Antares-CDC Research

For several years Antares has been collaborating with the Centers for Disease Control and Prevention (CDC) to coordinate a series of studies addressing issues of stress amongst humanitarian workers. This has involved several researchers from institutions based in Europe, north America and the rest of the  world.


The major focus of the group has been a longitudinal study of expatriate humanitarian workers, combined with 4 national staff surveys in Uganda, Sri Lanka, Kosovo and Jordan.


Humanitarian workers are at significant risk for mental health problems, both in the field and after returning home. The good news is that there are steps that they and their employers can take to mitigate this risk.


The team surveyed 212 international humanitarian workers across 19 NGOs. Prior to deployment, 3.8% reported symptoms of anxiety and 10.4%, symptoms of depression, broadly in line with prevalence of these disorders in the general population. Post-deployment, these rates jumped to 11.8% and 19.5%, respectively. Three to six months later, while there was some improvement in rates of anxiety—they fell to 7.8%—rates of depression were even higher at 20.1%.


Rather than experiencing particular dangerous or threatening situations, it was continual exposure to a challenging work environment that increased risk for depression. Weak social support and a history of mental illness also raised risks. On the plus side, aid workers who felt highly motivated and autonomous reported less burnout and higher levels of life satisfaction, respectively.


The paper outlines several recommendations for NGOs:

(1) screen candidates for a history of mental illness, alert them to the risks associated with humanitarian work, and provide psychological support during and after deployment; (2) provide a supportive work environment, manageable workload, and recognition; and

(3) encourage and facilitate social support and peer networks.


The wellbeing of humanitarian workers can be overshadowed by the needs of the populations they serve. “It has been challenging to get mental health care for workers onto the agendas of agencies employing them—and even onto the radar of workers themselves,” says Alastair Ager, one of the research team. “Depression, anxiety and burnout are too often taken as an appropriate response to the experience of widespread global injustice. We want them to know that the work they are doing is valuable and necessary and the situations difficult, but this doesn’t mean they need to suffer.”  The study, he suggests, provides “the first robust research evidence to establish the case that good staff care can make a real difference.”



Eriksson, C. B., Lopes Cardozo, B., Foy, D., Sabin, M., Ager, A., Snider, L., Scholte, W.F., Kaiser, R., Olff, M., Rijnen, B., Gotway Crawford, C., Zhu, J. & Simon, W. “Predeployment Mental Health and Trauma Exposure of Expatriate Humanitarian Aid Workers Risk and Resilience Factors”. Traumatology, 19(1), 41-48.

Cardozo, B.L., Crawford, C.G., Eriksson, C., Zhu, J., Sabin, M., Ager, A., Foy, D., Snider, L., Scholte, W., Kaiser, R., Olff, M., Rijnen, B. & Simon, W. “Psychological Distress, Depression, Anxiety, and Burnout among International Humanitarian Aid Workers: A Longitudinal Study” Public Library of Science One, September 2012, 7(9).

The team has also been researching the experience of national humanitarian workers that make up the vast majority of the humanitarian workforce. Studies have been completed in a range of settings, including Uganda, Sri Lanka and Jordan. All have indicated the vulnerability of national staff to high levels of stress and the potential value of organizational support.


Ager, A, Pasha, E, Yu, G., Duke, T., Eriksson, C. & Lopes Cardozo, B. “Stress, mental health, and burnout in national humanitarian aid workers in Gulu, northern Uganda.” Journal of Traumatic Stress. 2012, 713-720. 


Ansloos, J., Duke, T., Yeh, D-A., Wilkins, A., Kilman Liu, R., Frederick, N., Coppinger Pickett, C. & Eriksson, C. (2011, November). Traumatic Exposure in Humanitarian Aid Work: A Quantitative Analysis of Iraqi and Jordanian Aid Workers and the Prevalence of Trauma Related Symptoms. Poster presentation at the 27th annual meeting of the International Society of Traumatic Stress Studies (ISTSS), Baltimore, MD.


Duke, T., Yeh, A., Coppinger, C., Ager, A., Pasha, E., & Eriksson, C. (2012, November). Family support, chronic stressors, and mental health outcomes for Ugandan aid workers. Poster presented at the 28th annual meeting of the International Society of Traumatic Stress Studies (ISTSS), Los Angeles, CA.


Eriksson, C. B., Lopes Cardozo, B., Ghitis, F., Sabin, M., Gotway Crawford, C., Zhu, J., & ... Kaiser, R. (2013). “Factors associated with adverse mental health outcomes in locally recruited aid workers assisting Iraqi refugees in Jordan” Journal of Aggression, Maltreatment & Trauma, 22(6), 660-680. doi:10.1080/10926771.2013.803506


Lopes Cardozo, B., Sivilli, T.I., Crawford, C., Scholte, W.F., Petit, P., Ghitis, F., Ager, A., & Eriksson, C. “Factors Affecting Mental Health of Local Staff Working in the Vanni Region, Sri Lanka” Psychological Trauma: Theory, Research, Practice, and Policy. 11 February 2013. Advance online publication.


The research group is now analysing specific issues relevant to the stresses faced by humanitarian workers and their means of coping. This includes a study of cortisol levels of humanitarian workers during the course of humanitarian deployment and the role of spirituality in shaping perspectives on experience of humanitarian work.


Eriksson, C. B., Holland, J. M., Currier, J. M., Snider, L., Ager, A., Kaiser, R., & Simon, W. (under review). “Trajectories of spiritual change and posttraumatic adjustment among expatriate humanitarian aid workers following deployment: A prospective longitudinal study.”




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