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Exploratory Study on Psychosocial Impact of the Severe Acute Respiratory Syndrome (SARS) Outbreak on Chinese Students Living in Japan

Identifieur interne : 000036 ( Istex/Corpus ); précédent : 000035; suivant : 000037

Exploratory Study on Psychosocial Impact of the Severe Acute Respiratory Syndrome (SARS) Outbreak on Chinese Students Living in Japan

Auteurs : G. Zheng ; M. Jimba ; S. Wakai

Source :

RBID : ISTEX:F4C24582789974E3D17A3E4141FB1EA068269B3F

English descriptors

Abstract

The aim of this study is to explore the impact of the 2003 SARS outbreak on Chinese students living in Japan. A cross-sectional study was conducted using a semi-structured questionnaire. The participants were recruited at multiple locations at the University of Tokyo, Japan. The results showed approximately 60% (96/161) of the respondents felt an impact of SARS on college life; they had experienced SARS-related fear, worry, depression as well as social discrimination and had taken SARS prevention measures for daily protection in Japan during the epidemic. The magnitude of the impact was associated with sociodemographic factors, including their age, specialty, area of previous residence in China and length of stay in Japan. The findings suggest that the SARS outbreak had a psychosocial impact on the Chinese students living in Japan, even though none of them had SARS. Social support tailored for these foreign students should be provided during such a disease outbreak. Asia Pac J Public Health 2005; 17(2): 124-129.

