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Haiti Earthquake 2010: Psychosocial Impacts

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Abstract

SynonymsDisaster behavioral health; Disaster health; Disaster mental and behavioral health; Disaster mental healthOverviewAt 4:53 PM local time (21:53 GMT) on January 12, 2010, a magnitude 7.0 earthquake devastated the Haitian capital city of Port-au-Prince and surrounding area, killing an estimated 222,570–316,000 persons (Inter Agency Standing Committee, 2010; CBC News, 2011). The Haiti 2010 earthquake is noteworthy among natural disasters that subject the affected human population to intense psychological stressors (Table 1).Norris and colleagues (2002) posit that disasters that possess two or more of the following four characteristics are likely to create significant mental health consequences for the affected community: (1) large numbers of deaths and/or injuries, (2) widespread destruction and property damage, (3) disruption of social support and ongoing economic problems, and (4) “human” contribution to the disaster’s causation. By the numbers, the Haiti 2010 ear ...
H
CASE STUDY
HAITI EARTHQUAKE 2010: PSYCHOSOCIAL
IMPACTS
James M. Shultz
1
, Louis Herns Marcelin
2
, Zelde Espinel
1
,
Sharon B. Madanes
3
, Andrea Allen
4
, Yuval Neria
5
1
Center for Disaster & Extreme Event Preparedness
(DEEP Center), University of Miami Miller School of
Medicine, Miami, FL, USA
2
Interuniversity Institute for Research and Development
(INURED), Port-au-Prince, Haiti, and University of
Miami, Coral Gables, FL, USA
3
Columbia University, New York, NY, USA
4
Barry University, Miami Shores, FL, USA
5
Columbia University, The New York State Psychiatric
Institute, New York, NY, USA
Synonyms
Disaster behavioral health; Disaster health; Disaster men-
tal and behavioral health; Disaster mental health
Overview
At 4:53 PM local time (21:53 GMT) on January 12, 2010,
a magnitude 7.0 earthquake devastated the Haitian capital
city of Port-au-Prince and surrounding area, killing an
estimated 222,570316,000 persons (Inter Agency Stand-
ing Committee, 2010; CBC News, 2011). The Haiti 2010
earthquake is noteworthy among natural disasters that
subject the affected human population to intense psycho-
logical stressors (Table 1).
Norris and colleagues (2002) posit that disasters that
possess two or more of the following four characteristics
are likely to create significant mental health consequences
for the affected community: (1) large numbers of deaths
and/or injuries, (2) widespread destruction and property
damage, (3) disruption of social support and ongoing eco-
nomic problems, and (4) humancontribution to the
disasters causation. By the numbers, the Haiti 2010 earth-
quake possesses all of these attributes: (1) mass mortality,
(2) near-total physical destruction over large areas,
(3) social dislocation to a point bordering on societal col-
lapse, and (4) ample evidence of human amplification of
the earthquakes harm (preventable deaths and severe
injuries attributable to dangerous and derelict standards
for housing construction; uncommonly widespread and
brutal interpersonal violence directed against earthquake
survivors in the aftermath) (Shultz et al., 2011).
Profiling the Haiti 2010 earthquake will provide
insights into the psychologically traumatizing capacity of
this exceptional event (Shultz et al., 2011). The psycho-
logical consequences of the Haiti 2010 earthquake can
be portrayed across five salient dimensions: (1) disaster
type, (2) severity, (3) duration, (4) mortality, and (5) scope
and social context of psychological impact (Table 2).
Disaster type: event description and disaster
consequences
Haiti occupies the western third of the island of Hispan-
iola, one of the Greater Antilles islands, located between
Puerto Rico and Cuba. The Haiti 2010 earthquake
occurred south of the east-west trending strike-slipfault
zone separating the massive North American tectonic
plate (to the north) from the Caribbean plate (to the south).
Relative to the North American plate, the Caribbean plate
slipsabout 20 mm to the east each year. In Haiti, the
plate boundary between these two plates presents a more
complex scenario; historically, shearing pressures have
created an additional fracture along the ragged juncture.
The resulting tectonic shard, the Gonave microplate,
on which Haiti rides, is bracketed by two fault zones run-
ning east-west in northern and southern Haiti. The Haiti
2010 earthquake occurred along the Enriquillo-Plantain
P.T. Bobrowsky (ed.), Encyclopedia of Natural Hazards, DOI 10.1007/978-1-4020-4399-4,
#Springer Science+Business Media Dordrecht 2013
Garden Fault Zone (EPGFZ) to the south. Along the
EPGFZ, the plates had been lockedin position for
approximately 250 years, with escalating stress prior to
the moment of release. At that moment, 4:53 PM, January
12, 2010, along 65 km of the EPGFZ, the Caribbean Plate
jolted violently eastward an average distance of 1.8 m
(with amplitudes as large as 4 m in some locales). As pre-
cisely described by Calis et al. (2010), the earthquake
occurred on a previously unmapped steeply dipping fault
that makes a high angle with the Enriquillo-Plantain fault.
With a rupture that was as close as 17 km from down-
town Port-au-Prince, Haitis capital and major population
center, this near-surface earthquake shattered the city and
terrified its population. At Moment Magnitude 7.0, the
Haiti 2010 earthquake was very intense, but for perspec-
tive, the February 2010 earthquake in Maule, Chile, regis-
tered Moment Magnitude 8.8, generating 500 times the
energy of its Haitian counterpart. Although the 2010
Chilean earthquake ranks high among the most powerful
seismic events, its memory was short lived, whereas the
weaker 2010 Haitian earthquake, by decimating
a densely packed and structurally vulnerable population,
has made its mark on human history and on the psyche
of the Haitian people.
The entire nation of Haiti experienced the sensations of
ground movement during the initial shock, with millions
in the throes of significant shaking. The death toll, in the
range of 222,570316,000 deaths (Inter Agency Standing
Committee, 2010; CBC News, 2011), places this event
among the deadliest sudden-impact natural disasters on
record. More than 300,000 survivors were seriously
injured. Among these, an estimated 4,000 survivors
sustained amputating injuries. Millions experienced
excruciating pain from personal injury, or directly
observed gruesome harm or brutal death as buildings top-
pled, or witnessed piles of decomposing bodies strewn
throughout the streets. In the aftermath, with hundreds of
thousands of collapsed or uninhabitable dwellings, 1.3
million persons were internally displaced, eventually find-
ing temporary lodging in the myriad impromptu camps
that were hastily erected. In the weeks following the earth-
quake, displaced persons, deprived of secure shelter and
personal privacy, were easy prey to looting, gang violence,
and gender-based violence including rape. Environmental
hazards posed risks for falls, punctures, abrasions, and lac-
erations. Destruction of infrastructure, leading to absence
of clean water, sanitation, and hygienic healthcare ser-
vices, produced a cascade of untoward outcomes: infec-
tious disease outbreaks, life-threatening wound
infections, and malnutrition contributing to preventable
deaths among infants and young children. Population-
wide vulnerability following the earthquake exacerbated
the spread and severity of a raging outbreak of cholera that
caused illness in 470,000 persons and killed almost 7,000
in 1 year (CDC, 2011) (Table 3).
