Posttraumatic stress disorder and identification in disaster workers

Objective: Disaster workers who work with deceased victims are at increased risk of posttraumatic stress disorder (PTSD). Identification with the dece ased has been proposed as one of the mechanisms in this stress-illness rela tionship. To examine this hypothesis, this study investigated three types o f identification with the dead in a group of disaster workers: identificati on with the deceased as oneself, identification with the deceased as a frie nd, and identification with the deceased as a family member. Method: Fifty- four volunteer disaster workers who worked with the dead following an explo sion on the USS lowa naval ship were assessed 1, 4, and 13 months after the disaster. PTSD symptoms (measured with the DSMPTSD-IV scale), intrusive an d avoidant disaster-related symptoms (measured with the Impact of Event Sca le), somatization and general distress (measured with the SCL-90-R), and he alth care utilization were assessed. Results: Disaster workers who reported identification with the deceased as a friend were more likely than those w ho did not to have PTSD, more intrusive and avoidant symptoms, and greater levels of other posttraumatic symptoms including somatization. Disaster wor kers who reported identification with the deceased as a family member had g reater intrusive symptoms 1 month after the disaster than those who did not . There were no differences between those who did and did not identify with the deceased as self. Health care utilization was not associated with iden tification. Conclusions: Identification with the deceased is a risk factor for PTSD and posttraumatic symptoms in disaster workers exposed to the dead . Identification with the dead as a friend is specifically associated with higher risk for these workers.