The long-term aftermath of the Amsterdam air disaster: psychological wellbeing of professionally involved rescue workers
Year: 2006
Type: dissertation
Study design: Observational Study
Abstract: While in these first few years (1992)(1993)(1994) after the air disaster most attention was paid to the psychological aftercare and to issues about what had caused the disaster and who was responsible for it, the second period from 1995 to 1999 was characterized by increasing rumors and suspicions about potential effects on the health of those exposed to the disaster [2].Several factors gave rise to these suspicions and rumors.For instance, the cockpit voice recorder was never found (although voice recorders are designed to survive crashes and to be easily found), part of the depleted uranium used as balance weight in the aircraft was never recovered, and it was also speculated that the aircraft contained military goods with potential toxic substances.At the same time a gradually increasing number of residents of the Bijlmermeer and involved rescue workers were worried about their health and some, publicly, linked their physical symptoms to their involvement and exposure at the site of the air disaster.Whereas the immediate response of public authorities was evaluated by a crisis research team as adequate and positive [6, 7], the public authorities did not respond quickly and decisively to these growing suspicions about physical health effects of the disaster and journalists and action groups became determined to find out what information on the disaster was being held back by the authorities.Among the fire fighters and police officers the waxing and waning of concerns inside their own departments, might also have played an important role.Overall, these THE EPIDEMIOLOGICAL STUDY AIR DISASTER AMSTERDAMAround the time that the Parliamentary inquiry was started (i.e., in 1998), the employers of fire fighters and police officers in Amsterdam decided that the health status of their employees involved in the air disaster should be assessed.The employer of the hangar workers of Schiphol airport and government representatives of the affected residents of the Bijlmermeer and volunteer (rescue-) workers joined this initiative and all persons involved in the disaster were offered a medical examination.The occupational health service of fire fighters and police officers (KLM Health Services) was assigned to carry out this investigation.Simultaneously, the KLM Health Services approached the Institute for Research in Extramural Medicine (EMGO Institute) to carry out an epidemiological study, which was started in 2000.In this epidemiological study all professional fire fighters who were, according to company records, employed in the Amsterdam fire department and the police officers who were employed in the Amsterdam-Amstelland regional police force at the time of the air disaster and who were still in employed in 2000, were invited to participate.In addition, because almost the entire fire department had been exposed to the disaster, fire fighters who started working in the fire department after the disaster had taken place were also invited to participate in the study.Hangar workers, who were involved in the transport, security and sorting of the wreckage of the aircraft in the hangar where the wreckage was placed and their not-involved colleagues, were also part of this epidemiological study.In the current thesis, however, we do not report on the hangar workers because they were differently and less directly exposed to the air disaster than fire fighters and police officers.For instance, they were not exposed to the potential traumatic events and tasks However, the ESADA is strictly speaking a cross-sectional study because exposure status and psychological distress were based on self-reports 8.5 years after the air disaster.In this cross-sectional study the following questions were studied: 1) Do occupationally exposed rescue workers (i.e., fire fighters and police officers) differ from nonexposed colleagues regarding psychological distress, i.e., (symptoms of) PTSD and other (general) psychological distress (e.g., anxiety, somatic complaints and fatigue) 8.5 years after the air disaster?Which background-related and exposure-related (risk) factors are associated with the potential long-term psychological distress among exposed rescue workers?2) Do occupationally exposed rescue workers differ from non-exposed rescue workers regarding self-reported health and laboratory outcomes 8.5 years after the air disaster?3) Do occupationally exposed police officers differ from non-exposed colleagues regarding selfreported negative life events experienced in the pre-and particularly in the post-disaster period?Is the number and nature of pre-and/or post-disaster negative life events associated with psychological distress, and is this association significantly stronger for exposed than for non-exposed police officers? OUTLINE OF THIS THESISChapter 2 presents a comprehensive review of studies reporting on psychological distress among rescue workers in the aftermath of disasters.The studies are evaluated regarding outcomes, risk factors, sampling issues, assessment instruments, and disaster characteristics in order to accurately determine the place and value of the current thesis and its findings in relation to the literature.The findings of the review are related to the findings of this thesis in the Discussion section (Chapter 11).In Chapter 3 the design of the ESADA is described and discussed.In the Discussion section characteristics of the design are related to the findings of the research questions of this thesis.In Chapters 4 and 5 the psychometric properties of the self-report instruments of posttraumatic stress are studied.More specifically, in Chapter 4 the utility of the instruments in screening for PTSD is evaluated and in Chapter 5 the same screening measures are evaluated regarding the dimensions underlying the posttraumatic stress response of fire fighters and police officers exposed to the air disaster, and discriminant and convergent validity of both instruments.Findings related to the psychometric properties of the instruments are related to the findings of the research questions in the Discussion section.In Chapter 6 the outcome measures of psychological distress of the exposed fire fighters and police officers are evaluated and compared to the outcome measures of non-exposed colleagues 8.5 years after occupational exposure to the air disaster.In addition, disaster-related exposure among fire fighters and police officers is evaluated, and associations between (degree of) exposure and other background factors with psychological distress of fire fighters and police officers are studied.Chapter 6 focuses on the first research question of the thesis.Chapter 7 explores differences on measures of several physical health outcomes, several psychological health outcomes, and hematological and biochemical laboratory values and urinalysis outcomes between exposed and non-exposed fire fighters and police officers.This chapter focuses on the second research question of the thesis.In Chapter 8 differences regarding pre-and postdisaster life events between exposed and non-exposed police officers are assessed and evaluated.In this chapter, possible associations between negative life events and several outcomes of psychological distress in exposed police officers compared to non-exposed police officers are also explored.In Chapter 8 the third research question is examined.In Chapter 9 the relationship between disaster exposure and the occurrence of multiple long-term physical symptoms among professional fire fighters and police officers is examined.In addition, the potential mediating or moderating role of posttraumatic stress symptoms in this relationship was explored.This chapter focuses on the fourth research question.In Chapter 10 differences in basal cortisol levels from saliva obtained from exposed and non-exposed fire fighters and police officers were examined.In addition, associations between salivary cortisol concentrations and PTSD symptoms (related and unrelated to the disaster) among exposed fire fighters and police officers are examined.This chapter focuses on the fifth research question.In Chapter 11 the results of the five research questions are summarized and their implications are discussed, i.e., methodological considerations and the relevance of the findings of the thesis are discussed and recommendations for future research are made.
Author: Anke B. Witteveen
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W1599337415