Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review

Abstract

Background Terrorist attacks have strong psychological effects on rescue workers, and there is a demand for effective and targeted interventions. Aims The present systematic review aims to examine the mental health outcomes of exposed emergency service personnel over time, and to identify risk and resilience factors. Method A literature search was carried out on PubMed and PubPsych until 27 August 2021. Only studies with a real reported incident were included. The evaluation of the study quality was based on the Quality Assessment Tool for Quantitative Studies, and the synthesis used the ‘Guidance on the Conduct of Narrative Synthesis in Systematic Reviews’. Results Thirty-three articles including 159 621 individuals were identified, relating to five different incidents with a post-event time frame ranging from 2 weeks to 13 years. The post-traumatic stress disorder prevalence rates were between 1.3 and 16.5%, major depression rates were between 1.3 and 25.8%, and rates for specific anxiety disorders were between 0.7 and 14%. The highest prevalence rates were found after the World Trade Center attacks. Reported risk factors were gender, no emergency service training, peritraumatic dissociation, spatial proximity to the event and social isolation. Conclusions The inconsistency of the prevalence rates may be attributable to the different severities of the incidents. Identified risk factors could be used to optimise training for emergency personnel before and after catastrophic events. Voluntary repetitive screening of rescue workers for mental health symptoms is recommended.

Anxiety and Depression Survey and Analysis of Hospital Staff in a Designated Hospital in Shannan City During the COVID-19 Pandemic

“…Second, all information was based on self-report measures that inevitably deliver a systematic bias in evaluating the target construct. Finally, our study was based on web-based questionnaires instead of clinical interviews, and therefore the point prevalence is often overestimated due to the low specificity of the tests [ 28 ]. Combining questionnaires and clinical interviews can reduce the rate of false-positive results.…”

Post-traumatic stress disorder among COVID-19-affected high-risk cardiac patients

“…However, both studies are limited by the use of questionnaires, which often overestimate prevalence due to specificity. 5 Further research is needed to examine age and gender differences in different groups of affected persons with regard to comorbidities and vaccination status.…”

A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks

“…However, studies have shown the importance of such elements in how stress is experienced during the acute phase of a terrorist attack ( 9 , 10 ). For example, depending on the type of disaster, different preparations will be necessary ( 11 ). Therefore, it is expected that, in addition to the terrorist attack itself, other factors will play a role in acute stress, but also future possible PTSD or depression ( 11 ).…”

“…For example, depending on the type of disaster, different preparations will be necessary ( 11 ). Therefore, it is expected that, in addition to the terrorist attack itself, other factors will play a role in acute stress, but also future possible PTSD or depression ( 11 ).…”

“…For example, one study showed that hospital personnel after the Manchester Attacks in the United Kingdom felt stress due to being ill-prepared for the massive inflow of victims and felt guilty for not being able to work at the scene of the terrorist attacks ( 9 ). Another qualitative study showed that stressors are also the scene in which emergency responders work, as each large disaster is, in a way, unique ( 10 , 11 ).…”