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A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders

  • Vamanjore Aboobaker Naushad (a1), Joost JLM Bierens (a2), Kunnummel Purayil Nishan (a1), Chirakkal Paramba Firjeeth (a1), Osama Hashim Mohammad (a1), Abdul Majeed Maliyakkal (a1), Sajid ChaliHadan (a1) and Merritt D. Schreiber (a3)...



Medical responders are at-risk of experiencing a wide range of negative psychological health conditions following a disaster.


Published literature was reviewed on the adverse psychological health outcomes in medical responders to various disasters and mass casualties in order to: (1) assess the psychological impact of disasters on medical responders; and (2) identify the possible risk factors associated with psychological impacts on medical responders.


A literature search of PubMed, Discovery Service, Science Direct, Google Scholar, and Cochrane databases for studies on the prevalence/risk factors of posttraumatic stress disorder (PTSD) and other mental disorders in medical responders of disasters and mass casualties was carried out using pre-determined keywords. Two reviewers screened the 3,545 abstracts and 28 full-length articles which were included for final review.


Depression and PTSD were the most studied outcomes in medical responders. Nurses reported higher levels of adverse outcomes than physicians. Lack of social support and communication, maladaptive coping, and lack of training were important risk factors for developing negative psychological outcomes across all types of disasters.


Disasters have significant adverse effects on the mental well-being of medical responders. The prevalence rates and presumptive risk factors varied among three different types of disasters. There are certain high-risk, vulnerable groups among medical responders, as well as certain risk factors for adverse psychological outcomes. Adapting preventive measures and mitigation strategies aimed at high-risk groups would be beneficial in decreasing negative outcomes.


Corresponding author

Correspondence: VA Naushad, MD, Department of General Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:


