Up to 50 per cent of Sars survivors still suffer from mental problems six years after the outbreak, raising concern that more needs to be done to deal with the psychological impact of pandemics on patients. Doctors say the problems they experience are similar to those that affect people hit by such natural disasters as earthquakes and tsunami. A study by the United Christian Hospital 21/2 years after the outbreak found that 60 per cent of 90 Sars survivors were suffering psychiatric disorders, including post-traumatic stress disorder and depression. Six years on, between 20 and 50 per cent still had problems of different kinds, according to Mak Wing-chit of the hospital's psychiatry department, one of the researchers. Patients suffering from post-traumatic stress often experience flashbacks and nightmares that are easily triggered by small things which remind them of the trauma. Earthquake and tsunami survivors often have such symptoms. But unlike natural disasters, the impact of severe acute respiratory syndrome was lasting longer because patients were treated over a longer period, and so the time they experienced feeling of helplessness would be longer, Dr Mak said. 'Sars patients were isolated and no one could give them direct support. They were uncertain of their health because the disease was novel,' Dr Mak said. Another doctor on the research team, Chu Chung-ming, said: 'Those who experienced a great fire would be scared of going to a barbecue. Similarly, cloudy and wet spring days would remind Sars patients of their experience.' He said some patients complained of pain all over their bodies even though X-rays showed they had no physical problems. 'The pain might be caused psychologically,' Dr Chu said. The current swine flu pandemic and a genetically modified H3N2 seasonal flu strain might also have a similar psychological impact if they became more virulent. Dr Mak said: 'As with Sars, patients are facing unpredictability. They do not know if the virus will mutate. The sense of fear may loom.' The government should learn from the 'mental health catastrophe' of Sars and not focus solely on treatments for infectious diseases, but also assess the psychological impact on patients. 'Even though the government is already offering some degree of psychological support, the scale should be larger,' he said. The chairman of the Alliance for Patients' Mutual Help Organisation, Cheung Tak-hai, said the government was not offering enough psychological support to patients. More staff and funding should be allocated to promoting mental health, he said. Support had been stepped up since Sars, but attention seemed to have lapsed after six years. Dr Mak said health care workers were at higher risk of suffering from mental disorders because they were exposed to diseases more often. They could also feel frustrated when their role was switched from being a caregiver to being a patient. Young people were also more vulnerable because their physical abilities before and after an illness could differ greatly and they might not be able to accept the change, he said.