The occurrence of and factors associated with mental ill-health amongst humanitarian aid workers: A systematic review and meta-analysis

PLoS One. 2024 May 15;19(5):e0292107. doi: 10.1371/journal.pone.0292107. eCollection 2024.

Abstract

Background: Humanitarian crises and disasters affect millions of people worldwide. Humanitarian aid workers are civilians or professionals who respond to disasters and provide humanitarian assistance. In doing so, they face several stressors and traumatic exposures. Humanitarian aid workers also face unique challenges associated with working in unfamiliar settings.

Objective: To determine the occurrence of and factors associated with mental ill-health among humanitarian aid workers.

Search strategy: CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2005-2020. Grey literature was searched on Google Scholar.

Selection criteria: PRISMA guidelines were followed and after double screening, studies reporting occurrence of mental ill-health were included. Individual narratives and case studies were excluded, as were studies that reported outcomes in non-humanitarian aid workers.

Data analysis: Data on occurrence of mental ill-health and associated factors were independently extracted and combined in a narrative summary. A random effects logistic regression model was used for the meta-analysis.

Main results: Nine studies were included with a total of 3619 participants, reporting on five types of mental ill-health (% occurrence) including psychological distress (6.5%-52.8%); burnout (8.5%-32%); anxiety (3.8%-38.5%); depression (10.4%-39.0%) and post-traumatic stress disorder (0% to 25%). Hazardous drinking of alcohol ranged from 16.2%-50.0%. Meta-analysis reporting OR (95% CI) among humanitarian aid workers, for psychological distress was 0.45 (0.12-1.64); burnout 0.34 (0.27-0.44); anxiety 0.22 (0.10-0.51); depression 0.32 (0.18-0.57) and PTSD 0.11 (0.03-0.39). Associated factors included young age, being female and pre-existing mental ill-health.

Conclusions: Mental ill-health is common among humanitarian aid workers, has a negative impact on personal well-being, and on a larger scale reduces the efficacy of humanitarian organisations with delivery of aid and retention of staff. It is imperative that mental ill-health is screened for, detected and treated in humanitarian aid workers, before, during and after their placements. It is essential to implement psychologically protective measures for individuals working in stressful and traumatic crises.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Altruism
  • Anxiety / epidemiology
  • Burnout, Professional / epidemiology
  • Depression / epidemiology
  • Female
  • Humans
  • Male
  • Mental Disorders* / epidemiology
  • Mental Health
  • Psychological Distress
  • Relief Work
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / psychology

Grants and funding

This study was self-funded by Lily Cameron, as part of her dissertation of the Master’s in Humanitarian Studies programme at the Liverpool School of Tropical Medicine. MMC and NvD did not receive any funding for this work. Co-author HMC was funded by a grant from the Global Fund (20168770). The funders played no role in the writing of the manuscript or the decision to submit it for publication. Publication costs were supported by Ken Newell Bursary from the Liverpool School of Tropical Medicine.