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1.Norris, FH. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol. 1992;60(3):409418.
2.Breslau, N, Davis, GC, Andreski, P, et al. Traumatic events and post-traumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry. 1991;48(3):216222.
3.Kessler, RC, Sonnega, A, Bromet, E, et al. Post-traumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):10481060.
4.Burkle, FM , Jr. Acute-phase mental health consequences of disasters: implications for triage and emergency medical services. Ann Emerg Med. 1996;28(2):119128.
5.Kessler, RC, Berglund, P, Delmer, O, et al. Life time prevalence and age-of-onset distributions of DSM-IV disorders in the national co morbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593602.
6.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):207239.
7.North, CS, Nixon, SJ, Shariat, S, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282(8):755762.
8.Erichsen, JE. On Concussion of the Spine: Nervous Shock and Other Obscure Injuries of the Nervous System in their Clinical and Medico-Legal Aspects. London, United Kingdom: Green and Company; 1882.
9.Myers, CS. Shell Shock in France 1914-1918. Cambridge, United Kingdom: Cambridge University Press; 1940.
10.Southard, EE. Shell-Shock and Other Neuropsychiatric Problems Presented in Five Hundred and Eighty-Nine Case Histories from the War Literature, 1914-1918. Boston, Massachusetts USA: WM Leonard, Publisher; 1919.
11.Kardiner, A. The Traumatic Neuroses of War (Psychosomatic Medicine Monographs 2-3). New York, New York USA: Paul B. Hoeber; 1941.
12.Kilpatrick, DG, Veronen, LJ, Resick, PA. Responses to rape: behavioral perspectives and treatment approaches. Scand J Behav Ther. 1977;6:8590.
13.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third edition. Washington, DC USA: American Psychiatric Association; 1980.
14.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. Washington, DC USA: American Psychiatric Association; 2014, 271274.
15.North, CS, Tivis, L, McMillen, JC, et al. Psychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. 2002;159(5):857859.
16.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):171175.
17.McFarlane, AC. The etiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychiatry. 1989;154:221228.
18.McFarlane, AC. The longitudinal course of posttraumatic morbidity. J Nerv Ment Dis. 1988;176(1):3039.
19.McFarlane, AC, Papay, P. Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. J Nerv Ment Dis. 1992;180(8):498504.
20.Spurrell, MT, McFarlane, AC. Post-traumatic stress disorder and coping after a natural disaster. Soc Psychiatry Psychiatr Epidemiol. 1993;28(4):194200.
21.Sims, A, Sims, D. The phenomenology of post-traumatic stress disorder. Psychopathology. 1998;31(2):96112.
22.Hull, AM, Alexander, DA, Klein, S. Survivors of the Piper Alpha oil platform disaster: long-term follow-up study. Br J Psychiatry. 2002;181(5):433438.
23.North, CS, Smith, EM, Spitznagel, EL. One-year follow-up of survivors of a mass shooting. Am J Psychiatry. 1997;154(4):16961702.
24.Tarabrina, NV, Lazebnaia, EO, Zelenova, ME. Psychological characteristics of post-traumatic stress states in workers dealing with the consequences of the Chernobyl accident. Journal of Russian & East European Psychology. 2001;39(3):2942.
25.Ursano, RJ, Fullerton, CS, Kao, T, et al. Longitudinal assessment of posttraumatic stress disorder and depression after exposure to traumatic death. J Nerv Ment Dis. 1995;183(1):3642.
26.Ersland, S, Weisaeth, L, Sund, A. The stress upon rescuers involved in an oil rig disaster “Alexander L. Kielland” 1980. Acta Psychiatr Scand. 1989;355:3849.
27.Hagstrom, R. The acute psychological impact on survivors following a train accident. J Trauma Stress. 1995;8(3):391402.
28.Mitchell, TL, Griffin, K, Stewart, SH, et al. “We will never ever forget…:” The Swissair Flight 111 disaster and its impact on volunteers and communities. J Health Psychol. 2004;9(2):245262.
29.Stewart, SH, Mitchell, TL, Wright, KD, et al. The relations of PTSD symptoms to alcohol use and coping drinking in volunteers who responded to the Swiss air Flight 111 airline disaster. J Anxiety Disord. 2004;18(1):5168.
30.Gillespie, GL, Bresler, S, Gates, DM, et al. Post-traumatic stress symptomatology among emergency department workers following workplace aggression. Workplace Health Saf. 2013;61(6):247254.
31.Halpern, J, Maunder, RG, Schwartz, B, et al. Identifying, describing, and expressing emotions after critical incidents in paramedics. J Trauma Stress. 2012;25(1):111114.
32.Lavoie, S, Talbot, LR, Mathieu, L, et al. An exploration of factors associated with post-traumatic stress in ER nurses. J Nurs Manag. 2016;24(2):174183.
33.Adriaenssens, J, de Gucht, V, Maes, S. The impact of traumatic events on emergency room nurses: findings from a questionnaire survey. Int J Nurs Stud. 2012;49(11):14111422.
34.Elvira, D, Dana, Rutledge et al. Prevalence of secondary traumatic stress among emergency nurses. J Emerg Nurs. 2009;35(3):199204.
