Modification effects of coping on post-traumatic morbidity among earthquake rescuers

Context as a barrier: Impaired contextual processing increases the tendency to develop PTSD symptoms across repeated exposure to trauma

Growing evidence links repeated traumatic exposure with impaired ability to process contextual information. Specifically, like individuals with PTSD, non-PTSD trauma-exposed individuals fail to react according to contextual demands. In the present study, we explored the process that underlies this impairment. First, we tested the ability of first responders to benefit from contextual primes to improve recognition. Second, we assessed its moderating role in the relationship between traumatic exposure and PTSD symptoms. Fifty-three active-duty firefighters and 33 unexposed civilians matched for age, gender, and years of education participated in the study. All participants completed the contextual priming paradigm, the CAPS-5 clinical interview, and the WAIS-IV vocabulary subtest and were assessed for depression and general traumatic exposure. Repeated traumatic exposure was assessed objectively using the fire-and-rescue-service tracking system. As predicted, we found that trauma-exposed individuals failed to use primes to facilitate rapid and accurate recognition of contextually related objects. Not only did contextual information not improve performance, but it achieved the opposite effect, manifested as negative priming. Hence, context appeared to be an obstacle for trauma-exposed individuals and delayed rapid and accurate recognition. Moreover, impaired ability to process contextual information predicted the tendency to develop PTSD symptoms across repeated exposure to trauma.

Duty-related trauma and PTSD symptoms in US urban firefighters

BACKGROUND

Little is known about the multi-dimensional nature of traumatic duty-related events encountered by firefighters in relation to their post-traumatic stress disorder (PTSD) risk.

AIMS

To describe the types of duty-related events encountered by career firefighters and explore if years in the fire service or total event load moderated the association of trauma exposure to PTSD symptoms.

METHODS

Participants included 755 career, male firefighters (19% of the department's firefighters and 76% of those who accessed the electronic anonymous survey). The Duty-Related Incident Stressors scale was used to assess exposure to 25 potentially traumatic events (event load) and self-appraisal of the stress associated with these events, grouped by type of event (indirect, direct and colleague-related). The Post-Traumatic Stress Disorder Checklist was used to assess PTSD symptoms.

RESULTS

Firefighters rated colleague-related events as the most stressful, followed by indirect and direct events. Event load (r = 0.25) and indirect, direct and colleague-related events stress (r = 0.32-0.35) were positively associated with PTSD symptoms. Results of moderation analyses indicated that event load served as a risk factor in the relation of indirect events stress to PTSD symptoms, and as a buffer in the relation of direct events stress to PTSD symptoms. Years in the fire service were not associated with PTSD symptoms nor moderated the relation of event stress to PTSD symptoms.

CONCLUSIONS

Findings underscored the importance of considering the differential effects that types of duty-related traumatic events and cumulative exposure to trauma may have on firefighters' PTSD symptoms.

Coping Strategies for Exposure to Trauma Situations in First Responders: A Systematic Review

Objective:

The objective of the present work was to characterize the coping strategies used by first responders to emergencies in the face of exposure to traumatic events.

Methods:

A systematic search was performed in the databases MEDLINE (Ovid), EMBASE, LILACS (Latin American and Caribbean Literature in Health Sciences), and the Cochrane Central Registry of Controlled Clinical Trials (CENTRAL) from their inception through February 2022. First responders to emergencies with training in the prehospital area and who used validated measurement instruments for coping strategies were included.

Results:

First responders to emergencies frequently used nonadaptive coping strategies, with avoidance or disconnection being one of the main strategies, as a tool to avoid confronting difficult situations and to downplay the perceived stressful event. The nonadaptive coping strategies used by these personnel showed a strong relationship with posttraumatic stress disorder (PTSD) symptoms, burnout syndrome, psychiatric morbidity, and chronic stress. As part of the adaptive strategies, active coping was found, which includes acceptance, positive reinterpretation, focusing on the problem, self-efficacy, and emotional support, either social or instrumental, as protective strategies for these personnel.

