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Psychological Resilience and Post-Traumatic Growth in Disaster-Exposed Organisations: Overview of the Literature Samantha Brooks,1 R Amlôt,2 G J Rubin,3 N Greenberg4

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Psychological Resilience and Post-Traumatic Growth in Disaster-Exposed Organisations: Overview of the Literature Samantha Brooks,1 R Amlôt,2 G J Rubin,3 N Greenberg4 Downloaded from http://jramc.bmj.com/ on February 3, 2018 - Published by group.bmj.com Review Psychological resilience and post-traumatic growth in disaster-exposed organisations: overview of the literature Samantha Brooks,1 R Amlôt,2 G J Rubin,3 N Greenberg4 1Psychological Medicine, Weston ABStract Key messages Education Centre, King’s College As disasters become increasingly prevalent, and reported London, London, UK 2 on, a wealth of literature on post-disaster mental health Emergency Response This paper provides an overview of the has been published. Most published evidence focuses ► Department, Public Health literature on factors associated with resilience England, London, UK on symptoms of mental health problems (such as 3 in disaster-exposed employees, and the Psychological Medicine, King’s post-traumatic stress disorder, depression and anxiety) College London, London, UK potential positive impact of experiencing a 4 and psychosocial factors increasing the risk of such Academic Centre for Defence disaster (post-traumatic growth). symptoms. However, a recent shift in the literature has Mental Health, Weston ► This paper provides an overview of the Education Centre, London, UK moved to exploring resilience and the absence of adverse literature on factors associated with resilience lasting mental health effects following a disaster. This in disaster-exposed employees, and the Correspondence to paper undertakes a qualitative review of the literature potential positive impact of experiencing a Dr Samantha Brooks, Weston to explore factors affecting psychological resilience, as Education Centre, King’s College disaster (post-traumatic growth). well as the potential positive impact of experiencing a London, London SE5 9RJ, UK; ► Experiencing a disaster may result in post- samantha. k. brooks@ kcl. ac. uk disaster (post-traumatic growth) by examining the litera- traumatic growth at both a personal and ture on employees in disaster-exposed organisations. We professional level. Received 31 October 2017 identify several protective factors: training, experience, Accepted 22 December 2017 and perceived (personal) competence; social support; and effective coping strategies. Post-traumatic growth frequently appeared to occur at both personal and profes- disasters worldwide, this capacity to adapt and sional levels for those rescue staff after a disaster, giving cope with traumatic events is important in allowing employees a greater appreciation of life and their relation- individuals and societies to either ‘bounce back’ (to their pretrauma state) or positively adapt to the new ships, enhancing their self-esteem and providing a sense 14 of accomplishment and better understanding of their situation in a timely and efficient way after crisis. work. Implications, in terms of how to build a resilient Though most research has focused on the risks workforce, are discussed. of adverse mental health effects, there has been a recent shift to exploring resilience as opposed to risk; Pietrantoni and Prati15 discuss this recent focus on resilience as an example of the paradigm shift INTRODUCTION within the trauma literature from focusing on aeti- Disasters are becoming more prevalent across the ology of disease to focusing on the origins of health. world, with a sustained rise in climate-related 1 Research has suggested that resilience after a disaster events such as floods and storms as well as trans- 16 2 may be common: for example, Bonanno et al national terrorism, with more countries than ever looked at the prevalence of resilience (which they 3 experiencing a terrorist incident of some kind. A defined as, simply, the absence of PTSD symptoms) wealth of literature has been published on the nega- in a sample of New York City residents during the tive psychological impact of experiencing a disaster, 6 months following the 9/11 attacks. Resilience was suggesting that the risk of suffering from post-trau- found in 65.1% of the (n=2752) sample and was 4 matic stress disorder (PTSD) is substantial, as well less prevalent among those highly exposed, but the as other mental health problems such as depression frequency of resilience did not fall below one-third 5 6 and anxiety. Research has also identified risk even among the exposure categories that generated factors associated with postdisaster mental health the greatest proportion of probable PTSD (eg, those problems, such as high levels of exposure to the who were physically injured and those who were in trauma, lack of predisaster training, experiencing the building at the time of attack had the highest injury or death of a loved one, having one’s personal levels of PTSD, but over a third of people in these and professional life affected by the disaster, categories were resilient). previous trauma and lack of social support.7–10 While it is inevitable that some trauma-ex- The meaning of the term resilience can