Occup Environ Med 2003;60(Suppl I):i40-i46Objectives: To predict symptomatology (post-traumatic distress, fatigue, and burnout) due to acute and chronic work related stressors among ambulance personnel. Methods: Data were gathered from 123 ambulance workers in The Netherlands in a longitudinal design. At two measurements they completed standardised questionnaires to assess health symptoms, such as the Impact of Event Scale, the Maslach Burnout Inventory, and the Checklist Individual Strength. Acute stressors were assessed with specific questions, and chronic work related stressors were measured with the Questionnaire on the Experience and Assessment of Work. Results: Most of the ambulance workers had been confronted with acute stressors in their work. They also reported more chronic work related stressors than a reference group. Of the participants, more than a tenth suffered from a clinical level of post-traumatic distress, a tenth reported a fatigue level that put them at high risk for sick leave and work disability and nearly a tenth of the personnel suffered from burnout. Best predictors of symptomatology at time 2 were lack of social support at work and poor communication, such as not being informed about important decisions within the organisation. Conclusions: Ambulance personnel are at risk to develop health symptoms due to work related stressors. Although, acute stressors are related to health symptoms, such as fatigue, burnout, and post-traumatic symptoms, it was not found to predict health symptoms in the long term. Main risk factors have to do with social aspects of the work environment, in particular lack of support from the supervisor as well as colleagues and poor communication. When implementing workplace interventions these social aspects need to be taken into account.

To assess the empirical basis of prevalence and risk factors of childbirth-related posttraumatic stress symptoms and PTSD in mothers, the relevant literature was critically reviewed. A MEDLINE and PSYCHLIT search using the key words bposttraumatic stressQ, bPTSDQ, bchildbirthQ and btraumatic deliveryQ was performed. The generated list of articles was supplemented by a review of their bibliographies. A total of 31 articles was selected. The primary inclusion criterion was report of posttraumatic stress symptoms or PTSD specifically related to childbirth. Case studies and quantitative studies on regular childbirth and childbirth by emergency cesarean section were identified. Consistency among studies was found with regard to development of posttraumatic stress symptoms as a consequence of traumatic delivery. Methodological issues concerning prevalence and risk factors were discussed. Case studies and quantitative studies confirm that childbirth may be experienced as so emotionally intense that it can lead to the development of posttraumatic stress symptoms or even a PTSD-profile. Among the identified risk factors were a history of psychological problems, trait anxiety, obstetric procedures, negative aspects in staff-mother contact, feelings of loss of control over the situation, and lack of partner support. The conclusion of the current review is twofold. First, traumatic reactions to childbirth are an important public health issue. Secondly, studying childbirth offers opportunity to prospectively study the development of posttraumatic stress reactions. D

A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group.

The Impact of Event Scale (ES; M. J. Horowitz, N. Wilner, & W. Alvarez, 1979) is a worldwide-used self-report measure to assess the frequency of intrusive and avoidant phenomena after a variety of traumatic experiences. The purpose of this article is to assess the psychometric value of the Dutch version of the IES (D. Brom & R. J. Kleber, 1985) in several samples of individuals who had experienced various traumatic stressors. The reliability and structure of the IES were evaluated in 3 different samples (total N = 1.588). The reliability of the Dutch version of the IES was adequate across the various stressors. The construct validity was assessed by using confirmatory factor analyses. Outcomes revealed a robust structure over the various samples, generally supporting the composition of the original IES.