Therapeutic approaches for survivors of disaster.

Common psychiatric responses to disasters include depression, PTSD, generalized anxiety disorder, substance-abuse disorder, and somatization disorder. These symptom complexes may arise because of the various types of trauma experienced, including terror or horror, bereavement, and disruption of lifestyle. Because different types of disaster produce different patterns of trauma, clinical response should address the special characteristics of those affected. Traumatized individuals are typically resistant to seeking treatment, so treatment must be taken to the survivors, at locations within their communities. Most helpful is to train and support mental health workers from the affected communities. Interventions in groups have been found to be effective to promote catharsis, support, and a sense of identification with the group. Special groups to be considered include children, injured victims, people with pre-existing psychiatric histories, and relief workers.     

Predictors of psychological distress in survivors of the 1999 earthquakes in Turkey: effects of relocation after the disaster

OBJECTIVE: Relocations after disasters are known to cause added distress in survivors. This study examined the effects of migration and other factors on psychological status of survivors 4 years after the two severe earthquakes in Turkey. METHOD: Five hundred and twenty-six adult survivors of the 1999 earthquakes currently living in Ankara were given self-report measures assessing traumatic stress, depression, earthquake experience and social support. RESULTS: The rates of current post-traumatic stress disorder (PTSD) and depression were 25% and 11%, respectively. Although both traumatic stress and depression factors were predicted by some demographic and trauma severity variables, relocation status predicted depression but not traumatic stress. CONCLUSION: The rates of psychological distress were higher than expected in a city considered to be safe in terms of earthquake risk. Relocation after the disaster may increase psychological distress by disrupting the social network.     

School based post disaster mental health services: decreased trauma symptoms in youth with multiple traumas

Children exposed to disasters are at an increased likelihood for multiple trauma exposure. The objective of our study is to understand the efficacy of post disaster school based services for reducing trauma symptoms of youth exposed to multiple traumatic events. Students (N = 112) age 8–17 that were survivors of Hurricane Katrina received individual treatment for multiple traumas on site at school. We used repeated measures ANOVA to investigate the effectiveness in self-reported trauma symptoms over time. Results indicated significant reduction in overall posttraumatic stress symptoms as well as subscales assessing anxiety, anger, depression, dissociation, overt dissociation, and fantasy dissociation. The school based services for students with multiple traumas were effective at reducing trauma symptoms following disaster.     

Responding to the mental health and psychosocial needs of the people of Sri Lanka in disasters

This paper describes the mental health and psychosocial response to the Boxing Day tsunami in Sri Lanka. The need to deal with the immediate psychological distress of survivors and provide psychosocial support after the tsunami was recognized early by the President of Sri Lanka and advisory group set up. In conjunction with the WHO regional office and local representatives, a National Plan of action for management and delivery of psychosocial and mental health care needs was set up. Advice was provided on the right type of psychological approaches to use when dealing with survivors–for example, not forcing people to relive their experiences, listening without offering opinions and not diagnosing or labelling people as suffering from post-traumatic stress disorder (PTSD). The early response and community level work are described in this paper as well as how this has led to a new level of disaster preparedness and a new national mental health policy and proposals for new mental health legislation.     

Factors Predicting Crisis Counselor Referrals to Other Crisis Counseling,Disaster Relief,and Psychological Services: A Cross-Site Analysis of Post-Katrina Programs

An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3–18 months after Hurricane Katrina. Referrals for disaster relief were predicted by clients’ losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban–rural disparities in access to services.     

Post-earthquake quality of life and psychological well-being: longitudinal evaluation in a rural community sample in northern China

This study aims to observe longitudinal change of quality of life (QOL) and psychological well-being in a community sample affected by an earthquake and to examine the relationship between QOL and disaster exposure, post-disaster support and other related variables. The subjects, from two villages at different distances from the epicenter, were assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and three subscales of a symptoms checklist at 3 months (n=335) and 9 months (n=253) after the earthquake, respectively. Exposure to the earthquake was associated with multidimensional impairment in QOL, including physical, psychological and environmental domains at 3 months, and psychological and environmental domains at 9 months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. At both assessment points the group that experienced lower initial exposure but then received less post-disaster help reported poorer QOL and psychological well-being. The two victim groups also differed significantly in changing trend along time. The group that received more support showed a general improvement in post-disaster well-being from 3 months to 9 months. The results confirm that post-disaster variables could be as important to post-disaster psychosocial outcomes as variables of pre-disaster vulnerability and disaster per se. A comprehensive and prospective assessment of disaster effects is imperative for the better organization of disaster relief programs and psychosocial interventions.     

