(1) have published an interestingstudy that found that some personssubject to quarantine for severe acuterespiratory distress syndrome (SARS)displayed symptoms of posttraumaticstress disorder and depression. Theyconclude that the psychologicalsymptoms result from quarantine. Ibelieve the study has serious flawsand that their conclusion is premature. First, their study sampled 129 vol-unteers among the >15,000 personssubjected to quarantine. As acknowl-edged by the authors, persons with themost severe symptoms may be morelikely to volunteer for the study,resulting in an overestimation of thefrequency and severity of the symp-toms. Second, more than two thirds ofthe participants were healthcare work-ers. Healthcare workers in Torontowho cared for SARS patients but werenot subject to quarantine were experi-encing extreme stress because theywere working with a poorly under-stood infectious disease, wearing pro-tective equipment for extended peri-ods, and watching colleagues becomeill and die while wondering if theythemselves were the next victims.Most healthcare workers subject toquarantine in Toronto (including 34%of persons on work quarantine) likelycared for SARS patients and wouldhave experienced stresses similar tothose not quarantined. Third, 85% ofthe study participants wore masks athome, indicating that they were likelyto have been symptomatic and subjectto isolation rather than quarantine.Certainly symptomatic persons wouldbe undergoing stress because of theirconcerns about SARS developing, thepossibility of dying, and the potentialfor exposing others. Increasing levelsof stress with increasing length of iso-lation found in the study may be dueto more severe or prolonged symp-toms rather than to isolation or quar-antine per se
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