Psychosocial sequelae of the 1989 Newcastle earthquake: III. Role of vulnerability factors in post-disaster morbidity

Investigation of the effectiveness of short-term grief-focused group intervention for 1st degree losses in earthquake

A considerable number of individuals who lost family members in the 2023 earthquake in Hatay province, Turkey, have been found to experience a range of psychosocial problems and disorders. In this randomised controlled trial, the efficacy of grief-focused group therapy was compared with that of a control group that did not receive any treatment. A total of 10 Turkish adults were randomly assigned to the group therapy group. The participants were evaluated at the outset of the study and at its conclusion in order to ascertain any changes in psychological resilience (Psychological Resilience Scale for Adults), grief symptoms (Grief Scale), and cognitive flexibility (Cognitive Flexibility Inventory). The results of the study are as follows: The results demonstrated that grief-focused group therapy was an effective intervention for reducing grief symptoms and enhancing psychological resilience and cognitive flexibility. A brief grief-focused group intervention has been demonstrated to be an efficacious intervention for earthquake survivors. The brief grief-focused group intervention proved more efficacious than the control condition in enhancing psychological resilience and cognitive flexibility, while concurrently attenuating grief symptoms, among adults who lost first-degree family members in the earthquake. Overall, the Grief Recovery Focused Group Therapy Program yielded a favourable impact on alpha, beta, and gamma scores in the experimental group, while exhibiting no discernible effect on delta and theta scores.

Weaker situations: Uncertainty reveals individual differences in learning: Implications for PTSD

Few individuals who experience trauma develop posttraumatic stress disorder (PTSD). Therefore, the identification of individual differences that signal increased risk for PTSD is important. Lissek et al. (2006) proposed using a weak rather than a strong situation to identify individual differences. A weak situation involves less-salient cues as well as some degree of uncertainty, which reveal individual differences. A strong situation involves salient cues with little uncertainty, which produce consistently strong responses. Results from fear conditioning studies that support this hypothesis are discussed briefly. This review focuses on recent findings from three learning tasks: classical eyeblink conditioning, avoidance learning, and a computer-based task. These tasks are interpreted as weaker learning situations in that they involve some degree of uncertainty. Individual differences in learning based on behavioral inhibition, which is a risk factor for PTSD, are explored. Specifically, behaviorally inhibited individuals and rodents (i.e., Wistar Kyoto rats), as well as individuals expressing PTSD symptoms, exhibit enhanced eyeblink conditioning. Behaviorally inhibited rodents also demonstrate enhanced avoidance responding (i.e., lever pressing). Both enhanced eyeblink conditioning and avoidance are most evident with schedules of partial reinforcement. Behaviorally inhibited individuals also performed better on reward and punishment trials than noninhibited controls in a probabilistic category learning task. Overall, the use of weaker situations with uncertain relationships may be more ecologically valid than learning tasks in which the aversive event occurs on every trial and may provide more sensitivity for identifying individual differences in learning for those at risk for, or expressing, PTSD symptoms.

Evaluating Community Resilience and Associated Factors One Year after the Catastrophic Fort McMurray Flood

BACKGROUND

Resilience after natural disasters is becoming an increasingly key area of research. In April 2020, parts of Fort McMurray were affected by severe floods. The flooding caused the loss of properties, evacuation of some residents, and effects on their mental health.

OBJECTIVE

This study explores the prevalence and associated factors between flood experience and low resilience a year after the 2020 floods in Fort McMurray.

METHOD

Data collection was accomplished one year after the flood, from 24 April to 2 June 2021, using an online survey. The data were analyzed with SPSS version 25 using univariate analysis with the chi-squared test and binary logistic regression analysis.

RESULTS

The prevalence of low resilience was 37.4%. Respondents under 25 years were nearly 26 times more likely to show low resilience (OR = 0.038; 95% CI 0.004-0.384) than respondents 40 years and above. Responders with a history of depression (OR = 0.258 95% CI: 0.089-0.744) and a history of anxiety (OR = 0.212; CI 95% 0.068-0.661) were nearly four to five times more likely to show low resilience than those without a history. Similarly, respondents willing to receive mental health counselling (OR = 0.134 95% CI: 0.047-0.378) were 7.5 times more likely to show low resilience. Participants residing in the same house before the flood were almost 11 times more likely to show low resilience (OR = 0.095; 95% CI 0.021-0.427) than those who relocated. Participants who received support from the Government of Alberta were less likely to express low resilience than those who received no or limited support (OR = 208.343; 95% CI 3.284-13,218.663).

CONCLUSION

The study showed a low resilience rate among respondents following the 2020 flooding in Fort McMurray. Factors contributing to low resilience include age, history of depression or anxiety, and place of residence after the flood. After the flood, receiving support from the government was shown to be a protective factor. Further studies are needed to explore robust risk factors of low resilience and measures to promote normal to high resilience among flood victims in affected communities.

Personality traits and income inequalities in self-rated oral and general health

The association of low income with poor health is widely recognized, but why some low-income individuals do not experience poor health remains unclear. The aim of this study was to determine whether greater positive personality trait scores modify the association between income and oral and general health-related quality of life (OHRQoL and HRQoL) among a representative sample of the South Australian population. Cross-sectional self-rated questionnaire data from a sample of 3645 adults in 2015-2016 were used for secondary analysis. In four factorial ANOVA models, the main effects, interaction, and effect modification of personality traits [measured using the Ten-Item Personality Inventory (TIPI)] on the association between income and OHRQoL [measured using the Oral Health Impact Profile (OHIP-14)] and HRQoL [measured using the European Quality of Life indicator (EQ-5D-3L)] were assessed. In the low-income group, participants with greater TIPI scale scores had lower means for the OHIP-14 and the EQ-5D-3L (better OHRQoL and HRQoL). Greater emotional stability scores modified the association between low income and HRQoL and OHRQoL. Stronger positive personality traits, such as emotional stability, appear to ameliorate the adverse effect of income inequalities in health.

