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Stressful Effects of SARS: Coping with the Threat of Infection

Stressful Effects of SARS: Coping with the Threat of Infection. Esther R. Greenglass York University  Anita DeLongis and Dayna Lee-Baggley University of British Columbia  George D. Bishop & the SARS Psychosocial Research Consortium National University of Singapore.

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Stressful Effects of SARS: Coping with the Threat of Infection

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  1. Stressful Effects of SARS: Coping with the Threat of Infection Esther R. Greenglass York University  Anita DeLongis and Dayna Lee-Baggley University of British Columbia  George D. Bishop & the SARS Psychosocial Research Consortium National University of Singapore Symposium on SARS Presented at APA Toronto, August 7-10, 2003

  2. SARS as a Stressor • Given the little scientific knowledge of SARS to date, its mortality rate, and its seeming ease of transmission, it would not be surprising that individuals react with varying degrees of anxiety to SARS • Stress would be more likely to occur when there is a perception of high risk, high vulnerability and a relative lack of control

  3. Avoidance Behavior • Avoidance behavior is typically regarded as an emotional coping form since its primarily goal is to escape from the stressor • Given the stress and uncertainty associated with an infection of this kind, it is expected that individuals will deal with their anxiety by using avoidance behavior, of places, things and people

  4. Method • Data were collected using two internet-based surveys • The first survey, based on 130 respondents from 14 areas, was conducted from May 15 to June 17, 2003 and includes items assessing public perceptions and concerns related to SARS as well as associated behaviors • The second internet survey, based on 47 respondents from 6 areas, was conducted from June 1 to July 22, 2003 and focused primarily on the stressful aspects of the perception of SARS and coping strategies employed

  5. Study #1George D. Bishop & the SARS Psychosocial Research Consortium The purpose of this study is to examine perceptions and thoughts about SARS and self-reported behaviors associated with them

  6. Demographicsn=130 • From 14 areas • Australia, New Zealand, Bahrain, Singapore, Taiwan, China, Hong Kong, Indonesia, Japan, Malaysia, The Netherlands, Finland, USA and Canada

  7. Demographics (cont’d) • Gender 63 Female 64 Male 3 missing • Age Age Frequency • Under 20 7 • 20-39 78 • 40-59 37 • 60+ 4 • Missing 4

  8. Demographics (cont’d) • Education Years Frequency • <6 years 1 • 7-12 7 • 13-16 43 • 16+ 77 • Missing 2

  9. Worry about Getting SARS

  10. How worried are you about getting SARS yourself?1 2 3 4 5not at all worried very worried Correlates with • Likelihood of you getting SARS# 0.56*** • Likelihood of you dying from SARS# 0.44*** # The higher the value, the greater the perceived likelihood

  11. Avoided Travel to SARS affected area Eating in restaurants Shaking hands Travel in taxis Travel in subways or commuter trains Eating in food courts Large gatherings of people Particular types of people Travel by plane Work/school Worn a mask Washed my hands more often Taken more care about cleanliness Used disinfectants Eaten a balanced diet Exercised regularly Taken an herbal supplement Made sure I got sufficient sleep To avoid getting SARS, I have personally: (tick those that apply) Score= sum of behaviors checked

  12. Taken my temperature Gone to a doctor Paid close attention to coughing Paid close attention to feelings of fatigue Paid close attention to headaches Paid close attention to sneezing Called a SARS hotline Which of the following have you done to determine if you might have SARS? (tick those that apply) Score= sum of behaviors checked

  13. How worried are you about getting SARS yourself?1 2 3 4 5not at all worried very worried Correlates with • Number of things done to avoid getting SARS 0.56*** • Number of things respondents have done to determine if they have SARS 0.33***

  14. From an infected area 0.30*** With a fever 0.46*** Who sneeze 0.41*** Who look unwell 0.44*** Who are coughing 0.41*** Who you think might be from an infected area 0.46*** A health care worker 0.53*** Who have a family member with SARS 0.47*** A stranger wearing a surgical mask 0.36*** A stranger not wearing a surgical mask 0.40*** How worried are you about getting SARS yourself?1 2 3 4 5not at all worried very worried Correlates with likelihood of avoiding the following types of people#: #1 very unlikely 5 very likely

  15. Affected and Unaffected Areas of Origin

  16. SARS Affected areas were:TorontoHong KongChinaSingaporeTaiwan

  17. Thoughts About SARS

  18. How often do you think about SARS? 1 2 3 4 5Rarely All the time Correlates with likelihood of avoiding people#:

  19. Emotional Coping • Prayed or found faith in God or my religion • Tried to keep my feelings about SARS from interfering with other things • Wished SARS would go away

  20. How often do you think about SARS?1 2 3 4 5Rarely All the time Correlates with Emotional Coping #

  21. Summary of Findings • In general, the more people worry about getting SARS, the more activities they engage in to avoid getting it and the more they avoid certain people • And, greater worry about getting SARS is associated with doing more things to determine if one has it

  22. Summary (cont’d) • People in SARS affected areas think about SARS more frequently, do more things to avoid getting SARS and to determine if they have it themselves • Frequent thoughts about SARS are significantly associated with emotional coping only in individuals from SARS affected areas

  23. Study #2Stressful Aspects of SARS: Coping with its Threat Esther R. Greenglass York University Anita DeLongis and Dayna Lee-Baggley University of British Columbia George D. Bishop National University of Singapore

