APASARS paper

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

Study #1 George 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 : 

Study #1 George 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  

Demographicsn=130: 

Demographics n=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’d): 

Demographics (cont’d) Education Years Frequency <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 5not at all worried very worried : 

How worried are you about getting SARS yourself? 1 2 3 4 5 not 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): 

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 Score= sum of behaviors checked

Which of the following have you done to determine if you might have SARS? (tick those that apply): 

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 Score= sum of behaviors checked

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

How worried are you about getting SARS yourself? 1 2 3 4 5 not 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***

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#: : 

How worried are you about getting SARS yourself? 1 2 3 4 5 not at all worried very worried Correlates with likelihood of avoiding the following types of people#: 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*** #1 very unlikely 5 very likely

Affected and Unaffected Areas of Origin: 

Affected and Unaffected Areas of Origin

SARS Affected areas were:TorontoHong KongChinaSingaporeTaiwan: 

SARS Affected areas were: Toronto Hong Kong China Singapore Taiwan

Thoughts About SARS: 

Thoughts About SARS

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

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

How often do you think about SARS? 1 2 3 4 5 Rarely 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 #2Stressful Aspects of SARS: Coping with its Threat: 

Study #2 Stressful 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 Stressor: 

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

Demographicsn=47: 

Demographics n=47 6 areas China, Hong Kong, Germany, Costa Rica, USA and Canada

Demographics (cont’d): 

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’d): 

Demographics (cont’d) Education Years Frequency <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 Behavior: 

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

Slide44: 

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

Slide45: 

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*** *p < .05 ***p < .001 Avoidance Behavior 58*** Avoidance of People 41**

Slide46: 

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

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