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Predictors of Fatigue in Rescue Workers and Residents in the Aftermath of an Aviation Disaster: A Longitudinal Study

From the Departments of Psychology (P.S., M.V.) and Psychiatry (P.S.), Leiden University, Leiden, The Netherlands.

Address correspondence and reprint requests to Philip Spinhoven, PhD, Leiden University, Department of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands. E-mail: spinhoven{at}fsw.leidenuniv.nl

Objectives: Although medically unexplained physical symptoms such as fatigue are frequently observed after exposure to trauma, the vast majority of health outcomes studies in trauma and disaster research relates to the psychological and psychiatric problems met by victims. The objectives of this study were to investigate the prevalence of (persistent) fatigue in the aftermath of a disaster and to analyze the predictive value of sociodemographic and various health-related variables for fatigue among both rescue workers and residents.

Methods: A total of 1951 rescue workers and 753 residents involved in the Bijlmermeer aviation disaster participated in this study. Follow-up data were gathered in 70% of randomly selected rescue workers and 53% of the residents. Multiple regression analyses, multivariate logistic regression analyses, and crosslagged panel analyses examined sociodemographic variables and self-report measures for psychopathology, posttraumatic stress reactions, quality of life, somatosensory amplification, health anxiety, and tendency to be reassured by a physician as predictors of fatigue at baseline and fatigue from baseline to 13 to 28 months follow up.

Results: Elevated levels of fatigue are common after involvement in a disaster in rescue workers (20.6%) and residents (45.4%). Higher levels of psychopathology, lower quality of life, and the tendency to be less reassured were multivariate predictors of both elevated and persistent fatigue. Tendency to be reassured was the most important causal factor for fatigue.

Conclusions: These results suggest that early identification, adequate reassurance, and treatment of individuals at risk may be worthwhile to prevent chronic fatigue.

Key Words: disaster • trauma • fatigue • psychopathology • quality of life • health anxiety

Abbreviations: MUPS = medically unexplained physical symptoms; CFS = chronic fatigue syndrome; MOVB = Medisch Onderzoek Vliegramp Bijlmermeer (Medical Investigation Bijlmermeer Aviation Disaster); ESADA = Epidemiological Study Air Disaster Amsterdam; CIS: Fa = Checklist Individual Strength; Fatigue; GHQ = General Health Questionnaire; IES = Impact of Event Scale; EQ-5D = EuroQol-5 Dimensions; SAS = Somatosensory Amplification Scale; IAS: HA = Health Anxiety subscale of the Illness Attitude Scale; RQ = Reassurance Questionnaire.