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Table 1 Complete list of included studies

From: History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002–2003 Severe Acute Respiratory Syndrome (SARS) outbreak

A.

 

Region of study

Language

Study design

Timeframes of study

Sample size

Age (year)

Female %

HCW%

ICU admission%

Mental health outcomes and measures used

Quality assessment

Liang et al. 2004# [16]

Taiwan

Chinese

Prospective cohort

During treatment, 1 month post discharge

90

55.9

37.8%

20.0%

NR

Anxiety: HADS

Depression: HADS

PTS: PTSD-RI

**/***

Tang et al. 2005 [17]

Mainland China

Chinese

Retrospective

During treatment

325

38.3

67.1%

NR

NR

Any neuropsychiatric disturbances (including psychosis and delirium): Clinician assessment

*/*

Wang J et al. 2005 [18]

Mainland China

Chinese

Prospective cohort

During treatment (multiple timepoints)

29

37.5

48%

NR

NR

General psychological distress: SCL-90

*/**

Huang et al. 2004 [19]

Mainland China

Chinese

cross-sectional

During treatment

218

81% within 31 to 41

79.8%

50%

NR

Depression: SDS

*/**

Lee D et al. 2004 [20]

Hong Kong

English

Case-control

During treatment

Psychotic cases: 15; Non- psychotic control: 30

32.8

60%

NR

6.7%

Psychosis: Clinician assessment

***/***

Cheng S et al. 2004 (a) [21]

Hong Kong

English

Cross-sectional

During treatment

10

34.8

60%

NR

NR

Any psychiatric disorder: Clinician assessment

**/**

Chua et al. 2004(a) [22]

Hong Kong

English

Cross-sectional

During treatment

79 (non-patient control:145)

18–60

61.1%

39%

NR

Stress/burnout: PSS-10

**/**

Wang W et al. 2005 [23]

Mainland China

English

Cross-sectional

During treatment

103

82% within 20 to 50

59%

NR

NR

General psychological distress: SCL-90

*/*

Hu et al. 2004 [24]

Mainland China

Chinese

Cross-sectional

During treatment

35 (Non-patient control: 50)

32

42.9%

NR

NR

General psychological distress: SCL-90

Anxiety: SAS

Depression: SDS

*/**

Kwek et al. 2006 [25]

Singapore

English

Cross-sectional

3 months post-discharge

63

34.8

79.4%

54%

9.5%

Anxiety: HADS

Depression: HADS

PTS: IES

HRQoL: SF-36

**/***

Hui et al. 2005 [26]

Hong Kong

English

Prospective cohort

3 months, 6 months and 12 months post-onset

97

36.9

66%

NR

32.0%

HRQoL: SF-36

***/***

Cheng S et al. 2004 (b) [27]

Hong Kong

English

Cross-sectional

1–2 months post discharge

180

36.9

66.7%

25%

11.1%

Anxiety: BAI

Depression: BDI

**/***

Cheng S et al. 2004(c) [28]

Hong Kong

English

Cross-sectional

1 month post discharge

100 (Non-patient control: 184)

37.1

66%

18%

9%

General psychological distress: GHQ-28

HRQoL: WHOQOL-BREF

*/**

Wu et al. 2005 [29]

Hong Kong

English

Cross-sectional (multiple timepoints)

1 month and 3 month post discharge

131

41.8

56%

11%

11%

Anxiety: HADS

Depression: HADS

PTS: IES-R

**/**

Xu et al. 2005 [30]

Mainland China

Chinese

Cross-sectional

3 months post discharge

114 (non-patient control: 93)

36.9

54%

NR

NR

PTS: IES-R

*/*

Hong et al. 2009 [31]

Mainland China

English

Prospective cohort

Multiple timepoints from 1 to 46 months post-discharge

70

38.5

67.1%

NR

NR

PTS: Clinician assessment by CCMD III criteria

***/***

Fang et al. 2004 [32]

Mainland China

Chinese

cross-sectional

3 months post discharge

286

33.4

52.8%

21.7%

NR

Anxiety: SAS

Depression: SDS

PTS: Clinician assessment by DSM4 criteria

**/**

Sun et al. 2005 [33]

Mainland China

Chinese

Prospective cohort

3 months and 12 months post discharge

114

36.9

54%

NR

NR

PTS: Clinician assessment by DSM4 criteria

*/**

Lin et al. 2004 [34]

Mainland China

Chinese

cross-sectional

Early post discharge

45 (Non-patient control: 45)

33.5

52%

NR

NR

General psychological distress: SCL-90

*/**

Lau H et al. 2005 [35]

