Abstract
BackgroundThe 2015 outbreak of Middle East Respiratory Syndrome (MERS) in the Republic of Korea is a recent and representative occurrence of nationwide outbreaks of Emerging Infectious Diseases (EIDs). In addition to physical symptoms, posttraumatic stress disorder (PTSD) and depression are common following outbreaks of EID.MethodsThe present study investigated the long-term mental health outcomes and related risk factors in survivors of MERS. A prospective nationwide cohort study was conducted 12 months after the MERS outbreak at multi-centers throughout Korea. PTSD and depression as the main mental health outcomes were assessed with the Impact of Event Scale-Revised Korean version (IES-R-K) and the Patient Health Questionnaire-9 (PHQ-9) respectively.Results42.9% of survivors reported PTSD (IES-R-K ≥ 25) and 27.0% reported depression (PHQ-9 ≥ 10) at 12 months post-MERS. A multivariate analysis revealed that anxiety (adjusted odds ratio [aOR], 5.76; 95%CI, 1.29–25.58; P = 0.021), and a greater recognition of stigma (aOR, 11.09, 95%CI, 2.28–53.90; P = 0.003) during the MERS-affected period were independent predictors of PTSD at 12 months after the MERS outbreak. Having a family member who died from MERS predicted the development of depression (aOR, 12.08, 95%CI, 1.47–99.19; P = 0.020).ConclusionThis finding implies that psychosocial factors, particularly during the outbreak phase, influenced the mental health of patients over a long-term period. Mental health support among the infected subjects and efforts to reduce stigma may improve recovery from psychological distress in an EID outbreak.
Highlights
The 2015 outbreak of Middle East Respiratory Syndrome (MERS) in the Republic of Korea is a recent and representative occurrence of nationwide outbreaks of Emerging Infectious Diseases (EIDs)
Acute infectious outbreaks of Emerging Infectious Diseases (EIDs) are known to influence the physical as well as the mental health of affected patients, as observed during similar events such as the Severe Acute Respiratory Syndrome (SARS) outbreak [3], which was associated with such issues during the acute phase [4] and the long-term follow-up phase [5, 6]. 35% of 425 survivors expressed anxiety or depressive symptoms at 1-month post-SARS in Hong Kong where 1755 citizens were infected, and its fatality was 17.0% [4]
The distribution of respondents at the point of MERS-CoV infection was as follows: patients, 31.7%; healthcare providers, 23.8%; caregivers, 17.5%; and those visiting the patients in hospitals, 17.5% (Table 2)
Summary
The 2015 outbreak of Middle East Respiratory Syndrome (MERS) in the Republic of Korea is a recent and representative occurrence of nationwide outbreaks of Emerging Infectious Diseases (EIDs). In addition to physical symptoms, posttraumatic stress disorder (PTSD) and depression are common following outbreaks of EID. The 2015 outbreak of the Middle East Respiratory Syndrome coronavirus (MERS-CoV) in the Republic of Korea had an enormous impact on medical, psychological, and social issues nationwide [1]. Acute infectious outbreaks of Emerging Infectious Diseases (EIDs) are known to influence the physical as well as the mental health of affected patients, as observed during similar events such as the Severe Acute Respiratory Syndrome (SARS) outbreak [3], which was associated with such issues during the acute phase [4] and the long-term follow-up phase [5, 6]. 35% of 425 survivors expressed anxiety or depressive symptoms at 1-month post-SARS in Hong Kong where 1755 citizens were infected, and its fatality was 17.0% [4]. Compared to patients with other diseases, those with EIDs may experience greater suffering in terms of the physical and psychiatric symptoms of the infectious illness itself [9]; extreme fear and anxiety due to their unfamiliarity with the disease, which may be lifethreatening [10]; abrupt isolation from family and society during the illness [8]; stigma due to the infectious disease [11]; the unexpected death of a family member; and/or social impairments [12]
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