  24. SARS as a Stressor In the present context, perception of SARS is studied from a stress and coping perspective

  25. Demographicsn=47 • 6 areas • China, Hong Kong, Germany, Costa Rica, USA and Canada

  26. Demographics (cont’d) • Gender 32 Female 13 Male 2 missing • Age Age Frequency • Under 20 4 • 20-39 29 • 40-59 12 • 60+ 0 • Missing 2

  27. Demographics (cont’d) • Education Years Frequency • <6 years 3 • 7-12 2 • 13-16 14 • 16+ 27 • Missing 1

  28. Perceived SARS Threat • A 5-item measure • Extent to which SARS is seen as a direct threat to one’s health • Sample item: SARS is threatening my health • Response: 1 not at all to 4 a great deal • Alpha = .60

  29. Coping with SARS • In dealing with stress, some strategies include preventive coping, taking precautions, relationship focused coping, seeking social support and avoidance • The relationship between anxiety and these strategies is examined here

  30. Preventive Coping • A 3-item measure that assesses behaviors designed to lessen the risk of getting SARS in the future • Sample item: I do what I can so that I will not get SARS • Response: 1 not at all true 4 completely true • Alpha = .78

  31. Taking Precautions • An 8-item measure of specific behaviors designed to minimize the risk of getting SARS • Sample item: Washed my hands more often • Response: yes no • Alpha = .71

  32. Seeking Social Support • A 2-item measure that assesses seeking information and emotional support to deal with concerns about SARS • Sample item: Talked to someone to find out more about SARS … • Response: 1 not at all 5 a great deal • Alpha =.83

  33. Relationship Focused Coping • A 4- item measure that assesses extent to which the individual helps others deal with SARS • Sample item: Tried to understand the other person’s concerns about SARS … • Response: 1 not at all 4 a great deal • Alpha = .93

  34. Avoidance Behavior • 18-item measure • Sum of behaviors to avoid getting SARS including avoiding travel, going to work, and being in large gatherings of people • Sample item: To avoid getting SARS, I have personally avoided eating in restaurants • Alpha = .75

  35. Avoidance of People • A 10-item measure • Sum of behaviors to avoid certain people including those who appear unwell,a health care worker, and a person who might be from an area infected with SARS, for example • Sample item: How likely are you to avoid a person who is coughing? • Response: 1 very unlikely to 5 very likely • Alpha = .91

  36. State Anxiety • Anxiety related to SARS • A 17-item measure • Adapted from the State-Trait Anxiety Inventory (STAI) A-State Anxiety measure (Spielberger et al., 1970) • Sample item: I am worried about possible misfortune regarding SARS … • Response: 1 not at all 4 very much so • Alpha = .95

  37. Relative Risk of Getting SARS vs Catching a Cold* • A 2-item measure • The relative risk of me or someone my age and sex getting SARS compared to the risk of catching a cold • Sample item: Compared to my risk of catching a cold, the risk of my getting SARS is … • Response: 1 very low to 5 very high • Alpha = .91 * Renner & Schwarzer, 2003

  38. Relative Risk of Getting SARS vs West Nile Virus* • A 2-item measure • The relative risk of me or someone my age and sex getting SARS compared to the risk of getting West Nile Virus • Sample item: Compared to my risk of getting West Nile virus, the risk of my getting SARS is … • Response: 1 very low to 5 very high • Alpha = .89 * Renner & Schwarzer, 2003

  39. Relative Risk of Getting SARS vs Getting AIDS* • A 2-item measure • The risk of me or someone of my age and sex getting SARS compared to the risk of getting AIDS • Sample item: Compared to my risk of getting AIDS, the risk of my getting SARS is … • Response: 1 very low to 5 very high • Alpha = .80 * Renner & Schwarzer, 2003

  40. Hypotheses • The greater the perceived threat from SARS, the greater the state anxiety • The greater the perceived threat from SARS, the greater the perceived relative risk of getting SARS compared to catching a cold, getting AIDS and getting West Nile Virus

  41. Correlations Between Perceived SARS Threat, State Anxiety, & Relative Risk of Getting SARS Compared to the Risk of Catching a Cold, Getting AIDS and Getting West Nile Virus • State Anxiety • Cold Risk • AIDS Risk • West Nile Virus 48*** 59*** 34* 22 *p < .05 ***p < .001

  42. Correlations between Perceived State Anxiety, Preventive Coping, Taking Precautions, Seeking Social support, Relationship Focused Coping and Avoidance • Preventive Coping • Taking Precautions • Seeking Social Support • Relationship-Focused Coping 51*** 49*** 49*** 50*** Avoidance Behavior 58*** Avoidance of People 41** *p < .05 ***p < .001

  43. SARS Threat Model Relating SARS Threat, Anxiety and Coping Strategies Preventive Coping Taking Precautions State Anxiety Seeking Social Support Relationshjp Focused Coping Avoidance Coping

  44. Implications of the Results • SARS represents a threat to public health that generates anxiety and avoidance behavior in varying degrees. An important factor here was whether the respondent lived in an affected area • Results illustrate the importance of studying this kind of threat to public health from a stress and coping perspective • These data may be used to enhance our knowledge of illness and cognition and responses to health threats as well as for purposes of formulating public policy concerning SARS and other health threats

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