Hong Kong

English

RCT

2 weeks post discharge

133

37

66.2%

NR

NR

HRQoL: SF-36

*/**

Shi et al. 2011 [36]

Mainland China

Chinese

Prospective cohort

Early post discharge and 5 years post discharge

43 (Non-patient control: 41)

30.6

88%

100%

NR

Depression: SDS

Neurocognitive function

*/**

Peng C et al. 2005 [37]

Mainland China

Chinese

cross-sectional

3 months post discharge

117

36.5

53.8%

NR

NR

General psychological distress: SCL-90

*/*

Cheng et al. 2006 [38]

Hong Kong

English

cross-sectional

2 to 6 months post discharge

57

38.1

66.7%

38.6%

17.5%

Anxiety: BAI

Depression: BDI

**/***

Tansey et al. 2007 [39]

Canada

English

Prospective cohort

First year post discharge

107

42

67%

65%

16%

HRQoL: SF-36

Psychiatric service utilisation

**/***

Lee A et al. 2007 [40]

Hong Kong

English

cross-sectional

1 year post SARS

96

NR

63.5%

34.4%

NR

Anxiety: DASS

Depression: DASS

PTS: IES-10

Stress/burnout: PSS-10

**/**

Gao et al. 2006 [41]

Mainland China

Chinese

cross-sectional

1 year post SARS

61

25.3

68.7%

NR

NR

PTS: Clinician assessment by CCMD III criteria

*/**

Moldofsky et al. 2011 [42]

Canada

English

retrospective

1–3 years post SARS

21

46.3

90.5%

90.50%

NR

Depression: BDI

PTS: PCL-C

Sleep: Polysomnography

Fatigue

*/**

Lam et al. 2009 [43]

Hong Kong

English

cross-sectional

3–4 years post SARS

181

44.7

68.5%

47.5%

11.7%

Any psychiatric diagnosis: Clinician assessment by DSM4

criteria

Fatigue: CFQ

***/***

Mak et al. 2009, Mak et al. 2010 and Yip 2015# [44,45,46]

Hong Kong

English

Prospective cohort

2–3 years and 10 years post SARS

90

41.1

62.2%

30%

10%

Any psychiatric diagnosis: Clinician assessment by DSM4, HADS

HRQoL: SF-36

***/***

Guo et al. 2019 [47]

Mainland China

English

Prospective cohort

12 years post SARS

67

33

57%

NR

NR

HRQoL: SF-36

**/**

B.

 

Region of study

Language

Study design

Timeframes of study

Specific population

Sample size

Age (year)

Female %

Mental health outcomes and measures used

Quality assessment

Chen CS et al. 2005 [48]

Taiwan

English

Prospective cohort

During epidemic (multiple timepoints)

Nurses of SARS units

116

31

98.3%

Anxiety: SAS

Depression: SDS

Sleep: PSQI

*/**

Nickell et al. 2004 [49]

Canada

English

Cross-sectional

During epidemic

HCWs of SARS hospital

510

NR

81.1%

General psychological distress: GHQ-12

*/**

Chong et al. 2004 [50]

Taiwan

English

Cross-sectional

During epidemic

HCWs of SARS hospital

1257

31.8

81%

General psychological distress: CHQ

PTS: IES

***/***

Xu et al. 2004 [51]

Mainland China

Chinese

Cross-sectional

During epidemic

HCWs of SARS hospital

89

30.6

91%

PTS: IES-R

**/**

Chen N et al. 2007 [52]

Taiwan

English

Prospective cohort

During epidemic

HCWs of SARS hospital

172

31.4

NR

HRQoL: SF-36

**/**

Chen C et al. 2005 [53]

Taiwan

English

Cross-sectional

During epidemic

Nurses of SARS hospital

128

26.5

100%

General psychological distress: SCL-90-R

PTS: IES

**/**

Maunder et al. 2004 [54]

Canada

English

cross-sectional

During epidemic

HCWs of SARS outbreak region

1557

40.2

74.6%

PTS: IES

**/**

Zhang et al. 2005 [55]

Mainland China

Chinese

Cross-sectional

During epidemic

HCWs of SARS hospital

HCWs: 94; general public control: 58

31.5

72.3%

General psychological distress: SCL-90

*/*

Su et al. 2007 [56]

Taiwan

English

Prospective cohort

During epidemic (multiple timepoints)

Nurses of SARS hospital

102

25.4

100%

Anxiety: STAI, clinician assessment by M.I.N.I.

Depression: BDI, M.I.N.I.

PTS: DTS-C, M.I.N.I.

