Psychological Outcomes in Disaster Responders: A Systematic Review and Meta-Analysis on the Effect of Social Support

Abstract

Disaster response work is associated with various psychological outcomes. In post-disaster conditions, social support is generally observed to impact mental health, particularly for survivors. This review was conducted to survey the extent of social support effectiveness on disaster responder groups. Published quantitative social support studies on police, emergency medical responders, rescue and recovery workers, firefighters, and military responders were searched in various academic databases using keyword searches, a reference list search, and a citation search that resulted in 24 studies with 90 effect sizes being included in the final data base. Articles were coded and effect sizes were averaged using the Hedges–Vevea Random Effects model. Nineteen categories of psychological outcomes (for example, anxiety, depression, posttraumatic stress symptoms, and psychological distress) and eight classifications of support were coded. Social support was found to be associated with anxiety, burnout, depression, job control, job satisfaction, psychological distress, turnover intentions, and work engagement, with mean effect sizes from − 0.36 to 0.57. Most studies measured perceived social support and negative outcomes. Social support correlated with outcomes in police responders and rescue and recovery workers. This review discusses the breadth of effect of social support, as well as other elements, such as temporal factors, that may affect the effectiveness of social support in disaster responders.

Keywords

Disaster responders / Meta-analysis / Post-disaster psychological outcomes / Psychological distress / Social support

References

[1] Alvarez J, Hunt M. Risk and resilience in canine search and rescue handlers after 9/11. Journal of Traumatic Stress, 2005, 18(5): 497-505

[2] Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 1998, 10(2): 176-181

[3] Ask E, Gudmundsdottir D. A longitudinal study of posttraumatic stress symptoms and their predictors in rescue workers after a firework factory disaster. International Journal of Emergency Mental Health, 2014, 16(2): 316-321

[4] Bacharach SB, Bamberger PA. 9/11 and New York City firefighters’ post hoc unit support and control climates: A context theory of the consequences of involvement in traumatic work-related events. Academy of Management Journal, 2007, 50(4): 849-868

[5] Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 1988, 56(6): 893-897

[6] Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio, 1996, 78(2): 490-498.

[7] Benedek DM, Fullerton CS, Ursano RJ. First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health, 2007, 28: 55-68

[8] Biggs A, Brough P, Barbour JP. Exposure to extraorganizational stressors: Impact on mental health and organizational perceptions for police officers. International Journal of Stress Management, 2014, 21(3): 255-282

[9] Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM. The development of a clinician-administered PTSD scale. Journal of Traumatic Stresss, 1995, 8(1): 75-90

[10] Bonanno GA, Brewin CR, Kaniasty K, Greca AML. Weighing the costs of disaster: Consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest, 2010, 11(1): 1-49

[11] Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 2000, 68(5): 748-766

[12] Bromet EJ, Hobbs MJ, Clouston SAP, Gonzalez A, Kotov R, Luft BJ. DSM-IV post-traumatic stress disorder among World Trade Center responders 11–13 years after the disaster of 11 September 2001 (9/11). Psychological Medicine, 2016, 46(4): 771-783

[13] Brough P, Frame R. Predicting police job satisfaction and turnover intentions: The role of social support and police organisational variables. New Zealand Journal of Psychology, 2004, 33(1): 8-18.

[14] Caplan RD, Cobb S, French JRP Jr Harrison RV, Pinneau SR Jr Job demands and worker health: Main effects and occupational differences, 1980, Ann Arbor, MI: Institute for Social Research

[15] Carver CS. You want to measure coping but your protocol’s too long: Consider the brief cope. International Journal of Behavioral Medicine, 1997, 4(1): 92-100

[16] Chang CM, Lee LC, Connor KM, Davidson JRT, Lai TJ. Modification effects of coping on post-traumatic morbidity among earthquake rescuers. Psychiatry Research, 2008, 158(2): 164-171

