The Course of PTSD, Major Depression, Substance Abuse, and Somatization After a Natural Disaster

Washington University School of Medicine, Department of Psychiatry, St. Louis, Missouri 63110, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 01/2005; 192(12):823-9. DOI: 10.1097/01.nmd.0000146911.52616.22
Source: PubMed

ABSTRACT Flood research has used a variety of methods, yielding inconsistent findings. Universal definitions of illness are paramount to the science of psychiatric epidemiology of disasters. St. Louis area survivors (N = 162) of the Great Midwestern Floods of 1993 received a structured diagnostic assessment at 4 and 16 months postdisaster, with 88% follow-up. The purpose of the assessment was to examine predisaster and postdisaster rates of disorders and symptoms. Flood-related posttraumatic stress disorder was diagnosed in 22% and 16% at index and follow-up, respectively. Comorbidity with major depression determined whether the posttraumatic stress disorder would have remitted by 1 year later. Nearly one half of the men in the sample had a pre-existing alcohol use disorder. Virtually no new substance abuse followed the floods, and hence, substance abuse did not develop in response to the disaster or as part of coping with its aftermath. Somatization disorder was not observed; new somatoform symptoms represented a fraction of postflood somatic complaints. Findings are inconsistent with causal attribution of floods in the etiology of alcohol abuse and somatization. Methodological differences may account for much of the apparent discrepancy of these findings, with recent reports of increased alcohol use and somatic symptoms observed after other disasters.

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    • "Previous research has demonstrated the association between posttraumatic stress disorder (PTSD) and physical health symptoms in both military and civilian samples (Engel et al., 2000; Hoge et al., 2007; Sareen et al., 2007; Osório et al., 2012; Pacella et al., 2012), and up to 70% of individuals with psychological trauma report somatic symptoms (Escobar et al., 1983; Sierles et al., 1983; White and Faustman, 1989; Roszell et al., 1991; Baker et al., 1997; Van Ommeren et al., 2002). The development of somatic symptoms such as pain and neurological symptoms for which no organic cause can be found (American Psychiatric Association, 2001; North et al., 2004) has been conceptualized as the physical manifestation of psychological distress (McFarlane et al., 1994). However, the etiology of these symptoms remains unclear, and there is disagreement as to whether they are a consequence or causal factor in PTSD, or independent sequelae of psychological trauma (Elklit and Christiansen, 2009). "
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    ABSTRACT: This study examined the association between somatic complaints and health-related quality of life (HR-QoL) in treatment-seeking Canadian military personnel with military-related Posttraumatic Stress Disorder (PTSD). Current and former Canadian Forces (CF) members attending the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario (N=291) were administered self-report questionnaires assessing number and severity of somatic complaints, PTSD and depressive symptom severity, and mental and physical health-related quality of life (HR-QoL) prior to commencing treatment. Regression analyses were used to identify the role of somatic complaints on physical and mental HR-QoL, after controlling for PTSD symptom cluster and depressive symptom severity. Somatic symptom severity accounted for only a small amount of the variance in mental HR-QoL after accounting for PTSD symptom cluster and depressive symptom severity, but accounted for a larger proportion of the variance in physical HR-QoL after accounting for PTSD cluster and depressive symptom severity. Understanding the role of somatization in the symptom-presentation of military personnel with PTSD may provide additional avenues for treatment with this population.
    08/2014; 218(1-2). DOI:10.1016/j.psychres.2014.03.038
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    • "After natural disasters, much attention is devoted to the development of posttraumatic stress disorder (PTSD). However, MDD is also a significant concern and represents the second most common and impairing psychological problem after a natural disaster (David et al., 1996; North et al., 2004). The high degree of comorbidity between MDD and PTSD (Foa et al., 2006) underscores the importance of understanding unique and related determinants of MDD and PTSD and their comorbidity to shed light into the pathogenesis of these disorders after a traumatic event. "
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    ABSTRACT: The current study examined demographic and psychosocial factors that predict major depressive disorder (MDD) and comorbid MDD/posttraumatic stress disorder (MDD/PTSD) diagnostic status after Hurricane Katrina, one of the deadliest and costliest hurricanes in the history of the United States. This study expanded on the findings published in the article by Galea, Tracy, Norris, and Coffey (J Trauma Stress 21:357-368, 2008), which examined the same predictors for PTSD, to better understand related and unique predictors of MDD, PTSD, and MDD/PTSD comorbidity. A total of 810 individuals representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina were interviewed. Ongoing hurricane-related stressors, low social support, and hurricane-related financial loss were common predictors of MDD, PTSD, and MDD/PTSD, whereas educational and marital status emerged as unique predictors of MDD. Implications for postdisaster relief efforts that address the risk for both MDD and PTSD are discussed.
    The Journal of nervous and mental disease 10/2013; 201(10):841-847. DOI:10.1097/NMD.0b013e3182a430a0 · 1.69 Impact Factor
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    • "The authors did not explore in their report the secondary health impacts of disasters, the pathways from disasters to mental ill health, or the consequential impacts of developing a mental disorder. The authors considered one study that researched the somatic effects of mental ill health9, another that researched substance misuse50, and others that have considered gender-based violence272829. They conclude that clarification is required about what constitutes best practice in each of these areas. "
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    ABSTRACT: Introduction While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects on some people's health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of the hardiest of people who are affected. Methods The Health Protection Agency (HPA) undertook a review of the literature published from 2004 to 2010. It is intended to: assess and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes and recommendations from this review of the literature. Results The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are under-represented in the published data. Most people's psychosocial needs are met through their close relationships with their families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, there are a number of methodological challenges that arise when conducting research and when analysing and comparing data on the psychosocial and mental health impacts of floods. Conclusions The HPA's findings showed that a multi-sector approach that involves communities as well as agencies is the best way to promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research findings. Further research is needed on the longitudinal effects of flooding on people's mental health, the effects of successive flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people who respond to the needs of other persons in the aftermath of disasters. Corresponding author: Carla Stanke Address: Health Protection Agency 151 Buckingham Palace Road London SW1W 9SZ E-mail: Fax: 020 7811 7759 Telephone: 020 7811 7161.
    PLoS Currents 05/2012; 4:e4f9f1fa9c3cae. DOI:10.1371/4f9f1fa9c3cae
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