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Running head: LITERATURE REVIEW
1
Psychological Impact after Disaster on Healthcare Providers
Saleh Alamri
Thomas Jefferson University
LITERATURE REVIEW
2
Psychological Impact after Disaster on Healthcare Providers
The impact of natural disasters on healthcare providers can be overwhelming, but the
research into the number of first-responders in the sector that seek professional help after facing
these adverse natural or human-made incidents is unexplored. Aside from this lack of
information on the percentage of healthcare providers that undergo post-disaster counseling or
trauma management, researchers are concerned about the effectiveness of the psychological
evaluations in the reduction of stress levels in this category of workers. Also, the interest of
researchers in post-disaster management psychology is in the number of these providers who
develop mental illnesses after being exposed to disaster, as part of the efforts to provide solutions
to the psychological issues for these affected people. In the present review of the literature, the
goal is to examine previous and current studies on the psychological impact of disaster on
healthcare providers as a means to contribute to the expansion of the body of knowledge on the
topic. Finally, the comparative review of the various dimensions of the subject from the
outcomes of previous research findings will provide the framework that can be used to develop
the methods that researchers can utilize for understanding the mental effect of disasters on
healthcare providers.
How many healthcare providers seek professional help after facing a disaster?
Healthcare providers are exposed to a series of traumatic experiences during and after a
disaster, which increases that potential to develop mental health issues that would require
professional interventions. In addition, this category of first responders treats injuries and
prevents deaths under extreme conditions that make their psychological status essential for
achieving these objectives, especially when the health practitioner feels obligated to help people
overcome the impacts of these negative experiences (Dückers et al., 2018). In spite of their
LITERATURE REVIEW
3
emphasis on encouraging survivors of human-made or natural disasters to seek counseling or
gain support from their network of support, the findings from the literature showed a significant
percentage of healthcare providers not seeking help after a disaster. According to Carlton (2017),
the results of his study on the state of mental disorder symptoms among public health
professionals showed that over 50% of healthcare providers are unwilling to seek help for their
mental illnesses despite its high prevalence in the sector due to fear of job loss or stigmatization
by their colleagues. Macfarlane and Williams (2012) affirmed this perspective when the scholars
noted that exaggerated personal hardiness and the shame of seeking help with mental health
issues are some of the leading factors that are responsible for the high number of practitioners
that use avoidance as the approach for dealing with psychological effects. Therefore,
interventions for healthcare providers regarding their management of the psychological impact of
exposure to disasters should recognize these factors during the assessment of the disorder by
other relevant stakeholders.
The Incidence of Mental Illnesses among Healthcare Providers
The potential of healthcare providers to develop mental illnesses after their exposure to a
disaster is another dimension of the psychological impact of tragic incidents that have been
studied by researchers. In this regard, the investigation conducted by Iranmanesh (2013) on the
incidence of post-traumatic stress disorder among emergency medical personnel is relevant.
According to the scholars, the 94 percent of the participants of the study displayed the symptoms
of PTSD, which is a result that confirmed some of the findings of other scholars in various
studies. Similarly, Ringstad et al. (2017) posited that the psychological health status of healthcare
providers that work in emergency services is characterized by the high prevalence and incidence
of stress, depression, and anxiety disorders. Also, the investigation into the adverse mental
LITERATURE REVIEW
4
effects of disasters on healthcare professionals in developing countries showed that these
conditions exist for long periods in these individuals because of the lack of emphasis on testing
and evaluation of the professionals. Thus, the extent of the mental health issues that health care
providers face after their exposure to the traumatic experiences from the adverse incidents should
be studied as input to the development of policy-based interventions that are needed to reduce
the level of the problem.
