Modification effects of coping on post-traumatic morbidity among earthquake rescuers Chia-Ming Chang a , Li-Ching Lee b , Kathryn M. Connor c , Jonathan R.T. Davidson c , Te-Jen Lai a, ⁎ a Department of Psychiatry and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan b Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA c Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA Received 23 November 2005; received in revised form 17 May 2006; accepted 29 July 2006 Abstract This study aims to investigate the modification effects of coping strategies on the relationships between rescue effort and psychiatric morbidity (i.e. general psychiatric morbidity and post-traumatic morbidity) in earthquake rescue workers. Firefighters (n =193) who were involved in the rescue effort after the Taiwan Chi-Chi earthquake were invited to complete a questionnaire which contained questions on demographics, exposure to rescue work, general psychiatric morbidity, post-traumatic morbidity, and coping strategies. Multivariate regression models with interaction terms were carried out to investigate the modification effect of coping strategies on the relationships between rescue effort and psychiatric morbidities. Older age and longer job experiences (> 3 years) were associated with both general psychiatric and post-traumatic morbidities. Coping strategies such as confrontive coping, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem solving, and positive appraisal significantly modified the effect of exposure to dead bodies on general psychiatric morbidity. Furthermore, confrontive coping, distancing, and planned problem solving significantly modified the effect of exposure to direct rescue involvement on general psychiatric morbidity. However, coping strategies were not observed to buffer the effect of rescue involvement or contact with dead bodies on post-traumatic morbidity. More frequent use of coping strategies could reduce the effect that exposure to rescue efforts has on the incidence of general psychiatric morbidity in rescue workers. However, coping strategies do not seem to reduce the influence of such exposure on trauma-related morbidities. This suggests that coping strategies can be used to prevent general psychiatric morbidity but not trauma-related morbidities. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Earthquake; Rescue worker; Morbidity; Coping 1. Introduction Rescue workers must cope with a variety of traumatic incident exposures and consequently are at risk for developing psychological distress (Raphael et al., 1983–1984; Weiss et al., 1995), such as peritraumatic dissociation (Marmar et al., 1996), post-traumatic stress Available online at www.sciencedirect.com Psychiatry Research 158 (2008) 164 – 171 www.elsevier.com/locate/psychres ⁎ Corresponding author. Department of Psychiatry and Institute of Medicine, Chung Shan Medical University, No. 1142, Sec 3, Tai-Yuan Road, Taichung 406, Taiwan. Tel.: +886 4 2239 3981; fax: +886 4 2239 3903. E-mail address: ltj3123@ms2.hinet.net (T.-J. Lai). 0165-1781/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2006.07.015