Systematic Reviews
Copyright ©The Author(s) 2019.
World J Psychiatr. Oct 19, 2019; 9(6): 83-98
Published online Oct 19, 2019. doi: 10.5498/wjp.v9.i6.83
Table 1 Studies of dissociation in adult disaster survivors
Ferry sinking (Baltic Sea 1994)[93,94]42 survivors3 ASD dissoc. items3-mo dissoc. associated with 3-mo and 1-yr but not 14-yr posttraumatic stress
Earthquake (Haiti 2010)[28]167 exposed volunteersPDEQMean 27-mo PDEQ score = 25. Dissoc. predicted posttraumatic stress symptoms and depression
Explosion (France 2001)[95-97]430 survivors from local EDsPDEQ6-mo dissoc. posttraumatic stress at 6 and 15 mo but not 5 yr
Train crash (Israel 2005)[50]53 survivorsDES, PDEQScores higher in survivors with vs without fibromyalgia (9 vs 2; 20 vs 9)
Earthquake (San Francisco, CA 1993)[17]100 exposed volunteer college studentsSASRQAll 5 dissoc. subscale scores higher at 1 wk than 4 mo
Explosion (Denmark 2004)[29,42]169 evacuees4 TSC dissociation itemsMean dissoc. Score = 6 (of 12). 3-mo dissoc. predicted 1-yr posttraumatic stress in women only and not 1-yr somatization
Floods/ mudslides (Italy 2009)[48]287 exposed residentsDES, PDEQDES, difficulty identifying feelings, and externally oriented thinking predicted 27-mo PDEQ. PDEQ explained 44% of IES-R
Explosion (Belgium 2004)[98]1027 exposed residentsPDEQ5-mo dissociation predicted 5-mo (not 14-mo) posttraumatic stress
9/11, WTC (NYC 2001)[23]1009 Manhattan residents, workers1 DTS dissoc. item (event amnesia)Event amnesia was least endorsed item (2%)
Earthquake (NZ, 2011)[40]101 exposed treatment seekersPDEQ (4 items)Dissoc. predicted posttraumatic stress symptoms, anxiety at 2-8 wk
9/11 Pentagon (Washington, DC 2001)[44]77 exposed military, civilian staffPDEQDissoc. associated with posttraumatic stress (18 vs 5) and alcohol use and negatively with perceived safety
3 technological accidents (Netherland)[99]49 affected individualsPDEQ, SDQ-P20-d dissoc. did not predict 6-mo posttraumatic stress symptoms
Hurricane Katrina (New Orleans, LA 2005)[100]65 exposed pet ownersPDEQDissoc. associated with having to abandon pet (mean PDEQ = 30 vs 23), depression, acute stress, and posttraumatic stress symptoms.
Hurricane Katrina (New Orleans, LA 2005)[32]117 people in mandatory evacuation zonesPDEQMean PDEQ score = 12 (unknown timing). Dissoc. associated with property damage
Earthquakes; floods (Australia/NZ 2010-2011)[101]662 exposed residentsPDEQDissoc. associated with posttraumatic stress symptoms and negative beliefs about memory
Firestorm (Oakland/Berkeley 1991)[18,102]94 referral center help seekers, 93 local studentsSASRQ1-mo dissoc. associated with 7-9-mo posttraumatic stress symptoms but not intrusions
9/11 WTC (NYC 2001)[24]2001 NYC residents2 DIS dissoc. panic attack items4-5 mo dissoc. associated with posttraumatic stress symptoms, older age, female sex, non-white race, and fear of death or injury
Earthquake (Haiti 2010); tsunami (Japan, 2011)[103]140 Haiti/12 Japan disaster exposed; 80 other trauma exposedDESDissoc. scores (unknown timing) not different between trauma groups
Mass shooting (DeKalb, IL 2008)[25]583 female university students4 PDEQ items2-wk dissoc. predicted 2-wk to 3-mo and 8-mo probable posttraumatic stress
Earthquake (Iran 2017)[80]230 exposed volunteers from 2 citiesDES, PDEQ3-4 mo dissoc. associated with posttraumatic stress
Earthquake (Turkey 2011)[26]583 randomly sampled residentsDES (with Taxon)2-yr DES Taxon membership = 25%. Dissoc. predicted posttraumatic stress symptoms, re-experiencing, avoidance, and hyperarousal but not functional impairment
