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Factors Associated With the Psychological Impact of Severe Acute Respiratory Syndrome on Nurses and Other Hospital Workers in Toronto

From the Department of Psychiatry, University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Robert G. Maunder, MD, Department of Psychiatry, Ninth Floor, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. E-mail: rmaunder{at}mtsinai.on.ca

OBJECTIVES: A survey was conducted to measure psychological stress in hospital workers and measure factors that may have mediated acute traumatic responses.

METHODS: A self-report survey was completed by 1557 healthcare workers at three Toronto hospitals in May and June 2003. Psychological stress was measured with the Impact of Event Scale. Scales representing attitudes to the outbreak were derived by factor analysis of 76 items probing attitudes to severe acute respiratory syndrome. The association of Impact of Event Scale scores to job role and contact with severe acute respiratory syndrome patients was tested by analysis of variance. Between-group differences in attitudinal scales were tested by multivariate analysis of variance. Attitudinal scales were tested as factors mediating the association of severe acute respiratory syndrome patient contact and job role with total Impact of Event Scale by linear regression.

RESULTS: Higher Impact of Event Scale scores are found in nurses and healthcare workers having contact with patients with severe acute respiratory syndrome. The relationship of these groups to the Impact of Event Scale score is mediated by three factors: health fear, social isolation, and job stress.

CONCLUSIONS: Although distress in response to the severe acute respiratory syndrome outbreak is greater in nurses and those who care for patients with severe acute respiratory syndrome, these relationships are explained by mediating variables that may be available for interventions to reduce stress in future outbreaks. In particular, the data suggest that the targets of intervention should include job stress, social isolation, and health fear.

Key Words: infectious disease, • stress, • nursing, • risk factors, • social factors.

Abbreviations: SARS = severe acute respiratory syndrome;; IES = Impact of Event Scale;; HCW = healthcare worker;; MSH = Mount Sinai Hospital;; SMH = St. Michael’s Hospital;; CAMH = Centre for Addiction and Mental Health.

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