Personality

The review of the included literature identified various personality traits as contributing to disaster resilience in rescue workers, including hardiness, optimism, altruism, and a sense of humor.

Hardiness has been reported to be a significant psychosocial factor in individual resiliency. ^{Reference Hystad, Olsen and Espevik51} Hardiness is defined as a constellation of attitudes, beliefs, and behavioral tendencies consisting of commitment, control, and challenge. ^{Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Maddi and Kobasa52} It is considered to be an important personality trait that influences the coping strategies of people when in stressful situations. ^{Reference Kobasa, Maddi and Kahn53} It has been reported that military rescuers, including Vietnam veterans, who possessed the trait of hardiness, showed no change in psychological well-being or had fewer symptoms of depression and PTSD in the aftermath of a rescue. ^{Reference King, King and Fairbank36,Reference Bartone, Ursano and Wright42,Reference Dolan and Adler49}

Optimism is another personality trait that plays a salient role in protecting rescue workers from developing psychological disorders. Those who were optimistic were reported to have a lower prevalence of anxiety, depression, and stress after deployment to disaster sites than those who were not optimistic. ^{Reference Yasien, Nasir and Shaheen7} Two qualitative studies have revealed that volunteers, ^{Reference Carlile, Mauseth and Clark47} police officers, ^{Reference Carlile, Mauseth and Clark47,Reference Geiger50} and health care rescuers ^{Reference Mao, Loke and Fung39} who were optimistic about life were able to return and engage in normal daily work immediately after deployment to a disaster rescue site, and had fewer symptoms of psychological distress than those without the characteristic of optimism.

Altruism is also a personality trait that leads to disaster resilience. Rescue workers are inspired to work in disaster areas through the sentiments of volunteerism and altruism. Altruism is a selflessness act of volunteering, donating, and informally helping individuals, ^{Reference Cheng, Kwok and Cheung54} which protects one in the aftermath of adverse incidents and facilitates healing. ^{Reference Puvimanasinghe, Denson and Augoustinos55} The first responders who served survivors of the devastation wrought by Hurricane Katrina believed that it was altruism that caused them to put themselves in the shoes of other people and that supported them in continuing their disaster rescue work when they were confronted with difficulties. ^{Reference Wyche, Pfefferbaum and Pfefferbaum40} Volunteers who had a strong will to offer help to others during the earthquake in Haiti in 2010 reported an increase in personal resilience. ^{Reference Carlile, Mauseth and Clark47} Disaster health care rescuers were convinced that helping people in disasters was a responsibility in which they found true meaning in their work and in their own life. ^{Reference Mao, Loke and Fung39,Reference Ren, Gao and Yang56}

A sense of humor also contributed to resilience in rescue workers after involvement in adverse incidents. Humor is a complex, vague, and elusive phenomenon. ^{Reference Ren, Gao and Yang56} However, it has been proposed as a coping mechanism in a variety of stressful situations, such as disastrous events. Humor can be viewed as an important resource to have a positive effect on health and well-being among individuals. ^{Reference Tanay, Roberts and Ream57} Police officers who responded to a bombing/terrorist attack said that, in work meetings, troop members would refer to adverse events indirectly, tensely, and with a great deal of black humor, to release anxieties and fears arising from their traumatic memories of the incidents. ^{Reference Geiger50} Those police officers who demonstrated humor were less likely to suffer emotional distress when encountering traumatic experiences.

Perceived Control

Perceived control is another attribute of disaster resilience among rescue workers. Studies have reported that having some sense of control can help rescue workers to overcome unforeseen stressors and alleviate the level of their emotional distress and posttraumatic stress symptoms. ^{Reference McCanlies, Mnatsakanova and Andrew33,Reference McCanlies, Mnatsakanova and Andrew38,Reference Sattler, Boyd and Kirsch58} It has been found that soldiers who perceived that they had control over their own lives scored highly in resilience after they returned from the Operation Enduring Freedom and Operation Iraqi Freedom wars on terrorism. ^{Reference Pietrzak, Johnson and Goldstein32} Likewise, police officers with a strong locus of control were reported to have fewer PTSD symptoms and greater posttraumatic growth after deployment to disaster rescue work. ^{Reference McCanlies, Mnatsakanova and Andrew33,Reference Sattler, Boyd and Kirsch58} Disaster relief workers who had a sense of control could forge relationships of trust and foster support, mitigating the stress in their lives and work. ^{Reference Agarwal and Buzzanell44} That those who lost control and felt fear and anxiety during disaster rescue work reported experiencing PTSD symptoms after deployment – some to the point of developing mental illness – offers evidence supporting the importance of having a sense of control. ^{Reference Mitchell, Griffin and Stewart59}

