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PLOS ONE  2012 

Psychological Distress, Depression, Anxiety, and Burnout among International Humanitarian Aid Workers: A Longitudinal Study

DOI: 10.1371/journal.pone.0044948

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Background International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors. Objectives To examine consequences of such experiences on aid workers' mental health and how the impact is influenced by moderating variables. Methodology We conducted a longitudinal study in a sample of international non-governmental organizations. Study outcomes included anxiety, depression, burnout, and life and job satisfaction. We performed bivariate regression analyses at three time points. We fitted generalized estimating equation multivariable regression models for the longitudinal analyses. Results Study participants from 19 NGOs were assessed at three time points: 212 participated at pre-deployment; 169 (80%) post-deployment; and 154 (73%) within 3–6 months after deployment. Prior to deployment, 12 (3.8%) participants reported anxiety symptoms, compared to 20 (11.8%) at post-deployment (p = 0·0027); 22 (10.4%) reported depression symptoms, compared to 33 (19.5%) at post-deployment (p = 0·0117) and 31 (20.1%) at follow-up (p = .00083). History of mental illness (adjusted odds ratio [AOR] 4.2; 95% confidence interval [CI] 1·45–12·50) contributed to an increased risk for anxiety. The experience of extraordinary stress was a contributor to increased risk for burnout depersonalization (AOR 1.5; 95% CI 1.17–1.83). Higher levels of chronic stress exposure during deployment were contributors to an increased risk for depression (AOR 1·1; 95% CI 1·02–1.20) comparing post- versus pre-deployment, and increased risk for burnout emotional exhaustion (AOR 1.1; 95% CI 1.04–1.19). Social support was associated with lower levels of depression (AOR 0·9; 95% CI 0·84–0·95), psychological distress (AOR = 0.9; [CI] 0.85–0.97), burnout lack of personal accomplishment (AOR 0·95; 95% CI 0·91–0·98), and greater life satisfaction (p = 0.0213). Conclusions When recruiting and preparing aid workers for deployment, organizations should consider history of mental illness and take steps to decrease chronic stressors, and strengthen social support networks.