Conclusions:

Developing adaptive coping strategies, whether focused on problems or seeking emotional support, can benefit emergency personnel in coping with stressful situations. These coping strategies should be strengthened to help prevent people from experiencing long-term negative effects that could arise from the traumatic events to which they are exposed. Active coping strategies instead of avoidance strategies should be promoted.

Coping in the Emergency Medical Services: Associations With the Personnel's Stress, Self-Efficacy, Job Satisfaction, and Health

Background

Emergency Medical Services personnel (EMSP) are recurrently exposed to chronic and traumatic stressors in their occupation. Effective coping with occupational stressors plays a key role in enabling their health and overall well-being. In this study, we examined the habitual use of coping strategies in EMSP and analyzed associations of coping with the personnel's health and well-being.

Method

A total of N = 106 German Red Cross EMSP participated in a cross-sectional survey involving standardized questionnaires to report habitual use of different coping strategies (using the Brief-COPE), their work-related stress, work-related self-efficacy, job satisfaction, as well as mental and physical stress symptoms.

Results

A confirmatory factor analysis corroborated seven coping factors which have been identified in a previous study among Italian emergency workers. Correlation analyses indicated the coping factor "self-criticism" is associated with more work-related stress, lower job satisfaction, and higher depressive, posttraumatic, and physical stress symptoms. Although commonly viewed as adaptive coping, the coping factors "support/venting", "active coping/planning", "humor", "religion", and "positive reappraisal" were not related to health and well-being in EMSP. Exploratory correlation analyses suggested that only "acceptance" was linked to better well-being and self-efficacy in EMSP.

Conclusion

Our results emphasize the need for in-depth investigation of adaptive coping in EMSP to advance occupation-specific prevention measures.

Coping among public safety personnel: A systematic review and meta–analysis

Public safety personnel (PSP) are routinely exposed to potentially psychologically traumatic events (PPTEs) that, in turn, can result in posttraumatic stress injuries (PTSI), including burnout and increased symptoms of depression and anxiety. However, the longitudinal impact of PPTEs on PSP coping remains unclear. Coping can be operationalized as various strategies (i.e., behaviours, skills, thought and emotion regulation) for dealing with stressors, which are broadly categorized as either approach (adaptive, positive, social support) or avoidant coping strategies (maladaptive withdrawal, avoidance, substance use). This systematic review and meta-analysis aims to evaluate longitudinal coping outcomes among PSP. Thirteen eligible repeated-measures studies explicitly evaluated coping in 1854 police officers, firefighters, and rescue and recovery workers. Study designs included randomized-control trials, within-subject interventions and observational studies. Effect sizes (Cohen's d) at follow-up were described in 11 studies. Separate meta-analyses reveal small (d < 0.2) but non-significant improvements in approach and avoidant coping. Studies were of moderate quality and low risk of publication bias. Heterogeneity in outcome measures, follow-up durations, and study types precluded subgroup analyses. The current findings can inform the development and evaluation of organizational training programs that effectively promote sustained adaptive coping for PSP and mitigate PTSIs.

Strain Differences in Responsiveness to Repeated Restraint Stress Affect Remote Contextual Fear Memory and Blood Transcriptomics

The role of stress in altering fear memory is not well understood. Since individual variations in stress reactivity exist, and stress alters fear memory, exposing individuals with differing stress-reactivity to repeated stress would affect their fear memory to various degrees. We explored this question using the average stress-reactive Fisher 344 (F344) rat strain and the Wistar-Kyoto (WKY) strain with its heightened stress-reactivity. Male F344 and WKY rats were exposed to the contextual fear conditioning (CFC) paradigm and then chronic restraint stress (CRS) or no stress (NS) was administered for two weeks before a second CFC. Both recent and reinstated fear memory were greater in F344s than WKYs, regardless of the stress status. In contrast, remote memory was attenuated only in F344s after CRS. In determining whether this strain-specific response to CRS was mirrored by transcriptomic changes in the blood, RNA sequencing was carried out. Overlapping differentially expressed genes (DEGs) between NS and CRS in the blood of F344 and WKY suggest a convergence of stress-related molecular mechanisms, independent of stress-reactivity. In contrast, DEGs unique to the F344 and the WKY stress responses are divergent in their functionality and networks, beyond that of strain differences in their non-stressed state. These results suggest that in some individuals chronic or repeated stress, different from the original fear memory-provoking stress, can attenuate prior fear memory. Furthermore, the novel blood DEGs can report on the general state of stress of the individual, or can be associated with individual variation in stress-responsiveness.