Self-Efficacy

When confronting adverse incidents, those who possess self-efficacy are more likely to make an effort to achieve their goals. ^{Reference Ozer and Bandura60} Self-efficacy is a personal judgment that “one can successfully execute the behaviour required to produce the outcomes.” ^{Reference Bandura61}

In the context of disaster, those with a strong sense of self-efficacy were reported to manifest less burnout, compassion fatigue, and symptoms of depression after being dispatched to a disaster site. ^{Reference McCanlies, Mnatsakanova and Andrew38,Reference Pietrantoni and Prati62} The responders to the Hurricane Katrina and Wenchuan earthquake disasters took pride in being involved in the disaster response efforts and felt that they had become stronger after handling the challenges confronted in the rescue activities. ^{Reference Mao, Loke and Fung39,Reference Wyche, Pfefferbaum and Pfefferbaum40} Volunteers involved in the earthquake rescue effort in Haiti also experienced a sense of personal self-efficacy from the knowledge and skills that they acquired there, and reported having gained the ability to cope with the negative psychological sequelae and aftermath. ^{Reference Carlile, Mauseth and Clark47}

Adaptive Coping

Adaptive coping is an attribute of disaster resilience. Coping refers to the thoughts and behaviors that people use to manage distress and problems, and to maintain a sense of well-being. ^{Reference Folkman and Moskowitz63}

In adaptive coping strategies, such as problem-focused coping, the emphasis is on the taking of direct actions to address the cause of the problem. ^{Reference Lazarus64} In the context of disaster, problem-focused coping strategies have been identified as protective factors that reduce the risk of damage or minimize the negative consequences of a hazard, contributing to resilience. ^{Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Sattler, Boyd and Kirsch58} Research has shown that problem-focused coping and emotion-focused coping can also promote posttraumatic growth. ^{Reference Shepherd, McBride and Lovelock35,Reference Mao, Loke and Fung39,Reference Sattler, Boyd and Kirsch58} By contrast, maladaptive coping styles may put rescue workers at risk of developing psychological problems. For example, the adoption of disengaged coping through alcohol and substance abuse has been associated with increased posttraumatic stress symptoms such as PTSD ^{Reference Shepherd, McBride and Lovelock35,Reference Sattler, Boyd and Kirsch58,Reference Mitchell, Griffin and Stewart59} and with low scores for resilience. ^{Reference Shepherd, McBride and Lovelock35}

However, 2 qualitative studies have shown that rescue workers who adopted the coping strategy of psychological numbing did not necessarily experience a lower capacity to function and could continue to focus effectively on their jobs. ^{Reference Freedman31,Reference Geiger50} A cross-sectional study also showed that rescue workers who made greater use of problem-focused coping strategies had more severe PTSD symptoms, but they were able to deal with their persistent symptoms through meaning-focused coping. ^{Reference Marmar, McCaslin and Metzler65} Although it cannot be concluded which coping strategies are more effective in the context of disaster, it is noticeable that coping plays an essential role in mitigating the effects of adverse events on rescue workers, contributing to resilience.

Social Support

The included studies highlighted the importance of receiving social support from one’s workplace, including from co-workers, supervisors, and organizations, and/or from friends, ^{Reference Pietrzak, Feder and Singh10,Reference Freedman31,Reference Pietrzak, Johnson and Goldstein32,Reference King, King and Fairbank36,Reference McCanlies, Mnatsakanova and Andrew38–Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Bartone, Ursano and Wright42,Reference Agarwal and Buzzanell44,Reference Alvarez and Hunt46,Reference Mash, Fullerton and Kowalski-Trakofler48,Reference Geiger50,Reference Sattler, Boyd and Kirsch58,Reference Marmar, McCaslin and Metzler65,Reference Chang and Taormina66} family members, ^{Reference Pietrzak, Feder and Singh10,Reference Mao, Loke and Fung39,Reference Bartone, Ursano and Wright42,Reference Alvarez and Hunt46,Reference Sattler, Boyd and Kirsch58,Reference Marmar, McCaslin and Metzler65} and from one’s community or religion. ^{Reference Yasien, Nasir and Shaheen7,Reference Freedman31,Reference Agarwal and Buzzanell44,Reference Carlile, Mauseth and Clark47,Reference Geiger50,Reference Pietrantoni and Prati62,Reference Marmar, McCaslin and Metzler67} Such support contributes to the development of resilience after a person has been deployed to a disaster area. Social support refers to “a social network’s provision of psychological and material resources intended to benefit an individual’s capacity to cope with stress.” ^{Reference Cohen68}

