Elsevier

Psychiatry Research

Volume 198, Issue 1, 30 June 2012, Pages 100-105
Psychiatry Research

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

https://doi.org/10.1016/j.psychres.2012.02.017Get rights and content

Abstract

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.

Introduction

It is quite common today that countries have specialized and trained urban search and rescue forces. As part of an integrated disaster response, these forces can act within a very short period of time. The primary focus of these teams is to find and rescue victims trapped after a disaster including safely digging victims out of collapsed buildings, and giving medical care to victims during and after a rescue. In general, forces end their search and rescue work within approximately 10 days. The chance that trapped (and perhaps injured) victims could survive without water and food declines dramatically after 5–10 days.

Of course, urban search and rescue work – especially when trapped victims are rescued – can be very satisfying and rewarding. On the other hand, as shown in the review of McCaslin et al. (2009), critical exposure characteristics such as facing injured and dead adults and children, the smell of the deceased, destroyed areas, danger, unsuccessful operations, and emotions of survivors (such as anxiety, grief, helplessness, anger) may put workers at risk for event-related mental health problems such as posttraumatic stress disorder (PTSD). However, research has demonstrated that prevalence of posttraumatic distress and PTSD varies substantially across disasters and background of rescue workers. For example, in the study of Gabriel et al. (2007), 2 months after the Madrid bombing, 1.3% of the police officers of an elite corps met the criteria of PTSD. Four months after the Ash Wednesday bushfire, 31% of the volunteer firefighters qualified for a diagnosis of PTSD (McFarlane and Papay, 1992).

Almost all disaster studies focused on rescue workers have been conducted after the disaster. Therefore it is unclear to what extent mental health problems (MHP) can be attributed to disaster-exposure or were already present before the event. For example, after the Oklahoma bombing, North et al. (2002) found that the rate of post-event non-alcohol disorders among firefighters was four times higher in those with pre-disaster psychopathology (43% versus 11%). Similar findings were reported after the 9/11 terrorist attacks. Deployed canine and rescue handlers with a history of mental illness compared to colleagues without such a history reported more symptoms of depression and psychological distress, and they more often met criteria for a current disorder (Alvarez and Hunt, 2005). However, both of these studies were based on possibly biased, retrospectively collected data on previous MHP. Remarkably, one prospective study with pre–post measures among police officers (body handlers) found that affected officers had less anxiety 3 months post-disaster, while depression symptoms remained stable (Alexander and Wells, 1991). Further support for the importance of pre-event functioning is found in several prospective studies on critical incidents among officers (van der Velden et al., 2010). In addition, especially research among police officers has shown that organizational stressors are more likely sources of adverse psychological reactions, including PTSD, than critical incidents (Brown et al., 1999, Hartley et al., 2007, Huddleston et al., 2007, Liberman et al., 2002, van der Velden et al., 2010, Wang et al., 2010). To what extent specialized and trained urban search and rescue forces are at risk for post-disaster MHP remains unclear.

Because disasters occur suddenly, the relatively few prospective disaster studies that did conduct pre–post comparisons had this unique opportunity because researchers were already conducting a study when the disaster unexpectedly took place. To obtain reliable data about (mental) health before the disaster, an assessment just before rescue workers are deployed to the disaster site is optimal for this type of prospective investigation. With this goal in mind, we designed the present study. In cooperation with the Dutch Urban Search and Rescue (USAR NL), study materials (letters, questionnaires, informed consent forms) were prepared in case of a new disaster where USAR NL would be deployed. According to plan, in case of a new disaster before departure, workers would complete questionnaires and informed consent forms. Follow-up was scheduled approximately 3 months post-deployment. This pre-designed study was started soon after the first reports of the devastating Haïti earthquake (January 12, 2010).

Section snippets

Background

On January 12, 2010, around 5 P.M. local time Haiti, one of the poorest countries in the world (WHO, 2005) with a record of violence caused by the absence of State service (IRC, 2009), was struck by a massive earthquake registering 7.0 on the Richter scale. Many (governmental) buildings, the airport and houses collapsed, and the infrastructure was destroyed. Early after the disaster it was estimated that at least between 50,000 and 120,000 people had died and many more were (severely) injured.

Health

The large majority of participants were males (92.2%) with a mean age of 44.7 years (S.D. = 6.4). The sample consisted of police officers (n = 11), firefighters (n = 35), ambulance personnel (n = 4) and one surgeon. Almost 3/4 of the sample had been members of USAR NL for 2 years or longer. In total, 45.1% were deployed to previous disasters.