Mental health effects of the Gangwon wildfires

Background

The April 2019 wildfires in Gangwon Province, South Korea forced the evacuation of 1500 individuals and cost more than $100 million in damages, making it the worst wildfire disaster in Korean history. The purpose of this paper was to investigate the mental health effects on survivors following the wildfires.

Methods

Between April and May 2019, outreach psychological support services were delivered to people impacted by the wildfires. Post-disaster psychological responses using a checklist and the Clinical Global Impression Scale-Severity (CGI-S) were evaluated for 206 wildfires survivors. The CGI-S was administered consequently at 1, 3, and 6 months after baseline measurement.

Results

Among four response categories, somatic responses (76.2%) were most frequently observed among the wildfire survivors. Specifically, insomnia (59.2%), anxiety (50%), chest tightness (34%), grief (33%), flashbacks (33%), and depression (32.5%) were reported by over 30% of the participants. The mean CGI-S scores were significantly decreased at 1 month (mean score = 1.94; SE = 0.09) compared to baseline (mean score = 2.94; SE = 0.08) and remained at the decreased level until 6 months (mean score = 1.66; SE = 0.11). However, participants with flashbacks showed significantly higher CGI-S scores compared to those without flashback at 6 months.

Conclusions

Wildfire survivors have various post-disaster responses, especially somatic responses. While most participants’ mental health improved over time, a few of them may have experienced prolonged psychological distress after 6 months. Flashbacks were particularly associated with continuing distress. These results suggest that the characteristics of responses should be considered in early phase intervention and in follow-up plans for disaster survivors.

Psychosocial impacts of post-disaster compensation processes: Community-wide avoidance behaviors

RATIONALE

There is a small but growing body of literature on litigation- and compensation-related stress after disasters. Results of these studies are consistent and unsurprising: compensation processes are a source of stress to plaintiffs and their families. "Litigation Response Syndrome"-anxiety, stress, and depression-is common among those exposed to the pressures of litigation (Lees-Haley 1988). However, little is known about how compensation processes-claims, litigation, and settlements-affect communities at large.

OBJECTIVE

Building on prior research, we examine adverse impacts of compensation processes in Roane County, Tennessee five years following the Tennessee Valley Authority coal ash spill. We investigate whether compensation-related stress occurs at a community level, as well as avoidance behaviors as measured by the Impact of Event Scale.

METHOD

Based on data from a 2014 household mail survey of a random sample of 716 residents of Roane County, we examine the relationship between compensation processes and event-related avoidance behaviors.

RESULTS

We found that compensation-related stress is not limited to those directly involved with compensation processes. Respondents view these processes as adversely impacting the community at large. The strongest contributors to event-related avoidance behaviors are beliefs about adverse compensation impacts and the effectiveness of cleanup and restoration activities, socioeconomic status, and economic resource loss. Therefore, it appears that Litigation Response Syndrome can extend to some members of the community who were not directly involved in litigation and compensation processes.

Onset and remission of common mental disorders among adults living in temporary housing for three years after the triple disaster in Northeast Japan: comparisons with the general population

Background

People living in temporary housing for long periods after a disaster are at risk of poor mental health. This study investigated the post-disaster incidence and remission of common mental disorders among adults living in temporary housing for the 3 years following the 2011 Great East Japan Earthquake.

Methods

Three years after the disaster, face-to-face interviews were conducted with 1089 adult residents living in temporary housing in the disaster area, i.e., the shelter group, and a random sample of 852 community residents from non-disaster areas of East Japan. The World Health Organization Composite International Diagnostic Interview was used to diagnose DSM-IV mood, anxiety, and alcohol use disorders. Information on demographic variables and disaster experiences was also collected.

Results

Response rates were 49 and 46% for the shelter group and the community residents, respectively. The incidence of mood/anxiety disorder in the shelter group was elevated only in the first year post-disaster compared to that of the general population. The rate of remission for mood and anxiety disorders was significantly lower in the shelter group than in the community residents. The proportion seeking medical treatment was higher in the shelter group.

Conclusions

The onset of common mental disorders increased in the first year, but then levelled off in the following years among residents in temporary housing after the disaster. Remission from incident post-disaster mental disorders was slower in the shelter group than in the general population. Post-disaster mental health service could consider the greater incidence in the first year and prolonged remission of mental disorders among survivors with a long-term stay in temporary housing after a disaster.

A scoping review of post-disaster social support investigations conducted after disasters that struck the Australia and Oceania continent

This scoping review provides a summary of research findings on social support dynamics in the wake of disasters that occurred on the continent of Australia and Oceania between 1983 and 2013. Forty-one studies, quantitative and qualitative, were summarised, investigating different facets of post-disaster supportive interactions. All inquiries assessed disasters resulting from natural hazards, with the majority of them conducted following events in Australia and New Zealand. The review revealed similar patterns of post-disaster social support dynamics that routinely unfold after disastrous incidents all over the world. Consistent with the disaster mental health literature, the documentation of social support mobilisation and social support deterioration processes was common. Salutary direct effects of supportive behaviours on post-disaster psychological distress were also highly evident. Most studies, however, posed research questions or hypotheses that lacked empirical or theoretical grounding. In conclusion, the review offers several recommendations on how to advance research on post-disaster social support.

A new conception and subsequent taxonomy of clinical psychological problems

BACKGROUND

A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified.

MAIN TEXT

An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone.

CONCLUSION

A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.