Police officers and health care rescuers preferred to share feelings and memories about their rescue work with close friends and colleagues/co-workers, as mutual support from colleagues promoted a sense of trust within the rescue team, which helped them to deal with the rescue work. ^{Reference Freedman31,Reference Mao, Loke and Fung39} A study on resilience among firefighters demonstrated that support from colleagues and their work units positively correlated with posttraumatic growth. ^{Reference Sattler, Boyd and Kirsch58} Another study of police officers suggested social support from their work unit is associated with higher resilience and fewer symptoms of depression. ^{Reference McCanlies, Mnatsakanova and Andrew38} Members of their team “felt like family” and understand each other in the disaster site. ^{Reference Tseng, Shih and Shen43–Reference Alvarez and Hunt46}

Social support from family or relatives has been confirmed to be a key determinant in mitigating the negative effects on trauma and enhancing resilience in health care rescue workers in the context of disaster relief operations. ^{Reference Mao, Loke and Fung39} Members of canine search and rescue teams, rescue nurses, and volunteers who perceived that they had social support experienced less psychological distress, as friends and family members help them to “pick up the slack” by providing outlets for them to express sad feelings and memories of their disaster rescue relief work. This benefited their physical and psychological health, ^{Reference Lepore and Smyth69} professional quality of life, ^{Reference Tseng, Shih and Shen43} and resilience. ^{Reference Agarwal and Buzzanell44} A negative association was found between family support and severe and chronic PTSD symptoms in both police and non-traditional responders, while work support was reported to have a negative effect on delayed-onset PTSD among police responders. ^{Reference Pietrzak, Feder and Singh10,Reference Geiger50}

Receiving/perceiving support from community/religion was viewed as a form of social support ^{Reference Kaniasty, Norris, Neria, Galea and Norris70} that brought a feeling of belonging and emotional connectedness to a community. ^{Reference Chang and Taormina66} A sense of community has been described as a protective factor that is negatively associated with psychological distress ^{Reference Yasien, Nasir and Shaheen7,Reference Pietrantoni and Prati62} and physical burnout ^{Reference Pietrantoni and Prati62} in rescue workers. Two qualitative studies revealed that rescuers who were resilient had a positive perception of their team and felt pride in their rescue work during the disaster response operation. ^{Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Agarwal and Buzzanell44} Rescuers expressed the view that they were trained together and, when disasters happen, they work together, and that this was what made them successful in their rescue work. ^{Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Agarwal and Buzzanell44} Another qualitative study involving in-depth interviews with first responders reported that the firefighters involved in the 9/11 terrorist attack incident felt that they were almost like a religious community in helping each other at the disaster scene. ^{Reference Freedman31}

Four studies found that rescue workers who possessed strong religious/spiritual support experienced less psychological distress when they witnessed human suffering at disaster sites. ^{Reference Yasien, Nasir and Shaheen7,Reference Agarwal and Buzzanell44,Reference Carlile, Mauseth and Clark47,Reference Marmar, McCaslin and Metzler67} Another study revealed that those first responders who were regarded as resilient after deployment held the belief that “God” is the one who regulates the course of events and decides when and what will happen, and saw their rescue activity as a mission to save lives in this world stemming from God’s will. ^{Reference Geiger50}

In sum, disaster rescue workers who perceived or received support from friends, family members, colleagues, supervisors, and their community were characterized as resilient. They had high levels of psychological well-being and low levels of psychiatric symptoms and burnout after deployment. ^{Reference Pietrzak, Feder and Singh10,Reference Pietrzak, Johnson and Goldstein32,Reference King, King and Fairbank36,Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Bartone, Ursano and Wright42,Reference Alvarez and Hunt46,Reference Mash, Fullerton and Kowalski-Trakofler48,Reference Chang and Taormina66} Social support protected these rescue workers from developing symptoms of PTSD. ^{Reference Geiger50} and depression. ^{Reference Agarwal and Buzzanell44}

Antecedents of Disaster Resilience

Antecedents are events or situations that must happen prior to the occurrence of the concept. ^{Reference Walker and Avant13} From the included literature, the antecedents of disaster resilience among disaster rescue workers can be identified as exposure to disastrous events, experience in engaging in rescue work, and preparedness for disaster.