The usefulness of pre-employment and pre-deployment psychological screening for disaster relief workers: a systematic review

BACKGROUND

Individuals who conduct disaster relief work overseas are exposed to a variety of traumatic events that can cause distress and trigger psychological illnesses. Identification of which disaster relief workers may be at risk of experiencing psychological distress or mental health disorders is frequently carried out through pre-employment or pre-deployment psychological screening. The primary objective of our review was to assess the evidence for pre-employment and pre-deployment psychological screening of relief workers who work in disaster situations. We aimed to identify specific pre-employment and pre-deployment characteristics that predict impaired wellbeing of an individual following engaging in disaster-related work.

METHODS

A combined list of search terms was composed relating to disaster-related occupations, screening methods, psychological disorders, and study design. The databases used were PsycINFO, MEDLINE, EMBASE, and GlobalHealth. We included studies that used cross-sectional or longitudinal study designs; were published in the English language in peer-reviewed academic journals; reported on the association between pre-employment and pre-deployment features and post-deployment psychological disorders or distress; considered any occupational groups responding to a specified, discrete crisis; and used at least one validated measure of distress or disorder. We extracted data on the author; year of publication; disaster description; country of study; study design; population sample; disorder(s) outcome and the measures used; and results.

RESULTS

Sixty-two, high-quality studies were included in the review. Forty-one potential predictors were identified. Of these, only volunteer status and previous history of mental illness and life stressors emerged as reliable predictors of distress or disorder.

CONCLUSION

The results suggest that whilst it is attractive to screen for pre-employment and pre-deployment indicators of resilience, the evidence base for doing so is weak. At best, this sort of screening can only weakly suggest vulnerability and at worst may result in discrimination. Until better evidence about its usefulness becomes available, employers should exercise caution over its use.

Risks of post-traumatic stress disorder among emergency medical technicians who responded to the 2016 Taiwan earthquake

BACKGROUND

Few studies have explored the field experiences and risk factors related to post-traumatic stress disorder (PTSD) among disaster rescue workers.

METHODS

A 6.4-magnitude earthquake struck southern Taiwan on February 6, 2016. A standardized, paper-based, self-administered survey questionnaire including demographic information, field experiences and the Post-Traumatic Stress Disorder Checklist (PCL) was conducted among emergency medical technicians (EMTs) one month after the earthquake. A multivariate regression model was used to analyze the associations between risk factors and the PCL. A two-sided p value less than 0.05 was considered statistically significant.

RESULTS

The survey response rate was 86.1% (447/519). The respondents who exceeded the cut-off points for the re-experience, avoidance, or hyperarousal domains were 11.8%, 2.7%, or 4.7%, respectively. A proportion of 12.7% of respondents met partial PTSD. The personality characteristics of anxiety (p < 0.001), perfectionism (p = 0.023) and introvert tendency (p = 0.002) were significantly correlated with partial PTSD. Emergency medical services (EMS) were significantly associated with partial PTSD than other main tasks (p < 0.001). The prevalence of partial PTSD was higher but was not significantly different in the groups of lower educational level, longer EMT careers, earlier arrival date, fewer field working hours, or managing dead people. Both univariate and multivariate logistic regression analyses showed that an anxious personality and EMS as the main task during the missions were significantly associated with PTSD risk.

CONCLUSION

Not only personality characteristics but also the task components could alter the PTSD risks in disasters. A broad realization of these risks may improve the mental outcomes of disaster rescuers.

