Tulane University: Post-Katrina Heart Attack Rates - Revisited

Hurricane Katrina Approaching New Orleans August 2005

 

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In March of 2009, in a study led by Dr. Anand Irimpen (Associate Professor of clinical medicine at Tulane), it was disclosed that residents of New Orleans saw a 300% increase in heart attacks in the first 2 years after hurricane Katrina.

 

The Tulane University news NEW WAVE carried this report in 2009.

Post-Katrina Stress, Heart Problems Linked

March 30, 2009

(Excerpt)

There were 246 admissions for heart attacks, out of a total census of 11,282 patients, post-Katrina compared with 150 admissions out of a total 21,229 patients in the two years before the storm. In addition to a three-fold increase in heart attacks and a 120 percent increase in coronary interventions, the post-Katrina group had significantly higher prevalence of unemployment, lack of medical insurance, medication noncompliance, smoking, substance abuse, first-time hospitalization and people living in temporary housing. There were no significant differences in the racial, gender or age distribution of the two groups.

 

In 2011, we looked at an update to this Tulane study (see Post-Katrina Heart Attack Rates) that found – four years after the disaster – that heart attack rates remained 300% higher than pre-Katrina levels in the City, and that:

 

While psychiatric conditions such as clinical depression, a history of coronary artery disease and marital status did not appear to contribute to heart attacks in the two-year analysis, these factors seem to play a significant role as time has progressed.

Irimpen suggests there is a lag phase between the onset of psychiatric illness and its manifestation in the form of a heart attack. 

Today, Tulane University has announced a 6-year follow up to this study, and once again the impact of Katrina on cardiac health remains pronounced.  First some details on the study, after which I’ll return with more:

 

Rise in Heart Attacks After Hurricane Katrina Persisted Six Years Later

Researchers also find a lasting disruption in the timing of heart attacks after the disaster.

Released: 3/18/2014 10:00 AM EDT
Source Newsroom: Tulane University

Mayo Clinic Proceedings

Newswise — Lingering stress from major disasters can damage health years later, according to a new Tulane University study that found a three-fold spike in heart attacks continued in New Orleans six years after Hurricane Katrina.

Researchers also found a lasting disruption in the timing of heart attacks in the six years after the storm with significantly more incidents occurring on nights and weekends, which are typically times hospitals see fewer admissions for heart attacks.

The research, which will be published in the journal Mayo Clinic Proceedings, is an update of an ongoing study tracking the increases in admissions for heart attacks at Tulane Medical Center in downtown New Orleans after Hurricane Katrina. The new study confirmed the increase persisted even six years later.

“Prior to Hurricane Katrina, about 0.7 percent of the patients we were treating in our medical center were suffering from myocardial infarctions (heart attacks),” said lead author Dr. Matthew Peters, internal medicine resident at Tulane University School of Medicine. “This increased to about 2 percent in first three years after Katrina and continued to increase to almost 3 percent in years four through six after the storm.”

The hospital had 1,177 heart attack cases during the six years after the storm, representing 2.4 percent of patient admissions; only 0.7 percent of its patients were admitted for heart attacks two years before Katrina.

Researchers attribute the increase to several factors, most notably chronic stress, higher unemployment and greater risk factors for heart disease, such as increased rates of smoking, substance abuse, psychiatric disorders and noncompliance in taking prescribed medications.

“We found more patients without insurance, who were unemployed and more who had a previous history of coronary artery disease, showing us that the milieu of patients was a sicker population,” said senior author Dr. Anand Irimpen, an associate professor of medicine for the Tulane Heart and Vascular Institute and chief, cardiology section, Southeast Louisiana Veterans Health Care System.

Video interviews with both researchers are available online:

Dr. Matthew Peters – http://youtu.be/2oPOUZZLOmE

Dr. Anand Irimpen - http://youtu.be/nWANLTsSnzY

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

 

A little over a year ago, in Disaster’s Hidden Toll, we looked at the long-term, largely unseen, effect on nursing home patients who were forced to evacuate to temporary facilities after Japan’s Great Earthquake & Tsunami of 2011.

 

A study showed a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

And just last month, in The Long Term Effects Of A Major Disaster, we looked at the post-tsunami deaths due to stress and displacement that exceeded – at least in one prefecture – those experienced during the initial earthquake and tsunami.