EARLY INTERVENTIONS FOR PTSD: A REVIEW

The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic.     

Lessons learnt in mental health and psychosocial care in India after disasters

Different phases of intervention after any disaster bring with them specific issues that policy-makers as well as healthcare deliverers must take into account. There are some specific issues related to aid with dignity and dead-body identification that need to be taken into account. The human and material resources are important in planning and delivering mental healthcare. In India, with each successive disaster, the immediate response in the rescue and relief phase has improved and the administration is able to mobilize a large amount of resources from different sectors quickly, efficiently and in a co-ordinated manner in the immediate and short-term periods after a disaster. That psychological first aid will reduce psychiatric morbidity is now generally accepted as a key principle in interventions immediately after a disaster. In the recent events, large numbers of community-level volunteers have received short-term training and been able to provide effective psychosocial care and support. The paper presents the author's observations and provides an overview of some of the lessons learnt in mental health and psychosocial support care across the several natural and human-made disasters that have taken place in India. While significant progress has been made with respect to the rescue and relief response, there is still a lot to be achieved in the rehabilitation and rebuilding phases that follow a disaster. Disaster prevention and mitigation need global vision combined with local action. Building capacity through careful planning and training potential workers is an important step. The stakeholders must take into account local cultural and social needs.     

Lessons learnt in mental health and psychosocial care in India after disasters

Different phases of intervention after any disaster bring with them specific issues that policy-makers as well as healthcare deliverers must take into account. There are some specific issues related to aid with dignity and dead-body identification that need to be taken into account. The human and material resources are important in planning and delivering mental healthcare. In India, with each successive disaster, the immediate response in the rescue and relief phase has improved and the administration is able to mobilize a large amount of resources from different sectors quickly, efficiently and in a co-ordinated manner in the immediate and short-term periods after a disaster. That psychological first aid will reduce psychiatric morbidity is now generally accepted as a key principle in interventions immediately after a disaster. In the recent events, large numbers of community-level volunteers have received short-term training and been able to provide effective psychosocial care and support. The paper presents the author's observations and provides an overview of some of the lessons learnt in mental health and psychosocial support care across the several natural and human-made disasters that have taken place in India. While significant progress has been made with respect to the rescue and relief response, there is still a lot to be achieved in the rehabilitation and rebuilding phases that follow a disaster. Disaster prevention and mitigation need global vision combined with local action. Building capacity through careful planning and training potential workers is an important step. The stakeholders must take into account local cultural and social needs.     

The Aftermath of the 1999 Earthquake in Turkey

The earthquake that took place on August 17, 1999, in the Marmara region of Turkey affected almost 20 million people with 18,000 killed and 50,000 injured. Medical and mental health professionals together with national and international relief and rescue teams had to meet the needs of the survivors. The mental health professionals had to serve in the disaster area and get training from experts at the same time. This article focuses on studies conducted from 1971 to 2003 with disaster survivors in Turkey. The results of these studies are discussed and conclusions are drawn to be integrated with the experience gained from the work onsite.     

Natural disaster and mental health in Asia

The purpose of the present article was to review the literature on disaster mental health in relation to natural disasters such as earthquakes, volcanic eruptions, typhoons and cyclones throughout Asia. Articles reviewed show that disaster psychiatry in Asia is beginning to emerge from and leave behind the stigma attached to mental health. The emergence of the acceptance of disaster mental health throughout Asia can be attributed in part to the acceptance of the notion of post-traumatic stress disorder (PTSD). This has allowed greater involvement of mental health professionals in providing ongoing support to survivors of natural disasters as well as providing greater opportunities for further research. Also, articles reviewed in the present paper commonly suggested the need for using standardized diagnostic tools for PTSD to appropriately interpret the discrepancy of results among studies. The importance of post-disaster support services and cultural differences is highlighted.     