Relationship between ways of coping and posttraumatic stress symptoms in firefighters compared to the general population in South Korea

Professional firefighters frequently encounter stressful events in the line of duty, which may lead to the development of posttraumatic stress symptoms (PTSS). However, it remains unclear how PTSS relates to ways of coping in this population. We evaluated the differences in ways of coping between firefighters and the general population, and we determined the relationship between ways of coping and PTSS in both groups. Professional firefighters (N = 212) and adults from the general population (N = 500) completed measures of potentially traumatic events (PTEs), the Ways of Coping Checklist, the Beck Depression Inventory, the Childhood Trauma Questionnaire. Participants who reported experiencing at least one PTE also completed the Impact of Events Scale-Revised to assess PTSS severity. Firefighters showed greater use of problem-focused coping, seeking social support, and wishful thinking than did the general population. In the firefighters group only, there were negative correlations between PTSS and problem-focused coping and seeking social support; however, the opposite was found in the general population. This study identified the unique relationship between ways of coping and PTSS in professional firefighters. Our findings highlighted that active coping, including problem-focused and seeking social support, might play a key role in alleviating firefighters' post-traumatic stress reactions.

The impact of emotional labor on the severity of PTSD symptoms in firefighters

BACKGROUND

Despite attempts to identify predictors for posttraumatic stress disorder (PTSD) in firefighters, it is still uncertain whether occupational stress factors impact PTSD symptoms. Given the emotionally taxing job environment of firefighters, this population has been known to suffer from emotional labor. In this study, we investigated whether and how emotional labor, one of the occupational stress factors, influences the severity of PTSD symptoms in firefighters.

METHODS

A total of 7151 Korean firefighters (age range 21-60 years, 6484 (90.7%) male participants) were included for analysis. PTSD symptoms were assessed using the PTSD Checklist-Civilian Version, and the demands of emotional labor and emotional damage were measured using the Korean Emotional Labor Scale. Hierarchical multivariate regression was performed.

RESULTS

Hierarchical multivariate regression showed that a 2-way interaction between the presence of recent trauma and emotional damage was significantly associated with the severity of PTSD symptoms, even after adjusting for demographic factors, job-related factors, and perceived stress. The independent main effects of emotional labor were not significantly associated with PTSD symptoms.

CONCLUSION

These findings suggest that emotional labor can be a risk factor that makes firefighters vulnerable to PTSD symptoms by modulating the effect of traumatic experiences on PTSD symptoms.

Risk factors for long-term post-traumatic stress disorder among medical rescue workers appointed to the 2008 Wenchuan earthquake response in China

This study aims to determine the risk factors for clinically-significant post-traumatic stress disorder (PTSD) among Chinese medical rescue workers one year after the response to the Wenchuan earthquake on 12 May 2008. A sample of 337 medical workers who performed response work within the first three months of the event completed an online questionnaire, which included information on demographics, social support, the management and organisation of the disaster response, and an assessment of PTSD. Symptoms consistent with PTSD were prevalent in 17 per cent of the rescue workers. Those who developed PTSD symptoms were more likely to have been injured, experienced a water shortage, been disconnected from family and friends during the response, and have passive coping styles and neurotic personalities. Factors that cannot be changed easily, such as personality traits, should be evaluated prior to deployment to ensure that rescue workers at higher risk of PTSD are provided with adequate support before and during deployment.

Prevalence of probable posttraumatic stress disorder and determination of its relationship with everyday functioning in children and adolescents by using generalized estimating equations

INTRODUCTION

We investigated the prevalence rates for probable PTSD and used generalized estimating equations to identify risk factors for probable PTSD in children and adolescents exposed to the Lushan earthquake.

METHODS

A total of 1623 participants completed 3 assessments, including the Children's Revised Impact of Event Scale, at 2 weeks, 3, and 6 months after experiencing the Lushan earthquake. Additionally, demographic variables and variables related to everyday functioning were evaluated at 2 weeks after the earthquake via a self-constructed questionnaire.