 

Closer to home, last fall in Sandy 1 Year Later: Coping With The Aftermath, we looked at the lingering psychological effects of New England’s brush with that late season super storm of 2012.

 

While the psychological impact of a major disaster cannot be fully prevented, individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

 

FEMA, Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities of the value of preparing for a wide variety of emergencies and disasters.

 

Having a modest supply of food, water, and medicine – and a workable family or business disaster plan – can go a long ways toward reducing both stress and hardship during and after a disaster. The standard advice is that everyone needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

 

Sure . . .  they’d like you to be prepared for longer . . .  but 72 hours is a reasonable start. I personally advocate having 2 week’s worth of supplies, but then I live in the heart of hurricane country, and have a fondness for eating regularly (see NPM11: Living The Prepared Life). 

 

Although a good disaster plan and emergency kit are imperative to get you through the opening hours, days, or even weeks of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

 

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder). Luckily, there are things that can be done - even by the layperson - to help reduce the psychological impact of a disaster. 

 

A few resources you may wish to revisit:

 

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

Last August the World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement:

The bottom line is that those who follow FEMA’s, and Ready.gov’s advice to Have A Plan, Make A Kit, and Be informed  will be not only be better able to deal with a disaster, they will be better prepared to weather the rigors of a long recovery as well.

 

And that, in turn, could help reduce the risks of post-disaster health issues, such as has plagued New Orleans since Katrina.

 

A few of my (many) blogs on disaster preparedness include:

In An Emergency, Who Has Your Back?

When 72 Hours Isn’t Enough

When Evacuation Is The Better Part Of Valor

The Long Term Effects Of A Major Disaster

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Credit NHK News – Fukushima evacuation zone March 2011

 

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We are approaching the third anniversary of the Great East Japan Earthquake and Tsunami of 2011, and despite massive recovery operations, living conditions remain difficult for many in the hardest hit prefectures. As we’ve seen before with other major disasters, the emotional and physical challenges during the recovery phase can often equal or even exceed those experienced during the actual event.

 

Adding to the already enormous stress levels from this disaster are the almost daily reports of radiation readings in and around the damaged Fukushima power plant, and concerns over the safety of food, water, and even the air they breathe. Concerns that are likely to persist for years to come.

 

Today it is being widely reported that the number of post-tsunami deaths due to stress and displacement have exceeded – at least in one prefecture – those experienced during the initial earthquake and tsunami.  This from the Japan Times:

 

Fukushima stress deaths top 3/11 toll

Uncertainties amid nuclear crisis acutely felt by elderly

Kyodo

Feb 20, 2014

FUKUSHIMA – Stress and other illnesses related to the 2011 quake and tsunami had killed 1,656 people in Fukushima Prefecture as of Wednesday, outnumbering the 1,607 whose deaths were directly tied to disaster-caused injuries, according to data compiled by the prefecture and local police.

A prefectural official said many people “have undergone drastic changes in their lives and are still unable to map out their future plans, such as homecoming, causing increased stress on them.”

Around 136,000 people are still displaced in the prefecture, which has had to cope with the devastating effects of the natural disasters and meltdowns at the Fukushima No. 1 nuclear station.

(Continue . . . )

 

According to this report, roughly 90% of those killed by indirect causes were 66 years of age or older.  A little over a year ago, in Disaster’s Hidden Toll, we looked at the long-term, largely unseen, effect on nursing home patients who were forced to evacuate to temporary facilities.

 

A study showed a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

A unusually large number of these excess deaths were due to pneumonia or bronchitis, which many attribute to insufficient emergency shelters provided for the elderly and frail.

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

PTSD (Post Traumatic Stress Disorder) can often occur in the wake of a disaster or traumatic experience. Symptoms may include anxiety, depression, suicide and PTSD may even lead to drug and alcohol-related disorders.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are all at risk of suffering some level of PTSD.

 

I’ve written about post-disaster psychological first aid (PFA) several times in the past, including in Post Disaster Stress & Suicide Rates, PTSD Awareness Day, and Promising Practices: Psychological First Aid.  Last August the World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement:

Credit WHO

Publication details

Number of pages: 273
Publication date: 2013
Languages: English
ISBN: 978 92 4 150540 6

Downloads

• English

Overview

These WHO mhGAP guidelines were developed to provide recommended management strategies for conditions specifically related to stress, including symptoms of acute stress, post-traumatic stress disorder and bereavement.