[17] Chang K, Taormina RJ. Reduced secondary trauma among Chinese earthquake rescuers: A test of correlates and life indicators. Journal of Loss and Trauma, 2011, 16(6): 542-562

[18] Chen JM, Kim HS, Mojaverian T, Morling B. Culture and social support provision: Who gives what and why. Personality and Social Psychology Bulletin, 2012, 38(1): 3-13

[19] Cheng TA, Williams P. The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan. Psychological Medicine, 1986, 16(2): 415-422

[20] Cohen S, Gottlieb BH, Underwood LG. Cohen S, Underwood LG, Gottlieb BH. Social relationships and health. Social support measurement and intervention: A guide for health and social scientists, 2000, New York: Oxford University Press 3-25

[21] Cohen S, Mermelstein R, Karmarck T, Hoberman HM. Sarason IG, Sarason BR. Measuring the functional components of social support. Social support: Theory, research and application, 1985, The Hague, The Netherlands: Martinus Nijhoff 73-94

[22] Cone JE, Li J, Kornblith E, Gocheva V, Stellman SD, Shaikh A, Schwarzer R, Bowler RM. Chronic probable PTSD in police responders in the World Trade Center health registry ten to eleven years after 9/11. American Journal of Industrial Medicine, 2015, 58(5): 483-493

[23] Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety, 2003, 18(2): 76-82

[24] Curtona CE, Russell DW. Sarason IG, Pierce GR. Type of social support and specific stress: Toward a theory of optimal matching. Social support: An interactional view, 1990, Oxford: John Wiley 319-366.

[25] de Terte I, Stephens C, Huddleston L. The development of a three part model of psychological resilience. Stress and Health, 2014, 30(5): 416-424

[26] Derogatis LR, Cleary PA. Factorial invariance across genderfor the primary symptom dimensions of the SCL-90. British Journal of Clinical Psychology, 1977, 16(4): 347-356

[27] Derogatis LR, Spencer PM. Brief symptom inventory (BSI), 1993, Upper Saddle River, NJ: Pearson

[28] Diener ED, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. Journal of Personality Assessment, 1985, 49(1): 71-75

[29] Dougall AL, Hyman KB, Hayward MC, McFeeley S, Baum A. Optimism and traumatic stress: The importance of social support and coping. Journal of Applied Social Psychology, 2001, 31(2): 223-245

[30] Ehring T, Razik S, Emmelkamp PMG. Prevalence and predictors of posttraumatic stress disorder, anxiety, depression, and burnout in Pakistani earthquake recovery workers. Psychiatry Research, 2011, 185(1–2): 161-166

[31] Feder A, Mota N, Salim R, Rodriguez J, Singh R, Schaffer J, Schechter CB, Cancelmo LM Risk, coping and PTSD symptom trajectories in World Trade Center responders. Journal of Psychiatric Research, 2016, 82: 68-79

[32] Field AP, Gillett R. How to do a meta-analysis. British Journal of Mathematical and Statistical Psychology, 2010, 63(3): 665-694

[33] Fleming R, Baum A, Gisriel MM, Gatchel RJ. Mediating influences of social support on stress at Three Mile Island. Journal of Human Stress, 1982, 8(3): 14-23

[34] Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 1993, 56(4): 459-473

[35] Folkman S, Lazarus RS. Ways of coping questionnaire, 1988, Washington, DC: Consulting Psychologists Press

[36] Fullerton CS, McKibben JBA, Reissman DB, Scharf T, Kowalski-Trakofler KM, Shultz JM, Ursano RJ. Posttraumatic stress disorder, depression, and alcohol and tobacco use in public health workers after the 2004 Florida hurricanes. Disaster Medicine and Public Health Preparedness, 2013, 7(1): 89-95

[37] Fullerton S, Ursano RJ, Liu X, McKibben JBA, Wang L, Reissman DB. Depressive symptom severity and community collective efficacy following the 2004 Florida hurricanes. PloS One, 2015, 10(6): e0130863

[38] Gardner, R.C. 2010. Research design—Topic 10: Multiple regression and multiple correlation. http://publish.uwo.ca/~gardner/DataAnalysisDotCalm/Lectures2010/TOPIC10c.pdf. Accessed 24 May 2018.