Disaster severity and psychological impact
The confluence of multiple physical and psychological
consequences distinguishes the Haiti 2010 earthquake as
singularly destructive. In a disaster, one of the strongest
predictors of the severity of psychological effects is the
degree of exposure to the forces of harm (Neria et al.,
2008; Shultz et al., 2007, 2012a). The absolute magnitude
of the forces of harm largely determines the extent of dam-
age, destruction, displacement, death, and injury, as well
as the extent of stress and trauma experienced by the disas-
ter-affected population (Shultz et al., 2011).
At the moment of impact, exposure to the Haiti 2010
earthquake was experienced throughout the nation as
ground shaking. Both the objective intensity and the sub-
jective experience of ground shaking relate directly to
the distance from the earthquakes epicenter. Persons clos-
est to the strike zone were subjected to the kinesthetics of
extreme shaking, compounded by the multisensory
Haiti Earthquake 2010: Psychosocial Impacts, Table 1 Haiti
2010 earthquake: disaster stressors
Impact phase stressors Post-impact phase stressors
Exposure to severe
shaking Exposure to ongoing aftershocks
Physical injury and personal harm
Exposure to multiple
strong aftershocks Pain, debility, loss of function
Loss of limb
Physical injury and
personal harm Rampant infectious diseases
Searching for missing loved ones
Entrapment in collapsed
structures Caring for injured loved ones
Grief for lost loved ones
Perception of risk of
death/extreme harm Lack of access to emergency care
Lack of access to primary medical care
Panicked flight Lack of access to mental health care
Loss of loved one Lack of survival needs (food, water)
Separation from loved
ones during event Lack of utilities and essential services
Lack of sanitation, public health
Witnessing harm to others Lack of communications
Witnessing death of others Lack of transportation
Witnessing grotesque,
troubling scenes Lack of personal security
Rumors of additional shocks to come
Damage/destruction of
home Damage/destruction of home
Loss of personal possessions
Displacement from home Displacement
Community-wide
physical destruction Living in temporary camps
Witnessing dead bodies
Witnessing severely harmed persons
Witnessing traumatized/bereaved
survivors
Looting and gang activities
Interpersonal and gender-based
violence
Damage to worksite
Loss of employment
Financial hardship
Damage to place of worship
Absence of government infrastructure
Damage to schools
Earthquake trauma reminders from
aftershocks and scenes of destruction
Family distress
420 HAITI EARTHQUAKE 2010: PSYCHOSOCIAL IMPACTS
experience of structural disintegration occurring in all
directions around them. In some areas of particularly
intense tumult, liquefactionoccurred as the sediment
lost its weight-bearing properties, causing structures to
sink and crumble (Shultz et al., 2011). Punctuating the jar-
ring, disorienting, fear-triggering sensations of tremulous-
ness and vibration, many persons were physically injured,
pinned by falling rubble, or entrapped in collapsed struc-
tures. Bodily pain, injury, immobilization, trapped con-
finement, and perceived life threat are psychological
stressors (Shultz et al., 2011). Haitian survivors engaged
in frenetic, bare-handed scramble to find and extricate
family members and neighbors who had disappeared amid
the heaving earth and caving debris.
Assuming an earthquake source of given orientation
and rupture characteristics, it is possible to estimate the
levels of shaking over an area and convert them to ratings
on the Modified Mercalli Intensity Scale. The Modified
Mercalli Intensity Scale (MMI) is a 12-point rating scale
(IXII). Each point on the scale is composed of an esti-
mate of shaking intensity and a corresponding description
of structural damage. The MMI estimates how strongly an
earthquake is felt by people in a geographical area, and the
corresponding amount of damage to buildings and
dwellings.
For the Haiti 2010 earthquake, the United States
Geological Survey (USGS, 2010a) has created a shake-
mapdisplaying the geographic areas, and estimated
population numbers, for each of the MMI categories. For
example, more than 1.0 million Haitians experienced
violent or extreme shaking (MMI Scale IX or higher), with
heavy to catastrophic damage all around. An additional
3.5 million residents experienced strong, very strong, or
severe ground shaking (MMI Levels VIVIII). Together,
these data provide clear evidence that almost 4.6 million
Haitians experienced ground movement at the level of
Haiti Earthquake 2010: Psychosocial Impacts, Table 2 Haiti 2010 earthquake: hazard profile
Disaster type Definition Catastrophe/complex emergency
Initial event classification Natural disaster/geophysical/earthquake: left-lateral strike-slip faulting
at angle with the Enriquillo-Plantain Garden fault system
Ongoing event classification Complex emergency: natural disaster followed by infrastructure
collapse, massive loss of life, large-scale displacement, and
interpersonal violence
Forces of harm Strike-slip faulting on a fault associated with a tectonic plate boundary
Severe ground shaking
Structural collapse of buildings
Magnitude and severity Moment magnitude Initial earthquake: M 7.0
First 4 weeks: 16 aftershocks M5.0
First 4 weeks: 59 aftershocks M4.5
Modified Mercalli Intensity Epicenter: X (on a 12-point scale: IXII)
MMI intensity generally diminishes as a function of distance from
epicenter
Place dimension Epicenter A 40-km long rupture; shortest distance is 17 km from Haitian capital of
Port-au-Prince
Hypocenter Rupture from near surface to 13-km depth
Geography/geology The region is near a tectonic plate boundary region separating the
Caribbean plate and the North America plate. The main shock mostly
represents faulting on an unmapped steeply dipping fault at angle
with the Enriquillo-Plantain Garden fault zone (EPGFZ).
Scale/scope Intense shaking/destruction throughout southeastern Haiti, particularly
in the capital of Port-au-Prince and surrounding areas.
Shaking of varying intensity felt throughout entire nation of Haiti
(27,750 km
2
) and adjoining portions of Dominican Republic on
island of Hispanola.
