Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-04-30T13:05:12.471Z Has data issue: false hasContentIssue false
  • English
  • Français

Coping Behavior and Risk of Post-Traumatic Stress Disorder Among Federal Disaster Responders

Published online by Cambridge University Press:  23 December 2015

George T. Loo ,
Charles J. DiMaggio ,
Robyn R. Gershon ,
David B. Canton ,
Stephen S. Morse  and
Sandro Galea
George T. Loo*
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, New York
Charles J. DiMaggio
Affiliation:
New York University School of Medicine, New York, New York
Robyn R. Gershon
Affiliation:
University of California at San Francisco, Institute for Health Policy Studies, San Francisco, California
David B. Canton
Affiliation:
Shasta Community Health Center, Redding, California
Stephen S. Morse
Affiliation:
Columbia University, Mailman School of Public Health, New York, New York
Sandro Galea
Affiliation:
Boston University School of Public Health, Boston, Massachusetts.
*
Correspondence and reprint requests to George T. Loo, Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, Department of Population Health Science and Policy, 19 East 98 Street, Suite 3D, Box 1062, New York, New York 10029 (e-mail: george.loo@mountsinai.org).
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings.

Methods

Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist–Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders.

Results

In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22).

Conclusion

This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research. (Disaster Med Public Health Preparedness. 2016;10:108–117)

