stressful effects of sars: coping with the threat of infection stressful effects of sars: coping...
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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
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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
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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
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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
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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
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Demographicsn=130
• From 14 areas
• Australia, New Zealand, Bahrain, Singapore, Taiwan, China, Hong Kong, Indonesia, Japan, Malaysia, The Netherlands, Finland, USA and Canada
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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
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Demographics (cont’d)
• Education Years Frequency– <6 years 1– 7-12 7– 13-16 43– 16+ 77– Missing 2
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Worry about Getting SARS
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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
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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
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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
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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***
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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
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Affected and Unaffected Areas of Origin
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SARS Affected areas were:Toronto
Hong KongChina
SingaporeTaiwan
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Thoughts About SARS
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Thoughts About SARS
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
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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
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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*
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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
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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***
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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
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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
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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
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SARS as a Stressor
In the present context, perception of SARS is studied from a stress and coping perspective
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Demographicsn=47
• 6 areas
• China, Hong Kong, Germany, Costa Rica, USA and Canada
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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
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Demographics (cont’d)
• Education Years Frequency– <6 years 3– 7-12 2– 13-16 14– 16+ 27– Missing 1
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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**
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State AnxietySARS Threat
Preventive Coping
TakingPrecautions
SeekingSocial
Support
RelationshjpFocusedCoping
AvoidanceCoping
Model Relating SARS Threat, Anxietyand Coping Strategies
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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