Psychological impact extends to Haitian diasporain United States,
Canada, Caribbean, responders from many nations
Built environment Poorest nation in Western Hemisphere
Rank 147/182 on Human Development Index
55% below extreme poverty index
Widespread structural deficiencies
High-density urban crowding
Time dimension Initial earthquake strike January 12, 2010, 16:53 local time (21:53 GMT)
Duration Initial earthquake: 1535 s of strong shaking (estimate)
Frequency Strong aftershocks of gradually decreasing frequency over several
months (59 aftershocks M4.5 in first 4 weeks)
Duration of life/health risk Months: cholera outbreak caused illness in 470,000 with 6,631 deaths
through October 2011
Duration of disruption Years
HAITI EARTHQUAKE 2010: PSYCHOSOCIAL IMPACTS 421
MMI VI or higher. The entire Haitian population of
approximately 10 million persons experienced some
degree of perceptible ground shaking, as did millions
more in neighboring Dominican Republic and nearby
Caribbean islands (Table 4, Figure 1).
Duration and frequency of psychological stressors
During exposure to threat or overt forces of harm, survival
stress responses are activated. Moreover, the frequency of
discrete disaster impacts relates to psychological trauma;
a sequence of multiple strikes, and exposure to both stress
and loss, tends to be more alarming than a single, discrete
event (Neria and Litz, 2004). In the case of the Haiti 2010
earthquake, both duration and frequency operated in tan-
dem to exacerbate fear and distress.
While the duration of the initial earthquake was esti-
mated in the range of 1535 s, repeated strong aftershocks
triggered fear reactions and acted as powerful psycholog-
ical reminders of the initial mainshockexperience.
Aftershocks began immediately. The first powerful after-
shock (M 6.0) occurred 7 min after the mainshock.
The second aftershock (M 5.5) was experienced 12 min
later. According to the United States Geological Survey
(2010b), in precisely 4 weeks following the earthquakes
origin, 16 aftershocks of magnitude 5.06.0, and 43
aftershocks of magnitude 4.54.9, occurred close to the
original epicenter.
Disaster stress persisted long after the aftershocks
tapered. Hardships in the aftermath were severe and
prolonged with near-complete destruction of infrastruc-
ture, lack of survival supplies, absence of basic services,
and sporadic episodes of violence on the streets and in
the camps.
Mass mortality in relation to psychological impact
Sudden, concentrated, mass mortality distinguishes the
Haiti 2010 earthquake from past earthquakes of similar
magnitude. Most of the deaths occurred instantly or within
minutes or hours of the M 7.0 mainshock. Some injured
victims suffered a more protracted death over a period of
days due to the circumstances of injury, entrapment, lack
of access to medical care, or absence of basic survival
needs.
Only one earthquake in recorded history significantly
exceeded the numbers of deaths experienced in the Haiti
2010 earthquake; an estimated 830,000 persons died in
the catastrophic earthquake that leveled Shaanxi, China,
on January 23, 1556. Among ground-shaking seismic
incidents in modern times, the Tangshan, China earth-
quake on July 28, 1976, with 255,000 deaths, rivaled the
Haiti death toll. On December 26, 2004, a tsunami-
generating seismic event killed an estimated 280,000
coastal dwellers distributed across more than one dozen
nations encircling the Indian Ocean. Apart from these
two earthquakes and the Indian Ocean tsunami, no other
earthquake in recorded history has equaled the magnitude
of mortality experienced in Haiti on January 12, 2010.
Beyond the exceptional numbers of deaths, a related
feature of Haiti 2010 is the geographic concentration of
mortality in a densely populated urban capital city and
surrounding towns and communities. Large numbers of
Haitians lost multiple family members.
Haiti Earthquake 2010: Psychosocial Impacts, Table 3 Haiti
2010 earthquake: disaster consequences
Disaster consequence Haiti 2010 earthquake description
Exposure to ground shaking MMI
a
IX: violent/extreme
intensity: 1.0 million persons
MMI
a
VIVII: strong/very strong/
severe intensity: 3.5 million
persons
Mortality 222,570316,000 deaths
Bereavement Millions have lost a primary family
member
Morbidity: injury 300,000 injuries requiring medical
care
4,000 injuries requiring amputation
Morbidity: infectious disease Hundreds of thousands of disease
cases
Internally displaced persons
(IDPs) due to earthquake
1,300,000 earthquake IDPs
Damage to homes Destroyed homes: 97,000
Severely damaged homes: 188,000
Gender-based violence High rate of reported rapes and
assaults on women
Children without caregiver Separation from caregiver
Earthquake orphans
Lack of access to clean water Millions of persons
Lack of access to food Malnutrition risk: 495,000 children
and 198,000 pregnant/lactating
women
Lack of access to sanitation Millions of persons
a
MMI: Modified Mercalli Index
Haiti Earthquake 2010: Psychosocial Impacts, Table 4 Haiti
2010 earthquake: persons exposed to ground shaking by MMI
level
MMI Perceived shaking
Estimated
population
AT MMI
level
Estimated
population AT or
ABOVE MMI
level
XXII Extreme 118,000 118,000
IX Violent 908,000 1,026,000
VIII Severe 2,030,000 3,056,000
VII Very strong 598,000 3,654,000
VI Strong 926,000 4,580,000
V Moderate 6,361,000 10,941,000
IV Light 7,468,000 18,409,000
IIII Weak to imperceptible 50,000 18,459,000
Source
United States Geological Survey, 2010a.
422 HAITI EARTHQUAKE 2010: PSYCHOSOCIAL IMPACTS
The Centre for Research on the Epidemiology of Disas-
ters (CRED) in Brussels, Belgium, is a WHO Coordinat-
ing Center and serves as the international repository for
information on all reported disasters worldwide. CRED
maintains an international disaster database dating from
1900 to the present. During the 110 years of tracking inter-
national disasters, a total of 1,095 damaging earthquakes
have been reported including the early 2010 earthquakes
in Haiti and Chile. Collectively, across these earthquakes,
2,323,000 persons were killed. The death toll in Haiti
alone accounted for 10% of all earthquake deaths in
110 years of surveillance.