Prevalence Rates and Predictors of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray Six Months After a Wildfire

The Fort McMurray wildfire was the costliest disaster in Canadian history, with far-reaching impacts. The purpose of this paper is to examine the prevalence and risk factors of elevated generalized anxiety disorder (GAD) symptomatology in residents of Fort McMurray 6 months after the wildfire. Data were collected via random selection procedures from 486 participants. Generalized anxiety disorder symptoms were measured via the GAD-7. The 1-month prevalence rate for GAD symptomatology 6 months after the disaster was 19.8% overall, regression analyses revealed six variables with significant unique contributions to prediction of GAD symptomatology. Significant predictors were: pre-existing anxiety disorder, witnessing of homes being destroyed by the wildfire, living in a different home after the wildfire, receiving limited governmental support or limited family support, and receiving counseling after the wildfire. Participants with these risk factors were between two to nearly seven times more likely to present with GAD symptomatology. In addition, participants who presented with elevated symptomatology were more likely to increase use or problematically use substances post-disaster. This study extends the literature on mental health conditions and risk factors following disasters, specifically in the area of generalized anxiety. Findings and implications are discussed.

Does personality affect health-related quality of life? A systematic review

Background

Health-related quality of life (HRQOL) is increasingly measured as an outcome for clinical and health services research. However, relatively little is known about how non-health factors affect HRQOL. Personality is a potentially important factor, yet evidence regarding the effects of personality on HRQOL measures is unclear.

Methods

This systematic review examined the relationships among aspects of personality and HRQOL. Eligible studies were identified from Medline and PsycINFO. The review included 76 English-language studies with HRQOL as a primary outcome and that assessed personality from the psychological perspective. Individuals with various health states, including ill (e.g., cancer, cardiovascular disorders), aging, and healthy, were included in this review study.

Results

Some personality characteristics were consistently related to psychosocial aspects more often than physical aspects of HRQOL. Personality characteristics, especially neuroticism, mastery, optimism, and sense of coherence were most likely to be associated with psychosocial HRQOL. Personality explained varying proportions of variance in different domains of HRQOL. The range of variance explained in psychosocial HRQOL was 0 to 45% and the range of explained variance in physical HRQOL was 0 to 39%.

Conclusions

Personality characteristics are related to HRQOL. Systematic collection and analysis of personality data alongside HRQOL measures may be helpful in medical research, clinical practice, and health policy evaluation.

Moderate Depression Promotes Posttraumatic Growth (Ptg): A Young Population Survey 2 Years after the 2009 L'Aquila Earthquake

Background:

Earthquakes can result in a range of psychopathology and in negative and positive consequences for survivors.

Objective:

To examine the association between clinical aftereffects (anxiety and depressive symptoms) and post-traumatic growth (PTG) among young survivors of the 2009 L’Aquila earthquake, Italy.

Method:

316 young earthquake survivors enrolled in the University of L’Aquila were evaluated two years after the natural disaster. Participants completed three main questionnaires, including Patient Health Questionnaire-9 items (PHQ-9), Self-Rating Anxiety Scale (SAS), and Posttraumatic Growth Inventory (PTGI).

Results:

59.6% of the student sample showed different levels of depression, whereas 13.3% reported anxiety symptoms. In both clinical dimensions (anxiety and depression), gender differences were found: female gender was confirmed risk factor for a clinical post-traumatic response. Personal PTG, demonstrated by 18% of the L’Aquila youths included in our sample, was predicted by moderate levels of depression (O.R. 2.7). In our model, gender, age, and anxiety did not show any predictive value.

Conclusion:

In a post-traumatic setting, the development of individual cognitive strategies is crucial, whereas after a natural disaster, paradoxically, a moderate depressive condition and the related distress could promote the drive to overcome the psychological consequences of the traumatic event.

The relationship between psychiatric morbidity and quality of life: interview study of Norwegian tsunami survivors 2 and 6 years post-disaster

BACKGROUND

The study investigated the impact of psychiatric disorders on Quality of Life (QOL) cross-sectionally and longitudinally in a group of Norwegian tourists severely exposed to the 2004 tsunami.

METHODS

Sixty-two adult Norwegian tsunami survivors were interviewed face to face 2 years post-tsunami (T1) and 58 were interviewed again by telephone 6 years post-tsunami (T2). The majority (81 %) reported direct exposure to the waves, and 14 participants (23 %) lost a close family member in the tsunami. Psychiatric morbidity was measured by structured clinical interviews and QOL was assessed with WHO's Quality of Life-Bref scale. Multiple linear regression analyses were performed to assess the independent effects of psychiatric disorders on QOL 2 and 6 years after the tsunami.

RESULTS

Psychiatric disorders, especially depression, but also PTSD and other anxiety disorders, were associated with reduced QOL. Psychiatric disorders were more strongly related to QOL at 6 years after the tsunami than at 2 years.

CONCLUSIONS

Psychiatric disorders, and especially depression, is related to reduced QOL in a disaster exposed population. Post-disaster psychiatric disorders, such as PTSD and especially depression, should be addressed properly in the aftermath of disasters.

Posttraumatic stress and symptom improvement in Norwegian tourists exposed to the 2004 tsunami--a longitudinal study

BACKGROUND

Mental health consequences of disasters are frequently studied. However, few studies have investigated symptom improvement in victims after natural disasters. This study aimed to identify predictors of 6 months post-disaster stress symptoms and to study 6 months and 24 months course of symptoms among Norwegian tourists who experienced the 2004 tsunami.

METHODS

Norwegian tourists (≥ 18 years) who experienced the 2004 tsunami (n = 2468) were invited to return a postal questionnaire at two points of time. The first data set was collected at 6 months (T1, n = 899) and the second data set at 24 months post-disaster (T2, n = 1180). The population studied consisted of those who responded at both assessments (n = 674). Impact of Event Scale Revised (IES-R) was used to measure posttraumatic stress symptoms. IES-R score ≥ 33 (caseness) was used to identify various symptom trajectories from T1 to T2. Multiple linear regression was used to determine predictors of posttraumatic stress at T1 and to identify variables associated with symptom improvement from T1 to T2.

