Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers
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We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.
A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.
A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.
Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
KeywordsPosttraumatic stress disorder Prevalence Rescue workers Disaster Meta-analysis
This work was supported by CNPq (Nacional Research Council)—Federal Government of Brazil, FAPERJ—Programa de Apoio às Instituições de Ensino e Pesquisa (Projeto E-6/110.324/2007), and Confederação Nacional do Comércio de Bens, Serviços e Turismo (CNC). Drs. Berger, Coutinho, Figueira and Mendlowicz were partially supported by grants from CNPq. Dr. Marmar was partially supported by grant R01-MH056350-06 from the National Institute of Mental Health. Dr. Neylan was partially supported by the NIMH grants: MH057157 and MH73978.
- 1.Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, Liberman A, Pole N, Otte C, Yehuda R, Mohr D, Neylan T (2006) Predictors of posttraumatic stress in police and other first responders. Blackwell, Oxford, pp 1–18Google Scholar
- 3.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. Revised. American Psychiatric Press, WashingtonGoogle Scholar
- 4.Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T (2004) Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder trough previous trauma among West Nile refugees. BMC Psychiatry 4:34Google Scholar
- 5.American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3th edn. American Psychiatric Press, WashintonGoogle Scholar
- 23.Goldberg DP, Williams P (1988) A user’s guide to the General Health Questionnarie. NFER-Nelson, WindsorGoogle Scholar
- 26.Salama-Younes M, Montazeri A, Ismail A, Roncin C (2009) Factor structure and internal consistency of the 12-item General Health Questionnaire (GHQ-12) and the Subjective Vitality Scale (VS), and the relationship between them: a study from France. Health Qual Life Outcomes 7:22PubMedCrossRefGoogle Scholar
- 28.Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB, Meta-analysis Of Observational Studies in Epidemiology Group (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283:2008–2012PubMedCrossRefGoogle Scholar
- 29.International Monetary Fund. World Economic Outlook Database—WEO Groups and Aggregates Information. http://www.imf.org/external/pubs/ft/weo/2008/01/weodata/groups.htm#oem. 2008
- 39.Dean PG, Gow KM, Shakespeare-Finch J (2003) Counting the cost: psychological distress in career and auxiliary firefighters. Australas J Disaster Trauma Stud 1:1–13Google Scholar
- 41.Di Fiorino M, Massimetti G, Nencioni M, Paoli RA (2004) Full and subthreshold Post-Traumatic Stress Disorder seven years after a flooding in rescue squads. Bridging East West Psychiatry 2:18–25Google Scholar
- 58.Creamer M, Burgees P, McFarlane AC (2001) Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychol Med 3:1237–1247Google Scholar
- 60.Eun HJ, Lee SM, Kim TH (2001) The epidemiological study of posttraumatic stress disorder in an urban area. J Korean Neuropsychiatr Assoc 40:581–591Google Scholar
- 69.Shafique M, Van Der Meijde A, Kerle N, Van Der Meer F, Khan MA (2008) Predicting topographic aggravation of seismic ground shaking by applying geospatial tools. J Himal Earth Sci 41:33–43Google Scholar