Chapter 7: Psychological Response to Disasters

sychological trauma and other adverse psychological sequelae are frequently the side effects of events such as natural disasters and unintentional disasters caused by humans. With terrorism, the objective is to inflict psychological pain, trauma, and disequilibrium.

It is important that planners, providers, and policy makers understand the importance of psychosocial issues. They are important not only in the care of disaster victims, but also in all aspects of the medical and public health response. These issues are also important in assuring that responders do not become victims themselves. Planners and providers must consider their own denial, vulnerabilities, and fears.

Characteristics of Disasters that Affect Mental Health

Not all disasters have the same level of psychological impact. Disaster characteristics that seem to have the most significant mental health impact are the following:

• Little or no warning
• Serious threat to personal safety
• Potential unknown health effects
• Uncertain duration of the event
• Human error and/or malicious intent
• Symbolism related to terrorist target

Factors Impacting Psychological Response

Everyone who experiences a disaster, whether as a victim or as a responder, is affected by it. Fortunately, this does not mean that most will develop a mental health disorder. It does mean, however, that all individuals will have some type of psychological or emotional response to the event.

Similarly, there are both individual and collective reactions that interact as individuals and communities recover from these extraordinary events.

Factors affecting individual response to disasters include:

• Physical and psychological proximity to the event
• Exposure to gruesome or grotesque situations
• Diminished health status prior to or as a result of the disaster
• Magnitude of loss
• Trauma history

Factors impacting collective response to trauma include:

• Degree of community disruption
• Pre-disaster family and community stability
• Community leadership
• Cultural sensitivity of recovery efforts

Psychological Sequelae of Disasters

Post-disaster responses are wide-ranging, from mild stress responses to full blown post-traumatic stress disorder (PTSD), major depression, or acute stress disorder. While many people may exhibit signs of psychological stress, relatively few (typically 15%–25%) of those most directly impacted will subsequently develop a diagnosable mental disorder.

Interventions

• In cases where there is no diagnosed mental disorder, educational materials that help people understand what they and their families are experiencing is helpful.
  
• Brief crisis counseling should be provided, followed by referral when treatment is indicated.
  
• When a mental disorder is diagnosed, therapeutic interventions such as cognitive behavioral therapy and/or psychiatric medications can be helpful.