Date Published: October 31, 2018
Publisher: Public Library of Science
Author(s): Hannah Strohmeier, Willem F. Scholte, Alastair Ager, Peter G. van der Velden.
The latest data on major attacks against civilian aid operations have identified South Sudan as the most dangerous country for aid workers globally. Exposure to other traumatic events and chronic stress is also common in this population. No research exists on the mental health of humanitarian workers in South Sudan.
This study examined symptom burden and predictors of posttraumatic stress disorder (PTSD), depression, anxiety, hazardous alcohol consumption, and burnout among humanitarian workers in South Sudan.
We conducted a cross-sectional online survey with humanitarian workers (national and international staff, consultants, United Nations volunteers). We applied validated measures useful for this setting. We applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to fit models with high prediction accuracy for each outcome and used ordinary least squares (OLS) regression to obtain final coefficients and perform inference.
A total of 277 humanitarian workers employed by 45 organizations completed the survey (a response rate in the order of 10%). We estimated prevalence of PTSD (24%), depression (39%), anxiety disorder (38%), hazardous alcohol consumption in men (35%) and women (36%), and the burnout components emotional exhaustion (24%) and depersonalization (19%). Chronic stress exposure was positively associated with PTSD (p < .001), depression (p < .001), anxiety (p < .001), emotional exhaustion (p < .01), and depersonalization (p < .001). We found no significant association between emotion focused and problem focused coping and mental health outcomes. Associations between dysfunctional coping and depression (p < .001) and anxiety (p < .01) were positive. Higher levels of spirituality were associated with lower risk of hazardous alcohol consumption (p < .001). Contrary to expectations, working directly with humanitarian aid beneficiaries was significantly associated with lower risk for emotional exhaustion (p < .01). Our results suggest that humanitarian workers in South Sudan experience substantial levels of mental ill-health. This study points to the need for staff support strategies that effectively mitigate humanitarian workers’ chronic stress exposure. The dynamics between coping and mental health among humanitarian workers require further study.
The humanitarian needs in countries affected by crises are at an unprecedented level , and South Sudan is one of the countries in which the situation is worse than ever . The ongoing conflict and inter-communal violence accompanied by economic decline and climatic shocks in the world’s youngest nation have severe implications for its population . The severity of the situation also bears a high level of risk for humanitarian workers operating in the country–dedicated professionals with the objective to alleviate the effects of the ongoing crisis. According to latest data from Humanitarian Outcomes [4,5], there were over thirty major attacks against civilian aid operations in 2015, and this increased to over fifty in 2016. This made South Sudan the most dangerous country for aid workers globally in both years [6,7]. The outbreak of violence in July 2016 in the country’s capital Juba exemplifies the magnitude of the situation. Among other atrocities, humanitarian workers have been gang-raped, injured and killed, and embassies and international organizations felt compelled to temporarily evacuate large parts of their civilian personnel [8,9]. The number of deaths of humanitarian workers since independence has just reached 100 .
Our study addresses the gap in research on the mental health of humanitarian workers in South Sudan through analyses of cross-sectional online survey data. Specifically, we aimed at establishing the symptom burden of five mental health outcomes–PTSD, depression, anxiety, hazardous alcohol consumption, and burnout–among this occupation group. We also aimed at fitting models with high predictive accuracy to assess relationships between predictor variables and mental health outcomes.
Our results suggest that humanitarian workers in South Sudan experience substantial rates of mental health problems. This study highlights that chronic stress plays a dominant role in understanding mental health problems. It points to the need for organizational staff support strategies that mitigate humanitarian workers’ chronic stress exposure. Dysfunctional coping was associated with higher risk for mental disorder, indicating an important role for education of humanitarian workers regarding stress management. However, strategies that may be adaptive in other contexts may not be effective in high stress environments such as that studied here.