The objective of this study was to assess the psychological burden experienced by women in midlife during the outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong, 126 women aged 50–64 year who were previously enrolled in an ongoing study on cardiovascular risks during January 2002 to March 2003, with the baseline psychological tests done, were interviewed over the telephone in May 2003. Depressive symptoms and emotional distress before and during SARS were assessed using the Center of the Epidemiological Study of Depression Scale (CES-D) and Perceived Stress Scale (PSS). Differences in the CES-D and PSS scores over SARS were noted with higher scores during the SARS outbreak, indicating more depressive symptoms and emotional distress. The proportion of women who scored above the cut-off of the CES-D scale also increased. Logistic regression analysis identified three factors as being significantly associated with emotional high stress during SARS: felt scared (adjusted odd ratios (OR) 3.77, 95 per cent confidence interval (CI) 1.50–9.43), sleep was restless (adjusted OR 3.97, 95 per cent CI 1.48–10.63) and having financial losses (adjusted OR 5.56, 95 per cent CI 1.57–19.68). Financial loss was independently related to the increase in stress level over SARS. A significant psychological impact of the SARS outbreak on Hong Kong midlife women was demonstrated. Emotional distress was related to risk perception and financial loss. Clear preventive measure recommendations and coping strategies for financial strain would possibly reduce the public stress and panic. Copyright © 2005 John Wiley & Sons, Ltd.