RESULTS

The percentages of children and adolescents who changed from having no PTSD to probable PTSD and probable PTSD to no PTSD at each time point were approximately 8% and 20% of the sample, respectively. The percentage of participants without PTSD increased from 41.1% at the 2-week to 3-month time point to 54.3% at the 3-month to 6-month time point, and the percentage with persistent probable PTSD decreased from 29.6% to 16.4% at the 2 time points, respectively. Female gender, a sedentary lifestyle, and actively helping others were significant risk factors for probable PTSD, whereas initiating communications with others, actively playing with classmates and friends, and the ability to concentrate on academic studies after resuming class were factors that helped protect against probable PTSD.

DISCUSSION

Resistance to PTSD and persistent PTSD symptoms were both common occurrences in child and adolescent survivors. Specific variables related to everyday functioning may be risk factors for probable PTSD. These findings have implications for agencies that provide mental health services after an earthquake.

Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review

BACKGROUND

When disasters occur, there are many different occupational groups involved in rescue, recovery and support efforts. This study aimed to conduct a systematic literature review to identify social and occupational factors affecting the psychological impact of disasters on responders.

METHODS

Four electronic literature databases (MEDLINE®, Embase, PsycINFO® and Web of Science) were searched and hand searches of reference lists were carried out. Papers were screened against specific inclusion criteria (e.g. published in peer-reviewed journal in English; included a quantitative measure of wellbeing; participants were disaster responders). Data was extracted from relevant papers and thematic analysis was used to develop a list of key factors affecting the wellbeing of disaster responders.

RESULTS

Eighteen thousand five papers were found and 111 included in the review. The psychological impact of disasters on responders appeared associated with pre-disaster factors (occupational factors; specialised training and preparedness; life events and health), during-disaster factors (exposure; duration on site and arrival time; emotional involvement; peri-traumatic distress/dissociation; role-related stressors; perceptions of safety, threat and risk; harm to self or close others; social support; professional support) and post-disaster factors (professional support; impact on life; life events; media; coping strategies).

CONCLUSIONS

There are steps that can be taken at all stages of a disaster (before, during and after) which may minimise risks to responders and enhance resilience. Preparedness (for the demands of the role and the potential psychological impact) and support (particularly from the organisation) are essential. The findings of this review could potentially be used to develop training workshops for professionals involved in disaster response.

The hidden price and possible benefit of repeated traumatic exposure

There is a growing evidence showing that first-responders who are frequently exposed to traumatic events as part of their occupational routine may pay a hidden price. Although they display low to moderate levels of post-traumatic stress disorder (PTSD) symptoms, similar to individuals with full-blown PTSD, they show impaired ability to process and react according to contextual demands. We aimed to test whether this impairment affects performance on simple unrelated tasks and its association with cumulative traumatic exposure and level of PTSD symptoms. Thirty-nine trauma-exposed criminal scene investigator police and 35 unexposed civilians matched for age, gender, and education performed a simple discrimination task in the presence of aversive pictures with low or high intensity. We predicted and found that trauma-exposed individuals failed to modify their behavior in accordance with levels of negative intensity. Hence they were equally distracted in both low and high negative intensity conditions, compared to unexposed controls who showed improved performance in low intensity conditions. Importantly, performance of trauma-exposed individuals on conditions of low intensity negatively correlated with their levels of PTSD symptoms. These results highlight the maladaptive tendency of individuals with repeated traumatic exposure to maintain the same behavior in low-intensity contextual conditions when it is no longer adequate. Interestingly however, in high-intensity conditions trauma-exposed individuals outperformed unexposed controls. Specifically, when completing simple tasks in high intensity conditions. The results suggest that repeated traumatic exposure has both positive and negative consequences on the way individuals interpret and react to their environment.

Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster

BACKGROUND

When disasters occur, humanitarian relief workers frequently deploy to assist in rescue/recovery efforts.

AIMS

To conduct a systematic review of factors affecting the psychological wellbeing of disaster relief workers and identify recommendations for interventions.