In spite of the high incidence and prevalence rates of mental health disorders among
healthcare providers who deliver emergency medical services in different parts of the world, the
availability of organizational support is low. The outcome of a cross-sectional survey by Petrie et
al. (2018) provided evidence of this aspect of the problem when it showed that modifiable risk
factors such as work environments play a significant role in the development of mental illness in
this category of first responders. Although only 7.6% of the study participants were diagnosed
with one form of mental illnesses or the other, this result highlighted the importance of
implementing interventions recognizes the risk factors for mental illnesses among healthcare
providers in emergency services but constitute an integral component of the organizational
processes and procedures that deal with the problem. An additional evidence of the perspective
on the evaluation of the mental health status of health care providers in emergency services can
be found in the outcome of a study that was conducted by Rabiei, Nakhaee, and Pourhosseini
(2014) on the shortcomings in the approaches that are used for dealing with the psychological
effects of natural disasters. According to the scholars, the improper handling of the adverse
psychological impacts of disasters is due to weaknesses in organizational communication,
inadequate support for responders after the incident and non-recognition for the specific issues
that the group faces both in the short and long-term perspectives.
LITERATURE REVIEW
5
Psychological Evaluations and Management of Post-disaster Stress Levels
The traumatic experiences that are associated with disasters have the potential of
increasing the stress levels of healthcare and make the development and administration of
intervention critically. Austin, Pathak, and Thompson (2018) reported that psychological
evaluation is one of the coping resources that emergency medical service personnel can utilize
for dealing with the negative experiences from a disaster. They further found from their studies
that this type of intervention is considered as one of the most effective methods for increasing the
resilience of healthcare providers to anxiety, stress, depression, and post-traumatic stress disorder
(PTSD). Although the coping mechanisms for stress by people are different depending on their
history of exposure to these negative situations, studies showed that healthcare organizations
with psychological evaluation programs have employees that perform better than their
counterparts that do not provide this intervention (Ringstad et al. 2017). According to alpern,
Maunder, Schwartz, and Gurevich (2014), psychological evaluations consist of psychoeducational programs that teach healthcare providers and survivors the methods for dealing with
the mental health challenges from their experiences. The scholars claimed that their investigation
showed that organizations that allow downtime or the professional to narrate and discuss their
traumatic experiences displayed lower levels of depressive symptoms after the adverse events.
Consequently, the provision of psychological evaluation in the workplace after either natural or
human-made disasters is required to intervene the stressors that lead to mental health issues.
Furthermore, the evidence from the literature on the value of psychological evaluation to
the stress management approaches for healthcare providers in emergency services showed that it
has long-term effects when combined with other therapeutic techniques. According to Halpern et
al. (2014), organizations that have mandatory psychological evaluations in the form of the
LITERATURE REVIEW
6
downtimes for their health responders to a disaster and allows their employees to seek
professional help for at least six months recorded no residual effects of the adverse event. Martin
(2015) corroborated this perspective when the scholar claiming that the provision of
psychological evaluation is inexpensive but effective for stress reduction when consideration is
given to the number of tragic incidents that health providers handle. Therefore, the use of
psychological assessment methods such as downtime should be increased by health care
organizations since it contributes to stress reduction and maintenance of the mental health
wellbeing of the emergency medical services professionals.
Conclusion
I hypothesize that a significant percentage of healthcare providers fail to seek professional help
after exposure to the traumatic experiences forms a natural disaster because of the fear of job loss
and stigmatization by the organization. Also, the evidence from the review of the literature
showed that while psychological evaluations are one of the effective interventions for reducing
the stress levels in health care providers, the failure to seek help is preventing this category of
emergency services workers to undergo them. An additional outcome of the review of the
literature is how downtime can be used by organizations to reduce the adverse consequence of
anxiety, depression, and PTSD on the performance of their employers through these mental
evaluations. Similarly, the need to understand the number of emergency medical service
professionals who develop mental illnesses after exposure to a disaster from the literature was
accomplished through the discovery of the high prevalence and incidence levels of disorders
among these health care providers. Finally, the implications of the outcome of this review
include the extension of the body of knowledge on the subject, the development of policy-based
LITERATURE REVIEW
7
measures for the interventions, and the increased adoption of the use of psychological evaluation
techniques such as the downtime for stress management.