Earthquake (Turkey 2011)[27]317 volunteer college studentsDES (with Taxon)High (21%) DES Taxon membership (unknown timing). DES predicted posttraumatic stress symptoms. Pathological dissoc. mediated between posttraumatic stress symptoms and ADHD symptoms
Earthquake (Italy 2009)[35]84 university student volunteers14 TSI dissoc. items7-yr dissoc. scores in exposed than unexposed. Dissoc. not associated with exposure
Hurricane Ike (Texas coast, 2008)[66,104]75 older residentsPDEQMean PDEQ = 11. Dissoc. associated with 3-mo posttraumatic stress but not 3-mo depression. Dissoc. not associated with posttraumatic stress trajectories
Tsunami (Indonesia 2004)[30]660 evacuated Danish tourists4 ERDTS dissoc. items10-mo dissoc. predicted posttraumatic stress symptoms, depression
9/11 WTC (NYC 2001)[36,105]75 exposed NYC residentsPDEQ, DES, CDS, CADDSMean PDEQ = 35, DES = 17. 3-mo dissoc. not associated 1-yr posttraumatic stress symptoms. Dissoc. not associated with exposure
Explosion (Taiwan 2015)[47]116 burn survivorsSDQ25-mo dissoc. associated with posttraumatic stress but not depression
Fire (Nether-lands, 2000)[31]662 residentsPDEQMean PDEQ = 24. 2-3 wk dissoc. not associated with 18-mo or 4-yr posttraumatic stress symptom severity
Fire and explosion (Netherlands 2001, 2004)[106]94 disaster, 111 non-disaster burn survivors3 ADS dissoc. items1-wk dissoc. Disaster > others. Disaster: 1-wk dissoc. not associated with 12-mo posttraumatic stress
Table 2 Studies of dissociation in child and adolescent disaster survivors
Hurricane Katrina (New Orleans, LA 2005)[41]112 exposed students with ≥ 1 other trauma exposure9 TSCC dissoc. items4-mo to 7-yr dissoc. associated with posttraumatic stress symptoms, anger, anxiety, depression
Earthquake (Turkey 2011)[34]738 exposed high school studentsA-DES6-mo dissoc. associated with posttraumatic stress, anxiety, prior mental health problems, metacognitions, but not with age, sex, disaster exposure, prior exposure to trauma
Earthquake (Turkey 1999)[33]202 exposed, 101 unexposed children11 TDGS dissoc. itemsExposed children had higher 4-5 mo perceptual distortions (1.3 vs 1.2), body-self distortions (1.1 vs 1.1) (range = 1-3 for both subscales)
Ferry disaster (South Korea 2014)[65]57 child and adolescent survivors3 PDEQ items20-mo dissoc. associated with posttraumatic symptoms
Earthquake (China 2010)[116]753 exposed middle school students1 UPRI dissoc. item (derealization)Majority (77%) positive for derealization. 6-mo derealization predicted PTSD
Table 3 Studies of dissociation in exposed disaster workers
9/11, WTC (NYC 2001)[38]90 disaster workersPDEQNumber of 2-3 wk dissoc. symptoms associated with probable ASD
Typhoon Haiyan (Philippines 2013)[37]61 religiously, spiritually oriented humanitarian aid workersMBI-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 providersMBI-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 workers3 ASD dissoc. itemsNumber 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 respondersPDEQ2-wk dissoc. negatively associated with perceived safety
Hurricane Katrina (New Orleans, LA 2005)[51]441 rescue personnelPDEQ2-yr dissoc. associated with being single, exposure severity, physical victimization
Earthquake (Loma Prieta, CA 1989)[67,68]198 exposed, 251 unexposed rescue personnelPDEQ1.5-yr dissoc. associated with 3.5-yr posttraumatic stress symptoms, intrusion, avoidance, hyperarousal
Earthquake (Italy 2009)[49,120]285 healthcare workers at one hospitalMBI-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 personnel5-item scale developed by authors8-11 mo dissoc. predicted posttraumatic stress
Fire (Netherlands 2000)[45]66 ambulance personnelPDEQ2-3 wk dissoc. predicted 18-mo hostility, but not posttraumatic stress symptoms or depression