The experience of a natural or man-made disaster can be devastating, as you know either from your own life or from watching the coverage of hurricanes, fires, floods, and civilian terrorist attacks. However, you also know that not everyone is affected to the same degree, even in the most extreme of these disasters. Perhaps you’re lucky enough to count yourself as one of the resilient ones as you’ve been tested before and emerged relatively unscathed by the experience, even considering yourself stronger than you were before. Yet on the other hand, you learn that one of your closest friends was devastated and it took her months to recover emotionally, if at all. The cognitive model of stress and coping proposes that it’s how you view a stressor that determines its impact on you. It also proposes that you can be stressed or challenged vicariously. Watching the news coverage of a disaster can cause you to feel stressed by virtue of your empathizing with its victims.
It is known that depression is a possible emotional reaction to a stressor. Not all depression is caused by stressful life events, but it is certainly a risk associated with exposure to trauma. University of Otago (New Zealand) psychologist Caroline Bell and colleagues (2017) examined depressive symptoms in New Zealanders following the 2010 to 2011 Canterbury earthquakes. Their method took advantage of a unique opportunity to study reactions to a disaster in 35-year-olds who had been part of a long-term study. Because there was data from these individuals from birth, the researchers could examine predictors of depressive reactions to a disaster from over three decades worth of mental health (and other) assessments. The earthquakes affected 505 of the 962 surviving members of the sample, of whom 495 were available for interviews in the two years following what were actually four major earthquakes that took place between 2010 and 2011.
As Bell et al. noted, “There is a well-established literature linking life events to mental health problems including depression…as well as increasing recognition that a disaster is often the start of a complex series of events including not only the acute exposure, but also stressful life events that may follow, including death or injury of family and friends, loss of housing, loss of employment/earning, and widespread damage to the living environment." Indeed, you have undoubtedly witnessed the news coverage immediately after a disaster as victims sift through the remnants of their homes looking for any small reminders of the home that once was. However, this is just the start of the process, and unless you’re the one affected by the event, you won’t hear any more on the news about how the victims managed to reclaim their lives as the coverage shifts to the next big story. You won’t hear about the fact that they couldn’t go to a workplace that no longer exists, that they lost all of their important documents, and that they’ve spent days, if not weeks, in attempts to get insurance payments to cover at least part of their losses. Add to this the health problems that can ensue as a result of injury and illness, and the task seems almost insurmountable.
Again, however, people differ in their reactions to these tests of their resources. The New Zealand team assessed depressive symptoms in their participants in the period following the earthquakes as well as what they call "peri-traumatic stress," meaning stress levels experienced during and immediately after the traumatic event. Items included on the peri-traumatic distress inventory (PDI) were, for example, “felt afraid for your own safety,” “felt horrified by what you saw,” and “thought you might die.” The 35-year-olds in the study were also asked directly about the degree of disruption they experienced in their ordinary lives as a result of the earthquakes, including the need to find new housing, loss of employment, and even restoration of basic services of power, water, and sewage.
The indices available on the participants prior to the earthquakes were gender, New Zealand ethnicity, prior history of mental disorder, family social class, and extent of earthquake exposure. Taking all these factors into account, the results clearly showed that the extent of fear and distress during the earthquakes determined the experience of major depressive symptoms. Major depression was not, however, predicted by the lingering disruptive events following the earthquakes. The emotions of fear and horror during the actual disaster, in other words, had a greater impact on depression than the amount of readjustment individuals had to make in the weeks and months that followed.
As the authors note, they measured depression and not post-traumatic stress disorder. It is known that social support can buffer individuals against the depression that can follow a major life event involving loss. In the Canterbury case, there was widespread community action and support for earthquake victims, removing adversity and daily life disruption as a risk factor for depression. Instead, the emotional reactions of panic, fear, and horror seemed to trigger a chain of internal events that result in the development of depressive symptoms.
The study’s findings imply that providing emotional support to victims during the height of a disaster may provide a critical time for intervention. Helping people rebuild their homes and restore order to their daily lives are clearly important as well, but at that point, the sequence of emotional reactions may already be underway. Supporting these results are findings from other studies showing that having a panic attack during or right after the critical event, fearing for one’s life, losing loved ones during the disaster, being injured, and losing one’s home are all risk factors for the later development of depression. It was only the New Zealand study that pinpointed the depression risk as related to distress during the event itself.
What about if you’re not a direct victim yourself? The Canterbury earthquake study didn’t look at vicarious reactions to a disaster but, by extension, we might reason that people who allow themselves to become afraid of their own surroundings and home becoming devastated may be at risk as well. You may wonder why it is that so many people become so obsessed with the coverage of hurricanes, earthquakes, fires, and floods. Perhaps, at some level, we’re trying to figure out how we would react ourselves and whether we would be able to cope if in those situations. However, at some point it’s probably a good idea to disconnect from all that coverage and focus on the actual events you need to cope with in your own life, or at least on other news stories.
To sum up, predicting who will be most depressed after a disaster then becomes a matter of knowing how emotionally distraught the individual is during the event and in its immediate aftermath. People differ in their fear response to danger and threat; you may not be able to intervene during the disaster itself, but you will be of most help if you’re able to help alleviate those distressing emotions. At that basic level, your emotional support can help that individual cope with the challenges yet to come.
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Copyright Susan Krauss Whitbourne 2017
Bell, C. J., Boden, J. M., Horwood, L. J., & Mulder, R. T. (2017). The role of peri-traumatic stress and disruption distress in predicting symptoms of major depression following exposure to a natural disaster. Australian and New Zealand Journal of Psychiatry, 51(7), 711-718. doi:10.1177/0004867417691852