[39] Goldberg P. The detection of psychiatric illness by questionnaire: A technique for the identification and assessment of non-psychotic illness, 1972, Oxford: Oxford University Press

[40] Goldmann E, Galea S. Mental health consequences of disasters. Annual Review of Public Health, 2014, 35: 169-183

[41] Guha-Sapir D, Hoyois P, Wallemacq P, Below R. Annual disaster statistical review 2016: The numbers and trends, 2016, Brussels: CRED

[42] Halbesleben JRB. Sources of social support and burnout: A meta-analytic test of the conservation of resources model. Journal of Applied Psychology, 2006, 91(5): 1134-1145

[43] Hamblen JL, Norris FH, Symon KA, Bow TE. Cognitive behavioral therapy for postdisaster distress: A promising transdiagnostic approach to treating disaster survivors. Psychological Trauma: Theory, Research, Practice and Policy, 2017, 9(S1): 130-136

[44] Harada, N., J. Shigemura, M. Tanichi, K. Kawaida, S. Takahashi, and F. Yasukata. 2015. Mental health and psychological impacts from the 2011 Great East Japan Earthquake disaster: A systematic literature review. Disaster and Military Medicine 1(1): Article 17.

[45] Hedges LV, Olkin I. Statistical methods for meta-analysis, 1985, Orlando, FL: Academic Press

[46] Hedges LV, Vevea JL. Fixed- and random-effects models in meta-analysis. Psychological Methods, 1998, 3(4): 486-504

[47] Hobfoll SE, Stokes JP. Duck S, Hay DF, Hobfoll SE, Ickes W, Montgomery BM. The process and mechanics of social support. Handbook of personal relationships: Theory, research and interventions, 1988, Oxford: John Wiley 497-517.

[48] Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Berthold PR Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 2007, 70(4): 283-315

[49] Holahan CJ, Moos RH. Social support and psychological distress: A longitudinal analysis. Journal of Abnormal Psychology, 1981, 90(4): 365-370

[50] Horowitz M, Wilner N, Alvarez W. Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 1979, 41(3): 209-218

[51] Huang J, Liu Q, Li J, Li X, You J, Zhang L, Tian C, Luan R. Post-traumatic stress disorder status in a rescue group after the Wenchuan Earthquake relief. Neural Regeneration Research, 2013, 8(20): 1898-1906.

[52] Jenkins SR. Social support and debriefing efficacy among emergency medical workers after a mass shooting incident. Journal of Social Behavior & Personality, 1996, 11(3): 477-492.

[53] Jenkins SR. Coping and social support among emergency dispatchers: Hurricane Andrew. Journal of Social Behavior & Personality, 1997, 12(1): 201-216.

[54] Jose PE. Doing statistical mediation & moderation, 2013, New York: Guilford Press

[55] Joseph S, Andrews B, Williams R, Yule W. Crisis support and psychiatric symptomatology in adult survivors of the Jupiter cruise ship disaster. British Journal of Clinical Psychology, 1992, 31(1): 63-73

[56] Kaniasty K, Norris FH. A test of the social support deterioration model in the context of natural disaster. Journal of Personality and Social Psychology, 1993, 64(3): 395-408

[57] Kaniasty K, Norris FH. Mobilization and deterioration of social support following natural disasters. Current Directions in Psychological Science, 1995, 4(3): 94-98

[58] Kaniasty K, Norris FH. Longitudinal linkages between perceived social support and posttraumatic stress symptoms: Sequential roles of social causation and social selection. Journal of Traumatic Stress, 2008, 21(3): 274-281

[59] Kaniasty K, Norris FH. Neria Y, Galea S, Norris FH. Distinctions that matter: Received social support, perceived social support, and social embeddedness after disasters. Mental health and disasters, 2009, New York: Cambridge University Press 175-200

