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Who is going to rescue the rescuers? Post-traumatic stress disorder among rescue workers operating in Greece during the European refugee crisis

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Abstract

Purpose

During the European refugee crisis, numerous Greek and international rescue workers are operating in Lesvos, offering search, rescue, and first aid services. Exposure to stressful life events while engaging in this rescue work can result in developing Post-Traumatic Stress Disorder (PTSD). The study aimed to assess the prevalence of PTSD and explore potential differences between different categories of rescuers.

Methods

A cross-sectional study was conducted among 217 rescue workers. Participants were grouped according to affiliation: “Greek Professionals Rescuers/GPR”, “International Professionals Rescuers/IPR” and “Volunteer Rescuers/VR”. The PTSD Checklist-Civilian Version (PCL-C) was utilized. All tests were two-tailed (a = 0.05). Mann–Whitney, Kruskal–Wallis, and multivariate logistic regression were performed.

Results

Overall probable PTSD prevalence found was 17.1%. Rates varied significantly per rescuer’s category; 23.1% in GPR, 11.8% in IPR, and 14.6% in VR (p = 0.02). GPR demonstrated the highest risk compared to IPR and VR (p < 0.001). Females had approximately two times higher risk. Other significant risk factors included marital status, age, and number of children. Lack of previous experience, longer operation period, longer shift hours, and handling dead refugees and dead children were also considered major risk factors.

Conclusions

Rescue workers providing substantial aid to the refugees and migrants at Lesvos experience significant psychological distress. The present findings indicate the urgent need for targeted interventions. Further studies are needed to address long-term effects of the refugee crisis on rescuers, and explore effective measures to prevent PTSD.

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References

  1. United Nations High Commissioner for Refugees (UNHCR) (2016) Refugees/Migrants Emergency Response—Mediterranean. UNHCR website. http://data.unhcr.org/mediterranean/country.php?id=83. Accessed 19 April 2016

  2. Anagnostopoulos DC, Triantafyllou K, Xylouris G et al (2016) Migration mental health issues in Europe: the case of Greece. Eur Child Adolesc Psychiatry 25:119–122

    Article  PubMed  Google Scholar 

  3. Gkionakis N (2016) The refugee crisis in Greece: training border security, police, volunteers and aid workers in psychological first aid. Intervention 14:73–79

    Article  Google Scholar 

  4. Marmar CR, Weiss DS, Metzler TJ et al (1996) Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents. J Trauma Stress 9:63–85

    Article  CAS  PubMed  Google Scholar 

  5. Norris FH, Friedman MJ, Watson PJ (2002) 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry 65:240–260

    Article  PubMed  Google Scholar 

  6. Ozen S, Sir A (2004) Frequency of PTSD in a group of search and rescue workers two months after 2003 Bingol (Turkey) earthquake. J Nerv Ment Dis 192:573–575

    Article  PubMed  Google Scholar 

  7. Setti I, Argentero P (2015) Traumatization and PTSD in rescue workers: prevention, assessment, and interventions. Comprehensive guide to post-traumatic stress. Disorder Springer International Publishing, Switzerland

    Google Scholar 

  8. Gjerland A, Pedersen MJB, Ekeberg Ø et al (2015) Sick-leave and help seeking among rescue workers after the terror attacks in Norway, 2011. Int J Emerg Med 8:31

    Article  PubMed Central  Google Scholar 

  9. Thoresen S, Tonnessen A, Lindgaard CV et al (2009) Stressful but rewarding: Norwegian personnel mobilised for the 2004 tsunami disaster. Disasters 33:353–368

    Article  PubMed  Google Scholar 

  10. International Association of Fire Fighters (2000) International Association of Fire Fighters 2000 death and injury survey. International Association of Fire Fighters, Washington DC

    Google Scholar 

  11. Perrin MA, DiGrande L et al (2007) Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry 164:1385–1394

    Article  PubMed  Google Scholar 

  12. Lopes Cardozo B, Gotway Crawford C, Eriksson C et al (2012) Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study. PLoS One 7:e44948

    Article  PubMed  PubMed Central  Google Scholar 

  13. Silove D, Liddell B, Rees S et al (2014) Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor–Leste: a 6-year longitudinal study. Lancet Glob Health 2:e293–e300

