Firefighters and other first-responders to disasters often face both immediate and long-term psychological effects, researchers report, but early symptoms may help identify those at greatest risk of lasting problems.

In a study of 207 rescue workers who responded to a U.S. airliner crash, researchers found that just over 40 percent developed either acute stress disorder shortly afterward, or post-traumatic stress disorder (PTSD) or depression over the following year. Many subjects had two or all three disorders, as one often increased the risk of developing the others.

“Exposed disaster workers had significantly higher rates of acute stress disorder, PTSD at 13 months, depression at 7 months, and depression at 13 months than comparison subjects,” the researchers report.

The findings show that there are “early indicators” of which disaster-response workers may be particularly vulnerable to developing lasting problems, Dr. Carol S. Fullerton, the study’s lead author, told Reuters Health.

Another important finding, she said, is the fact that some of the responders her team followed - 17 percent - said they felt they needed health care, but did not get it.

It’s unclear why this is, according to Fullerton, but the finding serves as “an alert” that some disaster workers are failing to get the help they need.

“The next step would be to understand why,” she said.

A diagnosis of acute stress disorder was linked to a more than seven-times-greater risk of being diagnosed with PTSD 13 months after the plane crash, according to findings published in the American Journal of Psychiatry.

Overall, the researchers found, almost 17 percent of responders met the criteria for PTSD, the symptoms of which include flashbacks to the traumatic event, nightmares and emotional withdrawal.]

The study also found that responders with past disaster experience were nearly seven times more likely than their less-experienced comrades to develop PTSD.

It’s hard to say why this is, according to Fullerton. Previous experience could be expected to “inoculate” responders against long-term psychological effects, she speculated, but it could also serve to sensitize them to such problems.

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SOURCE: American Journal of Psychiatry, August 2004.

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