The guidelines were developed by an independent Guidelines Development Group and inform a new mhGAP module on the Assessment and Management of Conditions Specifically Related to Stress.

 

While there is much variability in the levels of stress created by different disasters (exacerbated by both the severity and duration), cultural attitudes towards suicide, and in the effectiveness of individual coping skills, there seems little doubt that major disasters can cause both temporary and long-term mental health problems.

 

The CDC’s website contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

(Continue . . .)

 

And from the National Center For PTSD, you’ll find abundant resources - including videos - on how to provide Psychological First Aid.

Lastly, while the psychological impact of a major disaster cannot be fully prevented, individual, family, and business preparedness can go a long ways towards reducing both the physical and emotional impact of any disaster.

 

Having a modest supply of food, water, and medicine – and a workable family or business disaster plan – can go a long ways toward reducing both stress and hardship.

Basic Preps: Emergency Weather Radio, First Aid Kit, Battery Lantern, Water storage

 

Those that follow FEMA’s, and Ready.gov’s advice to Have A Plan, Make A Kit, and Be informed  will be better equipped to deal with any eventuality.  Which is why I promote basic preparedness at every opportunity in this blog.

 

A few of my (many) blogs on that subject include:

 

In An Emergency, Who Has Your Back?

When 72 Hours Isn’t Enough

When Evacuation Is The Better Part Of Valor

NPM13: Pandemic Planning Assumptions

TEPCO Reports New Leak In Fukushima Plant

Photo credit IAEA

 

 

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It’s been nearly 2 &1/2 years since the Great East Japan Earthquake and tsunami of March 2011 which sparked the worst nuclear disaster since the Chernobyl meltdown and explosion of 1986.

 

Over the past 30 months crews have been working to safe and decommission the stricken Fukushima Daiichi #1 nuclear plant – a process that is expected to take decades.

 

About a month ago, TEPCO (Tokyo Electric Power Company) admitted that the Fukushima nuclear plant was likely leaking contaminated water into the Pacific (see AP article Japan nuclear plant likely contaminating sea).

 

Overnight, TEPCO announced the discovery of a new leak, which involves highly radioactive water.  The following coverage from AFP, BBC, and Reuters, after which I’ll have more. 

 

 

TEPCO reports worst radioactive leak from tank at Japan's Fukushima

AFP

Tuesday, Aug 20, 2013

TOKYO - Some 300 tonnes of radioactive water is believed to have leaked from a tank at Japan's crippled nuclear plant, the worst such leak since the crisis began, the operator said Tuesday.

 

Tokyo Electric Power Company (TEPCO) said the leak was believed to be continuing Tuesday at Fukushima and it had not yet pinpointed the source of it.

 

TEPCO said puddles with extremely high radiation levels - about 100 millisieverts per hour - have been found near the water tanks at the ruined plant.

 

"This means you are exposed to the level of radiation in an hour that a nuclear plant worker is allowed to be exposed to in five years," a TEPCO spokesman told a press conference.

(Continue  . . .)

 

 

 

Fukushima nuclear plant: Radioactive water leak found

BBC 20 August 2013 Last updated at 06:57 ET

Radioactive water has leaked from a storage tank into the ground at Japan's Fukushima plant, its operator says.

Tokyo Electric Power Company (Tepco) said the leak of at least 300 tonnes of the highly radioactive water was discovered on Monday.

(Continue . . .)

 

Wrecked Fukushima plant springs highly radioactive water leak

By Yoko Kubota and Yuka Obayashi

TOKYO | Tue Aug 20, 2013 10:31am BST

(Reuters) - Contaminated water with dangerously high levels of radiation is leaking from a storage tank at Japan's crippled Fukushima nuclear plant, the most serious setback to the cleanup of the worst nuclear accident since Chernobyl.

(Continue . . .)

 

 

While officials are describing this newest leak as a LEVEL 1 incident – the lowest level of concern on the 7 point International Nuclear and Radiological Event Scale - this is the first such declaration since the initial event in 2011.

