
the second half of the study, when the SARS infection was gradually brought
There were marked differences in respondents' reactions during the first
half of the study and the second half, the researchers found.
During the first half, respondents were shocked by the sudden disruption of
normal work and life. They felt extremely vulnerable, out of control,
helpless. They were terrified that they would fall ill or that they would pass
SARS to their family and friends. They were also feared by people in the
community, and their children were shunned during school and social
During the second half of the study, respondents tended to experience
depression rather than anxiety, as well as somatic symptoms, intrusion,
avoidance, and poor family relationships. Moreover, psychiatric morbidity was
greater during the second phase of the study and appeared to affect
respondents considerably regardless of their position in the hospital and how
much work experience they had had.
All in all, 75 percent of respondents experienced psychological
difficulties—a rate of psychiatric morbidity three times higher than
that of the general Taiwanese population.
"It is sobering that a newly emergent infectious disease was capable
of bringing a health care institution to a standstill, striking down nurses,
doctors, and other medical personnel," Chong and his team pointed out.
Their report is in the August British Journal of Psychiatry. The
outbreak, they add, "could be regarded as an acute episode of
These findings have implications for American psychiatrists, Chong
believes. "The traumatic effects of the bio-disaster of SARS, like
terrorism, are not limited to the direct victims alone and could extend to the
regional as well as global communities," he told Psychiatric
News. "In the future training of psychiatrists, trauma and disaster
should be emphasized."
"I was very impressed by both the quality and the findings of this
study," Julia Frank, M.D., an associate professor of psychiatry at
George Washington University who has a special interest in terrorism and
disasters, said in an interview. "The authors managed to conduct
methodologically rigorous research under near-combat conditions.... The high
levels of symptoms endorsed by the respondents to this questionnaire sound a
warning to all people responsible for crafting the medical response to new
epidemics, of which SARS may be a bellwether.
"In this study, more highly trained professionals and people of
lesser training showed equal vulnerability to overestimation of threat,
psychological distress, and erosion in their commitment to care for patients.
Exposure to trauma, like love in Gilbert and Sullivan, levels all
An abstract of the report, "Psychological Impact of Severe
Acute Respiratory Syndrome on Health Workers in a Tertiary Hospital," is
posted online at<http://bjp.rcpsych.org/cgi/content/abstract/185/2/127>.▪
Br J Psychiatry2004185127