RESULTS

The majority was identified as non-case at both assessments (57.7%), while 20.8% of the respondents were identified as case at both assessments. Symptoms at T1 were positively related to female gender, older age, unemployment, being chased or caught by the waves, witnessing death or suffering, loss of loved ones, experiencing intense fear during the disaster, low conscientiousness, neuroticism and low levels of social support. The IES-R sum score declined from 24.6 (SD = 18.5) at T1 to 22.9 (SD = 18.3) at T2, p < 0.001. Emotional stability and high IES-R scores at T1 were positively related to symptom improvement, while received social support was not. Being referred to a mental health specialist was negatively related to symptom improvement.

CONCLUSIONS

A significant minority (20-30%) among Norwegian tourists developed enduring posttraumatic stress symptoms in the aftermath of the 2004 tsunami. Tsunami exposure, peritraumatic fear, neuroticism and low levels of social support were the strongest predictors of posttraumatic stress at 6 months post-disaster. Decrease in posttraumatic stress was related to emotional stability and higher symptom levels at T1. Being referred to a mental health specialist did not facilitate symptom improvement.

How community organizations moderate the effect of armed conflict on migration in Nepal

This study analyses micro-level variability in migration during armed conflict in Nepal. The analysis is based on a multi-dimensional model of individual out-migration that examines the economic, social, and political consequences of conflict and how community organizations condition the experience of these consequences and systematically alter migration patterns. Detailed data on violent events and individual behaviour during the Maoist insurrection in Nepal and multi-level event-history analysis were used to test the model. The results indicate that community organizations reduced the effect of conflict on out-migration by providing resources that helped people cope with danger, as well as with the economic, social, and political consequences of the conflict. The evidence suggests that the conflict caused the population to be systematically redistributed in a way that will probably affect its future socio-demographic composition--the extent of the redistribution depending on the resources available in each community.

Acute stress reactions and associated factors in the help-seekers after the L'Aquila earthquake

BACKGROUND

The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L'Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed.

METHODS

For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies.

RESULTS

Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by 'full' ASD, whereas 48 subjects (39.3%) could be considered affected by 'partial' ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting 'behavioural disengagement' or 'requesting emotional support from others' were found to increase the likelihood of a positive estimate of being an 'ASD case', while the adoption of an 'acceptance' coping style seemed to reduce the likelihood of the positive estimate of being an 'ASD case'.

CONCLUSIONS

This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.

Factors impacting on the well-being of older residents in rural communities

BACKGROUND

In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes.

AIMS

This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors.

METHODS

Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI).

RESULTS

Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8).

CONCLUSIONS

Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.

Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia

BACKGROUND

Excessive alcohol use is a significant problem in rural and remote Australia. The factors contributing to patterns of alcohol use have not been adequately explained, yet the geographic variation in rates suggests a potential contribution of district-level factors, such as socio-economic disadvantage, rates of population change, environmental adversity, and remoteness from services/population centres. This paper aims to investigate individual-level and district-level predictors of alcohol use in a sample of rural adults.

METHODS

Using baseline survey data (N = 1,981) from the population-based Australian Rural Mental Health Study of community dwelling residents randomly selected from the Australia electoral roll, hierarchal logistic regression models were fitted for three outcomes: 1) at-risk alcohol use, indicated by Alcohol Use Disorders Identification Test scores ≥8; 2) high alcohol consumption (> 40 drinks per month); and 3) lifetime consequences of alcohol use. Predictor variables included demographic factors, pre-dispositional factors, recent difficulties and support, mental health, rural exposure and district-level contextual factors.

RESULTS

Gender, age, marital status, and personality made the largest contribution to at-risk alcohol use. Five or more adverse life events in the past 12 months were also independently associated with at-risk alcohol use (Adjusted Odds Ratio [AOR] 3.3, 99%CI 1.2, 8.9). When these individual-level factors were controlled for, at-risk alcohol use was associated with having spent a lower proportion of time living in a rural district (AOR 1.7, 99%CI 1.3, 2.9). Higher alcohol consumption per month was associated with higher district-level socio-economic ranking, indicating less disadvantage (AOR 1.2, 99%CI 1.02, 1.4). Rural exposure and district-level contextual factors were not significantly associated with lifetime consequences of alcohol use.

CONCLUSIONS

Although recent attention has been directed towards the potential adverse health effects of district or community level adversity across rural regions, our study found relatively few district-level factors contributing to at-risk alcohol consumption after controlling for individual-level factors. Population-based prevention strategies may be most beneficial in rural areas with a higher socio-economic ranking, while individual attention should be focused towards rural residents with multiple recent adverse life events, and people who have spent less time residing in a rural area.

Ethnic Differences in Symptoms of Post-traumatic Stress after the Exxon Valdez Oil Spill

Introduction:

Previous studies have reported ethnic differences in the prevalence of post-traumatic stress disorder (PTSD), but the reasons for these differences remain unclear.

Hypothesis:

Ethnic differences in the prevalence of PTSD may reflect ethnic differences in (1) exposure to traumatic events; (2) appraisal of such event as traumatic; and (3) culturally-determined responses to standardized diagnostic instruments, reflecting differences in cultural meanings associated with physical symptoms and idioms of distress.

Methods:

Ethnic differences in risk factors and factor structures of PTSD symptoms were examined in 188 Alaskan Natives and 371 Euro-Americans exposed to the Exxon-Valdez oil spill in 1989.

Results:

High levels of social disruption were associated with PTSD one year after the oil spill in both ethnic groups. However, low family support, participation in spill clean-up activities, and a decline in subsistence activities were significantly associated with PTSD in Alaskan Natives, but not in Euro-Americans. Factor analysis of the Diagnostic Interview Schedule PTSD subscale revealed five factors for both ethnic groups. However, the items comprising these factors were dissimilar.

Conclusions:

These results suggest that social disruption is sufficiently traumatic to be associated with symptoms of post-traumatic stress, but that a diagnosis of PTSD must take into consideration local interpretations of these symptoms.