METHOD

We searched MEDLINE®, Embase, PsycINFO® and Web of Science for relevant studies, supplemented by hand searches. We performed thematic analysis on their results to identify factors predicting wellbeing.

RESULTS

Sixty-one publications were included. Key themes were: pre-deployment factors (preparedness/training); peri-deployment factors (deployment length/timing; traumatic exposure; emotional involvement; leadership; inter-agency cooperation; support; role; demands and workload; safety/equipment; self-doubt/guilt; coping strategies) and post-deployment factors (support; media; personal and professional growth).

CONCLUSIONS

As well as role-specific stressors, many occupational stressors not specific to humanitarian relief (e.g. poor leadership, poor support) present a significant health hazard to relief workers. Humanitarian organisations should prioritise strengthening relationships between team members and supervisors, and dealing effectively with non-role-specific stressors, to improve the psychological resilience of their workforce.

What Occupational Health Needs Arise in Workplaces Following Disasters? A Joint Analysis of Eight Cases of Disaster in Japan

OBJECTIVE

To identify occupational health needs arising after disasters.

METHODS

Using semistructured interviews with expert informants, we jointly analyzed the needs arising in eight disaster cases that threatened the lives or health of workers in Japan.

RESULTS

Various types of health issues occurred in a wide range of employees. In total, we identified 100 needs in six phases after disasters and classified them across nine categories of worker characteristics. The proportion of health needs on the list that were applicable in each case varied from 13% to 49%. More needs arose when the companies were responsible for the disaster and when employee lives were lost. We also assessed the list as fairly comprehensive.

CONCLUSIONS

The list developed in this study is expected to be effective for anticipating occupational health needs after disasters.

Transtorno de Estresse Pós-Traumático (TEPT) em Bombeiros de Belo Horizonte, Brasil: Prevalência e Fatores Ocupacionais Associados

RESUMO O objetivo do presente estudo foi estimar a prevalência (últimos 30 dias) de Transtorno de Estresse Pós-Traumático (TEPT) e investigar se variáveis ocupacionais estão associadas ao desfecho em bombeiros de Belo Horizonte, Brasil. Estudo transversal foi realizado em 2011. Dentre 794 elegíveis, 711 (89,5%) participaram. Informações foram obtidas por questionário de autorrelato: variáveis sociodemográficas e ocupacionais, saúde e eventos extralaborais adversos. A prevalência de TEPT foi 6,9%. Variáveis ocupacionais contribuíram para explicar o desfecho no modelo final (regressão logística multivariável): fatores psicosssociais do trabalho, eventos traumáticos ocupacionais, tempo de trabalho e absenteísmo. Idade, problemas de saúde mental no passado e eventos adversos extralaborais também foram associados ao TEPT. Os resultados são discutidos considerando os pressupostos do Modelo Demanda-Controle.

Resilience as a mediator in emotional social support's relationship with occupational psychology health in firefighters

This study's objective is to examine the relationship between emotional demands and emotional social support at work, and the impact of resilience on health. A cross-sectional study of 156 firefighters was conducted. Descriptive analyses of the study's variables were performed, along with structural equation analysis and hierarchical regression analysis. The results suggest statistically significant relationships among the study's variables. Social support from one's boss and intense emotional demands were found to have an interaction effect on firefighters' resilience. The findings confirm the mediating role of resilience and the relationship with emotional social support from the boss on firefighters' occupational health.