 

The long term effects or implications of this release of radioactive water have not been determined, but at the very least, this is another psychological blow to those living or working in the stricken region.  

 

Last February, in  WHO: Estimated Health Risks From The Fukushima Radiation Release, we saw a report that stated the radiation risks to those living outside of the immediate Fukushima region were low, but `that the estimated risk for specific cancers in certain subsets of the population in Fukushima Prefecture has increased and, as such, it calls for long term continued monitoring and health screening for those people.’

 

But the  press release went on to state that cancers are not the only serious long-term health consequences from the Fukushima disaster.

 

As well as the direct health impact on the population, the report notes that the psychosocial impact may have a consequence on health and well-being. These should not be ignored as part of the overall response, say the experts.

 

In Disaster’s Hidden Toll, we looked at a report on the  long-term, largely unseen, effect of this disaster on nursing home patients who were forced to evacuate to temporary facilities.

 

The study showed a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

A unusually large number of these excess deaths were due to pneumonia or bronchitis, which many attribute to insufficient emergency shelters provided for the elderly and frail.

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

PTSD (Post Traumatic Stress Disorder) can often occur in the wake of a disaster or traumatic experience. Symptoms may include anxiety, depression, suicide and PTSD may even lead to drug and alcohol-related disorders.

 

Two weeks ago in WHO: Guidelines For Post-Trauma Mental Health Care we looked at a new report from the World Health Organization on post-disaster management of stress-related illness.

 

Credit WHO

 

The aftermath of disasters often results in social, economic, and psychological upheavals (see Surviving A Different Kind Of Aftershock).

 

Our short attention span, combined with the news media’s proclivity for moving on to the next big disaster or story, can make us forget that the struggle to rebuild devastated families and communities can take years.

 

Although a good disaster plan and emergency kit are imperative to get you through the opening hours and days of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

 

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

Psychological First Aid: Field Operations Guide

For Disaster Responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning.

 

A small reminder that not all wounds bleed, not all fractures will show up on an X-ray, and that the best treatment may not always reside inside your first aid kit.

WHO: Guidelines For Post-Trauma Mental Health Care

Credit WHO

 

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We’ve discussed some of the issues surrounding post-trauma mental health here in the past, including:

 

Disaster’s Hidden Toll

Surviving A Different Kind Of Aftershock

Psychological First Aid: The WHO Guide For Field Workers

Post Disaster Stress & Suicide Rates

 

PTSD (Post Traumatic Stress Disorder) is increasingly recognized as a serious factor in the wake of any traumatic event, and early recognition and treatment can be invaluable in reducing its impact.

 

The World Health Organization has just released new guidelines on the treatment of PTSD, acute stress, and bereavement, which you can access at the link below:

 

Publication details

Number of pages: 273
Publication date: 2013
Languages: English
ISBN: 978 92 4 150540 6

Downloads

• English

Overview

These WHO mhGAP guidelines were developed to provide recommended management strategies for conditions specifically related to stress, including symptoms of acute stress, post-traumatic stress disorder and bereavement.

The guidelines were developed by an independent Guidelines Development Group and inform a new mhGAP module on the Assessment and Management of Conditions Specifically Related to Stress.

 

 

 

Of note: Included in these guidelines is advice against the use of benzodiazepines (popular anti-anxiety drugs) during the first 30 days following a traumatic event, as they may actually slow recovery and have the potential to become addictive.  

 

For more background on these new guidelines we have the following press release:

 

 

WHO releases guidance on mental health care after trauma

New clinical protocol and guidelines to enable effective mental health care for adults and children exposed to trauma and loss

News release

6 August 2013 | GENEVA - WHO is releasing new clinical protocols and guidelines to health-care workers for treating the mental health consequences of trauma and loss.

 

Mental disorders are common, disabling and usually untreated, and WHO’s "Mental Health Global Action Programme (mhGAP)" was developed in 2008 to scale-up care for mental, neurological and substance use disorders with simple treatment protocols that can be offered by primary health-care doctors and nurses.

New care protocols for post-traumatic stress disorder and others

Now, WHO is extending this programme by including care for post-traumatic stress disorder (PTSD), acute stress and bereavement within its global programme.

 

“We have received numerous requests for guidance for mental health care after trauma and loss” says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health.

