If experience with severe acute respiratory syndrome reflects what might happen with other severe, epidemic diseases, problems with psychiatric symptoms after physical recovery may present a challenge to patients and physicians, according to an article in the June 25 issue of Archives of Internal Medicine.

“Severe Acute Respiratory syndrome (SARS) became a global epidemic in 2003. Most cases were in Asia, and the largest concentration of North American cases occurred in Toronto, Ontario,” according to background information in the article. “The longer-term physical and psychological consequences of SARS were not reported until recently.”

Rather than looking at mental health after the acute phase of illness, previous investigations of the disease have focused on lung function, distance walked in six minutes, and health-related quality of life.

Catherine M. Tansey, MSc, University Health Network, Toronto, and colleagues, evaluated 117 SARS survivors from Toronto who were discharged from the hospital in 2003. Patients were evaluated 3, 6, and 12 months after leaving discharge by undergoing a physical examination, a six-minute walk test, a lung function test, a chest X-ray and quality-of-life measures and reporting how often they saw a physician. Formal caregivers of survivors were given a survey on caregiver burden one year after patient discharge.

All but one patient had chest X-rays demonstrating normal or pre-illness condition by one year. At three months, 31 percent of survivors had a reduced six-minute walk distance and at one year, 18 percent did. For most, lung capacity measures and respiratory gas exchange were within normal limits at three months and during the rest of the follow-up period.

General health, vitality and social functioning remained below the normal range one year after discharge from hospital. Many patients returned to work part-time, increasing their workload over the first two months while 23 patients returned to work full-time with no need for a modified schedule. “At one year, 17 percent of patients had not returned to work, and a further 9 percent had not returned to their pre-SARS level of work,” the authors noted.

Survivors used health care services frequently the first year after hospitalization. “Psychiatric evaluation accounted for the greatest number of visits,” the authors wrote. “Of the patients, 74 percent saw their primary care physician a median of five times. Infectious disease specialists assessed 72 percent of patients, mostly in the first three months after discharge.” Caregiver surveys showed a decline in the mental health of caregivers, which was caused by reported lifestyle interference and loss of control.

“We have shown that most SARS survivors have pulmonary and functional recovery from their acute illness. However, one year after discharge from hospital, health-related quality of life remained lower than in the general population, and patients reported important decrements in mental health. These findings are reflected in the notable utilization of psychiatric and psychological services in the one-year follow-up period,” the authors concluded. “These data may help to highlight the needs of patients and caregivers during and after an epidemic, the potential benefit of a family-centered approach to follow-up care, and the importance of exploring strategies to minimize the psychological burden of an epidemic illness as part of future pandemic planning initiatives.”