[1]  Sheik M, Gutierrez MI, Bolton P, Spiegel P, Thieren M, et al. (2000) Deaths among humanitarian workers. BMJ 321: 166–168.
[2]  Lopes Cardozo B, Holtz T, Kaiser R, Gotway CA, Ghitis F, et al. (2005) Mental health of expatriate and Kosovar Albanian humanitarian aid workers. Disasters 29: 152–70.
[3]  Antares Foundation. Managing stress in humanitarian workers: guidelines for good practice. 2nd ed. Amsterdam, Netherlands: Antares Foundation, (2006). Available: 2011 Nov 29.
[4]  Lopes Cardozo B, Salama P (2001) Mental health of humanitarian aid workers in complex emergencies. In: Danieli Y, ed. Sharing the front line and the back hills: international protectors and providers: peacekeepers, humanitarian aid workers and the media in the midst of crisis. Amityville, NY: Baywood Publishing. pp. 242–255.
[5]  Eriksson CB, Vande Kemp H, Gorsuch R, Hoke S, Foy DW (2000) Trauma exposure and PTSD symptoms in international relief and development personnel. J Trauma Stress 14: 205–212.
[6]  Holtz TH, Salama P, Lopes Cardozo B, Gotway CA (2002) Mental health status of human rights workers, Kosovo, June 2000. J Trauma Stress 15: 385–395.
[7]  McCall M, Salama P (1999) Selection, training, and support of relief workers: an occupational health issue. BMJ 318: 113–116.
[8]  Thormar SB, Gersons BP, Juen B, Marschang A, Djakababa MN, et al. (2010) The mental health impact of volunteering in a disaster setting. J Nerv Ment Dis 198: 529–538.
[9]  Eriksson CB, Lopes Cardozo B, Foy DW, Sabin M, Ager A, et al.. (2012). Pre-deployment mental health and trauma exposure of expatriate humanitarian aid workers: Risk and resilience factors. Traumatology Published online before print?April 16, 2012.
[10]  Eriksson CB, Bjorck J, Abernethy A (2003) Occupational stress, trauma, and adjustment in expatriate humanitarian aid workers. In: Fawcett J, ed. Stress and trauma handbook: strategies for flourishing in demanding environments. Monrovia, CA: World Vision International. pp. 68–100.
[11]  Resnick HS (1996) Psychometric review of trauma assessment for adults (TAA). In: Stamm BH, ed. Measurement of stress, trauma, and adaptation. Lutherville, MD: Sidran Press.
[12]  Straus MA (1979) Measuring intrafamily conflict and violence: the conflict tactics (CT) scales. Journal of Marriage and the Family 41: 75–88.
[13]  Knutson J (1988) Physical and sexual abuse in children. In: Routh D, ed. Handbook of pediatric psychology. New York, NY: Guilford.
[14]  Cutrona CE (1989) Ratings of social support by adolescents and adult informants: degree of correspondence and prediction of depressive symptoms. J Pers Soc Psychol 57: 723–730.
[15]  Amirkhan JH (1994) Criterion validity of a coping measure. J Pers Assess 62: 242–261.
[16]  Centers for Disease Control and Prevention (CDC) (2010) Behavioral Risk Factor Surveillance System questionnaire 2000. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Available: Accessed, 2011 Nov 29.
[17]  Bliese PD, Halverson RR (1996) Individual and nomothetic models of job stress: an examination of work hours, cohesion, and well-being. J Appl Soc Psychol 26: 1171–1189.
[18]  Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19: 1–15.
[19]  Sandanger I, Moum T, Ingebrigtsen G, Sùrensen T, Dalgard OS, et al. (1999) The meaning and significance of caseness: the Hopkins Symptom. Checklist-25 and the Composite International Diagnostic Interview II. Soc Psychiatry Psychiatr Epidemiol 34: 53–59.
[20]  Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J (1987) Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry 144: 497–500.
[21]  Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52: 397–422.
[22]  Maslach C, Jackson SE (1996) Maslach burnout inventory–human services survey (MBI-HSS). In: Maslach C., Jackson SE, Leiter MP. Maslach burnout inventory manual 3rd ed. Palo Alto, CA: Consulting Psychologists Press, Inc.
[23]  Diener E, Emmons RA, Larsen RJ, Griffin S (1985) The satisfaction with life scale. J Pers Assess 49: 71–75.
[24]  Brayfield AH, Rothe HF (1951) An index of job satisfaction. J Appl Psychol 35: 307–311.
[25]  Coyne JC,?Benazon NR,?Gaba CG,?Calzone K,?Weber BL (2000) Distress and Psychiatric Morbidity Among Women From High-Risk Breast and Ovarian Cancer Families. J Consult Clin Psychol?68: 864–74.
[26]  Zeger SL, Liang KY (1986) Longitudinal data analysis using generalized linear models. Biometrics 42: 121–130.
[27]  Diggle PJ, Liang KY, Zeger SL (1994) Analysis of longitudinal data. Oxford, UK: Oxford University Press.
[28]  Ager A (1999) Psychology and humanitarian assistance. In J Hartley & A Branthwaite (eds) The Applied Psychologist (2nd edition). 226–243. Milton Keynes: OUP.
[29]  Ehrenreich JH (2001) Coping with disasters: a guidebook to psychosocial intervention. Rev ed. Old Westbury, NY: State University of New York. Available: Accessed 2011 Nov 29.
[30]  Goldberg R, Boss RW, Chan L, Goldberg J, Mallon WK, et al. (1996) Burnout and its correlates in emergency physicians: four years' experience with a wellness booth. Acad Emerg Med 3: 1156–1164.
[31]  Radostina KJ, Muros JP (2010) Gender differences in burnout: a meta-analysis. J Vocat Behav 77: 168–185.
[32]  Hackman JR, Oldham GR (1976) Motivation through the design of work: test of a theory. Organ Behav Hum Perform 16: 250–279.


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