Long-term anxiety of natural and biological hazards on community and healthcare workers

Background Exposure to natural and biological hazards has been linked to long-term declines in mental health. However, limited research has examined the sustained psychological impact of these disasters over extended follow-up periods. Methods This study investigated the long-term mental health consequences of natural and biological hazards among healthcare workers and community residents through three longitudinal datasets collected over two decades. Data sources included: (1) 127 healthcare workers exposed to Severe Acute Respiratory Syndrome (SARS) in 2003, with 123 followed up one year later; (2) 152 community residents affected by Typhoon Morakot in 2009, with 125 followed up 1.5 years later; and (3) 458 healthcare workers affected by Coronavirus disease 2019 (COVID-19) in 2020, with 321 followed up two years later. Results Findings show that mental distress prevalence among community residents remained stable (1.6% initially vs. 1.5% at follow-up), whereas healthcare workers exhibited increasing distress over time (SARS: 4.7% to 15.4%; COVID-19: 9.7% to 11.8%). Pathway modeling revealed that initial anxiety at the onset of SARS, Typhoon Morakot, and COVID-19 was a strong predictor of long-term psychological distress. Conclusions These results highlight the importance of sustained mental health interventions for healthcare workers facing prolonged exposure to stressors during biological disasters. In addition to early anxiety screening, system-level measures such as adequate staffing, transparent communication, and institutional preparedness are essential to mitigate long-term psychological consequences.