1. SARS and Its Effects: Coping with the Threat Esther Greenglass,Anita DeLongis & Dayna Lee-Baggley Paper presented at ICP, Bejing, August 8- 13, 2004

2. Grateful acknowledgement to George D. Bishop, National University of Singapore & the SARS Psychosocial Research Consortium

4. 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

5. Method Data were collected using an Internet-based survey based on 229 respondents from Europe, Asia, Australia, New Zealand, Canada, and the USA and was conducted from May 2003 to January 2004 This study focused primarily on the stressful aspects of the perception of SARS and coping strategies employed

6. Demographics Gender 159 Female 65 Male 5 missing Age Age Frequency Under 20 69 20-39 100 40-59 49 60+ 5 Missing 6

7. Demographics (cont.d) Education YearsFrequency <6 years 10 7-12 28 13-16 94 16+ 94 Missing 3

8. 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 =.71

9. 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 =.77

10. To avoid getting SARS, I have personally: (tick those that apply) Avoidance Behavior 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 Taking Precautions 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

11. 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

12. 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 =.91

13. 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

14. 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 =.94

15. Depression A 10-item measure* designed to measure Sample item: “I feel sad” Response: 1 rarely or none of the time 4 most or all of the time Alpha=.88 *Center for Epidemiological Studies Depression Scale

16. 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 =.82 * adapted from Renner & Schwarzer, 2003

17. Relative Risk of Getting SARS vs Getting 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 =.92 *adapted from Renner & Schwarzer, 2003

18. Relative Risk of Getting SARS vs Getting AIDS* A 2-item measure The relative risk of me or someone 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 =.82 *adapted from Renner & Schwarzer, 2003

19. Correlations Between SARS Threat, Anxiety, 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 Risk **p <.01 ***p <.001 59*** 51*** 31*** 29**

20. Correlations between Anxiety, Avoidance of People, Avoidance Behavior, Taking Precautions, & Risk of Getting SARS vs. Risk of Catching a Cold, Getting AIDS & Getting West Nile Virus Avoidance of People Cold Risk AIDS Risk West Nile Virus Avoidance Behavior Taking Precautions **p <.01 ***p <.001 52*** 39*** 33** 32** 30**

21. Theoretical Model Relating SARS Threat, Preventive Coping, Avoidance of People, Anxiety and Depression SARS Threat Prevent Coping Avoid of People State Anxiety Depression

22. Structural Model Relating SARS Threat, Preventive Coping, Avoidance of People, Anxiety and Depression SARS Threat Prevent Coping Avoid of People State Anxiety Depression.49***.39***.52***.27***.47***.12* -.25**.18**

23. ModelChi-SquaredfpGFIAGFINFICFIRMSEAPCLOSE Initial model 25.8354.000.962.856.919.929.155.001 Revised Model 1 a 11.2983.010.981.903.965.973.110.057 Revised Model 1 b 3.9582.138.993.949.988.994.066.291 Goodness of Fit Indices for Models a a Identical to the initial model except that a path from preventive coping to depression was added b Identical to the revised model 1a except that a correlation between preventive coping and avoiding people perceived to be at high risk of SARS was added

24. Conclusions Greater threat due to SARS leads to increases in preventive coping and avoidance of people associated with SARS Preventive coping includes avoidance of people Preventive coping and avoidance of people lead to greater anxiety Anxiety leads to depression Depression decreases with greater preventive coping