Sleep: PSQI

**/**

McAlonan et al. 2007 [57]

Hong Kong

English

cross-sectional (multiple timepoint)

During epidemic and 1 year after

HCWs of SARS hospital

360

30–50

68.3%

Anxiety: DASS-21

Depression: DASS-21

PTS: IES-R

Stress/burnout: PSS-10

**/**

Poon et al. 2004 [58]

Hong Kong

English

cross-sectional

During epidemic

HCWs of SARS hospital

1926

NR

NR

Anxiety: STAI

Stress/burnout: MBI

**/**

Chua et al. 2004(b) [59]

Hong Kong

English

cross-sectional

During epidemic

HCWs of SARS hospital

HCWs:271; general public control: 342

Most within 19–40

75%

Stress/burnout: PSS-10

**/**

Fiksenbaum et al. 2006 [60]

Canada

English

cross-sectional

During epidemic

Nurses of SARS hospital

333

43.8

93.6%

Stress/burnout: MBI

*/*

Wong S 2004# [61]

Hong Kong

English

Prospective cohort (only baseline data contains measures of interest)

During epidemic

HCWs of SARS hospital

87

NR

57.5%

PTS: IES

*/*

Tam et al. 2004 [62]

Hong Kong

English

cross-sectional

During epidemic

HCWs of SARS hospital

652

34.1

79%

General psychological distress: GHQ-12

**/**

Verma et al. 2004 [63]

Singapore

English

cross-sectional

During epidemic

General practitioners and traditional Chinese medicine practitioners

1050

46.6

39.7%

General psychological distress: GHQ-28

PTS: IES-R

**/**

Koh et al. 2005 [64]

Singapore

English

cross-sectional

During epidemic

HCWs of SARS outbreak region

10,511

36.6

82%

PTS: IES

**/**

Sim et al. 2004 [65]

Singapore

English

cross-sectional

During epidemic

HCWs of SARS hospital

47

Majority within 25–50

29.8%

General psychological distress: GHQ-28

PTS: IES

**/**

Styra et al. 2008 [66]

Canada

English

cross-sectional

1–2 months post- epidemic

HCWs of SARS hospital

248

36.9

86%

PTS: IES-R

***/***

Tham et al. 2004 [67]

Singapore

English

cross-sectional

6 months post-epidemic

HCWs of SARS hospital

96

31.9

68.8%

General psychological distress: GHQ-28

PTS: IES

**/***

Lung et al. 2009 [68]

Taiwan

English

Prospective cohort

1–9 months post epidemic, 1 year post epidemic

HCWs with direct clinical contact with SARS patients

127

32.3

58%

General psychological distress: CHQ-12

**/**

Lin et al. 2007 [69]

Taiwan

English

cross-sectional

1 month post epidemic

HCWs of SARS hospital

92

33.8

91.3%

General psychological distress: CHQ-12

PTS: DTS-C

**/**

Chen CC et al. 2004 [70]

Taiwan

Chinese

cross-sectional

1 month post epidemic

HCWs of SARS outbreak region

222

36

94%

General psychological distress: BSRS

*/**

Maunder et al. 2006 & Lancee et al. 2008 [71, 72]

Canada

English

cross-sectional

1–2 years post epidemic

HCWs of SARS outbreak region

769 (a subset of 139 for Lancee et al.)

NR

86.9%

General psychological distress: K10

PTS: IES

Any clinical psychiatric diagnoses: Clinician assessment by DSM4

Stress/burnout: MBI-EE

Maunder et al.: **/**;

Lancee et al.: */**

Wu et al. 2008, 2009 & Liu at al. 2127 [73,74,75]

Mainland China

English

cross-sectional

3 years post epidemic

HCWs of SARS hospital

539

47.1% within 36–50

76.5%

Depression: CES-D

PTS: IES-R

Alcohol use

**/** (all three)

C.

 

Region of study

Language

Study design

Timeframes of study

Specific population

Sample size

Age (year)

Female %

Mental health outcomes and measures used

Quality assessment

Yu et al. 2005 [76]

Hong Kong

English

Prospective cohort

Pre-SARS, during epidemic

Middle age women

126

56.7

100%

Depression: CES-D

Stress/burnout: PSS-10

*/**

Leung et al. 2005 [77]

Hong Kong

English

Cross-sectional (multiple timepoints)

During epidemic (multiple timepoints), 6 months post SARS

General public

4481

NR

57%

Anxiety: STAI-state (10 items)

***/***

Dang et al. 2004 [78]

Mainland China

Chinese

Cross-sectional

During epidemic

College students

6280

NR

39.4%

Anxiety: SAS

Depression: SDS

*/**

Cheng C et al. 2005 [53]

Hong Kong

English

Prospective cohort

During epidemic (multiple timepoints)