“Primary health-care providers will now be able to offer basic support consistent with the best available evidence. They will also learn when to refer to more advanced treatment.”

 

Traumatic events and loss a common experience

Traumatic events and loss are common in people’s lives. In a previous WHO study of 21 countries, more than 10% of respondents reported witnessing violence (21.8%) or experiencing interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) or trauma to a loved one (12.5%). An estimated 3.6% of the world's population has suffered from post-traumatic stress disorder (PTSD) in the previous year, the study showed.

 

Using the new protocol, which is co-published with the United Nations High Commissioner for Refugees (UNHCR), primary health-care workers can offer basic psychosocial support to refugees as well as people exposed to trauma or loss in other situations.

 

Types of support offered can include psychological first aid, stress management and helping affected people to identify and strengthen positive coping methods and social supports.

 

In addition, referral for advanced treatments such as cognitive-behavioural therapy (CBT) or a new technique called eye movement desensitization and reprocessing (EMDR) should be considered for people suffering from PTSD. These techniques help people reduce vivid, unwanted, repeated recollections of traumatic events. More training and supervision is recommended to make these techniques more widely available.

 

Warnings against some popular treatments

Primary health care staff are also warned against certain popular treatments. For example, benzodiazepines, which are anti-anxiety drugs, should not be offered to reduce acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event.

 

“PTSD needs to be managed along with other common mental disorders” reports Dr Mark van Ommeren, Scientist in the WHO Department of Mental Health and Substance Abuse. “This new, simple WHO-UNHCR treatment protocol will guide health workers around the world to help adults and children who suffer from conditions specifically related to stress.” The new guidelines and protocol were published today in an article in "The Journal of the American Medical Association".

Additional information

There is no evidence on the benefits of benzodiazepines, a common anti-anxiety drug, on symptoms of traumatic stress after a recent potentially traumatic event. Benzodiazepines may slow down the time to recover from potentially traumatic events.

 

Key concerns about the use of benzodiazepines are that many people develop tolerance to their effects, gain little therapeutic benefit from chronic consumption, become dependent on them and suffer a withdrawal syndrome when they stop taking them.

 

Thus, the WHO recommendation is that benzodiazepines should not be offered to adults to reduce acute traumatic stress symptoms associated with significant impairment in daily functioning in the first month after a potentially traumatic event.

 

The WHO recommendation also notes that benzodiazepines can have their use for other mental disorders.

(Continue . . .)

Disaster’s Hidden Toll

 

  +

Credit NHK News – Fukushima evacuation zone March 2011

 

# 6846

 

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often don’t closely follow the struggle to rebuild disaster stricken communities, which can take months or even years.

 

And for some caught in harm’s way, whose homes and businesses were destroyed - and loved ones lost - there is no going back to the way things used to be.

 

Not surprisingly, that can produce significant mental and physical health challenges for those affected.

 

Today we’ve a report out of Japan showing that the earthquake/tsunami of March 2011 that killed more than 20,000 people in Japan also had a long-term, largely unseen, effect on nursing home patients who were forced to evacuate to temporary facilities.

 

A study shows a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

A unusually large number of these excess deaths were due to pneumonia or bronchitis, which many attribute to insufficient emergency shelters provided for the elderly and frail.

This report from the Ashasi Simbum.

 

Death rates spike among elderly evacuees from Fukushima

January 11, 2013

By YURI OIWA/ Staff Writer

Former residents of nursing homes near the Fukushima No. 1 nuclear plant died at a higher rate than usual in 2011, a study has shown, likely because of the stress of evacuation and having to live in temporary accommodations such as draughty school gyms.

 

Researchers from the Fukushima Medical University studied reports submitted to the Fukushima prefectural government by 34 institutions for the elderly and found that the death rate over eight months in 2011 was 2.4 times that of the same period in 2010.

(Continue . . . )

 

A similar result was found in this study of nursing home evacuations from the University of South Florida.

 

The Effects of Evacuation on Nursing Home Residents With Dementia

Lisa M. Brown, PhD, David M. Dosa, MD, MPH, Kali Thomas, MA, Kathryn Hyer, PhD, MPP, Zhanlian Feng, PhD, Vincent Mor, PhD

Background: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired.

 

Conclusions: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.