Loss of a loved one in a natural disaster is one of the
most psychologically devastating experiences. Traumatic
bereavement, leading to complicated grief, is associated
with a host of psychiatric disorders including
posttraumatic stress disorder (PTSD) and depression
(Neria et al., 2007). Complicated (or prolonged) grief dis-
order (PGD) is a relatively new diagnosis, and different
from normal grief in its extended duration and symptom
profile (Horowitz et al., 1997). Correlates of PGD include
severe functional impairment, decreased productivity,
suicidality, and physical health problems (Neria et al.,
2007). Yet to be explored is the interaction between disas-
ter trauma and loss of a loved one (Neria and Litz, 2004);
many survivors of the 2010 Haiti earthquake experienced
both. More research is needed to fully understand the rela-
tions between PTSD and complicated grief, and whether
they differ in their risk and protective factors.
Scope and social context of psychological impact
Psychosocial consequences of disasters are wide ranging
and pervasive (Shultz et al., 2012a). More persons are
affected psychologically than are harmed physically
(Shultz et al., 2007). The Haiti 2010 earthquake has psy-
chologically affected not only the persons within the
immediate strike zone but the entire Haitian population
(10 million persons), the expansive diaspora of Haitian
PORT-AU-PRINCE
Cap-Haïtien
Gonaïves
Hinche
Jacmel
Jérémie
Les Cayes
Miragoâne
Port-de-Paix
Fort Liberte
Les Anglais
Tiburon
Chantal
Arniquet
Camp Perrin
Maniche
Cavaillon
St Louis
du Sud
Aquin
Grand
Goave
Petit
Goave
Bainet
Pestel
Roseau
Bonbon
Abricot
Dame Marie
Les Irois
Moron
Anse
d'Hainault Beaumont
Corail
Petit Trou de Nippes
Baraderes Anse-a-Veau
L'Asile
La vallee de Jacmel
Cayes
Jacmel
Marigot
Ernnery
Cerca
Carvajal
Vallieres
Terrier
Rouge
Trou
du Nord
Cerca
La Source
Thomassique
Belladere
Jimani
Lascahobas
Saut D'eau
Thomonde
Maissade
Pignon
La
Victoire Mombin
Crochu
Bahon
Milot
Limonade
Dondon
Saint
Raphael
Marmelade
Saint Michel
de l'Attatalaye
Dessalines
Petite Riviere
de l'Artibonite
Verrettes
La
Chapelle
Mirebalais
Grande Saline
Desdunes L'Estere
Anse
Rouge
Mole St Nicolas
Bombardopolis
Baie de Henne
Jean Rabel
Bassin Bleu
Chansolme
Anse-a-Foleur
Saint Louis du Nord
Le Borgne
Port Margot
Limbe
Pilate
Gros Morne
La Branle
Plaisance
Anse a pitres
Grand Gosier
Fond
Verrettes
Ganthier
Thomazeau
Cabaret
Archaie
Leogane
Chambellan
Perches
Ferrier
Carice
Bas Limbe
Acul du Nord
Terre Neuve
Boucan
carre
Kenscoff
Carrefour
Petion Ville
Gressier
Cornillon
Ile a Vache
Anse-a-Galets
Pointe-a-Raquette
La Tortue
Caracol
Belle Anse
Torbeck
St Jean
du Sud
Port-Salut
Coteaux
Port-a-Piment
Chardonnieres Thiote
Roche A Bateau
Ouanaminte
Monte Criste
Dajabón
Saint Marc
C U B A D O M I N I C A N
R E P U B L I C
H A I T I
SUD EST
N O R D E S T
A R T I B O N I T E
C E N T R E
S U D
G R A N D E
A N S E
N O R D O U E S T
N I P P E S
N O R D
O U E S T
ÎLE DE LA TORTUE
ÎLE DE
LA GONÂVE
PRESQU'ÎLEDES
BARADÈRES
ÎLES CAYÉMITES
ÎLE À VACHE
72°0'W72°30'W73°0'W73°30'W
74°0'W74°30'W
20°0'N
19°30'N19°0'N
18°30'N18°0'N
0 1020304050
km
Legend
Capital city
First admin capital
Towns
International Boundary
Port
First admin boundary
Haiti - Population Exposed and Exposure Level
Visit http://www.reliefweb.int/haiti to access this map and other crisis information.
Light
Moderate
Very strong
Severe
Violent
Extreme
Perceived
shaking
7,261,000
5,887,000
1,049.000
571,000
314,000
2,246,000
332,000
Population
exposed
Strong
Haiti Earthquake 2010: Psychosocial Impacts, Figure 1 Map of Haiti showing the epicenter of the January 12, 2010, earthquake and
population affected.
HAITI EARTHQUAKE 2010: PSYCHOSOCIAL IMPACTS 423
emigrants to the United States, Canada, and throughout
the Caribbean (Shultz et al., 2012b), and large numbers
of persons who have engaged in the earthquake response
efforts. According to CRED data, only two earthquakes
in the past 110 years affected more persons: The Haiti
2010 earthquake provides strong evidence that, in natural
disasters, the psychological footprintof disaster is larger
than the medical footprint(Shultz et al., 2007).
Adding to the widespread distress from physical hard-
ships was the public perception of a complete void of
national leadership to communicate with the public
(INURED, 2010). In a survey conducted in Cité Soleil,
Port-au-Prince, the key phrase that captured the
populations sense of despair and abandonment, was, We
are on our own.This sentiment was repeatedly
documented and echoed through the press and research
reports. A lead researcher stated, Failuretorallythecoun-
try at a time when it is gravely wounded added tothe suffer-
ing and trauma of the overallpopulation(INURED, 2010).
Summary
As we have previously stated, the 2010 Haiti earthquake
provides a potent example of the rare catastrophic event
where all major risk factors for psychological distress
and impairment are prominent and compounding,(Shultz
et al., 2011). In this case example, we have illustrated the
links between the descriptors of the event: (1) disaster
type, (2) severity, (3) duration, (4) mortality, and (5) scope
in relation to the psychological impact. We have attempted
to describe how the psychological and physical conse-
quences interplay and synergize in a seismic event of such
impact severity marked by quantum loss of life, oblitera-
tion of infrastructure, and barbarous hardship in the after-
math. In fact, our detailed assessment of this event became
the basis for introducing trauma signature analysis
(TSIG) to the field (Shultz et al., 2011).