LITERATURE REVIEW
8
References
Austin, C. L., Pathak, M., & Thompson, S. (2018). Secondary traumatic stress and resilience
among EMS. Journal of Paramedic Practice, 10(6), 240-247.
doi:10.12968/jpar.2018.10.6.240
Carleton, R. N et al. (2017). Mental disorder symptoms among public health professional in
Canada. The Canadian Journal of Psychiatry, 63(1), 54-64.
Dückers, M. L., Thormar, S. B., Juen, B., Ajdukovic, D., Newlove-Eriksson, L., & Olff, M.
(2018). Measuring and modelling the quality of 40 post-disaster mental health and
psychosocial support programmes. PloS one, 13(2), e0193285.
Halpern, J., Maunder, R. G., Schwartz, B., & Gurevich, M. (2014). Downtime after Critical
Incidents in Emergency Medical Technicians/Paramedics. BioMed Research
International, 2014, 1-7. doi:10.1155/2014/483140
Iranmanesh, S. (2013). Post-traumatic stress disorder among paramedic and hospital emergency
personnel in south-east Iran. World Journal of Emergency Medicine, 4(1), 26.
doi:10.5847/wjem.j.issn.1920-8642.2013.01.005
Martin, U. (2015). Health after disaster: A perspective of psychological/health reactions to
disaster. Cogent Psychology, 2(1), 1053741. Retrieved from
https://doi.org/10.1080/23311908.2015.1053741
McFarlane, A. C., & Williams, R. (2012). Mental health services required after disasters:
Learning from the lasting effects of disasters. Depression Research and Treatment, 2012.
Retrieved from doi:10.1155/2012/970194
LITERATURE REVIEW
9
Petrie, K., Gayed, A., Bryan, B. T., Deady, M., Madan, I., Savic, A., … Harvey, S. B. (2018).
The importance of manager support for the mental health and well-being of ambulance
personnel. PLOS ONE, 13(5), e0197802. doi:10.1371/journal.pone.0197802
Rabiei, A., Nakhaee, N., & Pourhosseini, S. S. (2014). Shortcomings in dealing with
psychological effects of natural disasters in Iran. Iranian Journal of Public Health, 43(8),
1132. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411910/
Ringstad, K., San, C. C., Than, M., Win, T., Oo, K. T., Khaing, K., … & Aye, H. K. (2017).
Understanding the psychological impacts of disasters on first responders and health care
professionals in Magway, Myanmar. Prehospital and Disaster Medicine, 32(S1), S186S186. Retrieved from https://doi.org/10.1017/S1049023X17004939
Canadian
Psychiatric Association
Association des psychiatres
du Canada
Original Research
Mental Disorder Symptoms among Public
Safety Personnel in Canada
The Canadian Journal of Psychiatry /
La Revue Canadienne de Psychiatrie
2018, Vol. 63(1) 54-64
ª The Author(s) 2017
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0706743717723825
TheCJP.ca | LaRCP.ca
Symptômes de trouble mental chez le personnel de la sécurité
publique du Canada
R. Nicholas Carleton, PhD1, Tracie O. Afifi, PhD2, Sarah Turner, MSc2,
Tamara Taillieu, MSc2, Sophie Duranceau, MA3, Daniel M. LeBouthillier, MA3,
Jitender Sareen, PhD2, Rose Ricciardelli, PhD4, Renee S. MacPhee, PhD5,
Dianne Groll, PhD6, Kadie Hozempa, BA3, Alain Brunet, PhD7,
John R. Weekes, PhD8, Curt T. Griffiths, PhD9, Kelly J. Abrams, PhD10,
Nicholas A. Jones, PhD3, Shadi Beshai, PhD3, Heidi A. Cramm, PhD6,
Keith S. Dobson, PhD11, Simon Hatcher, PhD12, Terence M. Keane, PhD13,
Sherry H. Stewart, PhD14, and Gordon J. G. Asmundson, PhD3
Abstract
Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police
officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of
developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of
mental disorder symptom frequencies and severities for Canadian PSP.
Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey
assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were
derived using well-validated screening measures.
Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/
dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police).
Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental
disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure.
1
Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
University of Manitoba, Winnipeg, Manitoba, Canada
3
University of Regina, Regina, Saskatchewan, Canada
4
Memorial University of Newfoundland, Saint John’s, Newfoundland and Labrador, Canada
5
Wilfrid Laurier University, Waterloo, Ontario, Canada
6
Queen’s University, Kington, Ontario, Canada
7
Douglas Hospital, Verdun, Quebec, Canada
8
Correctional Service of Canada, Ottawa, Ontario, Canada
9
Simon Fraser University, Burnaby, British Columbia, Canada
10
Canadian Health Information Management Association, Regina, Canada
11
University of Calgary, Calgary, Alberta, Canada
12
University of Ottawa, Ottawa, Ontario, Canada
13
National Center for Post Traumatic Stress Disorder, White River Junction, Vermont, USA
14
Dalhousie University, Halifax, Nova Scotia, Canada
2
Corresponding Author:
R. Nicholas Carleton, PhD, Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada.
Email: [email protected]
La Revue Canadienne de Psychiatrie 63(1)
55
Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible
because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous
difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.
Abrégé
Contexte : Le personnel de la sécurité publique (PSP) canadien (p. ex., les travailleurs des services correctionnels, les
répartiteurs, les pompiers, les ambulanciers, les officiers de police) sont exposés à des événements possiblement traumatisants
dans le cadre de leur travail. Ces expositions contribuent au risque de développer des symptômes cliniquement significatifs liés
à des troubles mentaux. La présente étude a été conçue pour offrir des estimations de la fréquence et de la gravité des
symptômes de trouble mental pour le PSP canadien.
Méthodes : Un sondage en ligne a été offert en anglais et en français de septembre 2016 à janvier 2017. Le sondage estimait
les symptômes actuels, et la participation a été sollicitée dans les agences nationales de PSP et les groupes de défense
d’intérêts. Les estimations ont été obtenues à l’aide de mesures de dépistage bien validées.
Résultats : Il y a eu 5813 participants (32,5 % de femmes) qui ont été regroupés en 6 catégories (p. ex., opérateurs/répartiteurs
de centres d’appels, travailleurs de services correctionnels, pompiers, police municipale/provinciale, ambulanciers, Gendarmerie
royale du Canada). Des proportions substantielles de participants ont déclaré des symptômes actuels compatibles avec un
(c.-à-d., 15,1 %) trouble mental ou plus (c.-à-d., 26,7 %) selon les mesures de dépistage. Il y avait des différences significatives entre
les catégories de PSP relativement aux proportions positives au dépistage, selon chaque mesure.
Interprétation : La proportion estimée de PSP déclarant des groupes de symptômes actuels compatibles avec un trouble
mental ou plus semble plus élevée que les estimations publiées précédemment pour la population générale; toutefois, les
comparaisons directes sont impossibles en raison des différences méthodologiques. Les données disponibles suggèrent que le
PSP canadien éprouve des difficultés de santé mentale substantielles et hétérogènes, et elles soulignent le besoin d’une étude
épidémiologique rigoureuse ainsi que des solutions propres à chaque catégorie.
Keywords
mental disorders, first responders, public safety personnel, operational stress injuries, posttraumatic stress disorder
Canadian public safety personnel (PSP) include, but are not
limited to, correctional workers (security and nonsecurity
roles), dispatchers, firefighters, paramedics, and police officers.1 Regular exposure to potentially traumatic events such
as exposure to threatened or actual physical assaults, fires, or
explosions2 is expected for PSP employment.3,4 Such exposures have been associated with increased risk for the development of mental disorders, including posttraumatic stress
disorder (PTSD),2 major depressive disorder (MDD),5 panic
disorder (PD), generalized anxiety disorder (GAD), and
social anxiety disorder (SAD), as well as vulnerability for
an alcohol use disorder (AUD).6,7 In Canada, mental health
di …
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