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: 1.81). 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Exposure to stress often is psychologically distressing. The impact of stress on alcohol use and the risk of alcohol use disorders (AUDs) depends on the type, timing during the life course, duration, and severity of the stress experienced. Four important categories of stressors that can influence alcohol consumption are general life stress, catastrophic/fateful stress, childhood maltreatment, and minority stress. General life stressors, including divorce and job loss, increase the risk for AUDs. Exposure to terrorism or other disasters causes population-level increases in overall alcohol consumption but little increase in the incidence of AUDs. However, individuals with a history of AUDs are more likely to drink to cope with the traumatic event. Early onset of drinking in adolescence, as well as adult AUDs, are more common among people who experience childhood maltreatment. Finally, both perceptions and objective indicators of discrimination are associated with alcohol use and AUDs among racial/ethnic and sexual minorities. These observations demonstrate that exposure to stress in many forms is related to subsequent alcohol consumption and AUDs. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of AUDs and potential risk moderators when individuals are exposed to stressors.
    11/2011; 34(4):391-400.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Protecting human health provides the crux of any response to a catastrophic event, such as a bio-attack or an influenza pandemic. In the event of a disaster, people's anxiety and perceptions of risk influence the amount of response efforts required to mitigate the threat. Their behavior may accumulate and become collective social anxiety. In this study, we use differential dynamics to model the potential psychosocial impacts of a disaster on the affected population. In particular, we model how individuals respond to a disaster event, as well as the population-level collective psychosocial impacts. We then explore how such psychosocial impacts may challenge the effectiveness of response efforts or social productivity. Applying the proposed model to examine the potential psychosocial effects of SARS on health care professionals demonstrates the great effectiveness of the proposed model. The proposed model therefore can be used as a framework for quick assessments of the psychological effects of a terror or natural disaster and provides a guide for response preparation, such as targeting interventions and resource allocations.
    The Journal of Defense Modeling & Simulation 10/2007; 4(4). DOI:10.1177/154851290700400403
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (July 30th, 2004) on physical, mental and social health in the affected population. The present study explored the risk for the development of four types of mental health disturbances (MHD) due to exposure to different aspects of this technological disaster in comparison with data obtained from previous health surveys among the population of the same province. Surveys were conducted 5 months (T1) and 14 months (T2) after the disaster. Potential adult victims (≥15 years) were included (n = 1027 and 579 at T1 and T2 respectively). The "Symptom Checklist-90-Revised" (SCL-90-R) has been used in order to compute actual prevalence rates of somatization-, depression-, anxiety- and sleeping disturbances for three defined exposure categories: direct witnesses who have seen human damage (SHD), direct witnesses who have not seen human damage (NSHD) and indirect witnesses (IW). Those prevalence rates were compared with overall rates using the inhabitants of the province of Hainaut (n = 2308) as reference population. A mental health co-morbidity index was computed. Relative risks were estimated using logistic regression models. Prevalence rates of the four MHD were much higher for the SHD than for the other exposure groups, at T1 and T2. Moreover, NSHD and IW had no increased risk to develop one of the 4 types of MHD compared to the reference population. The SHD had at T1 and T2 good 5-times a higher risk for somatization, about 4-times for depression and sleeping disorders, and 5- to 6-times for anxiety disorders respectively. Further, they suffered 13 times, respectively 17 times more from all mental disorders together. The present study calls attention to the fact that mental health problems disturbances are significantly more prevalent and long-lasting among survivors who have directly been exposed to human damage.
    Archives of Public Health 01/2015; 73(1):20. DOI:10.1186/s13690-015-0066-z