Impact of physical injury on mental health after the 2004 Southeast Asia tsunami

BACKGROUND

The risk of developing enduring post-traumatic stress reactions and mental health problems in the aftermath of disasters is substantial. However, there are inconsistencies regarding the contribution of physical injury as an independent risk factor for developing psychiatric morbidity after disasters.

AIMS

The aim was to assess whether physical injury was associated with post-traumatic stress reactions and general mental health after adjusting for perceived life-threat in the aftermath of the 2004 tsunami.

METHODS

A sample of 1501 highly exposed survivors from the 2004 Southeast Asia tsunami was selected from a cohort of Swedish survivors surveyed 14 and 36 months after the event. The impact of physical injury on post-traumatic stress and general mental health was assessed by regression models accounting for subjective life-threat.

RESULTS

Physical injury was associated with higher levels of post-traumatic stress reactions and poorer general mental health. These associations were observed at both 14 and 36 months after the disaster.

CONCLUSIONS

Physical injury has a specific contribution to the association between traumatic experience and both post-traumatic stress reactions and general mental health in victims of the 2004 tsunami. The effect is stable over several years.

The Role of Avoidance Coping in the Disclosure of Trauma

Little research has been undertaken to examine the empirical basis of commonly applied methods of posttrauma intervention. We propose that Pennebaker's work on structured disclosure of trauma provides a suitable analogue to explore questions of interest. The present study asks whether avoidance coping is likely to interfere with abbreviated disclosure of traumatic experiences. Subjects were 118 college students randomly allocated to either a one-session or four-session written trauma-disclosure condition. At 2 months postdisclosure, subjects with high avoidance coping within the one-session condition exhibited significantly more trauma-specific and physical symptoms than all other subjects. Avoidance coping significantly predicted trauma-specific symptoms at 2 months. These findings suggest that single session traumatic disclosure may not be useful for individuals with an avoidance style of coping.

Determinants of mental health and well-being within rural and remote communities

BACKGROUND

The individual and contextual factors influencing current mental health and well-being within rural communities are poorly understood.

METHODS

A stratified random sample of adults was drawn from non-metropolitan regions of NSW, Australia. One-quarter (27.7%) of the 2,639 respondents were from remote/very remote regions. An aggregate measure of current well-being was derived from levels of distress and related impairment (Kessler-10 LM), self-reported overall physical and mental health, functioning, satisfaction with relationships, and satisfaction with life. Multivariate methods investigated the contributions to current well-being of demographic/dispositional factors, recent events and social support, individual exposure to rural adversity, and district/neighbourhood level characteristics.

RESULTS

Respondents from very remote regions tended to be younger and have lower education. Univariate associations were detected between well being and exposure to rural adversity (greater drought-related worry, lower perceived service and support availability, greater number of years living in the current district). Multivariate analysis (n = 2,462) accounted for 41% of the variance in well-being scores. The major contributing variables were dispositional factors (trait neuroticism, marital status), recent adverse events and indices of social support. However, no additional effects were detected for district-level variables (drought severity, regional socioeconomic categorisation, population change). Similar associations were detected using the K-10 alone as the outcome measure.

CONCLUSIONS

The chief determinants of current well being were those reflecting individual level attributes and perceptions, rather than district-level rural characteristics. This has implications for strategies to promote well being within rural communities through enhancing community connectedness and combating social isolation in the face of major adversities such as drought.

The “Trauma Signature:” Understanding the Psychological Consequences of the 2010 Haiti Earthquake

The 2010 Haiti earthquake was one of the most catastrophic episodes in history, leaving 5% of the nation’s population killed or injured, and 19% internally displaced. The distinctive combination of earthquake hazards and vulnerabilities, extreme loss of life, and paralyzing damage to infrastructure, predicts population-wide psychological distress, debilitating psychopathology, and pervasive traumatic grief. However, mental health was not referenced in the national recovery plan. The limited MHPSS services provided in the first eight months generally lacked coordination and empirical basis.

There is a need to customize and coordinate disaster mental health assessments, interventions, and prevention efforts around the novel stressors and consequences of each traumatic event. An analysis of the key features of the 2010 Haiti earthquake was conducted, defining its “Trauma Signature” based on a synthesis of early disaster situation reports to identify the unique assortment of risk factors for post-disaster mental health consequences. This assessment suggests that multiple psychological risk factors were prominent features of the earthquake in Haiti. For rapid-onset disasters, Trauma Signature (TSIG) analysis can be performed during the post-impact/pre-deployment phase to target the MHPSS response in a manner that is evidence-based and tailored to the event-specific exposures and experiences of disaster survivors. Formalization of tools to perform TSIG analysis is needed to enhance the timeliness and accuracy of these assessments and to extend this approach to human-generated disasters and humanitarian crises.

Posttraumatic stress disorder among survivors of the Wenchuan earthquake 1 year after: prevalence and risk factors

Exposure to earthquakes has been associated with psychological distress in particular, the development of posttraumatic stress disorder (PTSD). The aims of this study are to estimate the prevalence of PTSD, explore the associated risk factors among survivors 1 year after the Wenchuan earthquake in China, and compare the findings in our study to other disasters. Cross-sectional sample survey was conducted to collect data in severely affected counties. We use the PTSD Check List-Civilian Version, which consists of 17 items corresponding to each symptom in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD criteria B, C, and D. The prevalence estimates of probable PTSD in our sample ranged from 21.5% (based on Check List-Civilian Version score of 50 or higher) to 40.1% (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The prevalence of PTSD was high, compared with rates of PTSD in previous studies. Low social support, feeling fear during the earthquake, female, young people, Han nationality, low monthly income, and low educational level were risk factors significantly related to the development of PTSD. Postdisaster mental health recovery interventions including early identification, ongoing monitoring, and sustained psychosocial support are required for the high-risk population with PTSD. Existing rural and urban health care services should be convenient for people, and special measures need to be designed, such as home visits and mobile clinics.

