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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

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


Sars as a stressor

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


Avoidance behavior

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


Method

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


Stressful effects of sars coping with the threat of infection

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


Demographics n 130

Demographicsn=130

  • From 14 areas

  • Australia, New Zealand, Bahrain, Singapore, Taiwan, China, Hong Kong, Indonesia, Japan, Malaysia, The Netherlands, Finland, USA and Canada


Demographics cont d

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


Demographics cont d1

Demographics (cont’d)

  • Education

    YearsFrequency

    • <6 years 1

    • 7-12 7

    • 13-16 43

    • 16+ 77

    • Missing 2


Worry about getting sars

Worry about Getting SARS


How worried are you about getting sars yourself 1 2 3 4 5 not at all worried very worried

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


To avoid getting sars i have personally tick those that apply

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


Which of the following have you done to determine if you might have sars tick those that apply

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


How worried are you about getting sars yourself 1 2 3 4 5 not at all worried very worried1

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***


Stressful effects of sars coping with the threat of infection

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


Affected and unaffected areas of origin

Affected and Unaffected Areas of Origin


Sars affected areas were toronto hong kong china singapore taiwan

SARS Affected areas were:TorontoHong KongChinaSingaporeTaiwan


Thoughts about sars

Thoughts About SARS


How often do you think about sars 1 2 3 4 5 rarely all the time

How often do you think about SARS? 1 2 3 4 5Rarely All the time

Correlates with likelihood of avoiding people#:


Emotional coping

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


How often do you think about sars 1 2 3 4 5 rarely all the time1

How often do you think about SARS?1 2 3 4 5Rarely All the time

Correlates with Emotional Coping #


Summary of findings

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


Summary cont d

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


Study 2 stressful aspects of sars coping with its threat

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


Sars as a stressor1

SARS as a Stressor

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


Demographics n 47

Demographicsn=47

  • 6 areas

  • China, Hong Kong, Germany, Costa Rica, USA and Canada


Demographics cont d2

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


Demographics cont d3

Demographics (cont’d)

  • Education

    YearsFrequency

    • <6 years 3

    • 7-12 2

    • 13-16 14

    • 16+ 27

    • Missing 1


Perceived sars threat

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


Coping with sars

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


Preventive coping

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


Taking precautions

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


Seeking social support

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


Relationship focused coping

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


Avoidance behavior1

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


Avoidance of people

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


State anxiety

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


Relative risk of getting sars vs catching a cold

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


Relative risk of getting sars vs west nile virus

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


Relative risk of getting sars vs getting aids

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


Hypotheses

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


Stressful effects of sars coping with the threat of infection

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


Stressful effects of sars coping with the threat of infection

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


Stressful effects of sars coping with the threat of infection

SARS Threat

Model Relating SARS Threat, Anxiety

and Coping Strategies

Preventive

Coping

Taking

Precautions

State Anxiety

Seeking

Social

Support

Relationshjp

Focused

Coping

Avoidance

Coping


Implications of the results

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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