Url:
DOI: 10.1177/101053950501700211

Links to Exploration step

ISTEX:F4C24582789974E3D17A3E4141FB1EA068269B3F

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<bold>The aim of this study is to explore the impact of the 2003 SARS outbreak on Chinese students living in Japan. A cross-sectional study was conducted using a semi-structured questionnaire. The participants were recruited at multiple locations at the University of Tokyo, Japan. The results showed approximately 60% (96/161) of the respondents felt an impact of SARS on college life; they had experienced SARS-related fear, worry, depression as well as social discrimination and had taken SARS prevention measures for daily protection in Japan during the epidemic. The magnitude of the impact was associated with sociodemographic factors, including their age, specialty, area of previous residence in China and length of stay in Japan. The findings suggest that the SARS outbreak had a psychosocial impact on the Chinese students living in Japan, even though none of them had SARS. Social support tailored for these foreign students should be provided during such a disease outbreak.
<italic>Asia Pac J Public Health 2005; 17(2): 124-129.</italic>
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<meta-value>124 Exploratory Study on Psychosocial Impact of the Severe Acute Respiratory Syndrome (SARS) Outbreak on Chinese Students Living in Japan SAGE Publications, Inc.2005DOI: 10.1177/101053950501700211 G. Zheng MD, MPH Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan M. Jimba MD, PhD Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan, mjimba@m.u-tokyo.ac.jp S. Wakai MD, PhD Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan Address for correspondence: Dr. Masamine Jimba Department of International Community Health, Graduate School of Medicine The University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan Abstract The aim of this study is to explore the impact of the 2003 SARS outbreak on Chinese students living in Japan. A cross-sectional study was conducted using a semi-structured questionnaire. The participants were recruited at multiple locations at the University of Tokyo, Japan. The results showed approximately 60% (96/161) of the respondents felt an impact of SARS on college life; they had experienced SARS-related fear, worry, depression as well as social discrimination and had taken SARS prevention measures for daily protection in Japan during the epidemic. The magnitude of the impact was associated with sociodemographic factors, including their age, specialty, area of previous residence in China and length of stay in Japan. The findings suggest that the SARS outbreak had a psychosocial impact on the Chinese students living in Japan, even though none of them had SARS. Social support tailored for these foreign students should be provided during such a disease outbreak. Asia Pac J Public Health 2005; 17(2): 124-129. Chinese students discrimination international health Japan SARS Introduction Severe acute respiratory syndrome (SARS) is a new infectious disease with an overall case-fatality of approximately 10%'. The disease is associated with a novel coronavirus, and outbreaks of SARS worldwide were observed during the first half of 2003 z~3. The outbreak of the disease posed a threat to the world. Because no specific interventions against the agent were available during the outbreak, specialists resorted to the control tools of isolation and quarantine 4. WHO's alert on travel to the epidemic area forced international travellers to change their plans, and elective or nonessential travel was postponed. The SARS panic led to job cuts and economic recession in SARS- hit countries and regions 5-7. In SARS-affected areas, particularly in China, an abnormal atmosphere was all too apparent. Social lives were changed 8-1°. People in South China were blamed for transmitting the disease, although the means by which the virus spread to human beings remained unclear2. The w Gr id vv iuc hysteria anu over-reaction, associating the disease with Chinese and other Asians, led to a surge in social discrimination. They were shunned in subways and streetcars, their children were singled out for special treatment in schools, public servants were wearing masks only when Chinese were present, real estate agents were told not to bring them to see houses, and outright hate messages were left at Chinese organizations". In Japan, which had a potential to act as a bridging population for the spread of the virus worldwide, Chinese students became a public concern. Following the WHO's alert for SARS, 12 the Foreign Ministry of Japan issued a travel warning for visiting China on April 3 and stepped- up quarantine efforts at airports. This marks the first time in Japan that such a warning has been made for an infectious disease'3. In response to the government policy on SARS, the Dean at the University of Tokyo issued recommendations to prevent transmission of SARS to the 125 University community. The recommendations included public service announcements about personal protection, requests for students returning from epidemic areas to stay at home at least for ten days, and requests for those who had been in close contact with patients to attend designated medical centers for screening. Despite an extensive literature on SARS, few researchers have studied its social impact on Chinese who stay in foreign countries. Our study aims to explore the impact of SARS on Chinese students who already stayed in Japan, and to identify factors that influenced the magnitude of its impact. Subjects and Methods Study area The University of Tokyo has approximately 2000 international students and researchers from many parts of the world. Of