A cross-sectional study among survivors of the 2008 Sichuan earthquake: prevalence and risk factors of posttraumatic stress disorder

OBJECTIVE

The objective of this study is to estimate the prevalence of probable posttraumatic stress disorder (PTSD), explore the related risk factors among Sichuan earthquake survivors in different counties and compare the findings in our study to others.

METHOD

A cross-sectional sample survey was conducted to collect data in heavily (n=367) and moderately damaged counties (n=337). We used the PTSD Check List-Civilian Version (PCL-C), which consists of 17 items corresponding to each symptom of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

RESULTS

The prevalence of probable PTSD in heavily damaged counties (48.2%) was higher than that in moderately damaged counties (14.5%). Many associated risk factors were identified in the cross-sectional study.

CONCLUSION

Female, Han nationality, low monthly income, fear during earthquake and low social support in the past year were significant risk factors in heavily damaged counties, while the probable PTSD in moderately damaged counties was related to female, youth, fear during earthquake and low social support.

Vulnerability factors in anxiety determined through differences in active-avoidance behavior

The risk for developing anxiety disorders is greater in females and those individuals exhibiting a behaviorally inhibited temperament. Growth of behavioral avoidance in people is a significant predictor of symptom severity in anxiety disorders, including post-traumatic stress disorder. Using an animal model, our lab is examining how the process of learning avoidant behavior may lead certain individuals to develop anxiety. Here we examined whether the known vulnerabilities of female sex and behaviorally inhibited temperament have individual or additive effects upon the acquisition of an active-avoidance response. A discrete trial lever-press escape-avoidance protocol was used to examine the acquisition of behavioral avoidance in male and female Sprague-Dawley (SD) rats and behaviorally inhibited inbred Wistar-Kyoto (WKY) rats. Overall, WKY rats of both sexes were indistinguishable in their behavior during the acquisition of an active-avoidance response, exhibiting quicker acquisition of reinforced responses both between and within session compared to SD rats. Further WKY rats emitted more non-reinforced responses than SD rats. Sex differences were evident in SD rats in both the acquisition of the reinforced response and the emission of non-reinforced responses, with SD females acquiring the response quicker and emitting more non-reinforced responses following lever presses that led to an escape from shock. As vulnerability factors, behavioral inhibition and female sex were each associated with more prevalent reinforced and non-reinforced avoidant behavior, but an additive effect of these 2 factors was not observed. These data illustrate the importance of genetics (both strain and sex) in the assessment and modeling of anxiety vulnerability through the acquisition of active-avoidance responses and the persistence of emitting those responses in periods of non-reinforcement.

Sampling and design challenges in studying the mental health consequences of disasters

Disasters are unpredictable and frequently lead to chaotic post-disaster situations, creating numerous methodologic challenges for the study of the mental health consequences of disasters. In this commentary, we expand on some of the issues addressed by Kessler and colleagues, largely focusing on the particular challenges of (a) defining, finding, and sampling populations of interest after disasters and (b) designing studies in ways that maximize the potential for valid inference. We discuss these challenges - drawing on specific examples - and suggest potential approaches to each that may be helpful as a guide for future work. We further suggest research directions that may be most helpful in moving the field forward.

Medium-term post-Katrina health sequelae among New Orleans residents: predictors of poor mental and physical health

AIMS

To assess the medium-term post-Katrina mental and physical health of New Orleans residents and to determine demographic, social and environmental factors that predict poor mental and physical health.

BACKGROUND

Major disasters can have a negative impact on the health of survivors for prolonged periods. Although the initial and short-term impacts of Hurricane Katrina have been well described, the medium-term impacts have not been studied as thoroughly.

DESIGN

Cross-sectional survey.

METHODS

A convenience sample (n = 222) of residents in Gentilly area of New Orleans completed questionnaires between 16 and 18 December 2006. Multivariate logistic regression and multiple regression models were employed to determine predictors of poor mental and physical health.

RESULTS

Poor mental health was reported by 52% of the respondents. Pre-Katrina depression [odds ratio (OR) = 19.1], post-Katrina depression (OR = 7.2), poor physical health (OR = 5.6), feeling unsafe from crime (OR = 4.3) and female gender (OR = 2.6) were significant predictor variables of poor mental health. Twenty-four percent of the variance in number of days of poor mental health was explained by the independent variables (R(2) = 0.24; p < 0.001). Poor physical health was reported by 48% of the respondents. Poor mental health (OR = 3.9), lack of money to buy food (OR = 2.7) and pre-Katrina arthritis (OR = 2.6) were significant predictor variables of poor physical health. Twenty-three percent of the variance in number of days of poor physical health was explained by the independent variables (R(2) = 0.23; p < 0.001).

CONCLUSIONS

Approximately half of the New Orleans residents continue to experience poor mental and physical health 15 months after Katrina. The results support focusing post-Katrina efforts to protect residents from crime, improve mental health services to the depressed and improve food supply to the poor.

RELEVANCE TO CLINICAL PRACTICE

Identifying predictors of poor mental and physical health may help clinicians and policy makers to focus their efforts in ameliorating the post-disaster health sequelae.

Factors impacting on psychological distress and recovery after the 2004 Niigata-Chuetsu earthquake, Japan: community-based study

AIM

This study was undertaken 5 months after the 2004 Niigata-Chuetsu earthquake in Japan to assess factors that impacted on psychological distress and its recovery.

METHODS

Three thousand and twenty-six adult victims who lived in temporary shelter and in seriously damaged areas were evaluated by questionnaire. The questionnaire queried subject profile, degree of house damage, health status, and psychological distress using a 5-point scale before, immediately and 5 months after the earthquake.

