Cortisol awakening response over the course of humanitarian aid deployment: a prospective cohort study.

Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. Methods: In this prospective study, n = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3-6 months post-deployment. Results: Linear mixed models showed significantly decreased CAR (b(SE) = -.036(.011), p = .002) and awakening cortisol over time (b(SE) = -.007(.003), p = .014). The extent of awakening cortisol change was significantly moderated by interactions between previous and recent trauma exposure. Also, a steeper awakening cortisol decrease was significantly associated with higher mean anxiety and PTSD symptoms across assessments. No significant effects were found for social support. Conclusions: We observed attenuated CAR and awakening cortisol upon HA deployment, with a dose-response effect between trauma exposure before and during the recent deployment on awakening cortisol. Awakening cortisol change was associated with PTSD and anxiety symptom levels across assessments. Our findings support the need for organizational awareness that work-related exposures may have long-lasting biological effects. Further research assessing symptoms and biological measures in parallel is needed to translate current findings into guidelines on the individual level.

Antecedentes: Los trabajadores de la ayuda humanitaria desplegados internacionalmente (HA) se enfrentan rutinariamente a estresores potencialmente traumáticos. Sin embargo, aún se desconoce si el despliegue de la HA y el estrés traumático relacionado están asociados con cambios a largo plazo en la función del eje hipotalámico-pituitaria-suprarrenal (HPA). Por lo tanto, investigamos si la respuesta del cortisol al despertar (CAR, en sus siglas en inglés) disminuyó en el momento del despliegue y si esto fue moderado por una anterior o reciente exposición a un trauma y los cambios paralelos en la gravedad de los síntomas y el apoyo social percibido.Métodos: En este estudio prospectivo, x = 86 trabajadores de la HA (68% mujeres) completaron cuestionarios sobre la exposición al trauma, el trastorno de estrés postraumático (TEPT), la ansiedad y los síntomas depresivos y el apoyo social percibido, así como evaluaciones del cortisol salival al despertar y 30 minutos después del despertar, antes, durante y 3-6 meses después del despliegue.Resultados: Los modelos lineales mixtos mostraron una disminución significativa de la CAR (b(SE) = −.036(.011), p = .002) y del cortisol al despertar, en el transcurso del tiempo (b(SE) = −.007(.003), p = .014). El grado de cambio en el cortisol al despertar fue significativamente moderado por las interacciones entre la exposición anterior y reciente al trauma. Además, una disminución más pronunciada del cortisol al despertar se asoció significativamente con una mayor media de ansiedad y síntomas de TEPT en todas las evaluaciones. No se encontraron efectos significativos en cuanto al apoyo social.Conclusiones: Observamos CAR atenuado y cortisol al despertar en el despliegue de HA, con un efecto dosis-respuesta en el cortisol al despertar, entre la exposición al trauma antes y durante el reciente despliegue. El cambio de cortisol al despertar se asoció con el TEPT y los niveles de síntomas de ansiedad en todas las evaluaciones. Nuestros hallazgos apoyan la necesidad de la conciencia organizacional de que las exposiciones relacionadas con el trabajo pueden tener efectos biológicos duraderos. Se necesitan más investigaciones que evalúen los síntomas y las medidas biológicas en paralelo para traducir los hallazgos actuales en directrices a nivel individual.

Mobile primary healthcare services and health outcomes of children in rural Namibia.

INTRODUCTION: In rural areas of Namibia where health facilities are far apart, health outcomes are poor among high utilization groups such as pregnant women and children. Among children, orphans and vulnerable children (OVC) are generally more affected than non-OVC. This study assessed the health changes of orphans and other vulnerable and non-vulnerable children visiting a mobile clinic in rural Namibia. METHODS: Over a 6 month period, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders and referrals was collected from the records of a mobile clinic serving farms and surrounding areas in parts of rural Namibia. Data were compared for all children with visits in months 1 or 2 (baseline) and a visit in months 5 or 6 (follow up). Data for a cohort of children seen at both time points (the longitudinal group) were also analyzed. RESULTS: For all children, there was significant reduction in outstanding immunizations (5% to 1% p<0.0001), skin and intestinal parasites (15.5% to 0.2% p<0.0001), and stunting (26.9% to 14.2% p<0.0001) between baseline and follow up. Within the longitudinal group, reductions were observed in the prevalence of anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001) between the two time points. At baseline, orphans were more likely to have incomplete immunizations and parasitic infections. Among orphans, incomplete immunizations declined from 25% to 0 (p<0.001) while parasitic infections decreased from 22.7% to 0 (p<0.001). Among other vulnerable children incomplete immunizations declined from 5% to 1% (p=0.002), as did skin and parasitic infestations (17.2% to 0.3% p<0.001). CONCLUSION: Regular mobile clinic visits improved the health indices of child attendees. The greatest change was among OVC whose disease burden was greater at baseline. Mobile clinics may be an effective intervention in hard-to-reach, resource-limited settings.

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

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.