Acute Stress Disorder, Posttraumatic Stress Disorder, and Depression in Disaster or Rescue Workers
Fullerton CS, Ursano UJ and Wang L;
Commented by , 23 Aug 2004
Aims of the study
To assess the prevalence of Acute Stress Disorder (ASD), early dissociative symptoms, Post-Traumatic Stress Disorder (PTSD), depression, and healthcare utilization in rescue workers after an airplane crash.
207 exposed rescue workers and 421 unexposed comparison subjects were examined 2, 7 and 13 months after an airplane crash. ASD was assessed using "a previously validated measure". Early dissociative symptoms were identified with an unspecified instrument. PTSD was evaluated with a DSM PTSD-IV Scale. Depression was assessed using a cut off score of >50 on the Zung Self-Rating Scale. Healthcare utilization was established through four questions.
Exposed rescue workers had significantly higher rates of of ASD than the comparison subjects (25.6% vs 2.4%). At 13 months, exposed rescue workers also had significantly higher rates of PTSD than the comparison subjects (16.7% vs 1.9%) as well as significantly higher rates of depression (21.7% vs 12.6%).
Previous exposure to trauma (Odds Ratio: 6.77), high exposure (Odds Ratio: 3.92), ASD (Odds Ratio: 7.33), and depression at 7 months (Odds Ratio: 9.5) were identified as risk factors for PTSD at 13 months. 42% of exposed rescue workers with ASD developed PTSD
ASD was identified as a risk factor for depression (Odds Ratio: 3.93) at 7 months, but not for depression at 13 months.
Rescue workers represent a special sub-population of people among persons who are exposed to trauma and disaster. They know that they will
1. be confronted with dead, disfigured or severely injured persons
2. be exposed to life-threatening situations
3. have to work with survivors and families.
In addition, rescue workers are professionals who have chosen their occupation and who have received at least some training before being confronted for the first time with a traumatic event. As such, it could be expected that the impact of the exposure to extreme stress might be less severe on rescue workers than on victims, families of victims, or unprepared witnesses.
In fact, as shown in another article published in this month's issue of the American Journal of Psychiatry (which features stress disorders as its main theme), the psychological impact on the victims of a traumatic event is far higher than on the rescue workers. Verger et al. (ref. 1) report on the psychological consequences of terrorist bombings in France. Assessment of victims 2.6 years after the bombings revealed a prevalence rate of 31.1% of PTSD, i.e. twice as high as in the study on rescue workers.
This does not mean, however, that rescue workers are immune to the psychological consequences of exposure to trauma. As shown by the results of the present study, 40.5% of the rescue workers involved in the aftermath of the plane crash had ASD, PTSD or depression at 13 months after the disaster. The results highlight the importance of providing extensive training and ongoing health care planning for rescue workers who have been or will be exposed to disaster.
1. Verger P, Dab W, Lamping DL, Loze JY, Deschaseaux-Voinet C, Abenhaim L, Rouillon F.The Psychological Impact of Terrorism: An Epidemiologic Study of Posttraumatic Stress Disorder and Associated Factors in Victims of the 1995–1996 Bombings in France.American Journal of Psychiatry 2004; 161:1384-1389.