Exposure to a disaster, such as an earthquake, ^{Reference Ke, Chen and Lin34,Reference Shepherd, McBride and Lovelock35,Reference Mao, Loke and Fung39,Reference Carlile, Mauseth and Clark47,Reference Ren, Gao and Yang56,Reference Chang and Taormina66} hurricane, ^{Reference McCanlies, Mnatsakanova and Andrew33,Reference McCanlies, Mnatsakanova and Andrew38,Reference Agarwal and Buzzanell44,Reference Raveis, VanDevanter and Kovner45,Reference Mash, Fullerton and Kowalski-Trakofler48,Reference Marmar, McCaslin and Metzler67} explosion, ^{Reference Freedman31,Reference Tseng, Shih and Shen43,Reference Alvarez and Hunt46} war, ^{Reference King, King and Fairbank36} and air crash, ^{Reference Bartone, Ursano and Wright42} is an obvious antecedent of disaster resilience. The rescue workers in such disasters experienced stressful circumstances through their exposure to the disaster and demonstrated more resilience than those without deployment experience. ^{Reference Sudom, Lee and Zamorski28} The degree and frequency of exposure to disastrous events were found to be related to psychological well-being. ^{Reference Bartone, Ursano and Wright42} Professional rescue workers such as police and firefighters, who were more likely to have been exposed to disasters, were more likely to be prepared to deal with the stressors associated with their rescue duties in response to disastrous incidents. They were also less likely to develop psychological problems after deployment. ^{Reference Pietrzak, Feder and Singh10,Reference Sakuma, Takahashi and Ueda71,Reference Perrin, DiGrande and Wheeler72} While those deployed to a disaster for the first time were found to be particularly vulnerable to developing psychological problems, ^{Reference Adler, Huffman and Bliese73,Reference Huffman, Adler and Castro74} those with more years of service in disaster rescue work have been reported as being less likely to suffer from PTSD, anxiety, depression, and burnout. ^{Reference Ehring, Razik and Emmelkamp75,Reference Boscarino, Figley and Adams76} Thus, being exposed to and experienced in disaster work are antecedents for disaster resilience.

Preparedness for disaster has been found to be another antecedent of disaster resilience among rescue workers. ^{Reference Paton77} Rescue workers, including soldiers, search and rescue workers, firefighters and police officers, health care rescuers, and volunteers, benefit from their training, including in professional/disaster rescue skills and knowledge, ^{Reference Crowe, Glass and Lancaster37,Reference Mao, Loke and Fung39,Reference Bartone, Ursano and Wright42} seek counseling for themselves if needed, ^{Reference Crowe, Glass and Lancaster37} engage in activities to build physical fitness, ^{Reference Mao, Loke and Fung39,Reference Bartone, Ursano and Wright42,Reference Dolan and Adler49} and receive training in leadership skills. ^{Reference Mash, Fullerton and Kowalski-Trakofler48,Reference Dolan and Adler49} All of these make them more likely to develop an internal locus of control and a sense of self-efficacy, and to be confident about their ability to handle difficulties at disaster sites. ^{Reference Alvarez and Hunt46} Eventually, these activities help them to develop fewer psychological problems such as PTSD, anxiety, and depression. ^{Reference Pietrzak, Feder and Singh10,Reference Sudom, Lee and Zamorski28,Reference Shepherd, McBride and Lovelock35,Reference Alvarez and Hunt46} It has been suggested that volunteers could benefit from receiving training in rescue work, and in other skills such as communication and relaxation strategies. ^{Reference Carlile, Mauseth and Clark47}

Consequences of Disaster Resilience

The consequences of disaster resilience are the outcomes that occur as a result of exposure to disaster. ^{Reference Walker and Avant13} The outcomes of the disaster resilience of rescue workers can be psychological well-being, posttraumatic growth, and work engagement.