 

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

 

PTSD (Post Traumatic Stress Disorder) can often occur in the wake of a disaster or traumatic experience. Symptoms may include anxiety, depression, suicide and PTSD may even lead to drug and alcohol-related disorders.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are all at risk of suffering some level of PTSD.

 

In Psychological First Aid: The WHO Guide For Field Workers we looked at the need for, and a guide for providing psychological first aid (PFA) in a post-disaster environment.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

A reminder that a disaster’s impact can linger long after the story has fallen off the front pages, and that indirect casualties can follow months after the initial event.

Post Disaster Stress & Suicide Rates

 

 

# 5739

 

 

Nearly 5 months after the triple horrors of a deadly 9.0 earthquake, a series of massive coastal tsunamis, and an ongoing nuclear crisis, the lives and futures of millions of Japanese remain disrupted and uncertain.

 

In a matter of a few hours more than  20,000 lives were lost, hundreds of thousands of survivors became refugees, families were separated, entire towns were destroyed, and uncounted businesses and individual livelihoods wiped out.

 

Added to that, millions of residents have endured scores of strong aftershocks, rattling both previously damaged infrastructures and already raw nerves.

 

And so stories, such as the one that appeared yesterday on the Voice of America's website about the fears of a rise in post-disaster suicides have become fairly common in the media.

 

Fears of Suicide Surge in Japan's Tsunami Zone

Henry Ridgwell | Sendai, Japan

Photo: VOA

These people care for their infant, and are among more than 430,000 forced into emergency shelters after the earthquake and tsunami struck Japan on March 11 of this year, in Sendai, Japan, August 2011

Months after Japan's devastating earthquake and tsunami, mental health experts say the psychological effects of the disaster might only now be coming to the surface. Phone counseling services are building up their presence along Japan's northeast coast for fear of increased suicides and other mental health problems.

(Continue . . .)

 

 

Japan, somewhat notoriously, was already known for having one of the highest rates of suicide in the world.  Not the highest, as many media stories have suggested (Lithuania, Kazakhstan, and Belarus all reportedly surpass Japan’s rate), but very high nonetheless.

 

According to the Japanese government, more than 30,000 citizens took their own lives in 2010. Differences in international reporting make exact comparisons between countries difficult to make.

 

Historically, Japan’s suicide rate has been closely tied to its economy, jumping more than 30% following their severe economic downturn in the late 1990s. Suicides often peak in May, during a period called  “gogatsu byo” or “May Sickness” – a time of increased stress that coincides with end of the corporate year in Japan.

 

While exact numbers in the wake of Japan’s tragedy are hard to come by, according to a report appearing in The Australian newspaper last June, suicide rates have risen markedly.

 

Suicide rates are increasing in Japanese regions most effected by the tsunami and nuclear disasters

Richard Lloyd Parry, Asia Editor June 17, 2011

The country already has one of the highest suicide rates in the world, but new figures show that the number of deaths has risen almost a fifth compared with a year ago. In Miyagi, the region worst hit by the March 11 tsunami, the figures are especially alarming, with suicides up 39 per cent.

(Continue . . . )

 

Many of these reports are anecdotal  in the turmoil following Japan’s disaster, and it will probably be years before the full psychological impact of this national rauma can be fully assessed.

 

Studies from previous disasters around the world have provided mixed, and sometimes confusing, results.

 

In 1999 a 7.3 earthquake struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

Among their findings:

 

. . .  the psychological effect of the earthquake in the disaster areas was far greater for women than for men. For men and women, suicide mortality rates were highest in the 25 to 39 year age group. Suicide rates among the 22 townships in the disaster areas varied markedly and were significantly correlated to severity of damage (number of injuries and number of collapsed/ partially collapsed buildings) within the township.

 

But another study, this time following California’s 6.7 magnitude Northridge earthquake in 1994, found exactly the opposite.  The rate of suicide actually dropped in the three years following that disaster.

 

Suicides in Los Angeles County in Relation to the Northridge Earthquake

Kimberley Shoaf,DrPH; Cary Sauter,MPH; Linda B. Bourque, PhD;Christian Giangreco,MPH;  Billie Weiss,MPH

Conclusion: It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological
impacts of the Northridge earthquake did not  culminate in an increase in the rates of suicide.