    Article  PubMed  Google Scholar 

  14. Neuner F, Schauer M, Karunakara U et al (2004) Psychological trauma and evidence for enhance vulnerability for posttraumatic stress disorder trough previous trauma among West Nile refugees. BMC Psychiatry 4:34

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kessler RC, Chin WT, Demler O et al (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  PubMed Central  Google Scholar 

  16. De Vries GJ, Olff M (2009) The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. J Trauma Stress 22:259–267

    Article  PubMed  Google Scholar 

  17. Berger W, Coutinho ES, Figueira I et al (2012) Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol 47:1001–1011

    Article  PubMed  Google Scholar 

  18. Hagh-Shenas H, Goodarzi MA, Dehbozorgi G et al (2005) Psychological consequences of the bam earthquake on professional and nonprofessional helpers. J Trauma Stress 18:477–483

    Article  PubMed  Google Scholar 

  19. Blanchard EB, Jones-Alexander J, Buckley RC et al (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673

    Article  CAS  PubMed  Google Scholar 

  20. Ruggiero KJ, Del Ben K, Scotti JR et al (2003) Psychometric properties of the PTSD Checklist-Civilian Version. J Trauma Stress 16:495–502

    Article  PubMed  Google Scholar 

  21. Dobie DJ, Kivlahan DR, Maynard CR et al (2002) Screening for post-traumatic stress disorder in female veteran’s affairs patients: validation of the PTSD Checklist. Gen Hosp Psychiatry 24:367–374

    Article  PubMed  Google Scholar 

  22. Watson P, McFalls M (2002) Best practice manual for posttraumatic stress disorder (PTSD). Compensation and Pension Examinations, Washington, DC

    Google Scholar 

  23. Forbes D, Creamer M, Biddle D (2001) The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behav Res Ther 39:977–986

    Article  CAS  PubMed  Google Scholar 

  24. North CS, Pfefferbaum B (2002) Research on the mental health effects of terrorism. JAMA 288:633–636

    Article  PubMed  Google Scholar 

  25. Calbari E, Anagnostopoulos F (2010) Exploratory factor analysis of the Greek adaptation of the PTSD Checklist-Civilian version. J Loss Trauma 15:339–350

    Article  Google Scholar 

  26. Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132:959–992

    Article  PubMed  Google Scholar 

  27. Ditlevsen DN, Elklit A (2012) Gender, trauma type, and PTSD prevalence: a re-analysis of 18 nordic convenience samples. Ann Gen Psychiatry 11:26

    Article  PubMed  PubMed Central  Google Scholar 

  28. Breslau N, Davis GC, Andreski P et al (1997) Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry 554:1044–1048

    Article  Google Scholar 

  29. Bowler R, Han H, Gocheva V et al (2010) Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack. Am J Ind Med 53:1186–1196

    Article  PubMed  Google Scholar 

  30. Kang P, Lv Y, Hao L et al (2015) Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: A neglected problem. Psychiatry Res 230:517–523

    Article  PubMed  Google Scholar 

  31. Armagan E, Engindeniz Z, Devay AO et al (2006) Frequency of post-traumatic stress disorder among relief force workers after the tsunami in Asia: do rescuers become victims? Prehosp Disaster Med 21:168–172

    Article  PubMed  Google Scholar 

  32. Fullerton CS, Ursano RJ, Wang L (2004) Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry 161:1370–1376

    Article  PubMed  Google Scholar 

  33. Marmar CR, McCaslin SE, Metzler TJ et al (2006) Predictors of posttraumatic stress in police and other first responders. Ann N Y Acad Sci 1071:1–18

    Article  PubMed  Google Scholar 

  34. Lilly MM, Pole N, Best SR et al (2009) Gender and PTSD: What can we learn from female police officers? J Anxiety Disord 23:767–774

    Article  PubMed  PubMed Central  Google Scholar 

  35. McFarlane AC (1986) Long-term psychiatric morbidity after a natural disaster. Med J Aust 145:561–563

    CAS  PubMed  Google Scholar 

  36. Skogstad L, Heir T, Hauff E, Ekeberg Ø (2016) Post-traumatic stress among rescue workers after terror attacks in Norway. Occup Med (ahead of print)

  37. Brooks SK, Dunn R, Amlôt R et al (2016) Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review. BMC Psychol 4:18

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cardozo BL, Crawford C, Petit P et al (2013) Factors affecting mental health of local staff working in the Vanni Region, Sri Lanka. Psychol Trauma Theor Res Pract Policy 5:581–590