The hidden price of repeated traumatic exposure

Neuroimaging studies have demonstrated reduced hippocampal volume in trauma-exposed individuals without posttraumatic stress disorder (PTSD). However, the implications of such a deficit in this non-clinical population are still unclear. Animal and human models of PTSD suggest that hippocampal deficit may result in impaired learning and use of associations between contextual information and aversive events. Previous study has shown that individuals with PTSD have a selective impairment in reversing the negative outcome of context-related information. The aim of this study was to test whether non-PTSD individuals who are repeatedly exposed to traumatic events display similar impairment. To that end, we compared the performance of active-duty firefighters who are frequently exposed to traumatic events as part of their occupational routine and civilian matched-controls with no history of trauma-exposure. We used a novel cue-context reversal paradigm, which separately evaluates reversal of negative and positive outcomes of cue and context-related information. As predicted, we found that while both trauma-exposed firefighters and unexposed matched-controls were able to acquire and retain stimulus-outcome associations, firefighters struggled to learn that a previously negative context is later associated with a positive outcome. This impairment did not correlate with levels of PTSD, anxiety or depressive symptoms. The results suggest that similar to individuals with PTSD, highly exposed individuals fail to associate traumatic outcomes with their appropriate context. This impairment may reflect a possible hidden price of repeated traumatic exposure, which is not necessarily associated with PTSD diagnosis, and may affect the way highly exposed individuals interpret and react to their environment.

Post-traumatic stress disorder status in a rescue group after the Wenchuan earthquake relief

Previous studies have suggested that the incidence of post-traumatic stress disorder in earthquake rescue workers is relatively high. Risk factors for this disorder include demographic characteristics, earthquake-related high-risk factors, risk factors in the rescue process, personality, social support and coping style. This study examined the current status of a unit of 1 040 rescue workers who participated in earthquake relief for the Wenchuan earthquake that occurred on May 12(th), 2008. Post-traumatic stress disorder was diagnosed primarily using the Clinician-Administered Post-traumatic Stress Disorder Scale during structured interviews. Univariate and multivariate statistical analyses were used to examine major risk factors that contributed to the incidence of post-traumatic stress disorder. Results revealed that the incidence of this disorder in the rescue group was 5.96%. The impact factors in univariate analysis included death of family members, contact with corpses or witnessing of the deceased or seriously injured, near-death experience, severe injury or mental trauma in the rescue process and working at the epicenter of the earthquake. Correlation analysis suggested that post-traumatic stress disorder was positively correlated with psychotic and neurotic personalities, negative coping and low social support. Impact factors in multivariate logistic regression analysis included near-death experience, severe injury or mental trauma, working in the epicenter of the rescue, neurotic personality, negative coping and low social support, among which low social support had the largest odds ratio of 20.42. Findings showed that the occurrence of post-traumatic stress disorder was the result of the interaction of multiple factors.

Mental health problems among search and rescue workers deployed in the Haïti earthquake 2010: a pre-post comparison

Search and rescue workers play an important role in rescuing trapped disaster victims. However, it is unclear whether they are at risk for post-disaster mental health problems. For this purpose we prospectively examined pre- and post-deployment health among Dutch search and rescue workers (USAR NL) deployed in the devastating Haiti earthquake disaster (2010). The evening before departure (T1, response=100%) and 3 months post-deployment (T2, response=91%), Search and rescue workers were administered standardized questionnaires assessing health (SCL-90-R, RAND-36), including use of substances and mental health services utilization (N=51). At T2 event-related PTSD-symptoms (IES) and coping self-efficacy (CSE), and experiences during and after deployment were examined. At both surveys health problems were almost absent and no significant increases in health problems and use of substances were found. PTSD-symptomatology was very low and coping self-efficacy rather high. Protective factors such as good team functioning, recognition and job satisfaction were clearly present, while risk factors such as sustained injuries or death of a co-worker were absent. Findings suggest that post-disaster health problems may (partly) be prevented by enhancing or restoring protective factors.

Disaster Psychiatry in Taiwan: A Comprehensive Review

Natural disasters have caused millions of deaths worldwide, and hundreds of millions of people have suffered from various types of physical or mental traumas. Disasters change patterns of thinking and the concept of security among members of a community, which highlights the importance of mental rehabilitation in disaster psychiatry. Mental rehabilitation is not only a short-term intervention, but also involves long-term follow-up and referral of cases to regular psychiatric management. We used PubMed (http://www.ncbi.nlm.nih.gov/pubmed) to search for papers related to the Chi-Chi Earthquake and the Morakot Typhoon published between January 2001 and November 2011. We found that 33 articles are involved in seven topics. The most common disaster-related psychiatric diagnoses were major depressive episodes and posttraumatic stress disorder. The prevalence of posttraumatic stress disorder ranged from 8.0% to 34.3% in Taiwan after the 1999 Earthquake. However, lifetime and current prevalence for psychiatric disorders ranged from 1% to 74%, affecting women twice more than men. Because disasters are becoming increasingly common, it is vital to train a sufficient number of specialists with guidelines for standard clinical treatment, and to create a standard operating procedure for reducing traumatic conditions.