Increase in the number of admissions to psychiatric hospitals immediately after the Great East Japan Earthquake

Introduction

Major natural disasters have a significant impact on the mental health of survivors in affected communities. Although it has been speculated that the number of survivors requiring admission to psychiatric hospital increases immediately after a major disaster, few studies have examined the issue.

Methods

On March 11, 2011, the Great East Japan Earthquake and subsequent tsunami devastated the relatively isolated city of Kesennuma. We therefore compared the weekly number of patients admitted to 2 psychiatric hospitals in Kesennuma in the 4 weeks immediately after the earthquake with those in the 4 weeks immediately preceding the earthquake. We also made comparisons between this 8‐week period and the corresponding 8‐week periods in 2009, 2010, and 2012.

Results

The number of patients admitted to the 2 psychiatric hospitals increased in 4 weeks after the disaster in 2011, with a weekly median (range) of 13 (9‐16), compared with 6 (5‐9) in the preceding 4 weeks in 2011. The corresponding figures were 5.5 (2‐10) in 2009, 6.5 (5‐9) in 2010, and 4 (3‐7) in 2012 (P = .01, H = 13.05). By diagnostic category, admissions for schizophrenia spectrum disorder and neurotic stress‐related disorder increased significantly following the disaster.

Discussion

Demands for inpatient psychiatric treatment increased immediately after the Great East Japan Earthquake. Government officials and mental health professionals must strengthen support for survivors with mental illness, especially those with schizophrenia spectrum disorder. This should include support for mental health authorities and medical staff in the affected community.     

Responding to the mental health and psychosocial needs of the people of Sri Lanka in disasters

This paper describes the mental health and psychosocial response to the Boxing Day tsunami in Sri Lanka. The need to deal with the immediate psychological distress of survivors and provide psychosocial support after the tsunami was recognized early by the President of Sri Lanka and advisory group set up. In conjunction with the WHO regional office and local representatives, a National Plan of action for management and delivery of psychosocial and mental health care needs was set up. Advice was provided on the right type of psychological approaches to use when dealing with survivors--for example, not forcing people to relive their experiences, listening without offering opinions and not diagnosing or labelling people as suffering from post-traumatic stress disorder (PTSD). The early response and community level work are described in this paper as well as how this has led to a new level of disaster preparedness and a new national mental health policy and proposals for new mental health legislation.     

The Mediating Role of Job Satisfaction in the Relationship between Disaster Relief Workers’ Perception of Survivors’ Rights and Their Performance of Human Rights Advocacy

This study aimed to investigate the mediating effect of disaster relief workers’ job satisfaction in the relationship between their perception of survivors’ rights and their performance of human rights advocacy. Two hundred disaster relief workers in Korea were invited to complete structured questionnaires pertaining to their perception of survivors’ rights, job satisfaction, and their performance of human rights advocacy, and the relationships between these variables were analyzed using correlation and multiple regression analysis. There were significant positive correlations between disaster relief workers’ perception of survivors’ rights, job satisfaction, and performance of human rights advocacy in this study. The higher their perception of survivors’ rights, the greater their performance of human rights advocacy and job satisfaction. Job satisfaction also acted as a mediator to increase the impact of their perception of survivors’ rights on their performance of human rights advocacy. In order to improve the human rights advocacy performance of disaster relief workers, it is necessary to raise their perception of survivors’ rights and increase their job satisfaction by providing a safe and nondiscriminatory work environment for them.     

Psychological aftermath of the Lviv air show disaster: a prospective controlled study

OBJECTIVE: To investigate the psychological aftermath of an air show disaster using prospectively obtained epidemiologic data. METHOD: Participants in a recently completed epidemiologic mental health survey in Lviv (disaster site) and controls from western Ukraine were interviewed shortly before and 6 months after a gruesome air show disaster. RESULTS: The Lviv group reported more psychopathology and post-traumatic stress symptom severity, but less anomie than controls. Somatization symptoms were similar in the two groups. Predisaster mental health and postdisaster threat were the strongest risk factors while demographic characteristics, emotional support, and repeated television viewing of the event were only weakly associated with postdisaster mental health. CONCLUSION: This is the first prospective study to find a significantly higher rate of disorder as well as post-traumatic stress disorder symptomatology after a disaster. The risk factor findings suggest avenues for targeting postdisaster interventions.     