Table 1 presents all health outcomes at T1 and T2. The results of the statistical analyses showed that there were no significant changes between T1 and T2 for each

Discussion

Findings from this prospective study clearly indicate that 3 months post-disaster, participants were as healthy as before deployment, perhaps even more so. Depression symptoms and interpersonal sensitivity were even significantly lower 3 months post-event. Use of physician-prescribed medicines, as well as alcohol use and smoking, remained stable. PTSD-symptom scores at 3 months were very low, and as low as IES scores of firefighters and ambulance personnel in the studies of van der Velden et al.,

Acknowledgments

We gratefully thank all members of USAR NL that participated in our study. This study is part of a large research project on coping self-efficacy, granted by the Victim Support Fund (Fonds Slachtofferhulp), The Netherlands.

References (42)

  • J. Alvarez et al.

    Risk and resilience in canine search and rescue handlers after 9/11

    Journal of Traumatic Stress

    (2005)
  • W.A. Arrindell et al.

    Handleiding bij een multidimensionele psychopathologie-indicator SCL-90

    (1986)
  • M. Ben-Ezra et al.

    Hospital personnel reactions to Haiti's earthquake: a preliminary matching study

    The Journal of Clinical Psychiatry

    (2010)
  • C.C. Benight et al.

    Psychometric validation of a domestic violence coping self-efficacy measure

    Journal of Traumatic Stress

    (2004)
  • R.V. Bijl et al.

    Psychiatrische morbiditeit, zorggebruik en zorgbehoefte. Resultaten van de Netherlands Mental Health Survey and Incidence Study

    Tijdschrift Gezondheidswetenschappen

    (1998)
  • A. Blokstra et al.

    Het project Monitoring Risicofactoren en Gezondheid Nederland (MORGEN project) Jaarverslag 1997 (The Monitoring Project on Risk Factors for Chronic Diseases (MORGENproject) Annual Report 1997)

    (1998)
  • R.M. Brackbill et al.

    Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack

    JAMA: The Journal of the American Medical Association

    (2009)
  • J. Brown et al.

    Distinguishing traumatic, vicarious and routine operational stressor exposure and attendant adverse consequence in a sample of police officers

    Work & Stress

    (1999)
  • L.R. Derogatis

    SCL-90-R Administration, Scoring, Procedures Manual-II for the (Revised) Version and Other Instruments of the Psychopathology Rating Scale Series

    (1983)
  • W.P. Dunlap et al.

    Skew reduces test–retest reliability

    Journal of Applied Psychology

    (1994)
  • GGD Nederland (Health Authority Netherlands)

    Standaard vraagstelling roken (Standardized questions for smoking)

    (2003)
  • Cited by (44)

    • Policing in pandemics: A systematic review and best practices for police response to COVID-19

      2020, International Journal of Disaster Risk Reduction
      Citation Excerpt :

      They recommend that such training facilitates social support networks for police officers [19,25] and focuses on building and enhancing resilience in police officers [31]. This is further stressed to reduce the risk of depression and substance abuse [40]. Efficiency of training and maintaining resilience amongst the force can further be facilitated by adhering to stringent employment processes and selection criteria [31].

    • Factors relating to anxiety among medical teams dispatched to the Fukushima nuclear power plant disaster

      2020, International Journal of Disaster Risk Reduction
      Citation Excerpt :

      It is also necessary for different job types to be able to engage in teamwork easily in disaster-affected areas. For example, good team functioning, identified job roles, and high job satisfaction were protective against PTSD and anxiety symptoms among personnel responding to the 2010 earthquake in Haiti [29]. The fact that clerical workers and drivers who were engaged in activities had the lowest percentage of knowledge of disaster medicine in general and radiation emergency medicine in particular and that those with the least knowledge of radiation experienced the greatest anxiety highlights the fact that there are professionals involved in disaster response that need additional training on radiation and radiation emergency medicine in preparation for disasters.

    • Psychological impacts of disaster on rescue workers: A review of the literature

      2018, International Journal of Disaster Risk Reduction
      Citation Excerpt :

      The PTSD Checklist-Civilian Version (PCL-C) was adopted in 21 studies [24,32,35,39,42,44,46,47,49-61]. The Impact of Event Scale-Revised (IES) was adopted in seven studies [9,38,45,62-65]. The Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) was adopted in five studies [63,66-69].

    View all citing articles on Scopus
    View full text