Keywords

stress disorderspost-traumaticmental healthemergency responderscoping behaviordisaster medicine
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 1 , February 2016 , pp. 108 - 117
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Benedek, DM, Fullerton, C, Ursano, RJ. First responders: mental health consequences of natural and human-made disasters for public health and public safety workers. Annu Rev Public Health. 2007;28(1):55-68. http://dx.doi.org/10.1146/annurev.publhealth.28.021406.144037.Google Scholar
2. Galea, S, Nandi, A, Vlahov, D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27(1):78-91. http://dx.doi.org/10.1093/epirev/mxi003.Google Scholar
3. Norris, FH, Friedman, MJ, Watson, PJ, et al. 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981-2001. Psychiatry. 2002;65(3):207-239. http://dx.doi.org/10.1521/psyc.65.3.207.20173.Google Scholar
4. DiMaggio, C, Galea, S. The behavioral consequences of terrorism: a meta-analysis. Acad Emerg Med. 2006;13(5):559-566. http://dx.doi.org/10.1111/j.1553-2712.2006.tb01008.x.Google Scholar
5. Durham, TW, McCammon, SL, Allison, EJ Jr. The psychological impact of disaster on rescue personnel. Ann Emerg Med. 1985;14(7):664-668. http://dx.doi.org/10.1016/S0196-0644(85)80884-2.Google Scholar
6. Dyregrov, A, Kristoffersen, JI, Gjestad, R. Voluntary and professional disaster-workers: similarities and differences in reactions. J Trauma Stress. 1996;9(3):541-555. http://dx.doi.org/10.1002/jts.2490090310.Google ScholarPubMed
7. Epstein, RS, Fullerton, CS, Ursano, RJ. Posttraumatic stress disorder following an air disaster: a prospective study. Am J Psychiatry. 1998;155(7):934-938. http://dx.doi.org/10.1176/ajp.155.7.934.Google Scholar
8. Ersland, S, Weisaeth, L, Sund, A. The stress upon rescuers involved in an oil rig disaster. “Alexander L. Kielland” 1980. Acta Psychiatr Scand Suppl. 1989;80(s355):38-49. http://dx.doi.org/10.1111/j.1600-0447.1989.tb05252.x.CrossRefGoogle Scholar
9. Grieger, TA, Staab, JP, Cardena, E, et al. Acute stress disorder and subsequent post-traumatic stress disorder in a group of exposed disaster workers. Depress Anxiety. 2000;11(4):183-184. http://dx.doi.org/10.1002/1520-6394(2000)11:4<183::AID-DA7>3.0.CO;2-M.Google Scholar
10. Noji, EK. Disaster epidemiology. Emerg Med Clin North Am. 1996;14(2):289-300. http://dx.doi.org/10.1016/S0733-8627(05)70252-2.CrossRefGoogle ScholarPubMed
11. Sims, A, Sims, D. The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma. Psychopathology. 1998;31(2):96-112. http://dx.doi.org/10.1159/000029029.Google Scholar
12. Berninger, A, Webber, MP, Cohen, HW, et al. Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005. Public Health Rep. 2010;125(4):556-566.Google Scholar
13. Berninger, A, Webber, MP, Niles, JK, et al. Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster. Am J Ind Med. 2010;53(12):1177-1185. http://dx.doi.org/10.1002/ajim.20894.Google Scholar
14. Cukor, J, Wyka, K, Jayasinghe, N, et al. The nature and course of subthreshold PTSD. J Anxiety Disord. 2010;24(8):918-923. http://dx.doi.org/10.1016/j.janxdis.2010.06.017.Google Scholar
15. Soo, J, Webber, MP, Gustave, J, et al. Trends in probable PTSD in firefighters exposed to the World Trade Center disaster, 2001-2010. Disaster Med Public Health Prep. 2011;5(suppl 2):S197-S203. http://dx.doi.org/10.1001/dmp.2011.48.Google Scholar
16. Luft, BJ, Schechter, C, Kotov, R, et al. Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers. Psychol Med. 2012;42(5):1069-1079. http://dx.doi.org/10.1017/S003329171100256X.Google Scholar
17. Pietrzak, RH, Schechter, CB, Bromet, EJ, et al. The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. J Psychiatr Res. 2012;46(7):835-842. http://dx.doi.org/10.1016/j.jpsychires.2012.03.011.Google Scholar
18. Bowler, RM, Harris, M, Li, J, et al. Longitudinal mental health impact among police responders to the 9/11 terrorist attack. Am J Ind Med. 2012;55(4):297-312. http://dx.doi.org/10.1002/ajim.22000.Google Scholar
19. Perrin, MA, DiGrande, L, Wheeler, K, et al. Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. 2007;164(9):1385-1394. http://dx.doi.org/10.1176/appi.ajp.2007.06101645.Google Scholar
20. Fullerton, CS, McCarroll, JE, Ursano, RJ, et al. Psychological responses of rescue workers: fire fighters and trauma. Am J Orthopsychiatry. 1992;62(3):371-378. http://dx.doi.org/10.1037/h0079363.Google Scholar
21. North, CS, Tivis, L, McMillen, JC, et al. Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing. J Trauma Stress. 2002;15(3):171-175. http://dx.doi.org/10.1023/A:1015286909111.Google Scholar
