Prevalence and Comorbidity of Mental Disorders in Humanitarian Aid Workers Operating in Intentional Human-Made Catastrophe Contexts: A Systematic Review

Humanitarian aid workers (HAWs) in intentional human-made catastrophe contexts (IHMCCs), such as armed conflicts or wars, face extreme psychological stress, increasing their risk of mental disorders. This systematic review examines the mental disorders assessed in HAWs, their prevalence, and whether psychopathological comorbidity is considered. A search in March 2025 included studies in English (representing 91.2% of published studies), with original quantitative data, assessing at least one mental disorder in HAWs working in IHMCCs. Ten studies were included (n = 2,380). Bias was assessed using the Newcastle-Ottawa Scale. Evidence certainty was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation criteria. Pooled prevalence rates from self-reported measures were high for anxiety (24.46%), depression (30.84%), and post-traumatic stress disorder (9.09%). However, significant heterogeneity and wide confidence intervals limited certainty. A single study using diagnostic interviews revealed lower prevalence rates than self-reports and global baseline rates. Methodological limitations of the studies leading to low evidence quality included: cross-sectional designs, self-reported tools prone to overestimation, lack of validated tools, and limited attention to psychopathological comorbidity and theoretical frameworks. Future research should be built upon modern psychopathology frameworks, adopt longitudinal designs, combine self-reports with diagnostic interviews, and use tailored tools for HAWs' unique contexts.