[60] Keane TM, Caddell JM, Taylor KL. Mississippi scale for combat-related posttraumatic stress disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 1988, 56(1): 85-90

[61] Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS. Contractual report of findings from the national Vietnam veterans’ readjustment study: Volumes 1–4, 1988, Research Triangle Park, NC: Research Triangle Institute

[62] Leppma M, Mnatsakanova A, Sarkisian K, Scott O, Adjeroh L, Andrew ME, Violanti JM, McCanlies EC. Stressful life events and posttraumatic growth among police officers: A cross-sectional study. Stress and Health, 2017, 34(1): 175-186

[63] Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, Liberman A, Pole N, Otte C, Yehuda R, Mohr D, Neylan T. Predictors of posttraumatic stress in police and other first responders. Annals of the New York Academy of Sciences, 2006, 1071: 1-18

[64] Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory, 1986, Palo Alto, CA: Mind Garden Inc

[65] McCullough ME, Emmons RA, Tsang JA. The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology, 2002, 82(1): 112-117

[66] Moher, D., A. Liberati, J. Tetzlaff, D.G. Altman, and The PRISMA Group Preferred reporting items for systmatic reviews and meta-analyses: The PRISMA statement. PLoS Med, 2009, 6(7): e1000097

[67] Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard trauma questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous & Mental Disease, 1992, 180(2): 111-116

[68] Mumford DB, Ayub M, Karim R, Izhar N, Asif A, Bavington JT. Development and validation of a questionnaire for anxiety and depression in Pakistan. Journal of Affective Disorders, 2005, 2: 175-182

[69] Mumford DB, Bavington JT, Bhatnagar KS, Hussain Y, Mirza S, Naraghi SS. The Bradford somatic inventory: A multi-ethnic inventory of somatic symptoms reported by anxious and depressed patients in Britan and the Indo-Pakistan subcontinent. The British Journal of Psychiatry, 1991, 158(3): 379-386

[70] Murphy SA, Johnson LC, Beaton RD. Fire fighters’ cognitive appraisals of job concerns, threats to well-being, and social support before and after the terrorist attacks on September 11, 2001. Journal of Loss and Trauma, 2004, 9(3): 269-283

[71] Norris FH, Elrod CL. Norris FH, Galea S, Friedman MJ, Watson PJ. Psychosocial consequences of disaster: A review of past research. Methods for disaster mental health research, 2006, New York: Guilford Press 20-42.

[72] Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry, 2002, 65(3): 207-239

[73] Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 2003, 129(1): 52-73

[74] Perilla JL, Norris FH, Lavizzo EA. Ethnicity, culture, and disaster response: Identifying and explaining ethnic differences in PTSD six months after Hurricane Andrew. Journal of Social and Clinical Psychology, 2002, 21(1): 20-45

[75] Pietrzak RH, Feder A, Singh R, Schechter CB, Bromet EJ, Katz CL, Reissman DB, Ozbay F Trajectories of PTSD risk and resilience in World Trade Center responders: An 8-year prospective cohort study. Psychological Medicine, 2014, 44(1): 205-219

[76] Prati G, Pietrantoni L. The relation of perceived and received social support to mental health among first responders: A meta-analytic review. Journal of Community Psychology, 2010, 38(3): 403-417

[77] Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1977, 1(3): 385-401

[78] Rini C, Dunkel Schetter CD. Sullivan K, Davila J. The effectiveness of social support attempts in intimate relationships. Support processes in intimate relationships, 2010, New York: Oxford University Press 26-67

[79] Ritvo PG, Fischer JS, Miller DM, Andrews H, Paty DW, LaRocca NG. Multiple sclerosis quality of life inventory: A user’s manual, 1997, New York: National Multiple Sclerosis Society

