Some SARS survivors continue to have mental health problems and chronic fatigue, researchers in Hong Kong have found.

Severe acute respiratory syndrome became a global epidemic in 2003, killing 800 people around the world, including 44 in Toronto.

A year after the outbreak, some survivors had mental problems despite improvements in their physical symptoms. The psychiatric illnesses persisted, Dr. Marco Ho-Bun Lam and colleagues from the Chinese University of Hong Kong reported in this week's issue of the Archives of Internal Medicine.

The team looked at 233 SARS survivors for an average of 41 months after study participants fell ill. On average, the participants were 43 years old and 70 per cent were women.

The researchers found:

• Over 40 per cent of respondents had active psychiatric illnesses — mostly post-traumatic stress disorder, depression, chronic pain due to psychological factors, and obsessive-compulsive disorder.
• 40.3 per cent reported a chronic fatigue problem.
• 27.1 per cent met the U.S. Centers for Disease Control and Prevention's criteria for chronic fatigue syndrome.

The risk of mental health problems was three times higher among health-care workers who were infected, nearly five times higher among those who were unemployed at followup and three times higher for those who felt socially stigmatized.

In 2007, researchers in Toronto also reported that the return of mental health was a longer process than the physical recovery for SARS survivors in the city.

"Our findings suggested that poor functional rehabilitation and adaptation after SARS were major issues among SARS survivors," the Chinese researchers wrote.

Since new infectious-disease threats pose pandemic potential, "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."