Disaster responders experience high PTSD burden, need mental health support, study finds
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Specific interventions may mitigate PTSD symptoms among mass disaster first responders, according to results of a prospective cohort study published in JAMA Network Open.
“A meta-analysis of studies on first responders estimated the incidence of full-blown PTSD among them at approximately 10%,” Masanori Nagamine, MD, PhD, of the division of behavioral science at the National Defense Medical College Research Institute in Japan, and colleagues wrote. “Major risk factors for PTSD in first responders usually relate to duty, such as earlier start date or longer duration of time working at a disaster site, exposure to human remains or nuclear disaster response. Other risk factors include female sex, direct personal experience of the disaster, low social support, and post-disaster life stressors, such as job loss.”
According to the investigators, most studies of first responders are cross-sectional, with most data related to the Sept. 11, 2001, terrorist attacks; however, longitudinal studies may better assess the development of PTSD symptoms among first responders, yet they are rare and have not observed large-scale natural disasters complicated by a nuclear event.
To address this research gap, Nagamine and colleagues conducted a 6-year longitudinal cohort study to determine the long-term course of PTSD symptoms, as well as to pinpoint risk factors and their relative association with PTSD, among first responders of the 2011 Japanese earthquake, tsunami and nuclear disaster. They analyzed data of 56,388 responders, of whom 97.1% were men and for whom the median age at enrollment was 34 years, at 1, 6, 12, 24, 36, 48, 60 and 72 months following missions completion. Exposures included stress related to personal or professional disaster experience, such as duties involving body recovery or radiation exposure risk, and working conditions, such as post-deployment overtime work or deployment length. The investigators assessed PTSD symptoms using the Impact of Event Scale-Revised, with scores at 25 or greater defined as probable PTSD.
Results showed a probable PTSD rate of 2.7% at 1 month, and Nagamine and colleagues observed a downward trend in the first year and a subsequent plateau. They noted a cumulative incidence of probably PTSD of 6.75%. Further, there was a high degree of rank-order stability over time linked to severity of PTSD symptoms. Although professional disaster experience did not appear associated with the incidence of probably PTSD, the investigators reported an association between this incidence and personal experience of the disaster (HR = 1.96; 95% CI, 1.72-2.24), deployment length of 3 months or longer (HR vs. < 1 month = 1.75; 95% CI, 1.52-2.02), increased age (HR for 46 vs. 25 years = 2.28; 95% CI, 1.79-2.92) and postdeployment overtime work of 3 months or longer (HR vs. little to none = 1.61; 95% CI, 1.39-1.87).
“It is vital to sustain mental health among first responders before, during and after disaster exposure so that they may effectively respond to disasters,” Nagamine and colleagues wrote. “In future disaster relief work, shortening deployment length, preventing overtime work after mission completion and offering additional support or accommodation to older personnel, especially those personally affected by the disaster, all have the potential to mitigate long-term adverse psychological effects among first responders. It is important that policy makers take these factors into consideration and develop labor management and mental health strategies for future disasters.”
In a related editorial, Conor Liston, MD, PhD, of the department of psychiatry and brain and mind research institute at Weill Cornell Medicine, provided highlighted the need for future related research.
“Further work will be needed to determine whether similar risk factors apply to first responders in the COVID-19 pandemic or other crises, whether mood and anxiety symptoms follow similar trajectories, and why some individuals develop highly disabling symptoms while others are relatively unscathed,” Liston wrote. “In the meantime, the results by Nagamine and colleagues suggest that efforts to reduce the duration of deployments to highly stressful work environments and to facilitate recovery periods could be useful and warrant further consideration.”