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PubMed1994

Children exposed to disaster: II. Risk factors for the development of post-traumatic symptomatology.

OBJECTIVE: To examine the influence of subject and exposure variables on the development of post-traumatic stress disorder (PTSD) symptoms and syndrome in children exposed to disaster. METHOD: Three months after Hurricane Hugo, 5,687 school-aged children were surveyed about their experiences and reactions to the hurricane. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index. RESULTS: The presence of PTSD symptoms was strongly related to children's reported severity of the hurricane, degree of home damage sustained, and continued displacement; however, children's level of trait anxiety and their reported emotional reactivity during the hurricane were more strongly related to the presence of PTSD symptoms than were the exposure factors. Different sets of risk factors appeared to differentially influence the development of the three DSM-III-R PTSD symptom clusters. Little evidence for a differential effect of the risk factors between females and males and younger and older children was found. CONCLUSIONS: Level of trait anxiety appears to be the single strongest risk for the development of severe post-traumatic reactions. The higher rate of post-traumatic symptoms in females and younger children in combination with the absence of differential reaction to the risk factors suggests that females and younger children are more likely to develop posttraumatic reactions following a disaster.

Adaptation, Psychological↗
PubMed1987

Acute posttraumatic stress disorder in victims of a natural disaster.

Five months after a tornado devastated a rural community in eastern North Carolina, the authors surveyed the mental health status of 116 disaster victims, using the Hopkins Symptom Checklist (HSCL) expanded to include most of DSM-III criteria for posttraumatic stress disorder (PTSD). A total of 69 (59%) victims met the criteria for acute PTSD, 19 of whom had a severe form. Although an inadequate degree of social support was more often noted in victims with severe PTSD, other demographic factors and degree of injury or property damage did not appear to be related to the presence of PTSD. Severity or presence of PTSD was supported by high scores on all HSCL subscale factors. These findings suggest a high incidence of acute PTSD in victims of natural disasters and the potential value of HSCL in screening for PTSD in large populations.

Acute Disease↗
PubMed1991

Impact of a humanmade disaster on the utilization pattern of a psychiatric emergency service.

In May 1980, Liberty City Miami, a black area, suffered a humanmade disaster: a riot. The effects of the riot on the utilization pattern of the only psychiatric emergency service (PES) for the Liberty City catchment area were studied in two ways: autocorrelation and cross-correlation analyses were used to determine whether PES presentations demonstrated a 7-day cycle and whether this cycle was disturbed by the riot; and analyses of variance (ANOVAs) were used to compare numerically the riot week to the preceding week, the riot week to the following 12 weeks, and the 12 pre-riot weeks to the 12 post-riot weeks. Black PES presentations did not demonstrate a statistically discernable cycle, and none of the ANOVAs were statistically significant. It was concluded that the riot did not have a significant psychiatric morbidity effect as measured by PES presentation data. These results are discussed in reference to previous disaster studies.

Analysis of Variance↗
PubMed1992

Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample.

Research has indicated significant comorbid psychopathology with chronic posttraumatic stress disorder (PTSD) in samples of war veterans. The present paper examines the issue of comorbidity in a disaster sample to learn whether findings from veterans generalized to this event. A total of 193 subjects exposed to the Buffalo Creek dam collapse of 1972 were examined 14 years later using diagnoses derived from the Structured Clinical Interview for DSM-III (SCID). Past and present PTSD was found in a significant portion of the sample. Major depression was the next most common diagnosis and was highly related to PTSD. Anxiety disorders were also common. The overlap with other diagnoses was quite similar to that found in a sample of Vietnam veterans we studied earlier, except that the disaster sample had fewer dysthymic disorders, substance abusers, and antisocial personality disorders. Possible explanations for comorbidity in chronic PTSD were discussed and it was suggested that the morphology of PTSD may be quite stable in at least some other nonveteran trauma populations.

Ambulatory Care↗
PubMed1993

Emotional distress in disaster victims. A follow-up study.

One hundred thirteen adult victims of a major Latin American disaster were screened for emotional distress 1 and 5 years after the catastrophe. We used the Self-Reporting Questionnaire to identify emotionally distressed victims. Results indicate that the prevalence of emotional distress decreased from 65% in 1986 to 31% in 1990. However, a comparison of the symptomatology on these two assessments indicates a similarity in the frequency and profiles of symptoms among the distressed. Also, the most frequent symptoms and the strongest predictors of emotional distress were essentially the same. These findings provide empirical support to the clinically observed course of emotional symptomatology of disaster victims and to the focused training of health workers on selected emotional problems that are consistently present over time.

Adult↗
PubMedDate not supplied

Outbreaks can be disasters: a guide to developing your plan.

Disaster can strike at any time. Most hospitals have a contingency plan for attack from without, but it can also happen from within as one small rural hospital discovered. The authors share practical tips for prevention, detection crisis management, and post-crisis follow-up based on principles of disaster planning. Experience is a great teacher and we can benefit from the authors' helpful tips for creating a more complete plan.