35.Hooper, C, Craig, J, David, R, et al. Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected in-patient specialties. J Emerg Nurs. 2010;36(5):420427.
36.Jonsson, A, Halabi, J. Work related post-traumatic stress as described by Jordanian emergency nurses. Accid Emerg Nurs. 2006;14(2):8996.
37.Lavoie, S, Talbot, LR, Mathieu, L. Post-traumatic stress disorder symptoms among emergency nurses: their perspective and a 'tailor-made’ solution. J Adv Nurs. 2011;67(7):15141522.
38.Gallagher, S, McGilloway, S. Living in critical times: the impact of critical incidents on frontline ambulance personnel--a qualitative perspective. Int J Emerg Ment Health. 2007;9(3):215223.
39.Khashaba, EO, El-Sherif, MA, Ibrahim, AA, Neatmatallah, MA. Work-related psychosocial hazards among emergency medical responders (EMRs) in Mansoura City. Indian J Community Med. 2014;39(2):103110.
40.Lazarus, A. Traumatized by practice: PTSD in physicians. J Med Pract Manage. 2014;30(2):131134.
41.Mills, LD, Mills, TJ. Symptoms of post-traumatic stress disorder among emergency medicine residents. J Emerg Med. 2005;28(1):14.
42.Pajonk, FG, Cransac, P, Muller, V, et al. Trauma and stress-related disorders in German emergency physicians: the predictive role of personality factors. Int J Emerg Ment Health. 2012;14(4):257268.
43.Somville, FJ, De Gucht, V, Maes, S. The impact of occupational hazards and traumatic events among Belgian emergency physicians. Scand J Trauma Resusc Emerg Med. 2016;24:59.
44.Carmassi, C, Gesi, C, Simoncini, M, et al. DSM-5 PTSD and posttraumatic stress spectrum in Italian emergency personnel: correlations with work and social adjustment. Neuropsychiatr Dis Treat. 2016;12:375381.
45.Joseph, B, Pandit, V, Hadeed, G, et al. Unveiling posttraumatic stress disorder in trauma surgeons: a national survey. J Trauma Acute Care Surg. 2014;77(1):148154.
46.Zafar, W, Khan, UR, Siddiqui, S, et al. Workplace violence and self-reported psychological health: coping with posttraumatic stress, mental distress, and burnout among physicians working in the emergency departments compared to other specialties in Pakistan. J Emerg Med. 2016;50(1):167177.
47.Kang, P, Yipeng, LV, Hao, Lu, et al. Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: a neglected problem. Psychiatric Research. 2015;230(2):517523.
48.De Soir, E, Knarren, M, Zech, E, et al. phenomenological analysis of disaster-related experiences in fire and emergency medical services personnel. Prehosp Disaster Med. 2012;27(2):115122.
49.Turner, SW, Thompson, J, Rosser, RM. The Kings Cross fire: psychological reactions. J Trauma Stress. 1995;8(3):419427.
50.Sloan, P, Rozensky, RH, Kaplan, L, et al. A shooting incident in an elementary school: effects of worker stress on public safety, mental health, and medical personnel. J Trauma Stress. 1994;7(4):565574.
51.Epstein, RS, Fullerton, CS, Ursano, RJ. Posttraumatic stress disorder following an air disaster: a prospective study. Am J Psychiatry. 1998;155(7):934938.
52.Weiss, DS, Marmar, CR, Metzler, TJ, et al. Predicting symptomatic distress in emergency services personnel. J Consult Clin Psychol. 1995;63(3):361368.
53.Luce, A, Firth-Cozens, J, Midgley, S, et al. After the Omagh bomb: posttraumatic stress disorder in health service staff. J Trauma Stress. 2002;15(1):2730.
54.Armenian, HK, Morikawa, M, Melkonian, AK, et al. Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy. Acta Psychiatr Scand. 2000;102(1):5864.
55.McCarroll, JE, Fullerton, CS, Ursano, RJ, et al. Posttraumatic stress symptoms following forensic dental identification: Mt. Carmel, Waco, Texas. Am J Psychiatry. 1996;153(6):778782.
56.Lesaca, T. Symptoms of stress disorder and depression among trauma counselors after an airline disaster. Psychiatr Serv. 1996;47(4):424426.
57.Chong, MY, Wang, WC, Hsieh, WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. British J of Psychiatry. 2004:185:127133.
58.Maunder, RG, Lancee, WJ, Balderson, KE, et al. Long term psychological and occupational effects of providing hospital health care during SARS outbreak. Emerg Infect Dis. 2006;12(12):19241932.
59.Nickell, LA, Crighton, EJ, Tracy, C, et al. Psychological effects of SARS on hospital staff: survey of a large tertiary care institution. JAMC. 2004;170(5):793798.
60.Chua, SE, Cheung, V, Cheung, C, et al. Psychological effects of SARS outbreak in Hong Kong on high risk health care workers. Can J Psychiatry. 2004;49(6):391393.
61.McAlonan, GM, Lee, AM, Cheung, V, et al. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry. 2007;52(4):241247.
62.YaMei, , Chao-Cheng, , Chih-Yuan, , et al. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatry Services. 2004;55(9):10551057.
63.Chan, AO, Huak, CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med. 2003;54(3):190196.
64.Poon, E, Liu, KS, Cheong, DL, et al. Impact of severe acute respiratory syndrome on anxiety levels of front-line health workers. Hong Kong Med J. 2004;5:325330.
