Understanding the chain of communication during a disaster

TOPIC: Every disaster begins on a local level and may, depending on size, evolve to a state of federal disaster response. Understanding California's State Disaster Plan and the importance of the chain of communication is a first step to understanding the Federal Disaster Response system. The chain of command is critical to making sure services and resources are utilized in a timely manner without duplication. PURPOSE: This paper's intent is to define California's present emergency management system (EMS) infrastructure from local to state level and educate healthcare professionals for disaster activation. CONCLUSIONS: It is imperative that all voluntary healthcare professionals learn the chain of command within the disaster response system. Each disaster response begins with the individual's preparedness at the local level and all disaster preparedness must incorporate training of health professionals, citizens, and families in local disaster drills.     

Vulnerable populations in an American Red Cross shelter after Hurricane Katrina

TOPIC: During Katrina, people suddenly encountered multiple losses, including homes, finances, medications, and death of loved ones. The Model of Vulnerable Populations illustrates how reduced resources placed individuals at greater risk for harm. PURPOSE: Using vignettes and the Model of Vulnerable Populations, a psychiatric nurse discusses her experiences as an American Red Cross psychiatric/mental health nurse volunteer after the Katrina disaster at a Mississippi shelter. CONCLUSIONS: The role of the mental health nurse volunteer was demonstrated by assessment and interventions of advocacy, referral, crisis intervention, and general support and education. PRACTICE IMPLICATIONS: Using the Model of Vulnerable Populations, psychiatric nurses can improve mental health assessment and services by counseling, advocacy, triage, and teaching disease prevention strategies such as hand washing.     

A person-centered analysis of posttraumatic stress disorder symptoms following a natural disaster: Predictors of latent class membership

The present study applied latent class analysis to a sample of 810 participants residing in southern Mississippi at the time of Hurricane Katrina to determine if people would report distinct, meaningful PTSD symptom classes following a natural disaster. We found a four-class solution that distinguished persons on the basis of PTSD symptom severity/pervasiveness (Severe, Moderate, Mild, and Negligible Classes). Multinomial logistic regression models demonstrated that membership in the Severe and Moderate Classes was associated with potentially traumatic hurricane-specific experiences (e.g., being physically injured, seeing dead bodies), pre-hurricane traumatic events, co-occurring depression symptom severity and suicidal ideation, certain religious beliefs, and post-hurricane stressors (e.g., social support). Collectively, the findings suggest that more severe/pervasive typologies of natural disaster PTSD may be predicted by the frequency and severity of exposure to stressful/traumatic experiences (before, during, and after the disaster), co-occurring psychopathology, and specific internal beliefs.     

Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country

OBJECTIVES: This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. STUDY SUBJECTS AND SAMPLE: Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. RESEARCH INSTRUMENTS: CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder. RESULTS: PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. CONCLUSION: No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor.     

Piloting a New Model of Crisis Counseling: Specialized Crisis Counseling Services in Mississippi After Hurricane Katrina

During January–April 2007, Project Recovery, a federally funded crisis counseling program implemented by Mississippi’s Department of Mental Health, piloted a new model of Specialized Crisis Counseling Services (SCCS) on the Mississippi Gulf Coast. In this team-based approach, a masters-level counselor trained in a variety of intervention techniques and a resource coordinator worked together with persons whose needs were relatively intense. Compared to regular program (RCCS) participants over the same interval (n = 29,522), SCCS participants (n = 281) were more likely to be female, middle-aged, and at greater risk for severe distress. In a participant survey conducted in both programs over the same week, SCCS participants reported significantly greater benefit than did RCCS participants. A subset of 129 SCCS participants provided pre- and post-participation assessments and showed large improvements in disaster-related distress.     

Evaluation of a National Effort to Reach Hurricane Katrina Survivors and Evacuees: The Crisis Counseling Assistance and Training Program

Hurricane Katrina created the largest population of internally displaced persons in the history of the United States. Exceptions to Federal Emergency Management Agency’s (FEMA’s) usual eligibility requirements allowed states from across the nation to apply for Crisis Counseling Assistance and Training Program (CCP) grants to provide services to evacuees. Over a 16-month period, crisis counselors documented 1.2 million individual and group encounters across 19 CCPs. Most encounters (936,000, 80%) occurred in Presidential disaster-declared areas of Louisiana, Mississippi, and Alabama, but many (237,000, 20%) occurred in 16 smaller “undeclared” programs across the country. Programs showed excellent reach relative to external benchmarks provided by FEMA registrations for individual assistance and population characteristics. Programs varied widely in service mix and intensity. The declared programs reached more people, but the undeclared programs provided more intensive services to fewer people with higher needs.