Canada↗
PubMedDate not supplied

Short- and long-term association between uric acid and a natural disaster.

OBJECTIVE: This paper analyzes the longitudinal relationship between serum uric acid level and a natural disaster. METHODS: The sample consists of factory workers who were participating in a longitudinal epidemiological study of coronary heart disease risk factors. Participants were seen in 1975 (baseline), 1980 (5 year follow-up), and 1987 (12 year follow-up). The 5 year (1980) follow-up examination was interrupted by a major earthquake and resumed 2 weeks after the quake. At this examination, participants seen after the quake had, on the average, significantly lower serum uric acid than those seen before the earthquake. In 1987 (7 years after the quake), participants were questioned whether or not (in their own perception) they were still suffering from damages due to the 1980 earthquake. RESULTS: At the examination in 1987, participants who reported suffering from damage due to the 1980 quake showed on the average significantly increased serum uric acid compared with participants who reported not suffering from damages due to the 1980 quake. The analyses of the data of 578 individuals who participated in all three examinations confirmed these findings and showed that they were independent from levels of uric acid measured prior to the disaster. CONCLUSIONS: The reason for this apparent different association with uric acid and acute and long-term exposure to the quake remains to be clarified but these findings are consistent with the existence of diverse patterns of physiologic response to different stressors.

Adaptation, Psychological↗
PubMed1983

Disaster preparedness.

The only rational approach to the potential chaos of a mass disaster is thoughtful predisaster preparation and realistic but optimistic confrontation of the situation. An appropriate response implies accurate assessment of the magnitude of the disaster, the establishment of a reliable and effective communication system, a realistic inventory of and provision for sustained personnel and logistical support, and proper triage of individual casualties. It is incumbent upon the medical community to provide imaginative and creative responses to the concept of mass casualty management, and for all physicians involved to function in the generic sense as trauma surgeons.

Disaster Planning↗
PubMedDate not supplied

Fear of terrorism and preparedness in New York City 2 years after the attacks: implications for disaster planning and research.

OBJECTIVES: To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD). METHOD: We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats. RESULTS: We found 44.9 percent (95% confidence interval [CI] = 41.9-47.9) of residents were concerned about future attacks and 16.9 percent (95% CI = 14.7-19.3) reported a fear level of "10" on a 10-point analog scale. Furthermore, 14.8 percent (95% CI = 12.8-17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95% CI = 39.6-45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95% CI = 31.5-37.3) reported they would evacuate immediately against official advice. Predictors of high terrorism fear in a multivariate model included Hispanic ethnicity (odds ratio [OR] = 2.0, P = .006), lower education (OR = 4.4, P < .001, and OR = 3.7, P < .001, respectively, for nonhigh school and high school graduates, compared with college graduates), being exposed to stressful life events (OR = 1.6, P = .048), having current posttraumatic stress disorder (3.1, P < .001), having a fear of death (OR = 2.5, P = .002), and reporting a likelihood of fleeing an attack against advice (OR = 1.5, P = .034). The best predictors of preparedness in a multivariate model was being between 30 to 64 years old (30-44 years old, OR = 2.6, P = .001; 45-64 years old, OR = 1.8, P = .03, respectively, compared with 18-29 years old), having higher exposure to the WTCD (moderate exposure, OR = 1.7, P = .05; high exposure, OR = 2.4, P = .002; very high exposure, OR = 4.1, P < .001), respectively, compared with no little WTCD exposure), and having greater exposure to other lifetime traumatic events (high traumatic event exposure, OR = 2.1, P = .005, compared with no exposure). CONCLUSION: Our study suggests that among those exposed to ongoing terrorism threats, terrorism fear and preparedness were related to socioeconomic factors, mental health status, terrorism exposure levels, and exposure to stressful life events.

Adolescent↗
PubMed2005

Rethinking first response: effects of the clean up and recovery effort on workers at the world trade center disaster site.

OBJECTIVE: We sought to describe the physical and mental health effects of the cleanup and recovery effort on workers at the World Trade Center disaster site. METHODS: A mailed survey was sent to truck drivers, heavy equipment operators, laborers, and carpenters. It assessed work-related exposures and somatic and mental health symptoms. In one open-ended question, respondents shared any aspect of their experiences they wished; these 332 narrative responses were analyzed using qualitative techniques. RESULTS: Respondents reported suffering debilitating consequences of their work, including depression, drug use, and posttraumatic stress disorder. They felt poorly prepared to work in a disaster, lacked protective equipment and training, and felt overwhelmed by the devastation they faced. CONCLUSIONS: These workers' experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing "first" responders should be reconsidered more broadly.

Attitude to Health↗
PubMed2000

Let them eat risk? Wealth, rights and disaster vulnerability.