 

Adding to the confusion, we’ve seen conflicting reports on suicide rates following the devastation of New Orleans from Hurricane Katrina. 

 

While some sources have cited a 3-fold increase in suicide in the months following that disaster (see CNN report New Orleans' suicide rate nearly triples) a Harvard Study released in the summer of 2006 came to a different conclusion.

 

Mental illness and suicidality after Hurricane Katrina.

Ronald C. Kessler, Sandro Galea, Russell T. Jones, Holly A. Parker, and Hurricane Katrina Community Advisory Group

 

Funded by the  National Institute of Mental Health, the study surveyed 1,043 survivors.  They found:

 

• More than 11% were diagnosed with a serious mental illness following the storm. This compares to just over 6% before the hurricane.
• 9.9% had mild-moderate mental illness, compared to 9.7% before Katrina.
• They estimated  200,000 people facing serious mental problems, such as PTSS (Post Traumatic Stress Syndrome) and depression, in the three states most affected.

 

Despite this doubling of serious mental health issues, they found that fewer people expressed thoughts of committing suicide.

 

They concluded:

 

Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation

 

 

In 2002 (and updated in 2005) Fran H. Norris of the Dartmouth Medical School and National Center for PTSD released a comprehensive review of the mental health impact of 132 different disasters between 1981 and 2004.

 

Range, Magnitude, and Duration of the Effects of Disasters on Mental Health:  Review Update 2005

 

The following slides come from an HHS presentation on Research on the Mental Health Consequences of Disaster by Ferris Tuma, Sc.D.

 

 

While there appears to be much variability in the levels of stress created by different disasters (exacerbated by both the severity and duration), cultural attitudes towards suicide, and in the effectiveness of individual coping skills, there seems little doubt that major disasters can cause both temporary and long-term mental health problems.

 

The CDC’s website contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

Information for Individuals & Families

• Coping with Traumatic Events
  Provides general information regarding common reactions to expect after disasters.
• Video: Coping with a Traumatic Event
• Preventing Violence after a Natural Disaster
• Tips for Talking about Disasters
  Provides information that can be used by teachers, children, adults, families and response workers.
• Maintain a Healthy State of Mind
  Developed in partnership with the American Red Cross this site provides information for parents and caregivers, middle school students, high school students, adults and seniors.
• Helping Families Deal With the Stress of Relocation After a Disaster
  Helping family members deal with relocation stress from ATSDR.
• Helping Parents Prepare for a Disaster
• Helping Parents Cope with a Disaster

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And from the National Center For PTSD, some resources - including videos - on how to provide Psychological First Aid.

 

Psychological First Aid: Field Operations Guide

 

For disaster responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning. It is for use by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings. The 5th appendix consists of Handouts for Survivors (PDF).

 

Online training on how to provide Psychological First Aid is available from http://learn.nctsn.org/, and you can view a series of videos about the process that are available on the PFAOnlinevideos Channel of Youtube.

 

 

Lastly, while the psychological impact of a major disaster cannot be fully prevented, individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

 

Those that follow FEMA’s, and Ready.gov’s advice to Have A Plan, Make A Kit, and Be informed  will be better equipped to deal with any eventuality.

 

September is National Preparedness Month, but being ready to deal with an emergency – large or small – should be a year-round endeavor.

 

Finally, a couple of my (many) blogs on that subject include:

 

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

PTSD Awareness Day

 

 

# 5653

 

Today, June 27th, has been designated National PTSD Awareness Day by the Congress of the United States.

 

PTSD (Post Traumatic Stress Disorder) is a stress response that some people experience after a traumatic event that may include anxiety, depression, suicide, and may lead to drug and alcohol-related disorders.

 

The United States Department of Veterans Affairs has taken the lead in PTSD awareness and research, but the victims of PTSD are far more widespread than just military personnel returning from war zones.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are all at risk of PTSD.

 

From the National Center For PTSD today, some resources including videos on how to conduct Psychological First Aid.

 

 

 

Psychological First Aid: Field Operations Guide

For disaster responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning. It is for use by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings. The 5th appendix consists of Handouts for Survivors (PDF).

Online training on how to provide Psychological First Aid is available from http://learn.nctsn.org/, and you can view a series of videos about the process that are available on the PFAOnlinevideos Channel of Youtube.