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SARS survivors experience mental health decline
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CHICAGO—Most patients who survived severe acute respiratory syndrome (SARS) had good physical recovery, but they or their caregivers often reported a decline in mental health one year later, according to a study in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.


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 “Severe Acute Respiratory syndrome (SARS) became a global epidemic in 2003. Most cases were in Asia, and the largest concentration of North American cases occurred in Toronto, Ontario,” according to background information in the article. “The longer-term physical and psychological consequences of SARS were not reported until recently.” Investigations of the disease have focused on lung function, distance walked in six minutes and health-related quality of life.

Catherine M. Tansey, M.Sc., University Health Network, Toronto, and colleagues, evaluated 117 SARS survivors from Toronto who were discharged from the hospital in 2003. Patients were evaluated three, six and 12 months after leaving the hospital by undergoing a physical examination, a six-minute walk test, a lung function test, a chest X-ray and quality-of-life measures and reporting how often they saw a physician. Formal caregivers of survivors were given a survey on caregiver burden one year after patient discharge.

All but one patient had chest X-rays demonstrating normal or pre-SARS condition by one year. At three months, 31 percent of the survivors had a reduced six-minute walk distance and at one year, 18 percent did. For most, lung capacity measures and the lung’s ability to exchange respiratory gases were within normal limits at three months and during the rest of the follow-up period.

General health, vitality and social functioning remained below the normal range one year after discharge from the hospital. Many patients returned to work part-time, increasing their workload over the first two months while 23 patients returned to work full-time with no need for a modified schedule. “At one year, 17 percent of patients had not returned to work, and a further 9 percent had not returned to their pre-SARS level of work,” the authors note.

Survivors used health care services frequently the first year after hospitalization. “Psychiatric evaluation accounted for the greatest number of visits,” the authors write. “Of the patients, 74 percent saw their primary care physician a median of five times. Infectious disease specialists assessed 72 percent of patients, mostly in the first three months after discharge.” Caregiver surveys showed a decline in the mental health of caregivers, which was caused by reported lifestyle interference and loss of control.

“We have shown that most SARS survivors have pulmonary and functional recovery from their acute illness. However, one year after discharge from hospital, health-related quality of life remained lower than in the general population, and patients reported important decrements in mental health. These findings are reflected in the notable utilization of psychiatric and psychological services in the one-year follow-up period,” the authors conclude. “These data may help to highlight the needs of patients and caregivers during and after an epidemic, the potential benefit of a family-centered approach to follow-up care, and the importance of exploring strategies to minimize the psychological burden of an epidemic illness as part of future pandemic planning initiatives.”
(Arch Intern Med. 2007;167:1312-1320.

Editor's Note: This study was supported by the Ontario Thoracic Society (OTS) and Canadian Institutes of Health Research (CIHR). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .


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