WHO/UNHCR: New Mental Health Guidance For Humanitarian Emergencies

 

# 10,013

 

Over the years one of the topics we’ve returned to often has been the long-term psychological (and physical) effects that disasters, wars, and other humanitarian crises can inflict on a population. 

 

Last year, in Post-Katrina Heart Attack Rates – Revisited, we saw that heart attack rates in New Orleans remained greatly elevated 6 years after the city was inundated by Hurricane Katrina, while in Post Disaster Stress & Suicide Rates we looked at the psychological aftermath of some major disasters.

 

The loss of loved ones, personal injury or injury to a loved one, loss of one’s home or livelihood, and in some cases – the  uprooting and destruction of an entire community - can lead to increased rates of PTSD, depression, and even self-destructive behavior (i.e. drug and alcohol abuse, suicide, etc.) in a community.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are also  at risk of suffering some level of PTSD. PTSD symptoms may include anxiety, depression, suicide and PTSD may even lead to drug and alcohol-related disorders. 

 

While mental health professionals may be available in some settings, in others – particularly in low-resource regions of the world, or in the midst of a crisis – there may be little or no professional psychological support.  

 

In recent years, however, there has been an emphasis on psychological first aid (PFA) – that can be learned, and administered, by lay persons.

 

PFA training – which can usually be completed in a day – teaches the lay person how to provide emotional support to those who have recently experienced, or are currently going through, an emotionally traumatic experience.  In 2011, the World Health Organization unveiled a Psychological first aid: Guide for field workers in low-resource settings, which we looked at here.

 

In 2013, we looked at a far more comprehensive WHO: Guidelines For Post-Trauma Mental Health Care  on post-disaster management of stress-related illness, this time geared to health-care workers for treating the mental health consequences of trauma and loss.

Credit WHO

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.

 

 

Today the WHO has unveiled a new guide on dealing with mental health issues in the midst of a humanitarian emergency, one that builds on the successes and lessons of previous efforts.   This 68-page guide is written specifically for healthcare practitioners working in the midst of a humanitarian crises such as a war zone, or disaster.

 

 

WHO/UNHCR issue new guide on mental health in humanitarian emergencies

Joint WHO/UNHCR note for the media

5 May 2015 ¦ Geneva - Worldwide close to 80 million people are currently impacted by humanitarian emergencies arising from natural disasters and armed conflicts, such as those in the Central African Republic, South Sudan, Syrian Arab Republic, Yemen, and more recently, Nepal. WHO estimates 5% to 10% of these people suffer from a mental health condition such as depression as a result of the emergency.

People with mental health disorders rarely have access to specialized health workers trained in assessing and managing their conditions. WHO and the United Nations High Commissioner for Refugees (UNHCR) have therefore produced a Mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG), so non-specialist health workers can better identify, assess and manage mental health needs.

The new guide provides practical, first-line management recommendations for mental, neurological and substance use conditions. Contents include modules on assessing and managing conditions such as acute stress, grief, moderate-severe depressive disorder, post-traumatic stress disorder, epilepsy, and harmful use of alcohol and drugs.

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WHO and UNHCR

Publication details

Number of pages: 68
Publication date: 2015
Languages: English
ISBN: 978 92 4 154892 2

Downloads

• Read the publication

 

 

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.

 

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.

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

 

# 7548

 

 

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 . . .)

Surviving A Different Kind Of Aftershock

 

 

 

# 6109

 

 

FEMA and 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 to prepare for emergencies and disasters.

The standardized 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 few enough Americans can be bothered to prepare for even 72 hours.

 

I personally advocate a minimum of a week’s worth of supplies (two would be better), but then I live in the heart of hurricane country, and am admittedly a bit of a belt-and-suspenders kind of guy (see NPM11: Living The Prepared Life).

 

There are some post-disaster aftershocks, however, that even two weeks of supplies won’t prepare you for.

 

The recent earthquakes in Haiti and in Fukushima, Japan – along with  Hurricane Katrina in New Orleans – have shown how communities can be forever changed by a disaster.

 

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often forget that the struggle to rebuild devastated communities can take years.

 

And sometimes, for some of the people caught in harm’s way, there is no going back to the way things used to be.

 

Today, in a sobering news story by ABC (Australian Brocasting Corp), we learn that the first of what may eventually become 5,000 homes are to be demolished in the wake of their recent series of earthquakes near Christchurch, NZ.

 

The land they were built on experienced significant liquefaction during the September 2010 and February 2011 earthquakes, and so homes will not be rebuilt on these lots.

 

 

NZ begins demolishing Christchurch suburbs

By New Zealand correspondent Dominique Schwartz

Updated January 30, 2012 18:50:35

 

As this story indicates, that despite some compensation offered by the government, many residents have lost tens (or even hundreds) of thousands of dollars and say they have `no way of moving forward’.

 

With tremors continuing (see map above), those who escaped with only minor or moderate damage get nerve-wracking daily reminders that the ground beneath their feet could move violently again at any time.

 

And for those who would like to move away and start anew, the reality is that there are few buyers willing to purchase a home or a business in an area where the ground continues to shake.

 

Not all of the aftershocks of a disaster are seismic in nature. Some are economic, while others can be psychological.

 

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).

 

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.

 

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.

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 are readily visible to the naked eye, and that the proper bandage for them may not always reside inside your first aid kit.

Psychological First Aid: The WHO Guide For Field Workers

 

 

 

# 5760

 

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.

 

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.

 

PFA training – which can usually be completed in a day – teaches the lay person how to provide emotional support to those who have recently experienced, or are currently going through, an emotionally traumatic experience.

 

Friday, August 19th, is World Humanitarian Day and to coincide with that day the World Health Organization, in conjunction with The War Trauma Foundation (WTF) and World Vision International (WVI) have released a PFA guide for field workers in low and middle income countries.

 

Follow the links below to read the WHO article, and access the field guide.

 

 

 

Providing psychological first aid in emergencies

16 August 2011 -- Humanitarian emergencies - such as earthquakes, drought, or war - not only affect people’s physical health but also their psychological and social health and well-being. For World Humanitarian Day, celebrated on 19 August, WHO and partners are publishing Psychological First Aid Guide for Fieldworkers. These guidelines explain how to provide basic support to people in the immediate aftermath of extremely stressful events.

(Continue . . . )

 

Related links

• Psychological first aid: Guide for field workers
  pdf 1.38Mb
• Mental health and psychosocial support in emergencies

 

 

 

As I’ve written before, 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.

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

 (Continue . . . )

 

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.