casestudy

Disasters and the Psychosocial Impact

A Disaster Ecology Perspective

Schmitz 2012, PSY311_Online

The Impact of a Disaster

• Disasters physically impact communities – Property loss and damage (community/personal) – Environmental disruption and/or pollution – Economic loss (community/personal) – Structural disruption (government/community) – Loss of life and injury

• However, the larger impact is psychological

Schmitz 2012, PSY311_Online

Psychosocial Impact of Disasters

• The number of people impacted psychologically following a disaster vastly outnumbers those physically impacted.

• Example: World Trade Center attacks on September 11th, 2001 – 3,000 people died in the attacks – 7,500 people were injured – Millions of people around the world were effected

emotionally and psychologically to a varying degree

Schmitz 2012, PSY311_Online

Individuals Sustaining Psychological Impact

Source: Shultz JM, et al., Behavioral Health Awareness Training for Terrorism and Disasters, Miami FL, DEEP Center, 2003

Schmitz 2012, PSY311_Online

Common Adult Reactions to Disasters

Physiological Behavioral Emotional Cognitive/Spiritual

Nausea Changes in eating Anxiety Nightmares

Headache Changes in sleep Grief Disorientation

Restlessness Increased startle reaction

Anger Difficulty concentrating

Difficulty sleeping Withdrawal Guilt Memory problems

Body pain Emotional outbursts

Hopelessness / helplessness

Loss of faith

Increase substance abuse

Increase domestic violence

Reissman, D. B., Schreiber, M. D., Shultz, J. M., & Ursano, R. J. Disaster Mental and Behavioral Health. In Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices. Koenig, K. L. & Schultz, C. H. [eds.]. Page 103-112.

Schmitz 2012, PSY311_Online

Common Child Reactions to Disaster

All ages Preschool (1-5 years old)

Early Childhood (5-11 years old)

Adolescence (12-14 years old)

Irritability/anxiety Change in eating Aggression Disruptive

Withdrawal Clinging to parents Changes in eating High risk behaviors

Fear of separation / Clinging

Change in sleeping Problems concentrating

Abandon responsibilities (chores/school)

Headaches / Stomachaches

Disobedience Competing for attention

Competing for attention

Crying

Increased fear Drop in school performance

Resisting authority

Immature behavior Speech difficulties Desire to sleep with parents

Nightmares

Schmitz 2012, PSY311_Online

Reissman, D. B., Schreiber, M. D., Shultz, J. M., & Ursano, R. J. Disaster Mental and Behavioral Health. In Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices. Koenig, K. L. & Schultz, C. H. [eds.]. Page 103-112.

Direct Impact Survivors Directly exposed or injured

Schmitz 2012, PSY311_Online

Family Members Citizens Sustaining Potential Psychological Impact

Schmitz 2012, PSY311_Online

Co-Workers Citizens Sustaining Potential Psychological Impact

Schmitz 2012, PSY311_Online

Witnesses Citizens Sustaining Potential Psychological Impact

Schmitz 2012, PSY311_Online

Disaster Emergency Workers Citizens Sustaining Potential Psychological Impact

Schmitz 2012, PSY311_Online

Distressed Citizens Far from Scene Citizens Sustaining Potential Psychological Impact

Schmitz 2012, PSY311_Online

Early Reactions Post-Disaster Acute Stress Response

• Stress reactions (noted previously) • Fight/Flight/Freeze response • These reactions are typically adaptive and

pass

Schmitz 2012, PSY311_Online

Within the First Month Post-Disaster

• Adjustment disorder – Emotional and behavioral changes preceded by a

negative life event; the changes are generally greater than expected for the situation and cause problems with functioning

• Acute stress disorder (similar symptoms to PTSD but diagnosed within 1 month of trauma) – Symptoms similar to PSTD with an emphasis on

dissociative symptoms (requiring 3 dissociative symptoms)