Rescue workers who possess the characteristics of disaster resilience reported experiencing less peritraumatic distress, ^{Reference Yasien, Nasir and Shaheen7,Reference Pietrzak, Johnson and Goldstein32,Reference Tseng, Shih and Shen43,Reference Raveis, VanDevanter and Kovner45,Reference Alvarez and Hunt46,Reference Mitchell, Griffin and Stewart59,Reference Marmar, McCaslin and Metzler65,Reference Sakuma, Takahashi and Ueda71} fewer symptoms of PTSD, ^{Reference Pietrzak, Feder and Singh10,Reference Freedman31–Reference McCanlies, Mnatsakanova and Andrew33,Reference Shepherd, McBride and Lovelock35,Reference King, King and Fairbank36,Reference Geiger50,Reference Sattler, Boyd and Kirsch58,Reference Mitchell, Griffin and Stewart59,Reference Marmar, McCaslin and Metzler65,Reference Sakuma, Takahashi and Ueda71} lower levels of anxiety, ^{Reference Pietrzak, Feder and Singh10,Reference Alvarez and Hunt46,Reference Mitchell, Griffin and Stewart59,Reference Sakuma, Takahashi and Ueda71} less depression, ^{Reference Pietrzak, Johnson and Goldstein32,Reference McCanlies, Mnatsakanova and Andrew38,Reference Alvarez and Hunt46,Reference Sakuma, Takahashi and Ueda71} no evidence of secondary trauma, ^{Reference Pietrzak, Feder and Singh10,Reference Raveis, VanDevanter and Kovner45,Reference Geiger50,Reference Chang and Taormina66} less compassion fatigue, ^{Reference Tseng, Shih and Shen43,Reference Pietrantoni and Prati62} and were less likely to experience burnout ^{Reference Tseng, Shih and Shen43,Reference Pietrantoni and Prati62,Reference Chang and Taormina66} after exposure to traumatic events than those without the characteristics of disaster resilience.

Those who experienced negative psychological problems were reported to be relying on avoidance coping, engaging in risky alcohol drinking, ^{Reference McCanlies, Mnatsakanova and Andrew33,Reference Shepherd, McBride and Lovelock35,Reference Mitchell, Griffin and Stewart59} and lacking social support from colleagues and family. ^{Reference Pietrzak, Feder and Singh10,Reference Pietrzak, Johnson and Goldstein32,Reference King, King and Fairbank36,Reference Bartone, Ursano and Wright42,Reference Alvarez and Hunt46,Reference Chang and Taormina66}

Disaster rescue workers who were resilient also reported experiencing posttraumatic growth after exposure to disasters. ^{Reference Yasien, Nasir and Shaheen7,Reference Freedman31,Reference McCanlies, Mnatsakanova and Andrew38,Reference Mao, Loke and Fung39,Reference Tseng, Shih and Shen43,Reference Agarwal and Buzzanell44,Reference Carlile, Mauseth and Clark47,Reference Geiger50,Reference Pietrantoni and Prati62,Reference Marmar, McCaslin and Metzler67} However, the results regarding an association between posttraumatic growth and posttraumatic stress symptoms are inconsistent. A study found that posttraumatic growth was negatively associated with posttraumatic stress symptoms, ^{Reference Sattler, Boyd and Kirsch58} while 2 studies did not find any reduction in stress symptoms among those with posttraumatic growth, ^{Reference McCanlies, Mnatsakanova and Andrew33,Reference Mitchell, Griffin and Stewart59} in that posttraumatic growth was not necessarily associated with lower levels of distress. ^{Reference McCanlies, Mnatsakanova and Andrew33}

It was also found that rescue workers who demonstrated resilience were more satisfied with their rescue work, resulting in increased engagement in work after deployment to disasters. ^{Reference Wyche, Pfefferbaum and Pfefferbaum40,Reference Mash, Fullerton and Kowalski-Trakofler48,Reference Pietrantoni and Prati62,Reference Chang and Taormina66,Reference Nishi, Kawashima and Noguchi78} Congruent with the results of these studies, volunteers to disasters experienced an increase in interpersonal empowerment and social connectedness after they returned from disaster rescue work. ^{Reference Carlile, Mauseth and Clark47} It can be concluded that those who were resilient were able to bounce back to resume their “normal life” after deployment, and to continue with their work.