22. North, CS, Tivis, L, McMillen, JC, et al. Psychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. 2002;159(5):857-859. http://dx.doi.org/10.1176/appi.ajp.159.5.857.Google Scholar
23. Chang, CM, Lee, L-C, Connor, KM, et al. Posttraumatic distress and coping strategies among rescue workers after an earthquake. J Nerv Ment Dis. 2003;191(6):391-398. http://dx.doi.org/10.1097/01.NMD.0000071588.73571.3D.Google Scholar
24. Marmar, CR, Weiss, DS, Metzler, TJ, et al. Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. J Nerv Ment Dis. 1999;187(1):15-22. http://dx.doi.org/10.1097/00005053-199901000-00004.Google Scholar
25. Johnsen, BH, Eid, J, Christian Laberg, J, Thayer, JF. The effect of sensitization and coping style on post-traumatic stress symptoms and quality of life: two longitudinal studies. Scand J Psychol. 2002;43(2):181-188. http://dx.doi.org/10.1111/1467-9450.00285.Google Scholar
26. Fullerton, CS, Ursano, RJ, Wang, L. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry. 2004;161(8):1370-1376. http://dx.doi.org/10.1176/appi.ajp.161.8.1370.CrossRefGoogle ScholarPubMed
27. Endler, NS, Parker, JD. Multidimensional assessment of coping: a critical evaluation. J Pers Soc Psychol. 1990;58(5):844-854. http://dx.doi.org/10.1037/0022-3514.58.5.844.Google Scholar
28. Silver, RC, Holman, EA, McIntosh, DN, et al. Nationwide longitudinal study of psychological responses to September 11. JAMA. 2002;288(10):1235-1244. http://dx.doi.org/10.1001/jama.288.10.1235.Google Scholar
29. Baschnagel, JS, Gudmundsdottir, B, Hawk, LW Jr, et al. Post-trauma symptoms following indirect exposure to the September 11th terrorist attacks: the predictive role of dispositional coping. J Anxiety Disord. 2009;23(7):915-922. http://dx.doi.org/10.1016/j.janxdis.2009.05.005.Google Scholar
30. Gershon, RR, Lin, S, Li, X. Work stress in aging police officers. J Occup Environ Med. 2002;44(2):160-167. http://dx.doi.org/10.1097/00043764-200202000-00011.Google Scholar
31. North, CS, Pfefferbaum, B, Narayanan, P, et al. Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry. 2005;186(6):487-493. http://dx.doi.org/10.1192/bjp.186.6.487.CrossRefGoogle ScholarPubMed
32. Alexander, DA, Wells, A. Reactions of police officers to body-handling after a major disaster. A before-and-after comparison. Br J Psychiatry. 1991;159(4):547-555. http://dx.doi.org/10.1192/bjp.159.4.547.Google Scholar
33. Leffler, CT, Dembert, ML. Posttraumatic stress symptoms among U.S. navy divers recovering TWA flight 800. J Nerv Ment Dis. 1998;186(9):574-577. http://dx.doi.org/10.1097/00005053-199809000-00009.Google Scholar
34. Weiss, DS, Marmar, CR, Metzler, TJ, et al. Predicting symptomatic distress in emergency services personnel. J Consult Clin Psychol. 1995;63(3):361-368. http://dx.doi.org/10.1037/0022-006X.63.3.361.Google Scholar
35. Johnsen, BH, Eid, J, Løstad, T, et al. Posttraumatic stress symptoms in nonexposed, victims, and spontaneous rescuers after an avalanche. J Trauma Stress. 1997;10(1):133-140. http://dx.doi.org/10.1002/jts.2490100113.CrossRefGoogle ScholarPubMed
36. Ursano, RJ, Fullerton, CS, Kao, T-C, et al. Longitudinal assessment of posttraumatic stress disorder and depression after exposure to traumatic death. J Nerv Ment Dis. 1995;183(1):36-42. http://dx.doi.org/10.1097/00005053-199501000-00007.Google Scholar
37. Gil, S. Evaluation of premorbid personality factors and pre-event posttraumatic stress symptoms in the development of posttraumatic stress symptoms associated with a bus explosion in Israel. J Trauma Stress. 2005;18(5):563-567. http://dx.doi.org/10.1002/jts.20065.Google Scholar
38. Gil, S, Caspi, Y. Personality traits, coping style, and perceived threat as predictors of posttraumatic stress disorder after exposure to a terrorist attack: a prospective study. Psychosom Med. 2006;68(6):904-909. http://dx.doi.org/10.1097/01.psy.0000242124.21796.f8.Google Scholar
39. Galea, S, Vlahov, D, Resnick, H, et al. Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol. 2003;158(6):514-524. http://dx.doi.org/10.1093/aje/kwg187.Google Scholar
40. Spitzer, RL, Kroenke, K, Williams, JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097. http://dx.doi.org/10.1001/archinte.166.10.1092.Google Scholar
41. Swinson, RP. The GAD-7 scale was accurate for diagnosing generalised anxiety disorder. Evid Based Med. 2006;11(6):184. http://dx.doi.org/10.1136/ebm.11.6.184.Google Scholar
42. Saunders, JB, Aasland, OG, Babor, TF, De La Fuente, JR, Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993;88(6):791-804. http://dx.doi.org/10.1111/j.1360-0443.1993.tb02093.x.Google Scholar