65.Wong, TW, Yau, JKY, Chan, CLW, et al. Psychological impact of severe acute respiratory syndrome outbreak on health care workers in an emergency department and how they cope. Europ J of Emerg Med. 2005;12(1):1318.
66.Lancee, WJ, Maunder, RG, Goldbloom, DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after SARS outbreak. Psychiatry Services. 2008;59(1):9195.
67.Tham, KY, Tan, YH, Loh, OH, et al. Psychological morbidity among emergency department doctors and nurses after the SAS outbreak. Hong Kong J of Emerg Med. 2005;12(4):215223.
68.Lin, CY, Peng, YC, Wu, YH, et al. The psychological effect of severe acute respiratory syndrome on emergency staff. Emerg Med J. 2007;24(1):1217.
69.Cheng-Sheng, C, Hslu-Yueh, W, Yang, Pinchen, et al. The psychological distress of nurses in Taiwan who worked during the outbreak of SARS. Psychiat Serv. 2005;56(1):7679.
70.Pnagiota, G, Christos, M, Danai, D, et al. General hospital staff worries, perceived sufficiency of information and associated psychological distress during the A/H1N1 influenza pandemic. BMC Infect Dis. 2010;10:322.
71.Mohammaed, AG, Turki, A, Abdulla, A, et al. Perception and attitude of emergency room resident physicians toward Middle East Respiratory Syndrome outbreak. Emerg Med Int. 2017;2017:6978256.
72.Sakuma, A, Takahashi, Y, Ueda, I, et al. Post-traumatic stress disorder and depression prevalence and associated risk factors among local disaster relief and reconstruction workers fourteen months after the Great East Japan Earthquake. A cross-sectional study. BMC Psychiatry. 2015;15:58.
73.Erol, A, Zulfi, E, Ali, OD, et al. Frequency of posttraumatic stress disorder among relief force workers after the Tsunami in Asia: do rescuers become victims? Prehosp Disaster Med. 2006;21(3):168172.
74.Kang, P, Lv, Y, Hao, L, et al. Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake. A neglected problem. Psychiatry Res. 2015;230(2):517523.
75.Battles, ED. An exploration of post-traumatic stress disorder in emergency nurses following Hurricane Katrina. J Emerg Nurs. 2007;33(4):314318.
76.Velden, PGV, Kleber, RJ, Koenen, KC. Smoking predicts posttraumatic stress symptoms among rescue workers: a prospective study of ambulance personnel involved in the Enschede Fireworks Disaster. Drug Alcohol Depend. 2008;94(1-3):267271.
77.Misra, M, Greenberg, N, Hutchinson, C, et al. Psychological impact upon London Ambulance Service of the 2005 bombings. Occup Med. 2009;59(6):428433.
78.Skogstad, L, Fjetland, AM, Ekeberg, O. Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 ‐ a cross‐sectional study. Scand J Trauma Resusc Emerg Med. 2015;23:23.
79.Bashir, Alhajjar. Gaza nurses after war: are they traumatized? Procedia – Social and Behavioral Sciences. 2014:114:802809.
80.Abu-El-Noor, NI, Aljeesh, YI, Radwan, AS, et al. Post traumatic, stress disorder among health care providers following the Israeli attacks against Gaza Strip in 2014: a call for immediate policy actions. Arch Psychiatr Nurs. 2016;30(2):185191.
81.Lubin, G, Sids, C, Vishne, T, et al. Acute stress disorder and posttraumatic stress disorder among medical personnel in Judea and Samaria Areas in the years 2000-2003. Mil Med. 2007;172(4):376378.
82.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):13851394
83.Webber, MP, Glaser, MS, Weakley, J, et al. Physician diagnosed respiratory conditions seven to nine years following the world trade center disaster. Am J Industrial Medicine. 2011;54(9)
84.Yip, J, Zeig-Owens, R, Webber, MP, et al. World trade center–related physical and mental health burden among New York fire department emergency medical service workers. Occup Environ Med. 2015;73(1):1320.
85.Brewin, CR, Rose, S, Andrews, B, et al. Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry. 2002;181:158162.
86.Blevins, CA, Weathers, FW, Davis, MT, et al. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489498.
87.Blake, DD, Weathers, FW, Nagy, LM, et al. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8(1);7590.
88.Lovibond, SH, Lovibond, PF. Manual for the Depression Anxiety Stress Scales (DASS). New South Wales, Australia: Psychology Foundation Monograph; 1995.
89.Goldberg, D. Manual of the General Health Questionnaire. Windsor: NFER, Nelson Publishing Co; 1978.
90.Cheng, TA, Williams, P. The design and development of a screening questionnaire for use in community studies of mental disorders in Taiwan. Psycholog Med. 1986;16(2):415422.
91.Kroenke, K, Spitzer, RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals. 2002;32(9):509515.
92.Greenberg, N, Cawkill, P, March, C, et al. How to TRiM away at posttraumatic stress reactions: traumatic risk management-now and the future. J R Nev Med Serv. 2005;91(1):2631.


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A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders

  • Vamanjore Aboobaker Naushad (a1), Joost JLM Bierens (a2), Kunnummel Purayil Nishan (a1), Chirakkal Paramba Firjeeth (a1), Osama Hashim Mohammad (a1), Abdul Majeed Maliyakkal (a1), Sajid ChaliHadan (a1) and Merritt D. Schreiber (a3)...


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