We have developed practical guidelines for mental-health
professionals interested in addressing the psychological needs of
natural-disaster victims. In particular, we suggest the following:
1. Direct early relief efforts (3 to 6 months post-hurricane) at
assisting individuals and families in obtaining basic goods and services.
Don't underestimate the importance of food, water, shelter, and medicines
to positive mental health.
2. To the extent possible, encourage people to become involved in
collective selfhelp efforts. Continuing the pre-hurricane norm of
self-reliance is a set-up for misery. Family should help family,
neighbors should help neighbors, coworkers should help coworkers.
3. Watch out for forgotten groups. Certain groups-such as the
elderly, the poor, the physically and mentally ill, and those in rural
areas-may become isolated following a natural disaster.
4. Educate the public regarding normal psychological functioning in
the aftermath of a hurricane, especially regarding normative stress
reactions and available stressmanagement tips. Encourage people to share
their experience with other people. It is helpful to know that one is not
alone in having certain experiences and feelings.
5. Expect largely pro-social behavior from the community in the
weeks and months following Hurricane Andrew. Large-scale natural
disasters typically bring out the hero in many individuals. However, be
prepared for some increase in problematic behavior such as crime,
substance abuse, and family conflict (domestic violence, child
mistreatment).
6. Be prepared to provide formal mental-health services to
individuals and families in need. If some form of psychological recovery
is not significantly under way by three to six months following Andrew, a
formal mental-health evaluation may be needed.
MEMO FROM THE MEDICAL UNIVERSITY OF SOUTH CAROLINA
Part One: Reactions to Hugo
This memo is based upon the work of a clinical research team
centered at the Department of Psychiatry and Behavioral Sciences of the
Medical University of South Carolina, in Charleston. The team, including
professors John Freedy, Ph.D., and Dean Kilpatrick, Ph.D., specializes in
studying the relationship between natural disasters and psychological
adjustment. Although the analyses are preliminary, the Hurricane Hugo
data may suggest some experiences that might also be associated with
Hurricane Andrew
Based on a sample of 776 adults impacted by Hurricane Hugo, our
preliminary analyses suggest that the vast majority of adults did not
suffer a persistent major mental-health disorder during the two years
following the disaster. However, a small percentage of the general
population did report either post-traumatic stress disorder (PTSD) or
major depressive episode (MDE). Overall, the data suggest that a
relatively small percentage of individuals will suffer major mentalhealth
difficulties following Hurricane Andrew. However, even small percentages
can equate to thousands of people when applied to a large population
base.
We have been able to identify factors that contributed
significantly to the development of mental-health problems. We recommend
viewing these variables as "risk factors" suggesting vulnerability for
the development of more serious mental-health problems.
The following factors were associated with a significantly
increased risk for developing PTSD: history of general anxiety; history
of victimization by violent crime; higher rates of negative life events
following Hugo; a lack of necessary resources (e.g. family stability,
stable employment, support from others); and higher rates of coping
behavior.
These factors were related to the development of MDE: lower income;
extreme initial emotional reactions to the hurricane; lack of necessary
resources; and higher rates of negative life events following
Hugo.
The risk factors outlined above could be used to identify
populations at greatest potential mental-health risk. A few people
developed physical concerns; however, many people reported individual and
community resiliency by reporting the "good" that resulted from the
storm. Many seem to be aware of the risk of future storms, and this
appears to be good news for future preparedness.
Typical Reactions
It is generally believed that strong psychological reactions are
normal during and in the days and weeks following disasters. The
intensity and duration of distress is usually proportional to the
magnitude of disaster impact on the individual and community. Those more
strongly affected (by injury, loss of property, death of family/friends,
loss of job, etc.) are likely to be the most upset for the longest period
of time.
Psychological distress is usually relieved as the individual is
able to return to stable and predictable life circumstances. Recovery is
generally under way by three to six months following a disaster, yet can
take up to 18 months for those more seriously impacted. It is generally
believed that fewer than 10 percent of victims will develop a major
mental disorder as a function of their experience.
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