Psychoeducation for survivors of trauma

PURPOSE: Education about the persistent effects of trauma helps survivors better understand their own stress responses, and knowledge of coping strategies provides a sense of control over these responses. Trauma education for providers can minimize negative countertransference and prevent vicarious traumatization. CONCLUSIONS: This article discusses content areas to be covered in psychoeducation with survivors of acute traumatic events and prolonged trauma and abuse, and reviews resources for trauma psychoeducation with clients and healthcare providers. PRACTICE IMPLICATIONS: Advanced practice psychiatric nurses may provide psychoeducation to people who suffer from complex psychological and behavioral disturbances related to severe and persistent abuse or trauma, especially early in life.     

火灾灾民创伤后应激障碍的发生及其影响因素

目的调查火灾创伤后应激障碍(PTSD)的发生及其影响因素。方法采用PTSD症状自评和诊断工具,在灾后40天对87名火灾的直接受害者进行评估。结果40天后有人21.8%的灾民发生PTSD,女性明显多于男性;而且在不符合PTSD诊断的灾民中,71.7%存在再体验症状,51.7%存在麻木/回避症状,65%存在过度唤起症状;既往有创伤事件经历的灾民更容易产生PTSD。结论经历火灾后,有相当一部分灾民存在PTSD症状。     

Post-Disaster Mental Health Problems and the Utilization of Mental Health Services: A Four-year Longitudinal Comparative Study

This study examined mental health problems and mental health services (MHS) utilization after a fireworks disaster among adult survivors and a comparison group. The disaster took place on May 13, 2000, in the city of Enschede, The Netherlands. Victims (N=662) participated in a survey 2–3 weeks (T1), 18 months (T2) and 4 years (T3) post-disaster. The comparison group consisted of non-affected people from another city (N=526). They participated at T2 and T3. Victims used MHS more often than the comparison group in the 12-month period before T2 and T3 (OR 3.9 and 2.4). Victims with severe depression and anxiety symptoms at T2 used MHS more often than participants in the comparison group with these symptoms (OR 2.6 and 2.0). After 4 years, MHS utilization among participants in both groups with anxiety symptoms did not differ, suggesting attenuation of the observed effects. Results suggest that after a disaster survivors with mental health problems are less reluctant to use MHS than under normal circumstances.     

Physical symptoms 14 months after a natural disaster in individuals with or without injury are associated with different types of exposure

Objective

To investigate whether different types of exposure to the 2004 tsunami were associated with physical symptoms 14 months after the disaster and to study correlations between survivors' physical and psychological symptoms.

Methods

Using a cross-sectional design, 1505 survivors from the 2004 Indian Ocean Tsunami, tourists from Stockholm, who had been present in the disaster areas, responded to a postal questionnaire. Eight groups based on type of exposure were created. Physical symptoms occurring on a daily or weekly basis over the past year were investigated in four indices: musculoskeletal, cardiorespiratory, neurological, and gastrointestinal. Mental health symptoms (General Health Questionnaire-12) and posttraumatic stress symptoms (Impact of Event Scale-Revised) were also investigated. Multiple logistic regression analyses were conducted with controls for background variables and exposure, with physical symptoms as outcome variables. The association between physical and psychological symptoms was studied with the Spearman Rank Order Correlation.

Results

Different types of exposure during the disaster were associated with physical symptoms 14 months later for survivors both with and without severe physical injury. The single exposure of life threat, also in combination with other exposures, was associated with a higher risk for reporting of physical symptoms. Physical symptoms showed modest yet significant correlation with psychological symptoms.

Conclusion

It is important to pay attention to both physical and psychological symptoms among disaster survivors whether they have been injured or not. A relatively simple questionnaire about physical symptoms may be a good complement to the scales used to assess psychological problems after disaster.