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Cross-references
Casualties Following Natural Hazards
Community Management of Hazards
Critical Incidence Stress Syndrome
Disaster Relief
Disaster Risk Reduction (DRR)
Earthquake
Education and Training for Emergency Preparedness
Emergency Shelter
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Epidemiology of Disease in Natural Disasters
Federal Emergency Management Agency (FEMA)
Hazardousness of Place
Hypocentre
Indian Ocean Tsunami 2004
Modified Mercallit (MM) Scale
Mortality and Injury in Natural Disasters
Post Disaster Mass Care Needs
Post-Traumatic Stress Disorder (PTSD)
Psychological Impacts of Natural Disasters
Recovery and Reconstruction After Disaster
Risk
Seismology
Tangshan, China (1976 earthquake)
424 HAITI EARTHQUAKE 2010: PSYCHOSOCIAL IMPACTS
... 17 Surprisingly, findings were modest and equivocal, prompting the authors to conclude that the behavioral health impact of the spill was not as "widespread" as expected throughout the spill-impacted Gulf coast. 17 In the present study, an established methodology of trauma signature (TSIG) analysis [18][19][20][21][22][23][24][25][26][27][28][29][30][31] was applied to this landmark ecological disaster. TSIG analyses have been conducted on a wide spectrum of disasters, including natural, [20][21][22][23][24][25] nonintentional technological, hybrid, 26,27 and intentionally-perpetrated [28][29][30][31] variants. ...
... 17 In the present study, an established methodology of trauma signature (TSIG) analysis [18][19][20][21][22][23][24][25][26][27][28][29][30][31] was applied to this landmark ecological disaster. TSIG analyses have been conducted on a wide spectrum of disasters, including natural, [20][21][22][23][24][25] nonintentional technological, hybrid, 26,27 and intentionally-perpetrated [28][29][30][31] variants. In the present case study, TSIG analysis sheds light on the counterintuitive finding that a hazardous materials spill of epic proportions apparently caused only moderate behavioral health effects for the general population of the affected states. ...
... TSIG analysis [18][19][20][21][22][23][24][25][26][27][28][29][30][31] was applied to examine the psychological and mental health effects of the Deepwater Horizon oil spill. 18 TSIG analysis is defined as "an evidence-based method that examines the interrelationship between population exposure to a disaster, extreme event, or complex emergency, and the inter-related physical and psychological consequences for the purpose of providing timely, actionable guidance for effective DBH support that is organically tailored and targeted to the defining features of the event." ...
Article
Full-text available
Background. The 2010 Deepwater Horizon “BP” oil spill was a mega-disaster characterized as the petroleum industry’s largest-volume marine oil spill in history. Following a “wellhead blowout” that destroyed the drilling platform, 4.9 million barrels of petroleum flowed into the Gulf of Mexico over 87 days and the spill expanded to cover 68,000 square miles of sea surface. Yet, despite the expansive scope of the event, systematic surveys of affected coastal populations found only modest effects on mental health and substance abuse. Methods. An established trauma signature (TSIG) methodology was used to examine the psychological consequences in relation to exposure to the unique constellation of hazards associated with the spill. A hazard profile, a matrix of psychological stressors, and a “trauma signature” summary for the affected Gulf Coast population - in terms of exposure to hazard, loss, and change - were created specifically for this human-generated ecological disaster. Results. Psychological risk characteristics of this event included: human causation featuring corporate culpability, large spill volume, protracted duration, coastal contamination from petroleum products, severe ecological damage, disruption of Gulf Coast industries and tourism, and extensive media coverage. The multiple impact effect was notable due to prior exposure of the region to Hurricane Katrina. These stressors were counterbalanced by the relative absence of other prominent risks for distress and psychopathology. Coastal residents did not experience significant onshore spill-related mortality or severe injury, shortages of survival needs, disruption of vital services (health care, schools, utilities, communications, transportation), loss of homes, population displacement, destruction of the built environment, or loss of social supports. Initial acute economic losses were partially offset by large-sum BP payments for cleanup and recovery of the coastal economy. Conclusions. Not only did Gulf Coast populations display remarkable resilience in the face of daunting challenges, the behavioral health impact of the Deepwater Horizon spill appears to have been blunted by the absence of major evidence-based risks for psychological distress and disorder, the exemplary response, and infusion of economic resources.
... TSIG analyses have been conducted across a spectrum of disasters, both natural and anthropogenic. [17][18][19][20][21][22][23] In the depiction of Hurricane Matthew, TSIG analyses are applied to illuminate the manner in which the physical forces of harm associated with this tropical cyclone were tranmuted into psychological outcomes. ...
... Trauma signature (TSIG) analysis [16][17][18][19][20][21][22][23] was applied to examine the psychological and mental health effects of Hurricane Matthew. TSIG analysis is defined as "an evidence-based method that examines the interrelationship between population exposure to a disaster, extreme event, or complex emergency; and the inter-related physical and psychological consequences; for the purpose of providing timely, actionable guidance for effec-tive disaster behavioral health (DBH) support that is tailored to the defining features of the event." ...
Article
Study/Objective Examine the mental health and psychosocial dimensions of Hurricane Matthew’s impact on Haiti using Trauma Signature (TSIG) analysis. Background Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin season, bringing severe impacts to multiple nations including direct landfalls in Cuba, Haiti, Bahamas, and the United States. Haiti experienced the greatest loss of life and population disruption. Methods Trauma Signature (TSIG) analysis was used to examine the psychological consequences of Hurricane Matthew in relation to the distinguishing features of this event. TSIG analysis described the exposures of Haitian citizens to the unique constellation of hazards associated with this tropical cyclone. A hazard profile, a matrix of psychological stressors, and a “trauma signature” summary for the affected population of Haiti - in terms of exposure to hazards, losses, and life changes - were created specifically for this natural disaster (with salient anthropogenic elements). Results Psychological risk characteristics of this event included compounding exposures to: deluging rains that triggered mudslides along steep, deforested terrain; battering hurricane winds (Category 4 winds in the “eyewall” at landfall) converting the built environment into projectile debris; flooding “storm surge” moving ashore and submerging areas along the Tiburon peninsula; and piling wave action destroying infrastructure along the coastline. Many coastal residents were left defenseless to face the ravages of the storm. Hurricane Matthew’s slow forward progress as it remained over superheated ocean waters added to the duration and degree of the devastation. As an overlay to the havoc of the storm itself, the risks for infectious disease transmission were exacerbated, particularly in relation to the ongoing epidemics of cholera and Zika. Conclusion Hurricane Matthew was a ferocious tropical cyclone whose meteorological characteristics amplified the system’s destructive force during the storm’s encounter with Haiti. TSIG analysis facilitates an accounting of the prominent risks to Haiti’s mental health.
