Dissociation and disasters: A systematic review

Table 3 Studies of dissociation in exposed disaster workers

Disaster	Sample	Measures	Results
9/11, WTC (NYC 2001)[38]	90 disaster workers	PDEQ	Number of 2-3 wk dissoc. symptoms associated with probable ASD
Typhoon Haiyan (Philippines 2013)[37]	61 religiously, spiritually oriented humanitarian aid workers	MBI-HSS (5 depersonalization items)	Mean 8-mo depersonalization score = 1.1 (of 30). Depersonalization associated with negative religious coping but not with indirect exposure, direct exposure, or positive religious coping
Earthquake (Japan 2011)[43]	34 healthcare providers	MBI-HSS (5 depersonal-ization items)	Mean 2-yr depersonalization score = 0.6 (of 30). Depersonalization not associated with general mental health
Plane crash (Sioux City, IA 1989)[39]	207 exposed, 421 unexposed disaster workers	3 ASD dissoc. items	Number of 2-mo dissoc. symptoms associated with 13-mo posttraumatic stress but not depression. Any 2-mo dissoc. symptoms not associated with 13-mo posttraumatic stress or depression
9/11 WTC (NYC 2001)[46]	89 disaster responders	PDEQ	2-wk dissoc. negatively associated with perceived safety
Hurricane Katrina (New Orleans, LA 2005)[51]	441 rescue personnel	PDEQ	2-yr dissoc. associated with being single, exposure severity, physical victimization
Earthquake (Loma Prieta, CA 1989)[67,68]	198 exposed, 251 unexposed rescue personnel	PDEQ	1.5-yr dissoc. associated with 3.5-yr posttraumatic stress symptoms, intrusion, avoidance, hyperarousal
Earthquake (Italy 2009)[49,120]	285 healthcare workers at one hospital	MBI-HSS (5 depersonal-ization items)	Mean 6-yr depersonalization score = 1.1 (of 30) Depersonalization associated negatively associated with planning and positively with behavioral disengagement and self-distraction
Terror attacks (Norway 2011)[121]	238 rescue personnel	5-item scale developed by authors	8-11 mo dissoc. predicted posttraumatic stress
Fire (Netherlands 2000)[45]	66 ambulance personnel	PDEQ	2-3 wk dissoc. predicted 18-mo hostility, but not posttraumatic stress symptoms or depression

ASD: Acute stress disorder; dissoc.: Dissociation; MBI-HSS[22]: Maslach Burnout Inventory–Human Services Survey; NYC: New York City; NZ: New Zealand; PDEQ[19]: Peritraumatic Dissociative Experiences Scale; WTC: World Trade Center.