Select one infectious disease outbreak, either in the United States or worldwide, and discuss how epidemiological investigations were used to identify and monitor the spread of the disease. What effective intervention strategies were used and measured? Include a discussion regarding the use of surveillance systems to monitor the infectious disease you are addressing. What and how were interventions used to flatten the epi curve?
Review Article
Singapore Med J 2020; 61(7): 350-356
https://doi.org/10.11622/smedj.2020046
Narrative synthesis of psychological and coping
responses towards emerging infectious disease
outbreaks in the general population: practical
considerations for the COVID-19 pandemic
Qian Hui Chew1, BSocSci(Hons), Ker Chiah Wei2, MBBS, MMed, Shawn Vasoo3, MBBS, MRCP, Hong Choon Chua4, MBBS, MMed,
Kang Sim2, MBBS, MMed,
INTRODUCTION Emerging infectious disease outbreaks, such as the present coronavirus disease 2019 (COVID-19)
pandemic, often have a psychological impact on the well-being of the general population, including survivors and caregivers.
Our study aimed to synthesise extant literature regarding the combined psychological responses and coping methods
used by the general population in past outbreaks.
METHODS We conducted a narrative synthesis of the published literature over the last two decades with a quality appraisal
of included articles that reported both psychological responses and coping strategies within infectious disease outbreaks.
RESULTS A total of 144 papers were identified from the search, 24 of which were included in the review. Overall, 18
studies examined the psychosocial responses of the general population towards the severe acute respiratory syndrome
epidemic, four studies focused on the Ebola epidemic and two studies covered the H1N1 outbreak. Common themes
in psychological responses included anxiety/fears, depression, anger, guilt, grief and loss, post-traumatic stress and
stigmatisation, but also a greater sense of empowerment and compassion towards others. Coping strategies adopted
included problem-focused coping (seeking alternatives, self- and other-preservation), seeking social support, avoidance,
and positive appraisal of the situation.
CONCLUSION Amid the range of psychosocial responses seen in past infectious disease outbreaks, practical considerations
for the current COVID-19 pandemic need to focus on the individual in the context of the larger social environment, with
an emphasis on raising awareness of the range of possible psychosocial responses, access to psychological help, selfcare, empowering self-support groups and sustained engagement with updated, reliable information about the outbreak.
Keywords: coping, COVID-19, infectious disease outbreak, psychosocial responses
INTRODUCTION
information regarding the psychological effects and coping
The infectious disease outbreaks of recent years have had a
significant impact on not only the physical health but also the
psychological well-being of communities.(1) The severe acute
respiratory syndrome (SARS) outbreak in 2002/2003, H1N1
influenza pandemic in 2009, Middle East respiratory syndrome
(MERS) outbreak in 2012 and the current coronavirus disease
2019 (COVID-19) pandemic are all notable infectious disease
outbreaks affecting multiple countries and communities.(2) As of 26
March 2020, COVID-19 has affected more than 492,000 people
across 198 countries and territories; more than 22,000 people
have died from the disease and over 119,000 have recovered at
the time of writing.(3) Of note, the general population, including
caregivers who are not infected by the disease, is not spared from
the psychological consequences of such outbreaks.(4-7) This can
be related to various factors including a disruption of the usual
routine of life,(8) grief and loss,(9) and stigmatisation experienced
during such outbreaks.(10,11) These psychological responses affect
the well-being of the individual and community, and can persist
long after the outbreak.(12) In the context of the present evolving
COVID-19 pandemic, there is a need to synthesise the available
strategies employed during past infectious disease outbreaks in
order to understand how we can better support the general public
in dealing with this current pandemic.
There are several knowledge gaps to bear in mind. First, the
psychosocial responses of patients, survivors, caregivers and the
general population could differ from one group to another across
outbreaks as the affected population may face unique concerns
and experiences during each outbreak. Factors influencing
these varying responses also require clarification, as variations
in systems of support may be required. Second, it is important to
examine different coping responses (adaptive and maladaptive)
that have been adopted by the general population, which can
have a bearing on overall psychological health.
In light of these knowledge gaps, our study aimed to conduct
a narrative synthesis of extant data that documents both the
psychological impact and coping responses in the general population
(including patients, survivors and caregivers) across past infectious
disease outbreaks. We then suggest practical considerations in the
current COVID-19 pandemic and possible future research directions.
Research Department, 2West Region, Institute of Mental Health, 3National Centre for Infectious Diseases, 4East Region, Institute of Mental Health, Singapore