... TSIG analyses have been conducted across a spectrum of disasters, both natural and anthropogenic. [17][18][19][20][21][22][23] In the depiction of Hurricane Matthew, TSIG analyses are applied to illuminate the manner in which the physical forces of harm associated with this tropical cyclone were tranmuted into psychological outcomes. ...
... Trauma signature (TSIG) analysis [16][17][18][19][20][21][22][23] was applied to examine the psychological and mental health effects of Hurricane Matthew. TSIG analysis is defined as "an evidence-based method that examines the interrelationship between population exposure to a disaster, extreme event, or complex emergency; and the inter-related physical and psychological consequences; for the purpose of providing timely, actionable guidance for effec-tive disaster behavioral health (DBH) support that is tailored to the defining features of the event." ...
Article
Full-text available
Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin season, bringing severe impacts to multiple nations including direct landfalls in Cuba, Haiti, Bahamas, and the United States. However, Haiti experienced the greatest loss of life and population disruption. Methods. An established trauma signature (TSIG) methodology was used to examine the psychological consequences of Hurricane Matthew in relation to the distinguishing features of this event. TSIG analyses described the exposures of Haitian citizens to the unique constellation of hazards associated with this tropical cyclone. A hazard profile, a matrix of psychological stressors, and a “trauma signature” summary for the affected population of Haiti - in terms of exposure to hazard, loss, and change - were created specifically for this human-generated ecological disaster. Results. Psychological risk characteristics of this event included: deluging rains that triggered mudslides along steep, deforested terrain; battering hurricane winds (Category 4 winds in the “eye-wall” at landfall) converting the built environment into projectile debris; flooding “storm surge” moving ashore and submerging areas along the Tiburon peninsula; and piling wave action destroying infrastructure along the coastline. Many coastal residents were left defenseless to face the ravages of the storm. The storm's slow forward progress as it remained over super-heated ocean waters added to the duration and degree of the devastation. Added to the havoc of the storm itself, the risks for infectious disease spread, particularly in relation to ongoing epidemics of cholera and Zika, were exacerbated. Conclusions. Hurricane Matthew was a ferocious tropical cyclone whose meteorological characteristics amplified the system's destructive force during the storm's encounter with Haiti.
... Consistent with the Disaster Ecology Model [29][30][31][32], TSIG analysis advances the position that this singular "signature" of exposure risks is a predictor of the psychosocial and mental health consequences sustained by Colombian IDPs. Internal displacement in Colombia provides the context for extending TSIG applications from catastrophic natural disasters [33][34][35][36][37][38], human-generated (anthropogenic) technological disasters [39], and "hybrid" disasters (featuring both prominent natural and anthropogenic elements) [40,41], to the realm of intentional, perpetrated acts of violence [42] and armed conflict situations that can evolve into complex emergencies [1••, 43-45]. ...
... The TSIG summary table illustrates that internal displacement generates a confluence of major psychological risk factors that, singly and collectively, carry a high risk for psychopathology. The elements of (1) decades-long duration, (2) everenlarging numbers of persons affected, and (3) intentional human causation differentiate forced migration in Colombia from TSIG case studies of natural, hybrid, and non-intentional technological disasters previously performed [33][34][35][36][37][38][39][40][41]. These features also contribute to the finding that most psychological risk factors appearing in Table 5 are rated as either "very severe" or "extreme." ...
Article
Full-text available
While conflict-induced forced migration is a global phenomenon, the situation in Colombia, South America, is distinctive. Colombia has ranked either first or second in the number of internally displaced persons for 10 years, a consequence of decades of armed conflict compounded by high prevalence of drug trafficking. The displacement trajectory for displaced persons in Colombia proceeds through a sequence of stages: (1) pre-expulsion threats and vulnerability, (2) expulsion, (3) migration, (4) initial adaptation to relocation, (5) protracted resettlement (the end point for most forced migrants), and, rarely, (6) return to the community of origin. Trauma signature analysis, an evidence-based method that elucidates the physical and psychological consequences associated with exposures to harm and loss during disasters and complex emergencies, was used to identify the psychological risk factors and potentially traumatic events experienced by conflict-displaced persons in Colombia, stratified across the phases of displacement. Trauma and loss are experienced differentially throughout the pathway of displacement.
... Consistent with the Disaster Ecology Model [29][30][31][32], TSIG analysis advances the position that this singular "signature" of exposure risks is a predictor of the psychosocial and mental health consequences sustained by Colombian IDPs. Internal displacement in Colombia provides the context for extending TSIG applications from catastrophic natural disasters [33][34][35][36][37][38], human-generated (anthropogenic) technological disasters [39], and "hybrid" disasters (featuring both prominent natural and anthropogenic elements) [40,41], to the realm of intentional, perpetrated acts of violence [42] and armed conflict situations that can evolve into complex emergencies [1••, 43-45]. ...
... The TSIG summary table illustrates that internal displacement generates a confluence of major psychological risk factors that, singly and collectively, carry a high risk for psychopathology. The elements of (1) decades-long duration, (2) everenlarging numbers of persons affected, and (3) intentional human causation differentiate forced migration in Colombia from TSIG case studies of natural, hybrid, and non-intentional technological disasters previously performed [33][34][35][36][37][38][39][40][41]. These features also contribute to the finding that most psychological risk factors appearing in Table 5 are rated as either "very severe" or "extreme." ...
Article
Full-text available
While conflict-induced forced migration is a global phenomenon, the situation in Colombia, South America, is distinctive. Colombia has ranked either first or second in the number of internally displaced persons for 10 years, a conse-quence of decades of armed conflict compounded by high prevalence of drug trafficking. The displacement trajectory for displaced persons in Colombia proceeds through a sequence of stages: (1) pre-expulsion threats and vulnerability, (2) expulsion, (3) migration, (4) initial adaptation to relocation, (5) protracted resettlement (the end point for most forced migrants), and, rarely, (6) return to the community of origin. Trauma signature analysis, an evidence-based method that elucidates the physical and psychological consequences asso-ciated with exposures to harm and loss during disasters and complex emergencies, was used to identify the psychological risk factors and potentially traumatic events experienced by conflict-displaced persons in Colombia, stratified across the phases of displacement. Trauma and loss are experienced differentially throughout the pathway of displacement. Keywords Internal displacement . Internally displaced persons . Victims of armed conflict . Humanitarian crisis . Complex emergency . Forced displacement . Forced migration . Trauma signature analysis . TSIG
... 27 The January 12, 2010 earthquake in Haiti was one of the most destructive on record. 6,28,29 An estimated 1.3 million Haitians were displaced to improvised camps in the vicinity of the earthquake's epicenter, 600,000 were relocated to rural communities, and thousands more emigrated from Haiti to join family members in the Haitian diaspora communities, primarily in the United States. The largest Haitian diaspora population resides in Miami, Florida, and some of Miami's Haitian residents provided lodging for earthquake-displaced family members and acquaintances. ...
