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Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis
J P Bonde1, N Utzon-Frank2, M Bertelsen2
1J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark jpb@bbh.regionh.dk.
Background:
Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression.
Aims:
To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment.
Method:
A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs).
Results:
The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30-3.98), technological disaster OR = 1.44 (95% CI 1.21-1.70), terrorist acts OR = 1.80 (95% CI 1.38-2.34) and military combat OR = 1.60 (95% CI 1.09-2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06-1.87).
Conclusions:
Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.
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