Psychological consequences of a firework factory disaster in a local community

Objective This study assessed the prevalence of post-traumatic stress disorder (PTSD) and other psychological consequences of an explosion disaster in a residential area in Kolding, Denmark, in November 2004. Method A community sample of 516 evacuated adults and a control group of 119 residents situated near the disaster area, but not affected by the explosion were assessed 3 months after the disaster by standardized instruments. Results Of the evacuated sample, 13% met DSM-IV criteria for PTSD in contrast to 1% in the control group; 35% of the exposed sample and 7% of the control group were identified as ‘probable cases’ by the GHQ-30 (both p’s < 0.0005). Conclusion The study provides evidence of the negative impact of a technological disaster on mental health and the need of preventive interventions.     

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.     

河北张北尚义地震后受灾群体生活质量纵向研究

目的 纵向研究地震后受灾群体生活质量随时间的改变,探讨社会支持等变量对灾后生活质量的影响。方法 调查对象来自距震中不同距离的2个自然村,震后3个月及9个月完成世界卫生组织生活质量简表等问卷的人数分别为335和256。结果 地震经历伴随着有生活质量多方面的损害,涉及心理、生理和环境维度。灾后获得的支持与援助是影响生活质量的重要因素。结论 灾害后生活质量受灾前,灾后及灾害相关的各种变量影响,应该全面评估并进行长期追踪。此外,本文提示灾后早期积极的援助和干预具有重要意义。     

Trajectory and predictors of depression in a 12-month prospective study after the Madrid March 11 terrorist attacks

Background

Few longitudinal studies have examined the trajectory of and the risk factors for depression in a representative sample of the population exposed to terrorism. A 12 month prospective study was conducted among a sample of Madrid city residents after the March 11, 2004 terrorist attacks. We aimed to document the trajectories of depressive symptoms and determine the risk factors associated with these trajectories.

Methods

We conducted telephone surveys among a representative sample of Madrid citizens (N = 1589) to recruit baseline respondents approximately 1 month after the March 11 terrorist attacks. Participants were re-contacted at 6 and 12 months after baseline for further telephone interviews.

Results

Findings reveal heterogeneity in the longitudinal trajectories of depression ranging from the absence of depressive symptoms over time, to transient or chronic depression. Life and recent stressors, experiencing direct exposure to the attacks, personality traits, poor physical health and other psychological disorders were principally associated with a worse trajectory of depression after this event.

Conclusions

Consistent with a stress diathesis model, ongoing stressors and intense event exposure are key drivers of a chronic depression trajectory after a mass traumatic event.     

Properties of Swedish posttraumatic stress measures after a disaster

This study evaluated the properties of Swedish versions of self-report measures of posttraumatic stress disorder (PTSD), with emphasis on the Impact of Event Scale-Revised (IES-R). Survey data from adult survivors 1, 3, and 6 years after the 2004 Indian Ocean tsunami (n = 1506) included the IES-R (from which the IES-6 was derived) and the 12-item General Health Questionnaire (GHQ-12). The PTSD Checklist (PCL) was included in one survey. A structured clinical interview was performed after 6 years (n = 142). Factor analyses of the IES-R and PCL indicated that a dysphoric-arousal model provided good fit invariant across assessments. Both measures were accurate in excluding PTSD while all measures provided poorer positive predictive values. The IES-R, but not the IES-6 and GHQ-12, evidenced stability across assessments. In conclusion, the Swedish IES-R and PCL are sound measures of chronic PTSD, and the findings illustrate important temporal aspects of PTSD assessment.     

精神疾病伴垂体瘤患者溴隐亭治疗联合心理护理的效果观察

目的：探讨溴隐亭对重症精神疾病伴垂体瘤患者的治疗效果,并总结临床心理护理的方法及重要作用。方法我院2012‐02—2014‐01精神疾病合并脑垂体瘤门诊患者56例随机分组,研究组和对照组各28例。所有患者均常规给予抗精神病类用药积极治疗,并配合健康教育和心理护理,研究组在此基础上加用甲磺酸溴隐亭片治疗。结果研究组总有效率100％,对照组64.3％,2组比较差异有统计学意义（P＜0.01）。2组治疗后SAS和SDS评分均显著低于治疗前,组内比较差异有统计学意义（P＜0.01）;治疗前后2组间比较SAS和SDS评分比较差异无统计学意义（P＞0.05）。结论精神疾病伴垂体瘤患者应用溴隐亭治疗联合心理护理具有良好的效果,可改善不良心理状态,提高疗效。     

唐山大地震心理创伤后应激障碍的抽样调查研究

目的 调查唐山大地震心理创伤后应激障碍（ＰＩＳＤ）的患病率,方法 应用自行编制的ＰＩＳＤ调查表和标准化评定工具,对地震时在唐山市区居住且亲身经在地震者１８１３人进行抽样调查。结果 １８１３人中诊断为急性应激反应（ＡＳＲ）３３５例（１８．４８％）延迟性应激障碍（ＤＳＤ）４０２例（２２．１７％）其中现患ＤＳＤ１７例,现患率为０．９４％,结论 大地震后ＡＳＲ和ＤＳＤ的患病率高,个体远期心身健康水平较低。     

恶性肿瘤病人的心理护理研究

目的探讨心理护理在恶性肿瘤病人治疗中的作用.方法用上海精神卫生中心译定的SCL-90症状自评量表对49例恶性肿瘤病人进行自测,评价恶性肿瘤病人的心理健康水平,并与放疗和心理护理后比较分析.结果恶性肿瘤病人SCL-90的9个因子分均高于国内常模（P〈0.01）,放疗配合心理护理,患者治疗后SCL-90的9个因子分明显降低（P〈0.01）.结论恶性肿瘤病人都有不同程度的心理障碍,心理健康水平低于正常人.心理护理在肿瘤的治疗中明显提高了病人的心理健康水平,在肿瘤的治疗中发挥了重要的作用.     