RESULTS

Immediately after the earthquake, 59.3% of the subjects had psychological distress. At 5 months after the earthquake, however, this percentage decreased to 21.8%. The psychological distress immediately after the earthquake was significantly serious in victims who: (i) were female; (ii) felt stronger fear of the earthquake and the aftershocks; (iii) lived at home or office after the earthquake; and (iv) were injured due to the earthquake or suffered from sickness after the earthquake. In contrast, the factors impairing psychological recovery 5 months after the earthquake were as follows: (i) being with unfamiliar member(s) during the night after the earthquake; (ii) serious house damage; (iii) living in temporary shelter or at a relative's home after the earthquake; and (iv) physical illness after the earthquake.

CONCLUSION

Despite differences between disasters, these results were consistent with those in some previous studies and may be useful for long-term mental care support.

The impact of pretrauma analogue GAD and posttraumatic emotional reactivity following exposure to the September 11 terrorist attacks: a longitudinal study

The relation between analogue generalized anxiety disorder (GAD) assessed the day before the events of September 11, 2001 (9/11) and long-term outcome was examined in 44 young adults who were directly exposed the following day to the terrorist attacks in New York City. After controlling for high exposure to the attacks, preattack analogue GAD was associated with greater social and work disability, loss of psychosocial resources, anxiety and mood symptoms, and worry, but not symptoms of posttraumatic stress, assessed 12 months after 9/11. Fear and avoidance of emotions assessed 4 months after 9/11 statistically mediated the relation between preattack analogue GAD and social and work disability, loss of psychosocial support, mood and anxiety symptoms, and worry at 12-month follow-up. Avoidance of emotions 4 months after 9/11 also mediated the relation between preattack analogue GAD and posttraumatic stress symptoms 12 months after 9/11.

Post-traumatic stress disorder following disasters: a systematic review

BACKGROUND

Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated.

RESULTS

We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13).

CONCLUSIONS

The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

Modification effects of coping on post-traumatic morbidity among earthquake rescuers

This study aims to investigate the modification effects of coping strategies on the relationships between rescue effort and psychiatric morbidity (i.e. general psychiatric morbidity and post-traumatic morbidity) in earthquake rescue workers. Firefighters (n=193) who were involved in the rescue effort after the Taiwan Chi-Chi earthquake were invited to complete a questionnaire which contained questions on demographics, exposure to rescue work, general psychiatric morbidity, post-traumatic morbidity, and coping strategies. Multivariate regression models with interaction terms were carried out to investigate the modification effect of coping strategies on the relationships between rescue effort and psychiatric morbidities. Older age and longer job experiences (>3 years) were associated with both general psychiatric and post-traumatic morbidities. Coping strategies such as confrontive coping, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem solving, and positive appraisal significantly modified the effect of exposure to dead bodies on general psychiatric morbidity. Furthermore, confrontive coping, distancing, and planned problem solving significantly modified the effect of exposure to direct rescue involvement on general psychiatric morbidity. However, coping strategies were not observed to buffer the effect of rescue involvement or contact with dead bodies on post-traumatic morbidity. More frequent use of coping strategies could reduce the effect that exposure to rescue efforts has on the incidence of general psychiatric morbidity in rescue workers. However, coping strategies do not seem to reduce the influence of such exposure on trauma-related morbidities. This suggests that coping strategies can be used to prevent general psychiatric morbidity but not trauma-related morbidities.

Post-traumatic stress disorder and comorbid depression among survivors of the 1999 earthquake in Turkey

This study examined the prevalence of post-traumatic stress disorder (PTSD) and comorbid depression some three years after the August 1999 earthquake in Turkey among a sample of 769 survivors relocated to a permanent housing site built for homeless survivors in the epicentre region. Time since trauma was 3.1 years for 81 per cent of the participants and 3.9 years for the remainder. Survivors were assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors, an easily administered self-rating scale with demonstrated validity. The estimated rates of PTSD and comorbid depression were 40 per cent and 18 per cent, respectively. Linear regression analyses showed that PTSD strongly related to fear during the earthquake, while depression related to loss of family members. These results suggest that catastrophic earthquakes have long-term psychological consequences and highlight the need for a cost-effective mental health care model for earthquake survivors.

Impaired psychological recovery in the elderly after the Niigata-Chuetsu Earthquake in Japan:a population-based study

BACKGROUND

An earthquake measuring 6.8 on the Richter scale struck the Niigata-Chuetsu region of Japan at 5.56 P.M. on the 23rd of October, 2004. The earthquake was followed by sustained occurrence of numerous aftershocks, which delayed reconstruction of community lifelines. Even one year after the earthquake, 9,160 people were living in temporary housing. Such a devastating earthquake and life after the earthquake in an unfamiliar environment should cause psychological distress, especially among the elderly.

METHODS

Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12) in 2,083 subjects (69% response rate) who were living in transient housing five months after the earthquake. GHQ-12 was scored using the original method, Likert scoring and corrected method. The subjects were asked to assess their psychological status before the earthquake, their psychological status at the most stressful time after the earthquake and their psychological status at five months after the earthquake. Exploratory and confirmatory factor analysis was used to reveal the factor structure of GHQ12. Multiple regression analysis was performed to analyze the relationship between various background factors and GHQ-12 score and its subscale.

RESULTS

GHQ-12 scores were significantly elevated at the most stressful time and they were significantly high even at five months after the earthquake. Factor analysis revealed that a model consisting of two factors (social dysfunction and dysphoria) using corrected GHQ scoring showed a high level of goodness-of-fit. Multiple regression analysis revealed that age of subjects affected GHQ-12 scores. GHQ-12 score as well as its factor 'social dysfunction' scale were increased with increasing age of subjects at five months after the earthquake.

CONCLUSION

Impaired psychological recovery was observed even at five months after the Niigata-Chuetsu Earthquake in the elderly. The elderly were more affected by matters relating to coping with daily problems.

