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
Demographics n=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 5 not 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 5 not 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 5 not 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: Toronto Hong Kong China Singapore Taiwan : 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 5 Rarely 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 5 Rarely 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 #2 Stressful 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
Demographics n=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