Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;7(9):e44948.
doi: 10.1371/journal.pone.0044948. Epub 2012 Sep 12.

Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study

Barbara Lopes Cardozo  1 , Carol Gotway Crawford, Cynthia Eriksson, Julia Zhu, Miriam Sabin, Alastair Ager, David Foy, Leslie Snider, Willem Scholte, Reinhard Kaiser, Miranda Olff, Bas Rijnen, Winnifred Simon
Affiliations

Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study

Barbara Lopes Cardozo et al. PLoS One. 2012.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Mental Health Outcomes.
Mental health outcomes at pre-deployment (N = 212), post-deployment (N = 169), and follow-up (N = 154) 3–6 months after returning from assignment.
Figure 2
Figure 2. Burnout Outcomes.
Burnout outcomes at pre-deployment (N = 210 or 211), post-deployment (N = 169), and follow-up (N = 151 or 152) 3–6 months after returning from assignment.
See this image and copyright information in PMC

References

    1. Sheik M, Gutierrez MI, Bolton P, Spiegel P, Thieren M, et al. (2000) Deaths among humanitarian workers. BMJ 321: 166–168. - PMC - PubMed
    1. 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. - PubMed
    1. Antares Foundation. Managing stress in humanitarian workers: guidelines for good practice. 2nd ed. Amsterdam, Netherlands: Antares Foundation, (2006). Available: http://www.antaresfoundation.org/download/managing_stress_in_humanitaria....Accessed 2011 Nov 29.
    1. 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.
    1. 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.

Publication types