Article
Full-text available
Objectives: Studies on the mental health of families hosting disaster refugees are lacking. This study compares participants in households that hosted 2010 Haitian earthquake disaster refugees with their nonhost counterparts. Methods: A random sample survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants were assessed regarding their 2010 earthquake exposure and impact on family and friends and whether they hosted earthquake refugees. Using standardized scores and thresholds, they were evaluated for symptoms of three common mental disorders (CMDs): posttraumatic stress disorder, generalized anxiety disorder, and major depressive disorder (MDD). Results: Participants who hosted refugees (n = 51) had significantly higher percentages of scores beyond thresholds for MDD than those who did not host refugees (n = 365) and for at least one CMD, after adjusting for participants' earthquake exposures and effects on family and friends. Conclusions: Hosting refugees from a natural disaster appears to elevate the risk for MDD and possibly other CMDs, independent of risks posed by exposure to the disaster itself. Families hosting refugees deserve special attention.
Article
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Nas últimas décadas ocorreram inúmeros desastres, catástrofes e acidentes de origem natural ou humana, incluindo a pandemia COVID-19. Todos se caracterizam por desencadear stress intenso e emoções negativas que constituem fatores de risco do adoecer psicológico. Contudo, se as catástrofes constituem situações delimitadas no tempo e no espaço, a pandemia COVID-19 tem sido prolongada no tempo. Passados dois anos é consensual o seu impacto económico, social e psicológico devido aos confinamentos, teletrabalho, e sobretudo, de sobrecarga para quem trabalha na linha da frente. Pretende-se descrever o impacto das catástrofes e das pandemias na saúde mental e psicológica dos sobreviventes e dos profissionais, apresentando estudos sobre o adoecer psicológico expresso em stress pós-traumático, ansiedade, depressão, stress ocupacional e burnout dos profissionais de saúde e de socorro. São, ainda, descritas estratégias de prevenção, nas quais se incluem a e-health e a monitorização de sintomas através de apps, plataformas e de wearable sensors no sentido de permitirem maior autonomia individual na promoção da saúde mental, psicológica e ocupacional.
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Using primary data gathered from a field survey in Sindhupalchowk, Nepal following the 7.8 magnitude earthquake in 2015, this paper investigates the role that households’ ex-post coping responses play in their economic and psychosocial recovery after disasters. For empirical estimation, we use a full-information multi-equation system and allow for contemporaneous correlation across equations to account for the processes that influence households’ responses. We find that financial access and labor adjustment opportunities increase the likelihood of higher economic resilience. On the other hand, while the adoption of financial coping strategies contributes to higher psychosocial resilience, we find that labor adjustment choices may disrupt family and social dynamics, thereby decreasing psychosocial resilience. Based on these findings, we argue that top-down post-disaster policy approaches face challenges in identifying tradeoffs across different aspects of wellbeing. Our findings underscore the importance of mobilizing local institutions and expanding market and non-market alternatives for post-disaster recovery.
Article
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This study examined the mental health consequences of the January 2010 Haiti earthquake on Haitians living in Miami-Dade County, Florida, 2–3 years following the event. A random-sample household survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants (N D 421) were assessed for their earthquake exposure and its impact on family, friends, and household finances; and for symptoms of post-traumatic stress disorder (PTSD), anxiety, and major depression; using standardized screening measures and thresholds. Exposure was considered as " direct " if the interviewee was in Haiti during the earthquake. Exposure was classified as " indirect " if the interviewee was not in Haiti during the earthquake but (1) family members or close friends were victims of the earthquake, and/or (2) family members were hosted in the respondent's household, and/or (3) assets or jobs were lost because of the earthquake. Interviewees who did not qualify for either direct or indirect exposure were designated as " lower " exposure. Eight percent of respondents qualified for direct exposure, and 63% qualified for indirect exposure. Among those with direct exposure, 19% exceeded threshold for PTSD, 36% for anxiety, and 45% for depression. Corresponding percentages were 9%, 22% and 24% for respondents with indirect exposure, and 6%, 14%, and 10% for those with lower exposure. A majority of Miami Haitians were directly or indirectly exposed to the earthquake. Mental health distress among them remains considerable two to three years post-earthquake.
Article
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Trauma signature (TSIG) analysis is an evidence-based method that examines the interrelationship between population exposure to a disaster, extreme event, or complex emergency, and the inter-related physical and psychological consequences for the purpose of providing timely, actionable guidance for effective mental health and psychosocial support that is organically tailored and targeted to the defining features of the event. A series of TSIG case studies has been published since 2011 and TSIG analyses of recent disasters are in process. Disaster Health intends to expedite and feature novel TSIG research focusing on late-breaking disaster events. At the current stage of development, expert consensus is sought for refining the TSIG methodology using a Delphi process. The overarching goal is to create a fully operational system to provide timely guidance for adapting disaster behavioral health support to the salient psychological risk factors in each disaster.
Article
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On 12 January 2010, a Mw7.0 earthquake struck the Port-au-Prince region of Haiti. The disaster killed more than 200,000 people and caused an estimated $8 billion in damages, about 100% of the country's gross domestic product. The earthquake was initially thought to have ruptured the Enriquillo-Plantain Garden fault of the southern peninsula of Haiti, which is one of two main strike-slip faults inferred to accommodate the 2cmyr-1 relative motion between the Caribbean and North American plates. Here we use global positioning system and radar interferometry measurements of ground motion to show that the earthquake involved a combination of horizontal and contractional slip, causing transpressional motion. This result is consistent with the long-term pattern of strain accumulation in Hispaniola. The unexpected contractional deformation caused by the earthquake and by the pattern of strain accumulation indicates present activity on faults other than the Enriquillo-Plantain Garden fault. We show that the earthquake instead ruptured an unmapped north-dipping fault, called the Léogâne fault. The Léogâne fault lies subparallel to-but is different from-the Enriquillo-Plantain Garden fault. We suggest that the 2010 earthquake may have activated the southernmost front of the Haitian fold-and-thrust belt as it abuts against the Enriquillo-Plantain Garden fault. As the Enriquillo-Plantain Garden fault did not release any significant accumulated elastic strain, it remains a significant seismic threat for Haiti and for Port-au-Prince in particular.
