title: Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study.
abstract: BACKGROUND
  International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors.
  
  
  OBJECTIVE
  To examine consequences of such experiences on aid workers' mental health and how the impact is influenced by moderating variables.
  
  
  METHODS
  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.
authors.affiliation: Center for Global Health, International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. bhc8@cdc.gov
authors.forename: Barbara
authors.initials: B
authors.lastname: Lopes Cardozo
authors.forename: Carol
authors.initials: C
authors.lastname: Gotway Crawford
authors.forename: Cynthia
authors.initials: C
authors.lastname: Eriksson
authors.forename: Julia
authors.initials: J
authors.lastname: Zhu
authors.forename: Miriam
authors.initials: M
authors.lastname: Sabin
authors.forename: Alastair
authors.initials: A
authors.lastname: Ager
authors.forename: David
authors.initials: D
authors.lastname: Foy
authors.forename: Leslie
authors.initials: L
authors.lastname: Snider
authors.forename: Willem
authors.initials: W
authors.lastname: Scholte
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kaiser
authors.forename: Miranda
authors.initials: M
authors.lastname: Olff
authors.forename: Bas
authors.initials: B
authors.lastname: Rijnen
authors.forename: Winnifred
authors.initials: W
authors.lastname: Simon
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology*; D002055:Burnout, Professional; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D007391:International Cooperation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009938:Organizations; D012044:Regression Analysis; D012944:Social Support; D013315:Stress, Psychological