恶性肿瘤病人的心理护理研究

目的探讨心理护理在恶性肿瘤病人治疗中的作用。方法用上海精神卫生中心译定的SCL-90症状自评量表对49例恶性肿瘤病人进行自测,评价恶性肿瘤病人的心理健康水平,并与放疗和心理护理后比较分析。结果恶性肿瘤病人SCL-90的9个因子分均高于国内常模(P<0·01),放疗配合心理护理,患者治疗后SCL-90的9个因子分明显降低(P<0·01)。结论恶性肿瘤病人都有不同程度的心理障碍,心理健康水平低于正常人。心理护理在肿瘤的治疗中明显提高了病人的心理健康水平,在肿瘤的治疗中发挥了重要的作用。     

San Antonio Mental Health Disaster Consortium: Hurricanes Katrina and Rita, a personal perspective

TOPIC: This is the personal perspective of the author's experience during Hurricanes Katrina and Rita. As a member of a professional mental health volunteer organization, this chronicles 3 months' experience in the local shelters. PURPOSE: Difficulties with organizational support and structure hampered the effectiveness and functioning of this volunteer organization in the shelters. To identify lessons learned from this experience. CONCLUSIONS: It is essential to identify where each mental health volunteer group fits into the organizational structure and what the role of each is. Volunteers need to be scheduled and relieved at regular intervals to rest so as to prevent stress reactions.     

Rejoinder to Mordock's Critique of the Fort Bragg Evaluation Project: The Sample Is Generalizable and the Outcomes Are Clear

The Fort Bragg Evaluation Project (FBEP) showed that children in a well implemented and expensive continuum of care had no better clinical outcomes than those experiencing more traditional and fragmented services. In an article published in this journal that was critical of the evaluation, Mordock argued that the FBEP results be viewed with skepticism because of what he perceived to be methodological, design, measurement, and analytic failures of this study. We think it is important to respond to Mordock's critique since it contributes to the great reluctance to seriously consider the study's findings and their implications.     

The future pattern of psychiatric provision in England

The events that led to a reduction in both the size and number of mental hospitals in the United Kingdom are reviewed, and the mental hospitals remaining are shown to be mainly providing care in specialised units. Studies of mental hospital closure have shown that care in the community is generally preferred by patients, although for the “old long stay” the total costs are broadly similar. However, for patients with new illnesses care is undoubtedly much cheaper, and patients acquire fewer secondary handicaps of their psychotic illness. Hospital beds are still needed for a community mental health service; and in inner city areas, where prevalence rates for psychotic illness are higher, there are often too few beds to run an efficient service so that patients needing admission may either not be admitted at all, or be admitted to a distant hospital. The allocation of funds for mental illness to local health authorities takes some account of socio-demographic indicators of illness, but authorities are free to spend more or less than their allocation on the mental illness service. One study suggests that there is an optimal number of beds for a given location and that costs of the service increase if there are either too few or too many beds available. It is argued that for care in the community to succeed there must be adequate numbers of beds available, a range of sheltered residential accomodation in the community, as well as enought staff to provide a service for them. Future changes to the way in which the National Health Service is funded – with resource being allocated by groups of general practitioners – make it likely that there will be a shift of resources towards primary care services.     

社区心理咨询门诊184例案例分析

目的 了解社区居民心理咨询的主要问题及相关因素,以便更好地做好社区心理卫生服务工作.方法 使用中文版患者健康问卷（PHQ）分量表、健康状况调查问卷（SF-36）及自制量表对社区心理咨询门诊来访者进行问卷调查.对受调查来访者同时进行生命质量评估及相关分析.结果 （1）184例来访者中咨询原因居前3住的分别是：情绪问题（24.5％）,人际关系困扰（19.0％）,用药咨询（17.9％）.疾病诊断前4位的为精神分裂症（41.3％）,焦虑障碍（17.4％）,一般心理问题（15.8％）,抑郁发作（10.3％）.（2）76例（41.3％）来访者至少存在抑郁症状群或焦虑症状群或躯体症状群中一种症状群,其中81.58％为轻度;这一类来访者的SF-36各维度评分低于整体来访者的评分.结论 社区心理咨询门诊中,以精神症状群来访者为主,这一部分人群生活质量较差,尤其以精神健康方面生活质量明显降低.