[80] Schaufeli WB, Bakker AB, Salanova M. The measurement of work engagement with a short questionnaire: A cross-national study. Educational and Psychological Measurement, 2006, 66(4): 701-716

[81] Schenk EJ, Yuan J, Martel LD, Shi GQ, Han K, Gao X. Risk factors for long-term post-traumatic stress disorder among medical rescue workers appointed to the 2008 Wenchuan Earthquake response in China. Disasters, 2016, 41(4): 788-802

[82] Schwarzer R, Bowler RM, Cone JE. Social integration buffers stress in New York police after the 9/11 terrorist attack. Anxiety, Stress, and Coping, 2014, 27(1): 18-26

[83] Schwarzer, R., J.E. Cone, J. Li, and R.M. Bowler. 2016. A PTSD symptoms trajectory mediates between exposure levels and emotional support in police responders to 9/11: A growth curve analysis. BMC Psychiatry 16: Article 201.

[84] Shepherd D, McBride D, Lovelock K. First responder well-being following the 2011 Canterbury Earthquake. Disaster Prevention and Management, 2017, 26(3): 286-297

[85] Sherbourne CD, Stewart AL. The MOS social support survey. Social Science and Medicine, 1991, 32(6): 705-714

[86] Stamm BH. The professional quality of life scale, 2005, Pocatello: Idaho State University

[87] Stamm, B.H., M.A. Rudolph, A. Smith, and E.M. Varra. 1998. Life status review: Monitoring biopsychosocial risk factors in traumatic stress. http://www.isu.edu/~bhstamm/pdf/LSR_pos.pdf. Accessed 24 May 2018.

[88] Stephens C, Long N, Miller I. The impact of trauma and social support on posttraumatic stress disorder: A study of New Zealand police officers. Journal of Criminal Justice, 1997, 25(4): 303-314

[89] Tak SW, Driscoll R, Bernard B, West C. Depressive symptoms among firefighters and related factors after the response to Hurricane Katrina. Journal of Urban Health, 2007, 84(2): 153-161

[90] Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: Stress and psychological impact among frontline healthcare workers. Psychological Medicine, 2004, 34(7): 1197-1204

[91] Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 1996, 9(3): 455-471

[92] Timmerman IGH, Emanuels-Zuurveen ES, Emmelkamp PMG. The social support inventory (SSI): A brief scale to assess perceived adequacy of social support. Clinical Psychology and Psychotherapy, 2000, 7(5): 401-410

[93] Vreven DL, Gudanowski DM, King LA, King DW. The civilian version of the Mississippi PTSD scale: A psychometric evaluation. Journal of Traumatic Stress, 1995, 8(1): 91-109

[94] Wagnild G, Young HM. Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1993, 1(2): 165-178.

[95] Wall TD, Jackson PR, Mullarkey S. Further evidence on some new measures of job control, cognitive demand and production responsibility. Journal of Organizational Behavior, 1995, 16(5): 431-455

[96] Warr P, Cook J, Wall T. Scales for the measurement of some work attitudes and aspects of psychological well-being. Journal of Occupational and Organizational Psychology, 1979, 52(2): 129-148

[97] Weathers, F.W., B.T. Litz, D.S. Herman, J.A. Huska, and T.M. Keane. 1993. The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. In Proceedings of the Annual Conference of the International Society for Traumatic Stress Studies, 25 Oct 1993, San Antonio, Texas.

[98] Weiss DS. Wilson JP, Tang CS. The impact of event scale: Revised. Cross-cultural assessment of psychological trauma and PTSD, 2007, New York: Springer 219-238

[99] Weiss DS, Marmar CR, Metzler TJ, Ronfeldt HM. Predicting symptomatic distress in emergency services personnel. Journal of Consulting and Clinical Psychology, 1995, 63(3): 361-368

[100] Wu KK, Chan KS. The development of the Chinese version of impact of event scale—revised (CIES-R). Social Psychiatry and Psychiatric Epidemiology, 2003, 38(2): 94-98