New Study Examines Public Fears During Disease Outbreaks


Researchers studying how pregnant women in the United States responded to the Zika virus outbreak of 2015-2016 emphasize the need to manage stress and fear during disease outbreaks.

A team of researchers from Pennsylvania State University and Louisiana State University has found that individuals who suppress their fears during a health scare, such as the 2015-2016 outbreak of Zika virus, can experience a cycle of emotional suppression and fear.

Prior to the 2015-2016 outbreak of Zika virus in Brazil and other South American and Central American countries, the disease was relatively unknown in the Western Hemisphere. Brazilian health officials first reported cases of an illness marked by a skin rash to the World Health Organization (WHO) in March of 2015, and by May, confirmed that the illnesses were caused by Zika virus. With the outbreak, Brazil and other affected countries reported cases of neurological disorders—including Guillain-Barré syndrome—as well as an unusual increase in the number of infants born with microcephaly, a congenital malformation marked by small head size. Babies born with microcephaly may experience seizures, vision or hearing problems, and developmental disabilities.

In February 2016, WHO announced a Public Health Emergency of International Concern, with the Emergency Committee noting a strongly suspected causal relationship between Zika infection during pregnancy and microcephaly. Now, there is a scientific consensus that Zika virus causes microcephaly, and can be transmitted to pregnant women both sexually and through mosquitoes. A new study published on July 10, 2018, in the journal PLOS ONE, examines the impact of the Zika virus outbreak on pregnant women in areas of the United States susceptible to the virus. The study’s authors note that media reports during the outbreak cautioned pregnant women on the risk of catching Zika.

Researchers seeking to measure the emotional responses and levels of fear of pregnant women in the United States during the outbreak recruited 1,002 women between the ages of 18 and 35 who lived in areas believed to be in the range of Zika-carrying mosquitoes in Arizona, New Mexico, Texas, Louisiana, Mississippi, Alabama, and Florida. Of those initially recruited into the study, 912 participants provided usable data. The researchers collected data twice in 2016, first from February 10 to 20—9 days after the World Health Organization declared Zika an international health emergency—and again from March 1 to March 15. Study participants filled out surveys to help researchers assess their fear and use of emotional regulation strategies such as avoidance of news, reappraisal, contesting, and suppression.

The study team found that participants who reported trying to suppress their fears of Zika had higher levels of fear later, prompting more emotional stress. Media reports about the dangers of Zika virus during pregnancy were a common cause of concern.

"It turns out that not only is suppression ineffective at handling fear, but it's counter-productive," said the study’s lead author, James Dillard, PhD, in a recent statement. The authors note that previous studies have found that stress and fear during pregnancy can have their own health consequences, and may lead to lower infant birth weights. "It creates a cycle of fear—and it's a vicious cycle."

The findings highlight the role of health officials in maintaining accurate and up-to-date health information during disease outbreaks and other public health events, according to the researchers. "When people become frightened there are some good things that can happen—they search out information, they get politically engaged, they might engage in self-protective behavior—but when people get really scared, it's harmful for them," Dr Dillard said. "Stress hormones pour out and staying in that hyper-vigilant state—fear—is also resource intensive."

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