Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study

PLoS One. 2012;7(9):e44948. doi: 10.1371/journal.pone.0044948. Epub 2012 Sep 12.


Background: International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors.

Objectives: To examine consequences of such experiences on aid workers' mental health and how the impact is influenced by moderating variables.

Methodology: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anxiety / diagnosis*
  • Anxiety / etiology*
  • Burnout, Professional*
  • Depression / diagnosis*
  • Depression / etiology*
  • Female
  • Humans
  • International Cooperation
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Organizations
  • Regression Analysis
  • Social Support
  • Stress, Psychological*

Grants and funding

This study was funded by the Antares Foundation. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.