Many survivors of the severe acute respiratory syndrome (SARS) pandemic of 2003 suffer from persistent mental health problems and chronic fatigue years later, new research from Hong Kong shows.

What's more, these psychiatric problems seemed to become more common among survivors over time, say Dr. Marco Ho-Bun Lam and colleagues from The Chinese University of Hong Kong, who call the persistence of these problems alarming.

A year after the disease outbreak, Lam and his team note in their report in the Archives of Internal Medicine, some survivors still had mental problems even though their physical symptoms had improved.

To look at these effects long-term, and to further investigate chronic fatigue symptoms often reported by SARS survivors, Lam and his team looked at 233 SARS survivors an average of 41 months after the study participants had gotten sick. The study participants' average age was 43 years, and 70 percent were women.

More than 40 percent had active psychiatric illness at the time of follow-up, the researchers found, most commonly post-traumatic stress disorder, depression, somatoform pain disorder (chronic pain due to psychological factors), and obsessive-compulsive disorder.

Forty percent reported some degree of chronic fatigue and 27 percent met diagnostic criteria for chronic fatigue syndrome; people with fatigue symptoms were also more likely than those without them to have psychiatric disorders. For comparison, far less than one percent of Americans met chronic fatigue syndrome criteria, according to the U.S. Centers for Disease Control and Prevention, although many more than that have symptoms.

As found in other studies, health care workers were at particularly high risk of mental health problems; Lam and his team found their risk was more than tripled.

People who were unemployed at follow-up were nearly five times as likely to have psychiatric problems, and the risk for people who felt socially stigmatized was tripled. While these factors could both increase risk of psychiatric problems and result from these problems, our findings suggested that poor functional rehabilitation and adaptation after SARS were major issues among SARS survivors, the researchers write.

Because new infectious diseases are emerging at an unprecedented rate and pose a global threat for pandemics, Lam and his colleagues conclude, there should be better preparation in public health strategies for dealing with both the acute phase of a disease and the long-term potential mental health complications.

They conclude: Various channels to mental health services should be available to patients, health care workers, and the general public, not only during the acute phase of a disease but also the aftermath of an infectious disease outbreak.

SOURCE: Archives of Internal Medicine, December 14/28, 2009.

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