SAMHSA News - July/August 2006, Volume 14, Number 4 - Post-Disaster Response: Learning from Research (Part 1)

	Text Only \| SAMHSA News Home

Post-Disaster Response: Learning from Research

By Deborah Goodman

"It's reasonable to expect that we are going to have disasters time and time again. So it's essential to think critically now about how we can prepare ourselves for what history tells us is inevitable," said Sandro Galea, Ph.D., Dr.P.H., at the SAMHSA-sponsored "Spirit of Recovery" Conference in New Orleans in May.

Dr. Galea, an associate professor of epidemiology at the University of Michigan School of Public Health, spoke as part of the panel titled, "Understanding and Addressing Mental Health and Substance Abuse Needs Over Time: What Research Tells Us."

Farris Tuma, Sc.D., M.H.S.

The panel, moderated by Farris Tuma, Sc.D., M.H.S., Chief of the Traumatic Stress Disorders Research Program at the National Institute of Mental Health, presented the available information about the epidemiology of disaster-related trauma, the array of interventions, and the implications for the Gulf State populations affected by the fall 2005 hurricanes.

Epidemiology

Dr. Galea emphasized that the majority of people in the proximity of the disaster are very resilient and do not develop psychopathology. To understand the impact of disasters, he said, "It's useful to conceptualize a hierarchy of persons affected."

photo of Dr. Matthew Friedman, Dr. Sandro Galea, and Dr. Farris Tuma talking with Spirit of Recovery conference participants

Dr. Matthew Friedman (left), Dr. Sandro Galea (center), and Dr. Farris Tuma (right) talk with Spirit of Recovery conference participants.

The largest group in a pyramid of those affected is the general population. The next levels, in ascending order of proximity, are persons in the area of the disaster, rescuers, family members of those killed or injured, and people directly injured in the disaster (see Figure A).

Sandro Galea, Ph.D., Dr.P.H.

Dr. Galea described a related pyramid for conceptualizing the psychological consequences of disasters (see Figure B). The emotional resilience of the majority of people forms the base. The next tier includes people who have concerns and may experience some behavior changes—a reaction that he said is normal. This tier is followed (again in ascending order) by people with non-specific psychological distress, individuals with acute stress disorder, those with short-term psychopathology, and those with long-term psychopathology.

According to this schema, the severity of the psychological consequences in the second pyramid corresponds to the level of proximity to the disaster in the first pyramid. Because of this, research results that might at times appear conflicting "are in fact different results for different groups," Dr. Galea said.

He also noted that the bulk of clinical and research resources "focus on the smallest group of people at the top of the pyramid."

Figure A click to view larger image d	Figure B click to view larger image d
To explain the impact of disasters, Dr. Sandro Galea created two related pyramids. The level of proximity to a disaster in the first pyramid corresponds to the severity of the psychological consequences in the second.

Dr. Galea used data from a study he conducted after the March 11, 2004, terrorist train bombing in Madrid and from another study he conducted after the September 11, 2001, attacks in New York City to discuss differences in psychological response following each event. He attributed the much higher level of post-traumatic stress disorder (PTSD) in the general population of New York City to the highly visible nature of the 9/11 attacks and the fact that the attacks took place in a busy downtown area.

Dr. Galea also said that populations already stressed for any pre-existing reason—social, economic, or health-related—have a higher incidence of PTSD following a disaster. "The course of psychopathology is complicated after disasters," he said, indicating a need for more research.

« See Part 1: Hurricane Recovery Guides Preparedness Planning

« See Part 2: Hurricane Recovery Guides Preparedness Planning

See Also—Hurricane Recovery Guides Preparedness Planning

Schools Offer Stability for Children of Disasters »

Documentary Features New Orleans High School »

Disaster Readiness Resources »

See Photo Gallery »