Post-Disaster Response: Learning from Research (Part 1)
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."
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."
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).
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 shows a pyramid representing levels
of proximity to a disaster. The levels of persons
affected by disasters include the following: At
the top, are those killed and injured, followed
in descending order by the family of killed/injured,
rescuers, persons in proximity, families of rescuers,
and the general population at the bottom. The levels
increase in size as they go up the pyramid. The
levels of proximity to a disaster correspond to
risk of psychopathology in Figure B showing the
psychological consequences of disasters.
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Figure B shows a pyramid representing the psychological
consequences of disasters. At the top, is long-term
psychopathology, followed in descending order by
short-term psychopathology; acute stress disorder;
non-specific psychological distress; concerns,
behavior change; and resilience at the bottom.
Levels increase in size as they go up the pyramid.
The levels of severity of mental health consequences
correspond to Figure A showing persons affected
by disaster. |
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.
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