    Article  Google Scholar 

  39. Boscarino JA, Figley CR, Adams RE (2004) Compassion fatigue following the September 11 terrorist attacks: a study of secondary trauma among New York City social workers. Int J Emerg Ment Health 6:1–10

    Google Scholar 

  40. Skogstad M, Skorstad M, Lie A et al (2013) Work-related post-traumatic stress disorder. Occup Med (Lond) 63:175–182

    Article  CAS  Google Scholar 

  41. Leffler CT, Dembert ML (1998) Posttraumatic stress symptoms among U.S. navy divers recovering TWA flight 800. J Nerv Ment Dis 186:574–577

    Article  CAS  PubMed  Google Scholar 

  42. Pietrzak RH, Schechter CB, Bromet EJ et al (2012) The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. J Psychiatr Res 46:835–842

    Article  PubMed  Google Scholar 

  43. Regehr C, Hill J, Glancy GD (2000) Individual predictors of traumatic reactions in firefighters. J Nerv Ment Dis 188:333–339

    Article  CAS  PubMed  Google Scholar 

  44. Alvarez J, Hunt M (2005) Risk and resilience in canine search and rescue handlers after 9/11. J Trauma Stress 18:497–505

    Article  PubMed  Google Scholar 

  45. Berger W, Figueira I, Maurat AM et al (2007) Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life. J Trauma Stress 20:637–642

    Article  PubMed  Google Scholar 

  46. Guo YJ, Chen CH, Lu ML et al (2004) Posttraumatic stress disorder among professional and non-professional rescuers involved in an earthquake in Taiwan. Psychiatry Res 127:35–41

    Article  PubMed  Google Scholar 

  47. Argentero P, Setti I (2011) Engagement and vicarious traumatization in rescue workers. Int Arch Occup Environ Health 84:67–75

    Article  PubMed  Google Scholar 

  48. Westphal M, Bonanno GA (2007) Posttraumatic growth and resilience to trauma: different sides of the same coin or different coins? Appl Psychol Int Rev 56:417–427

    Article  Google Scholar 

  49. Feldner MT, Monson CM, Friedman MJ (2007) A critical analysis of approaches to targeted PTSD prevention: current status and theoretically derived future directions. Behav Modif 31:80–116

    Article  PubMed  Google Scholar 

  50. Terhakopian A, Sinaii N, Engel CC et al (2008) Estimating population prevalence of posttraumatic stress disorder: an example using the PTSD checklist. J Trauma Stress 21:290–300

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Calbari E and Anagnostopoulos F, the developers of the Greek version of the PCL-C questionnaire, for providing permission to use the tool; and the original developers of the tool for their approval and support. Additionally, the authors would like to acknowledge the significant contribution of all participating rescuers and foundations in the current study, during the most crucial period of the European refugee crisis.

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Author notes

    Authors and Affiliations

    1. Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Office 4D10, P.O. Box: 2208, 71003, Heraklion, Crete, Greece

      Dimitra Sifaki-Pistolla & Vasiliki-Eirini Chatzea

    2. Department of Sociology, University of the Aegean, Mytilene, Lesbos, Greece

      Sofia-Aikaterini Vlachaki

    3. University Hospital of Heraklion, Heraklion, Crete, Greece

      Evangelos Melidoniotis

    4. Health Region of Crete, Heraklion, Crete, Greece

      Georgia Pistolla

    5. Faculty of Medicine, University of Crete, Heraklion, Crete, Greece

      Georgia Pistolla

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    1. Dimitra Sifaki-Pistolla
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    Correspondence to Dimitra Sifaki-Pistolla.

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    The authors declare that they have no conflict of interest.

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    D. Sifaki-Pistolla and V.-E. Chatzea contributed equally.

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    Sifaki-Pistolla, D., Chatzea, VE., Vlachaki, SA. et al. Who is going to rescue the rescuers? Post-traumatic stress disorder among rescue workers operating in Greece during the European refugee crisis. Soc Psychiatry Psychiatr Epidemiol 52, 45–54 (2017). https://doi.org/10.1007/s00127-016-1302-8

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    • DOI: https://doi.org/10.1007/s00127-016-1302-8

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