these, Chinese students account for nearly 40%. According to the Academic Calendar (2002-2003) compiled by the Public Relations and Administration Bureau in the University of Tokyo, 619 students from mainland China are currently studying in the University, including 70 undergraduates, 549 graduates and research students; 456 of whom are studying at the Hongo (main) campus. Data collection A cross-sectional study was conducted using a semi-structured questionnaire. The questions were researched and designed based on literature review and informal interviews with 20 Chinese students in the University of Tokyo. Based on the informal interview, we developed question items as shown in the results. The initial questionnaire was pre-tested and modified before it was used in the study. The students who participated in the informal interviews and who had not stayed in Japan during the epidemic period (late March - early June)-were excluded from the study. The questionnaires were self-administered, and the participants were recruited at multiple locations at the Hongo campus. As the name list of the students was not available due to the University privacy policy, we tried to approach all of the 456 Chinese students registered at Hongo campus at different occasions from early October till mid-November, 2003. Those who gave their informed consent were expected to complete the questionnaires without consulting other students. The researchers could answer questions and monitor the process of completing the questionnaires. A scripted set of instructions was used to introduce the questionnaires, including a statement that there were no right or wrong answers to the questions being asked, and that the purpose was to identify how the participants felt about or experience the topic under investigation. We assured them that this study was voluntary, anonymous and confidential. Variables assessed by the questionnaires included: socio-demographic characteristics of the participants which were used as independent variables. The dependent variable, "SARS impact", was assessed by a statement with responses on a four-point scale ranging from "strongly agree", "agree", to "disagree", "strongly disagree". Those who agreed or strongly agreed that SARS had influenced them were categorized as students who have experienced an impact of SARS in their lives. In particular, we also included some of their specific psychosocial experiences in Japan which were related to the SARS outbreak. Data analysis We analyzed the data using SPSS 10.0 statistical software. Chi-square test or Fisher's exact test was applied to determine the variables that were associated with the self-reported SARS impact. All the statistical analyses employed a p-value of 0.05 for statistical significance. Results Socio-demographic characteristics Of the 456 Chinese students, we were able to collect 167(36.6%) responses. Of the 167 returned questionnaires, six were found incomplete, so we excluded them. Thus, the effective answers totaled 161. Table 1. Socio-demographic characteristics (N=161) Table 1 shows the socio-demographic characteristics of the respondents. Eighty respondents (49.7%) were male; 73 (45.3%) were single and 88 (54.7%) were married. They ranged in age from 21 to 44 years old, with a mean of 30.7 years old (SD=4.7). Self-reported SARS impact on college life All the respondents had heard about SARS. With respect to the statement that SARS had "an impact on my life", 34(21.1 %) of them strongly agreed, 62(38.5%) agreed, 42(26.1%) disagreed, and 23(14.3%) strongly disagreed with it. In short, 59.6% of the respondents felt an impact of SARS on their college life. 126 As Table 2 shows, those from SARS-affected areas in China were 3.22 times (95% CI=1.49-6.92) more likely to report the impact of SARS than those from non-affected areas. Beyond this, several other demographic factors were associated with the impact. First, those who had stayed for less than one year in Japan were 2.72 times ( 95% CI =1.33-5.56) more likely to be affected than those who stayed longer. Next, those in medicine, education and sociology were more likely to be affected than those in engineering, sciences and other specialties (OR=2.18, 95% CI=1.08-4.43). Finally, those who were equal to or older than median age 31 years were more likely to be affected than those younger than 31 1 years old (OR=1.85, 95% CI=0.98- 3.50). Psychosocial experiences during the epidemic Table 3 depicts psychosocial experiences of the participants during the SARS outbreak. A considerable part of the respondents reported a variety of psychosocial impact of SARS on their college lives. About 74.5% of them talked about SARS very often when the epidemic peaked, 66.5% showed great concern about the world-wide SARS situation, 56.5% felt much depressed about the epidemic taking place in China; 55.3% experienced much fear of SARS transmission at some point, 74.5% worried much about the safety of family members in China, and 22.4% often felt helplessness during the epidemic. More strikingly,18.6% of the respondents experienced SARS-related social discrimination, and 31.7% of them had heard of SARS discrimination against other Chinese in Japan. Panel 1 shows the responses to some of the open-ended questions. They showed worries, depressed feelings and helplessness as shown in the panel. Some of them also experienced SARS-related social discrimination at public places such as hotels and shops. SARS prevention behavior Table 4 depicts SARS-prevention measures taken by the students for Table 2. Socio-demographic factors and SARS impact "N" refers to the number of respondents who answered "yes" to the question on the left. "n" refers to the number of people who answered "yes" as