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


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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    • "Moreover, frequent comorbidities associated with traumatic stress, e.g. depression and substance abuse (Kessler et al., 1995; North et al., 2004; Zlotnick et al., 2006; El Hage et al., 2006; Tapia et al., 2007), are not always taken into account as potential confounding factors. Taken together, these considerations question the unitary view of the neural basis for the PTSD syndrome, and raise the possibility of the "
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    • "Long-term effects of disasters on mental health have been the focus of increasing interest in recent years. The majority of disaster survivors do not develop chronic reactions of distress and do not need professional help, whereas a sizeable minority may suffer for a prolonged period of time (Norris, Murphy, Baker, & Perilla, 2004; North, Kawasaki, Spitznagel, & Hong, 2004). Distressing psychological reactions are often most distinct during the first weeks after a traumatic event and gradually decrease during the following two years (Connor, Foa, & Davidson, 2006; Ford, Adams, & Dailey, 2007; Meewisse, Olff, Kleber, Kitchiner, & Gersons, 2011; Piyasil et al., 2007). "
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    ABSTRACT: Background: The characteristics of long-term trajectories of distress after disasters are unclear, since few studies include a comparison group. This study examines trajectories of recovery among survivors in comparison to individuals with indirect exposure. Methods: Postal surveys were sent to Swedish tourists, repatriated from the 2004 Indian Ocean tsunami (n=2268), at 1, 3, and 6 years after the tsunami to assess posttraumatic stress (PTS) and poor mental health. Items were used to ascertain high and moderate disaster exposure groups and an indirect exposure comparison group. Results: Long-term PTS trajectories were best characterized by a resilient (72.3%), a severe chronic (4.6%), a moderate chronic (11.2%) and a recovering (11.9%) trajectory. Trajectories reported higher levels of PTS than the comparison group. Exposure severity and bereavement were highly influential risk factors. Conclusions: These findings have implications regarding anticipation of long-term psychological adjustment after natural disasters and need for interventions after a single traumatic event with few secondary stressors.
    Journal of anxiety disorders 09/2015; 36:15-24. DOI:10.1016/j.janxdis.2015.07.007 · 2.68 Impact Factor
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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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