vary posed people will develop mental health problems To cite: Brooks S, Amlôt R, within the literature: a systematic review on how following a disaster, many people continue to func- Rubin GJ, et al. community resilience is defined suggested that tion well and may even have positive emotional J R Army Med Corps Epub 17 18 ahead of print: [please the term is understood and applied differently experiences. Tedeschi and Calhoun refer to 11 include Day Month Year]. by different researchers. Most commonly, resil- these positive experiences as post-traumatic growth doi:10.1136/ ience tends to refer to positive adaptation despite and developed the Post-Traumatic Growth Inven- jramc-2017-000876 adversity.12 13 Due to the increasing prevalence of tory,18 which examines positive responses to trauma Brooks S, et al. J R Army Med Corps 2018;0:1–5. doi:10.1136/jramc-2017-000876 1 Downloaded from http://jramc.bmj.com/ on February 3, 2018 - Published by group.bmj.com Review in five areas: appreciation of life, relationships with others, new found that for nurses working during the SARS crisis, greater possibilities in life, personal strength and spiritual change. family support was associated with lower levels of mental health The literature covers a wide scope of employees, from those symptoms. Tak et al30 found that fire-fighters working during specifically working in crisis-related occupations (such as relief the Hurricane Katrina crisis were less likely to report depressive workers and emergency services personnel) to healthcare symptoms if they were living with their families than not. workers working during disease outbreaks and employees of As well as family support, support from colleagues and occupations who would not expect to face trauma in their roles managers also appears to be protective against adverse mental but who were caught up in major incidents by chance. The liter- health effects. For example, Marjanovic et al31 found that high ature also covers a range of disasters, from terrorist attacks to organisational support predicted less avoidance behaviour and pandemics to natural disasters such as hurricanes and tsunamis. lower state anger in nurses exposed to the SARS crisis. A study of Given that the two areas most commonly discussed within the police officers after a major flood in Australia32 found that work concept of resilience are experiencing potentially traumatic situ- culture support and supervisor support negatively correlated ations without subsequent mental health disorder and adapting with psychological strain. in a positive way to such experiences, this paper aims to quali- Social support has been shown to be protective in military tatively explore the literature on both, focusing particularly on samples in general33 and the same holds true for civilians. Support research looking at employees in disaster-exposed organisations. from family, friends and/or the workplace has frequently been associated with resilience. The low rates of psychopathology in FCTA ORS ASSOciatED WITH PSYCHOLOGICAL RESILIENCE police after the Madrid bombings, as described in the previously Training, experience and perceived competence reported study by Gabriel et al20 may also have been associated Many papers report that resilience may be associated with an with social support as well as with training: high levels of social employees’ sense of competence or preparedness; specifically, support were reported. Better support has been associated with those who feel they have had adequate training and preparation lower levels of distress in social workers following the terrorist for crisis work appear to be more resilient and less at risk of attacks that occurred in the USA on 9 September 2011, commonly suffering with mental health symptoms. For example, a study referred to as 9/11.19 In addition, lower levels of work tension of social workers after the 9/11 terrorist attacks in New York19 in various occupational groups exposed to Hurricane Andrew34; found that those with a higher sense of professional mastery were less symptom severity on measures of post-traumatic stress, less distressed in general, experienced less secondary trauma and anxiety, depression and burnout in recovery workers after the the higher participants scored on a ‘mastery’ scale, the lower 2005 North Pakistan earthquake35 and lower levels of depres- they tended to score on a measure of burnout. sion, psychological distress and burnout, as well as higher levels Gabriel et al20 carried out a study with police after the 2004 of life satisfaction, in humanitarian aid workers.36 Madrid bombings. Only two officers reported depressive symp- Brackbill et al37 explored risk factors for post-traumatic stress toms and no other psychopathology was observed. The authors symptoms in various employees and residents of New York explain this unexpectedly low prevalence of mental health City following the 9/11 attacks and found that social support symptoms as being partly due to the fact that the majority of the was inversely related to post-traumatic stress symptoms across police involved had extensive experience and training in dealing groups, with the greatest effect being observed among rescue with terrorist attacks—70% of them had previously participated and recovery workers.
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