to whether SARS had an impact on their lives. Table 3. Psycho-social experiences during the epidemic(N=161) 127 daily protection. Many of the respondents had taken SARS prevention behaviour in Japan for self- protection. At some point they had specifically decreased contact with other Chinese (23.0 %), postponed visits to the affected area (41.6 %), increased care of washing hands (59.0 %), increased care of room ventilation (60.9 %), decreased visits to public gatherings (60.2 %) and decreased visits to hospitals (50.9 %). Discussion In this study, nearly 60% of the respondents reported that the SARS outbreak had an impact on them. They experienced SARS-related fear, worry, helplessness and showed great concern about the epidemic. These findings are consistent with some other similar researches. Studies on biological threats showed that a wide array of intense psychological reactions are normative in the immediate aftermath of a natural disaster; 14 however, a smaller number of people may experience a more severe reaction unless dealt with in a timely and appropriate manner'4,15. Table 4. SARS prevention measures taken during the epidemic (N=161) Panel 1. Selected responses to open-ended questions Worries ' "For some moment, I even did not touch Chinese newspapers in the international students' center of the University for fear of SARS virus left on the paper by others. " "I worried about my younger sister, because she is a nurse in a hospital in China. " "SARS was identified in my hometown in China, I worried much about my parents. " "My daughter in Beijing was asked to leave school and stay at home all day for the period, anyway I worried much about her safety. " "I was told that tens ofpeople in Beijing were infected with SARSfrom the same taxi driver I began to worry about my family there. " "No SARS was reported in my city, but I still felt worry about my relatives. " Depressed feelings "I felt depressed because Chinese people were blamed for their unhygienic habits or eating wild animals which were said to have resulted in the SARS spreading. " "The Chinese government was condemned by WHO and other countries for covering the epidemic in the first place, that made me feel depressed for the moment. They criticized the government, but I felt I was also criticized. " "I was depressed with the Chinese government for its delayed action and lack of transparency on this matter " .. .~ Helplessness "I meant I had to find useful information by myself for SARS prevention, no one told me how to do, even at the moment I experienced much fea~: " "For some moment I worried much about my daughter who was in Beijing, but I was only proposed by the University Recommendation not to go home. " "When a worldwide hysteria and over-reaction prevailed, sometimes I felt a prick in local peoples eyes and I felt kind of helpless for the moment. " SARS-related discrimination "I felt much discriminated when I was ba~red from staying in a hotel in Tokyo just because I am a Chinese and might carry SARS virus. " "I was shocked when I saw a standing board in front of a store, which said Chinese and Taiwanese were prohibited to enter for prevention of SARS. That's a discrimination. " "At an amusement center the staff member wore a mask immediately after he got to know that I am a Chinese, and showed impatience when I asked him about the service items. " "I failed many times in finding a part-time job during the epidemic, feeling much more difficult than before. They usually rejected me under the guise of SARS prevention. " "I was discriminated just when they learned I am a Chinese instead of any other reasons during the epidemic. " 128 This study revealed some particular psychosocial experiences of the respondents during the SARS epidemic. About 20% of the respondents were discriminated in Japan under the guise of SARS prevention. For example, in the returned semi-structured questionnaire, one respondent mentioned that he was barred from staying at a hotel in Tokyo just because he was a Chinese. Another participant was shocked when he passed an electrical equipment store, because of a sign board in front of it, which prohibiting Chinese and Taiwanese from entering the store. This was to prevent SARS. Some respondents felt depressed because the Chinese were blamed for their unhygienic habit or eating wild animals which was said to have resulted for the spread of SARS though the means by which the virus spread to human beings remained unclear 2 . Meanwhile, our study demonstrated that more than 50% of the respondents used different preventive measures for self- protection. For example, as we showed in the results, the majority of the respondents increased care of room ventilation for SARS prevention. Nevertheless, it was striking that many Chinese students themselves tended to avoid contact with other Chinese for fear of getting SARS during the epidemic period, though no SARS cases were reported in Japan'3 . Other research has also indicated that the impact of this type of outbreak on individuals and the community can be over-exaggerated if the public response to it is not well organized and communications are not well understood 15 . Examples of mass sociogenic illness such as bioterrorism- related symptoms remind us of the dangers of inadvertently amplifying psychological responses and thus adding to the impact'6. The study revealed that several factors were associated with the SARS impact. Firstly, the respondents' area of' residence in China was associated with it. This might result from the more concern about the safety of family members and other relatives by the respondents from SARS-affected area, as we showed in the Panel 1 of the results regarding such experiences. Secondly, the