Stressful Effects of SARS: Stressful Effects of SARS: Coping with the Threat of InfectionCoping with the Threat of Infection

 Esther R. GreenglassYork University

 Anita DeLongis and Dayna Lee-BaggleyUniversity 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

• 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 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• 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

 

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)

• 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)

• Education Years Frequency– <6 years 1– 7-12 7– 13-16 43– 16+ 77– Missing 2

Worry about Getting SARS

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)

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)

• 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

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#: • 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

SARS Affected areas were:Toronto

Hong KongChina

SingaporeTaiwan

Thoughts About SARS

Thoughts About SARS

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Number of things done to avoidgetting SARS

Number of things done todetermine if person has SARS

Unaffected

Affected

How often do you think about SARS? 1 2 3 4 5

Rarely All the timeCorrelates with likelihood of avoiding people#:

Non-affected area Affected area

From an infected area 0.14 0.34**

With a fever 0.12 0.33*

Who sneeze 0.12 0.33*

Who cough 0.07 0.27*

Who you think are from an infected area

# 1 very unlikely 5 very likely

0.20 0.31*

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

Correlates with Emotional Coping #

Non-affected area Affected area

Prayed or found faith in God or my religion

-0.08 0.34*

Tried to keep my feelings about SARS from interfering with other things

-0.08 0.37**

Wished SARS would go away

# 1 not at all 5 a great deal

0.05 0.55***

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)

• 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

Esther R. GreenglassYork University

 Anita DeLongis and Dayna Lee-Baggley

University of British ColumbiaGeorge D. Bishop

National University of Singapore

 

SARS as a Stressor

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

Demographicsn=47

• 6 areas

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

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)

• Education Years Frequency– <6 years 3– 7-12 2– 13-16 14– 16+ 27– Missing 1

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

• 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

• 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

• 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

• 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

• 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

• 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

• 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 • 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*

• 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*

• 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*

• 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

• 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

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

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**

State AnxietySARS Threat

Preventive Coping

TakingPrecautions

SeekingSocial

Support

RelationshjpFocusedCoping

AvoidanceCoping

Model Relating SARS Threat, Anxietyand Coping Strategies

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