The establishment of a standard operation procedure for psychiatric service after an earthquake

This study presents information on the design and creation of a standard operation procedure (SOP) for psychiatric service after an earthquake. The strategies employed focused on the detection of survivors who developed persistent psychiatric illness, particularly post-traumatic stress and major depressive disorders. In addition, the study attempted to detect the risk factors for psychiatric illness. A Disaster-Related Psychological Screening Test (DRPST) was designed by five psychiatrists and two public health professionals for rapidly and simply interviewing 4,223 respondents within six months of the September 1999 Chi-Chi earthquake. A SOP was established through a systemic literature review, action research, and two years of data collection. Despite the limited time and resources inherent to a disaster situation, it is necessary to develop an SOP for psychiatric service after an earthquake in order to assist the high number of survivors suffering from subsequent psychiatric impairment.

Prevalence and predictors of posttraumatic stress disorder, anxiety, depression, and burnout in Pakistani earthquake recovery workers

Past research has shown a substantial prevalence of emotional disorders in professionals involved in rescue and/or relief operations following natural disasters, including earthquakes. However, no published study to date has investigated whether disaster rehabilitation and reconstruction workers involved in later phases of the earthquake response are also affected by emotional problems. A nearly complete sample of earthquake rehabilitation and reconstruction workers (N=267) involved in the response to the 2005 earthquake in Northern Pakistan filled in a set of self-report questionnaires assessing emotional problems and predictor variables approximately 24 months after the earthquake. Most participants had experienced the disaster themselves and suffered from a number of stressors during and shortly after the acute earthquake phase. A substantial subgroup of participants reported clinically relevant levels of emotional disorders, especially earthquake-related posttraumatic stress disorder (42.6%), as well as depression and anxiety (approx. 20%). Levels of burnout were low. Symptom levels of posttraumatic stress disorder were associated with the severity of the earthquake experience, past traumas, work-related stressors, low social support, and female gender. The results document a high prevalence of emotional problems in earthquake rehabilitation and recovery workers.

Psychological distress among adolescents in Chengdu, Sichuan at 1 month after the 2008 Sichuan earthquake

A devastating earthquake occurred on May 12, 2008 in Sichuan, China. This study investigated the prevalence and factors in association with psychological problems among secondary school students living in Chengdu (90 km away from the disaster epicenter) in June 2008. In a cross-sectional survey, 3,324 secondary students self-administered a structured questionnaire in classroom setting. Validated scales were used in this study. Among all respondents, 22.3% reported post-traumatic stress disorder (PTSD); 22.6% were probable depression cases; 10.6% reported suicidal ideation; and 14.1% would like to receive psychological counseling. No gender differences were found. While social/emotional support from teachers or peers (OR from 0.40 to 0.78) and exposure to positive news reports (OR from 0.59 to 0.62) were found protective, prior experience of severe mental distress (OR from 1.60 to 2.68) and corporal punishment (OR from 1.31 to 1.58), worry about future aftershocks (OR from 1.64 to 3.11), absence from school when it was not closed (OR from 1.38 to 1.48), exposures to scary or sorrowful disaster media coverage (OR from 1.39 to 2.07), post-disaster visits to affected sites (OR from 1.51 to 1.59), separation from parents (OR = 1.61), etc., were risk factors predictive of some of the aforementioned psychological problems. Negative mental health impacts were prevalent among the respondents. Teachers, parents, and the mass media are all important in maintaining good mental health among adolescents that are indirectly affected by the severe earthquake. The results have important implications for earthquake preparedness and relief work in the future.