43. Allen, JP, Litten, RZ, Fertig, JB, Babor, T. A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcohol Clin Exp Res. 1997;21(4):613-619. http://dx.doi.org/10.1111/j.1530-0277.1997.tb03811.x.Google Scholar
44. Kroenke, K, Spitzer, RL, Williams, JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x.CrossRefGoogle ScholarPubMed
45. Martin, A, Rief, W, Klaiberg, A, et al. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006;28(1):71-77. http://dx.doi.org/10.1016/j.genhosppsych.2005.07.003.Google Scholar
46. Pinto-Meza, A, Serrano-Blanco, A, Peñarrubia, MT, Blanco, E, Haro, JM. Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone? J Gen Intern Med. 2005;20(8):738-742. http://dx.doi.org/10.1111/j.1525-1497.2005.0144.x.Google Scholar
47. Blanchard, EB, Jones-Alexander, J, Buckley, TC, et al. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996;34(8):669-673. http://dx.doi.org/10.1016/0005-7967(96)00033-2.Google Scholar
48. Joseph, S, Williams, R, Yule, W. Crisis support, attributional style, coping style, and post traumatic symptoms. Pers Individ Dif. 1992;13(11):1249-1251. http://dx.doi.org/10.1016/0191-8869(92)90262-N.Google Scholar
49. Eid, J, Thayer, JF, Johnsen, BH. Measuring post-traumatic stress: a psychometric evaluation of symptom--and coping questionnaires based on a Norwegian sample. Scand J Psychol. 1999;40(2):101-108. http://dx.doi.org/10.1111/1467-9450.00105.CrossRefGoogle Scholar
50. Berger, W, Coutinho, ESF, Figueira, I, et al. 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. 2012;47(6):1001-1011. http://dx.doi.org/10.1007/s00127-011-0408-2.Google Scholar
51. Johnsen, BH, Laberg, JC, Eid, J. Coping strategies and mental health problems in a military unit. Mil Med. 1998;163(9):599-602.Google Scholar
52. Galea, S, Ahern, J, Resnick, H, et al. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002;346(13):982-987. http://dx.doi.org/10.1056/NEJMsa013404.Google Scholar
53. Breslau, N, et al. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry. 1991;48(3):216-222. http://dx.doi.org/10.1001/archpsyc.1991.01810270028003.Google Scholar
54. Kessler, RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060. http://dx.doi.org/10.1001/archpsyc.1995.03950240066012.Google Scholar
55. Pietrzak, RH, Feder, A, Singh, R, et al. Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study. Psychol Med. 2014;44(1):205-219. doi: 10.1017/S0033291713000597.Google Scholar
56. Breslau, N. The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatry. 2001;62(suppl 17):16-22.Google Scholar
57. Breslau, N. The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse. 2009;10(3):198-210. http://dx.doi.org/10.1177/1524838009334448.Google Scholar
58. Brunello, N, Davidson, JRT, Deahl, M, et al. Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology. 2001;43(3):150-162. http://dx.doi.org/10.1159/000054884.Google Scholar
59. Shultz, JM, Russell, J, Espinel, Z. Epidemiology of tropical cyclones: the dynamics of disaster, disease, and development. Epidemiol Rev. 2005;27(1):21-35. http://dx.doi.org/10.1093/epirev/mxi011.CrossRefGoogle ScholarPubMed
60. Bowler, RM, Han, H, Gocheva, V, et al. Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack. Am J Ind Med. 2010;53(12):1186-1196. http://dx.doi.org/10.1002/ajim.20876.Google Scholar
61. Haskell, SG, Gordon, KS, Mattocks, K, et al. Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut War Veterans of Iraq and Afghanistan. J Womens Health (Larchmt). 2010;19(2):267-271. http://dx.doi.org/10.1089/jwh.2008.1262.Google Scholar
62. Hoge, CW, Clark, JC, Castro, CA. Commentary: women in combat and the risk of post-traumatic stress disorder and depression. Int J Epidemiol. 2007;36(2):327-329. http://dx.doi.org/10.1093/ije/dym013.Google Scholar
63. Palgi, Y, Ben-Ezra, M, Essar, N, et al. Acute stress symptoms, dissociation, and depression among rescue personnel 24 hours after the Bet-Yehoshua train crash in Israel:the effect of gender. Prehosp Disaster Med. 2009;24(5):433-437. http://dx.doi.org/10.1017/S1049023X00007275.Google Scholar
64. Adams, RE, Boscarino, JA, Galea, S. Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City. Am J Drug Alcohol Abuse. 2006;32(2):203-224. http://dx.doi.org/10.1080/00952990500479522.Google Scholar
65. McFarlane, AC. Long-term psychiatric morbidity after a natural disaster. Implications for disaster planners and emergency services. Med J Aust. 1986;145(11-12):561-563.Google Scholar
66. Galea, S, Resnick, H. Posttraumatic stress disorder in the general population after mass terrorist incidents: considerations about the nature of exposure. CNS Spectr. 2005;10(2):107-115.Google Scholar