Predictors of psychological distress in survivors of the 1999 earthquakes in Turkey: effects of relocation after the disaster

OBJECTIVE

Relocations after disasters are known to cause added distress in survivors. This study examined the effects of migration and other factors on psychological status of survivors 4 years after the two severe earthquakes in Turkey.

METHOD

Five hundred and twenty-six adult survivors of the 1999 earthquakes currently living in Ankara were given self-report measures assessing traumatic stress, depression, earthquake experience and social support.

RESULTS

The rates of current post-traumatic stress disorder (PTSD) and depression were 25% and 11%, respectively. Although both traumatic stress and depression factors were predicted by some demographic and trauma severity variables, relocation status predicted depression but not traumatic stress.

CONCLUSION

The rates of psychological distress were higher than expected in a city considered to be safe in terms of earthquake risk. Relocation after the disaster may increase psychological distress by disrupting the social network.

[Violence is also a public health issue]

In 1996, the World Health Organization declared violence a major and growing public health problem across the world. In Spain, despite the growing incidence of reports of deaths and abuse due to intimate partners violence; the emergent data on school-based violence among children and adolescents; the persisting political violence and the tragic experience of the 11-M attacks in Madrid; a clear positioning over the role of the public health structures in the study and intervention of violence has not taken place. This article provides a characterization of the impact of violence in the health of its victims, as derived from a non-systematic review of the clinical, psychological and social literature. It also includes some prevalence data from Spanish studies. Special emphasis is given to violence against women, and political violence. The article highlights the scarcity of epidemiological data, which hinders the assessment of the health impact of violence in Spain. It brings, instead, the opinions of a number of public health professionals over the role of the Spanish communities of epidemiology and public health in this matter. The article concludes with a call to public health professionals, including the Spanish scientific societies involved in public health, to facilitate the public debate leading to the definition of the role of the Spanish public health in the understanding and reduction of the impact of violence on the health of its victims.

Sources of social support as determinants of psychiatric morbidity after severe life events: prospective cohort study of female employees

OBJECTIVE

The aim of this study was to study prospectively the associations between sources of social support, life events, and psychiatric morbidity, as explicated in the chronic strain and the stress-buffering hypotheses.

METHODS

Psychiatric morbidity and sources of social support were assessed at Time 1 and 3 years later at Time 2 among 4250 female municipal employees. At Time 2, the participants were also asked about their preceding life events during the year.

RESULTS

After adjustment for baseline characteristics, low support from one's partner, coworkers, and supervisor at Times 1 and 2 was positively associated with psychiatric morbidity at Time 2 (OR = 1.1-1.6). The support of friends at Time 1 lowered the risk of psychiatric morbidity after death or severe illness in the family and after interpersonal conflict. High postevent network heterogeneity also lowered the risk of psychiatric morbidity after financial difficulty. For the remaining 33 combinations between different sources of social support and life events, no corresponding interactions were found.

CONCLUSION

The observed associations support the chronic strain hypothesis, but the support for the stress-buffering hypothesis was limited.

Psychological effects of the November 1999 earthquake in Turkey: an epidemiological study

OBJECTIVE

This study assessed the traumatic stress symptoms and related factors in two towns affected by two earthquakes, which killed 20000 people in 1999 in Turkey.

METHOD

A total of 430 people in selected households were seen 18 months after the earthquake. They were given a self-report questionnaire assessing post-traumatic stress (PTSD) and depressive symptoms, demographics and trauma exposure.

RESULTS

The rates of PTSD and depression were higher in the site closer to the epicenter. The traumatic stress symptom checklist scores were predicted by fear during earthquake, loss of friends and neighbours, female gender, lower education and living in rented accomodation. Depression was predicted by study site, death of relatives and past psychiatric illness.

CONCLUSION

These results show that severe earthquakes can cause long-lasting morbidity. Our previous findings that showed a differential prediction for depressive and traumatic stress symptoms after earthquakes are also supported.

Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey. The estimated rates of PTSD and major depression were 39% and 18%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, older age, participation in rescue work, having been trapped under rubble, and personal history of psychiatric illness. More severe depression symptoms related to older age, loss of close ones, single marital status, past psychiatric illness, previous trauma experience, female gender, and family history of psychiatric illness. These findings suggest that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure. These findings lend further support to the need for long-term mental health care policies for earthquake survivors. Outreach service delivery programs are needed to access non-treatment-seeking survivors with chronic PTSD.

Traumatic stress responses in earthquake survivors in Turkey

This study examined the rates of posttraumatic stress disorder (PTSD) and depression and associated risk factors in earthquake survivors in Turkey. A group of 1,000 people from 3 camps and 2 prefabricated housing sites in the epicenter region was assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors. The estimated rates of PTSD and major depression were 43 and 31 %, respectively. Traumatic stress symptoms related to more intense fear during the earthquake, female gender, having been trapped under rubble, death of a family member, past psychiatric illness, having participated in rescue work, and lower education. Avoidance of trauma reminders was the most common symptom and needs special attention in survivor care because of its mental health, social, and economic implications.

Research on psychiatric outcomes and interventions subsequent to disasters: a review of the literature

Tragic events such as those of September 11, 2001, underscore the increasingly prominent role that psychiatrists play in aiding survivors, emergency workers, and broader communities to cope with disaster. The present review was undertaken to identify whether there exists a scientific basis for the practice of psychiatry in the aftermath of disasters. Most of the extensive literature over the past 30 years suggests that disasters have psychopathological consequences as well as medical and social ones. Pre-existing mood and anxiety disorders, although surprisingly not psychotic illness, appear to be risk factors for further psychopathology after a disaster. Thus, both acute psychopharmacological and psychotherapeutic interventions at disaster sites may prevent long-term sequelae, although their efficacy remains uncertain. Future controlled treatment trials are needed to determine the optimal treatment strategy.

60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research

On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.