Disaster-vulnerability reduction is an impure public good: when provided to one it is provided to others, but not equally provided to all. This means that in addition to the question of how much disaster-vulnerability reduction to provide, policymakers face the question of to whom it should be provided. This essay distinguishes between two broad classes of approaches to the latter question, one based on wealth, the other on rights.

Disasters↗
PubMed2006

Post-disaster resettlement, development and change: a case study of the 1990 Manjil earthquake in Iran.

Planned and involuntary resettlement after natural disasters has been a major policy in post-disaster reconstruction in developing countries over the past few decades. Studies show that resettlement can result in significant adverse impacts on the resettled population. Conversely, a well-planned and managed resettlement process can produce positive long-term development outcomes. This article presents the results of a case study undertaken 11 years after the 1990 Manjil earthquake in Iran. During the reconstruction period, a policy of involuntary planned resettlement was pursued extensively. The socioeconomic changes that occurred as a consequence of this policy of involuntary resettlement are analysed. Data were collected via a questionnaire survey that involved a sample of 194 relocated households (grouped into a settlement that later became a town). The paper shows that relocated families face difficult socioeconomic challenges after relocation and regrouping. This is especially true with respect to employment, income, the empowerment of women and lifestyle issues.

Agriculture↗
PubMed1994

Disasters, family tracing and children's rights: some questions about the best interests of separated children.

Large numbers of children get separated from their families and communities in disasters. Family tracing is an attempt to find the families and assess if the children can be reunited. This paper examines how questions about the rights of children arise in the context of family tracing. It then looks at the challenges posed by effective and child sensitive tracing to both emergency and development programmes. The paper suggests that traditional coping mechanisms within communities are part of the social infractructure which all disaster intervention, including family tracing programmes, need explicitly to build on and repair.

Child↗
PubMed2006

Disaster risk, climate change and international development: scope for, and challenges to, integration.

Reducing losses to weather-related disasters, meeting the Millennium Development Goals and wider human development objectives, and implementing a successful response to climate change are aims that can only be accomplished if they are undertaken in an integrated manner. Currently, policy responses to address each of these independently may be redundant or, at worst, conflicting. We believe that this conflict can be attributed primarily to a lack of interaction and institutional overlap among the three communities of practice. Differences in language, method and political relevance may also contribute to the intellectual divide. Thus, this paper seeks to review the theoretical and policy linkages among disaster risk reduction, climate change and development. It finds that not only does action within one realm affect capacity for action in the others, but also that there is much that can be learnt and shared between realms in order to ensure a move towards a path of integrated and more sustainable development.

Disasters↗
PubMed2006

Reducing hazard vulnerability: towards a common approach between disaster risk reduction and climate adaptation.

Over the past few decades, four distinct and largely independent research and policy communities--disaster risk reduction, climate change adaptation, environmental management and poverty reduction--have been actively engaged in reducing socio-economic vulnerability to natural hazards. However, despite the significant efforts of these communities, the vulnerability of many individuals and communities to natural hazards continues to increase considerably. In particular, it is hydro-meteorological hazards that affect an increasing number of people and cause increasingly large economic losses. Arising from the realisation that these four communities have been largely working in isolation and enjoyed only limited success in reducing vulnerability, there is an emerging perceived need to strengthen significantly collaboration and to facilitate learning and information exchange between them. This article examines key communalities and differences between the climate change adaptation and disaster risk reduction communities, and proposes three exercises that would help to structure a multi-community dialogue and learning process.

Community Networks↗
PubMed2006

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.

Adolescent↗
PubMed2006

Early post-tsunami disaster medical assistance to Banda Aceh: a personal account.

The south Asian tsunami on 26 December, 2004, saw Australia deploy civilian teams to an international disaster in large numbers for the first time. The logistics of supporting such teams in both a self sustainability capacity and medical equipment had not previously been planned for or tested. For the first Australian team deployed to Banda Aceh, which arrived on the fourth day after the tsunami, equipment sourced from the New South Wales Fire Brigades Urban Search and Rescue (US&R) cache supplied all food, water, tents, generators and sleeping equipment. The medical equipment was largely sourced from the CareFlight US&R medical cache. There were significant deficits in surgical equipment as the medical cache had not been designed to provide a stand alone surgical capability. This resulted in the need for substantial improvisation by the surgical teams during the deployment. Despite this, the team performed nearly 140 major procedures in austere circumstances and significantly contributed to the early international response to this major humanitarian disaster.

Attitude of Health Personnel↗
PubMed1994

The Marchioness disaster: preliminary report on psychological effects.

The psychological after-effects on 27 survivors of the Marchioness riverboat disaster of 20 August 1989 are described. On measures of intrusive memories and psychological difficulties these subjects are significantly higher than population norms, and somewhat higher than psychiatric in-patient populations. Personality measures taken after the disaster show that neuroticism scores are very much higher than population norms, but personality measures were not correlated with distress.

Adult↗