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