students with a shorter stay in Japan were more likely to report an impact on them than those who stayed longer. The outbreak might trigger more concerns of the short-term students about the SARS situation in China, while those who stayed longer in Japan lived a life with more stability, and thus less affected. Third, the study also showed the respondents' specialty and age were associated with the SARS impact. It suggests that older students as well as those studying in medical or social sciences might be more sensitive to potential health risk or other social changes caused by the SARS outbreak, and thus are more likely to be influenced. There are some limitations in this study. Firstly, the small sample size, as well as unawareness of how non-participants differ from the respondents limits generalization of the findings. Secondly, self-reported impact as the dependent variable may differ from that as a result of by their personal experiences and thus might be susceptible to bias. Because of data limitations, our results are indicative, not conclusive. Future studies are needed to further explore the causality of the psychosocial impact. However, as little information has been available to guide psychosocial support for people affected by the epidemic and only a few studies have partly dealt with such issues, "-'9 our results are valuable in helping health policy makers and service providers to develop more effective interventions towards foreign students during disease outbreaks such as SARS. Based on the findings, we recommend that social discrimination against Chinese and other foreign students living in Japan should be minimized during disease outbreaks like SARS. The recovery environment also should be constructed for them to create a sense of safety and to counteract the helplessness induced by the epidemic. Acknowledgements The authors would thank the International Center and the Association of Chinese Students in the University of Tokyo for providing support and cooperation. The authors are also grateful for all the Chinese respondents in this study. References Severe acute respiratory syndrome (SARS). Wkly Epidemiol Rec 2003; 78: 81-83. Peiris Jsm, Lai ST, Poon Llm, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003; 361: 1319-25. Ksiazek TG, Erdman D., Goldsmith CS, et al, SARS Working Group. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003 ; 348: 1953-1966. WHO Multicentre Collaborative Network for SARS Diagnosis. A multicentre collaboration to investigate the cause of severe acute respiratory syndrome. Lancet 2003; 361: 1730-33. Seto WH, Tsang D., Yung Rwh, et al. Effectiveness of precautions against droplets and contact in preventing of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003; 361:1519-20. Barboza D. Fears of war and illness hurt tourism in Asia. New York Times , New York, March 28, 2003. Fowler GA The high cost of sick days. Far Eastern Economic Review, p. 20,April 10, 2003. Enserink M., Vogel G. Deferring competition, global net closes in on SARS. Science 2003; 300: 224-25. Watts J. China takes drastic action over SARS threat. Lancet 2003; 361:1708-9. Kondro W. Canadians still stung by WHO's SARS travel advisory. Lancet 2003; 361: 1624 Schram J. How popular perceptions of risk from SARS are fermenting discrimination. BMJ 2003; 326: 939. Centers of Disease Control and Prevention. CDC update: outbreak of severe acute respiratory syndrome-worldwide, 2003. MMWR 2003; 52: 241-48. Takahashi J. Japan issues travel warning over SARS. The Japan Times; April 4,2003. 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<namePart type="family">Jimba</namePart>
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<affiliation>E-mail: mjimba@m.u</affiliation>
<affiliation>Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan, mjimba@m.u-tokyo.ac.jp</affiliation>
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<namePart type="family">Wakai</namePart>
<affiliation>Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan</affiliation>
<affiliation>Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan</affiliation>
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<abstract lang="en">The aim of this study is to explore the impact of the 2003 SARS outbreak on Chinese students living in Japan. A cross-sectional study was conducted using a semi-structured questionnaire. The participants were recruited at multiple locations at the University of Tokyo, Japan. The results showed approximately 60% (96/161) of the respondents felt an impact of SARS on college life; they had experienced SARS-related fear, worry, depression as well as social discrimination and had taken SARS prevention measures for daily protection in Japan during the epidemic. The magnitude of the impact was associated with sociodemographic factors, including their age, specialty, area of previous residence in China and length of stay in Japan. The findings suggest that the SARS outbreak had a psychosocial impact on the Chinese students living in Japan, even though none of them had SARS. Social support tailored for these foreign students should be provided during such a disease outbreak. Asia Pac J Public Health 2005; 17(2): 124-129.</abstract>
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<topic>Chinese students</topic>
<topic>discrimination</topic>
<topic>international health</topic>
<topic>Japan</topic>
<topic>SARS</topic>
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<title>Asia-Pacific Journal of Public Health</title>
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<date>2005</date>
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<identifier type="DOI">10.1177/101053950501700211</identifier>
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