College students

72

21.1

57%

Anxiety: STAI

**/***

Wong T et al. 2007 [79]

Hong Kong

English

Cross-sectional

During epidemic

College students

763

22.2

31.6%

Anxiety: SAS

*/*

Lee D et al. 2006 [80]

Hong Kong

English

Cross-sectional

During epidemic (with pre-SARS data as reference)

Pregnant women

235

29.6

100%

Anxiety: STAI

Depression: BDI

**/***

Chang et al. 2004 [81]

Singapore

English

Cross-sectional

During epidemic

General public

174

31.0

55%

Anxiety: STAI

Depression: CES-D

*/*

Chan et al. 2007 [82]

Hong Kong

English

Non-controlled interventional

During epidemic

Senior citizens

122

NR

63%

Anxiety: STAI

*/**

Jin et al. 2003 [83]

Mainland China

Chinese

Non-controlled interventional

During epidemic

College students

138

18–23

NR

Anxiety: SAS

*/*

Wang JD 2003 [84]

Mainland China

Chinese

Cross-sectional

During epidemic

Non-SARS patients to a hospital

114

16–60

35.7%

Anxiety: SAS

Depression: SDS

General psychological distress: SCL-90

*/*

Lau J et al. 2006 [85]

Hong Kong

English

Cross-sectional

During epidemic

General public

818

79% within 18–49

48.8%

PTS: IES

**/**

Hawryluck et al. 2004 [86]

Canada

English

Cross-sectional

During epidemic

Quarantined general public

129

80% within 26–55

NR

Depression: CES-D

PTS: IES-R

**/**

Reynolds et al. 2008 [87]

Canada

English

Cross-sectional

Immediate post- epidemic

Quarantined general public

1057

51.9

55.5%

PTS: IES-R

**/***

Peng E et al. 2010 [37]

Taiwan

English

Cross-sectional

4–5 months post epidemic

General public

1278

41.6

49.7%

General psychological distress: BSRS-5

**/***

Ko et al. 2006 [88]

Taiwan

English

Cross-sectional

1 month post epidemic

General public

1449

76% within 15–50

49.3%

Depression: TDQ

**/**

Ng et al. 2006 [89]

Hong Kong

English

RCT

2 months post epidemic

General public with chronic illness

34

55.3

74.5

Anxiety: BSI

Depression: BSI

*/*

Lee T et al. 2006 [80]

Hong Kong

English

Cross-sectional

3 months post epidemic

General public

146

61.1

NR

Depression: CES-D

PTS: IES-R

**/**

Cheung et al. 2008 [90]

Hong Kong

English

Retrospective

The year of SARS

Senior citizens

/

NR

NR

Suicide: Cause of death from death registry

**/***

Tan 2019 [91]

Taiwan

English

Retrospective

The year of SARS

General public

/

NR

NR

Depression: Diagnosis from health insurance registry

*/*

  1. List of included studies of which A. SARS patients, B. non-infected healthcare workers of SARS affected regions and C. general public of SARS affected regions were the primary study population, respectively
  2. SARS severe acute respiratory syndrome, HCWs healthcare workers, NR not reported, PTS post-traumatic stress, BAI Beck anxiety inventory, BDI Beck depression inventory, BSRS Brief symptoms rating scale, CCMD-III Chinese classification of mental disorders 3rd version, CES-D Center for Epidemiologic Studies Depression Scale, CHQ-12 Chinese Health Questionnaire, DSM4 Diagnostic and statistical manual of mental disorders 4th version, DASS Depression Anxiety Stress Scales, DTS-C Davidson Trauma Scale Chinese version, GHQ-12 General Health Questionnaire-12 items, GHQ-28 General Health Questionnaire-28 items, HADS Hospital anxiety and depression scale, ICD-10 International classification of disease 10th version, IES Impact of event scale, IES-R Impact of event scale-revised, K-10 Kessler Psychological Distress Scale, MBI Maslach Burnout Inventory, M.I.N.I. The Mini-International Neuropsychiatric Interview, PCL-C PTSD Checklist Chinese version, PSQI Pittsburgh Sleep Quality Index, PSS Perceived stress scale, PTSD-RI Post-Traumatic Stress Disorder reaction index, SAS Zung’s self-rating anxiety scale, SDS Zung’s self-rating depression scale, SCL-90 Symptoms checklist-90, SCL-90-R Symptoms checklist-90 revised, SF-36 The 36-Item Short Form Survey, STAI State-trait anxiety scale, TDQ Taiwanese Depression Questionnaire
  3. # unpublished theses
  4. */**/*** refer to poor/fair/good quality as rated by two reviewers independently using the Study Quality Assessment Tools by the National Heart, Lung and Blood Institute