Schmitz 2012, PSY311_Online

2-3 Months Post-Disaster

• Posttraumatic Stress Disorder (PTSD) symptoms – Intrusive thoughts (recurring and intrusive images or

thoughts about the trauma) – Avoidance behavior (efforts to avoid anything that

reminds person of trauma) – Hyper-arousal (irritability and difficulty sleeping)

• 24-39% of survivors may meet the criteria for PTSD in the first few months post-disaster

• Subclinical levels are often high (around 50%) in the first 3-6 months post-disaster

Schmitz 2012, PSY311_Online

Long-term Responses

• Chronic Stress Response – Long recovery period – Stressor may be constant or repetitive – Individual is hyper-alert – Stress is prolonged and unrelieved

• Traumatic Stress Response – Response and stressor are more intense – Response is physically and emotionally draining

Schmitz 2012, PSY311_Online

Reactions Depend on Many Things

• Disaster characteristics *This is what we’ll focus on*

• To come next week: – Individual characteristics – Proximal/Community characteristics – Distal/Societal characteristics

Schmitz 2012, PSY311_Online

Aspects of Disaster & its Power

• Exposure to hazard – The less exposure to a disaster the less negative effects to the

individual. – Further away, minimal contact, short exposure, and buffering

from hazard protect individuals. • Personal and societal loss

– The more loss personally felt the more negative consequences. – Number of family members injured or killed, amount of

personal property damaged or lost, and extent of societal damage creates environment for negative reactions.

• Change – The more disrupted a person’s life and the longer they

experience the disruption the more negative effects. – Delay in returning to home, work, community.

Schmitz 2012, PSY311_Online

Forces of Harm

• What aspects of an event make it a disaster? – Example: a hurricane is not a disaster until it has

strong enough winds or brings enough water to cause damage to a population and does then impact a population where its demands exceeds their capabilities.

• There are four important aspects to focus on

Schmitz 2012, PSY311_Online

1. Disaster Type: Natural vs. Man-made

• Man-made disasters cause more psychological harm to populations – 2005 Hurricane Katrina brought damage to New

Orleans but the more devastating destruction came from levee failures, leading to blame, anger, and distrust of people in authority.

• Intentional disasters are even more damaging psychologically – Acts of war can cause long lasting trauma and stress.

The trauma and stress from the former Yugoslavian war (1991-1995) are still being experienced by those who survived.

Schmitz 2012, PSY311_Online

Disaster Type: Natural vs. Man-made

Natural Disasters Man-made Disasters

Weather Related Unintentional/Technological

• Floods; Landslides • Hurricanes; Tornadoes

• Accidents (industrial, transportation) • Environmental Destruction

Geophysical Intentional

• Earthquakes; Tsunamis • Volcanic eruptions

• War; Civil Conflict • Terrorism

Temperature Related

• Drought; Wildfire • Extreme temperatures (cold/hot) Pandemic Diseases

• Pandemic Influenza • Disease outbreaks

Schmitz 2012, PSY311_Online

2. Magnitude of a Disaster

• The size of the impact matters; not the raw numbers but the scale of the magnitude based on the size of the population impacted.

• Three measures of the magnitude: – Mortality (number dead) – Morbidity (number injured) – Infrastructure and economic impact

• The more extreme and widespread the three measures are, the more severe and widespread the possible psychological impairment.

Schmitz 2012, PSY311_Online

3. The Time Aspect

• Time of year: cyclical or seasonal – An event that is seasonal or cyclical causes less stress

because it’s more predictable and people can prepare.

• Single, multiple, or serial events – If multiple events occur at one time, or an event is serial,

people experience more stress and trauma.

• Warning period: amt. of warning time before impact – The more warning people have, the less likely they are to

have negative psychological reactions.

• Duration of impact – The longer the impact, the more stress and trauma.

Schmitz 2012, PSY311_Online

4. The Place Aspect

• Geography and topography dictate the type of disaster risk. – For example: living in California on a geological

fault line places people at risk for earthquakes. Homes built on the side of mountains/hills in California are at higher risk of being effected by rock and mud slides.

Schmitz 2012, PSY311_Online