Chapter
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The psychological impacts of natural disasters are widespread, expand across a spectrum of severity, extend along a range of duration, and relate to the nature of the disaster event. The psychological consequences of disasters are spawned by, and directly proportional to, the degree of exposure to hazards, loss, and change, the “forces of harm” that characterize natural disasters. High-risk populations in harm’s way, those that are particularly vulnerable to the ravages of disaster and the combination of physical and psychological consequences, can only be partially defined before disaster strikes. Disaster impact, compounded by adversities in the aftermath, “reshuffles the deck” by creating new special populations of persons needing medical and psychological support composed of those who have sustained extreme exposure to trauma and harm. While most persons exposed to disaster rebound quickly from transient distress reactions, others progress to psychopathology including PTSD, major depression, anxiety disorders, and substance abuse. Those who lose loved ones in a natural disaster are likely to grapple with complicated grief. Prevention of psychological consequences of disaster holds great promise but is untried and untested. Early intervention is being redefined as psychological debriefing is supplanted by evidence-informed approaches; psychological first aid is the current contender. A stepped-care approach is advocated for moving survivors through a progression of early to intermediate psychological support and beyond this, for those whose distress is unabated, into psychological and psychiatric treatment. While focus is understandably drawn to timely, empirically based support and treatment for thosewho are impacted psychologically, some of the most affirmative guidance to emerge is that resilience, positive adaptation in the face of disaster’s adversity, is the most common and expectable outcome. Some survivors even emerge from the disaster experience stronger and more vital psychologically, a recently-recognized phenomenon known as posttraumatic growth. This sets the future agenda for the field; integrating disaster mental and behavioral health with the disciplines of public health, public safety, and emergency response to enhance preparedness for future catastrophic events.
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When people lose intimates unexpectedly, in particular from malicious acts of violence, they are at risk for chronic grief reactions. The phenomenology, clinical symptoms, clinical needs, and risk factors associated with loss by traumatic means and the combined influences of loss and trauma exposure are yet to be systematically studied. We review the complex interplay between trauma and loss by traumatic means. The distinctions between normal and traumatic loss, and complicated and traumatic grief, are contrasted with the traditional conceptualization of posttraumatic stress disorder. The role of various mediators such as concurrent or life-span trauma exposure and interpersonal factors, particularly the degree of attachment to the individual or group traumatically lost, is discussed. We offer a more integrated and focused view of traumatic grief, its predictors, and future directions for the integrative study of trauma and loss outcomes.
Article
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The 2010 Haiti earthquake was one of the most catastrophic episodes in history, leaving 5% of the nation’s population killed or injured, and 19% internally displaced. The distinctive combination of earthquake hazards and vulnerabilities, extreme loss of life, and paralyzing damage to infrastructure, predicts population-wide psychological distress, debilitating psychopathology, and pervasive traumatic grief. However, mental health was not referenced in the national recovery plan. The limited MHPSS services provided in the first eight months generally lacked coordination and empirical basis. There is a need to customize and coordinate disaster mental health assessments, interventions, and prevention efforts around the novel stressors and consequences of each traumatic event. An analysis of the key features of the 2010 Haiti earthquake was conducted, defining its “Trauma Signature” based on a synthesis of early disaster situation reports to identify the unique assortment of risk factors for post-disaster mental health consequences. This assessment suggests that multiple psychological risk factors were prominent features of the earthquake in Haiti. For rapid-onset disasters, Trauma Signature (TSIG) analysis can be performed during the post-impact/pre-deployment phase to target the MHPSS response in a manner that is evidence-based and tailored to the event-specific exposures and experiences of disaster survivors. Formalization of tools to perform TSIG analysis is needed to enhance the timeliness and accuracy of these assessments and to extend this approach to human-generated disasters and humanitarian crises.
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Originally published in 2007, this was the first textbook to focus specifically on disaster psychiatry. It brings together the views of international experts to provide a comprehensive review of the psychological, biological, and social responses to disaster, describing evidence-based clinical and service-led interventions to meet mental health needs and foster resilience and recovery. Chapters address the epidemiology of disaster response, the neurobiology of disaster exposure, socio-cultural issues, early intervention and consultation-liaison care, the role of non-governmental organizations, workplace policies, and implications for public health planning at the level of the individual and the community. This book is essential reading for all those involved in preparing for traumatic events and their clinical and social outcomes for public health planning.
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Some prolonged and turbulent grief reactions include symptoms that differ from the DSM-IV criteria for major depressive disorder. The authors investigated a new diagnosis that would include these symptoms. They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then designed a plan to investigate whether any combination of these would serve as criteria for a possible new diagnosis of complicated grief disorder. Using a structured diagnostic interview, they assessed 70 subjects whose spouses had died. Latent class model analyses and signal detection procedures were used to calibrate the data against global clinical ratings and self-report measures of grief-specific distress. Complicated grief disorder was found to be characterized by a smaller set of the assessed symptoms. Subjects elected by an algorithm for these symptoms patterns did not significantly overlap with subjects who received a diagnosis of major depressive disorder. A new diagnosis of complicated grief disorder may be indicated. Its criteria would include the current experience (more than a year after a loss) of intense intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, excessively avoiding tasks reminiscent of the deceased, unusual sleep disturbances, and maladaptive levels of loss of interest in personal activities.
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On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.
Article
Few studies have focused on the mental health consequences of indirect exposure to disasters caused by naturally occurring hazards. The present study assessed indirect exposure to the 2010 earthquake in Haiti among Haitian-Americans now living in Miami; these subjects had no direct exposure to the earthquake, but retained their cultural identity, language, and connection to family and friends in Haiti. Two months following the earthquake a sample of Haitian-Americans was surveyed inquiring about: (1) their psychological reactions to the quake; (2) types of exposures experienced by their family members and friends in Haiti; and (3) symptom levels of (a) major depression, (b) generalized anxiety disorder, (c) complicated grief, (d) mental health status, and (e) physical health status. Haitian-Americans living in Miami experienced a broad spectrum of indirect exposures to the 2010 earthquake in Haiti. These exposures were strongly associated with psychological distress, trauma-related mental health consequences, and diminished health status. Most notable was the multiplicity of indirect exposures to the on-scene experiences of multiple family members and friends in Haiti. Consideration should be given to the psychological impact and needs for support among indirectly-exposed populations with strong affiliation to directly-impacted victims.
Article
A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed.