epidemiology of psychiatric consequences of disaster ibrahim salmani salmani@ssu.ac.ir

Epidemiology of Psychiatric Consequences of Disaster

Ibrahim SalmaniSalmani@ssu.ac.ir

What is a Disaster?

A disaster is an occurrence that causes human suffering or creates human needs that the victim cannot

alleviate without assistance .

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What is a Critical Incident?

A natural or man-made event or situation that has the potential to temporarily overwhelm the ability to maintain psychosocial equilibrium.

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Epidemiology and its applications in measuring the effects of disasters

Epidemiology- The quantitative study of the distribution and determinants of health related events in human populations

Epidemiology and its applications in measuring the effects of disasters

Disaster Epidemiology- The use of epidemiology in disaster situations. Epidemiologic methods can be used to measure and describe the adverse effects of natural and human-caused

disasters .

Why Mental Health is Important

• Mental health is the leading cause of disability in the world• Major economic and social costs• Increasing demands on the health system following disaster• Decreased resources following disaster• Decreased ability to respond, recover and rebuild

Following Disaster

• Distress (normal reaction)• Behavior Change (normal or problematic)• Disorder (problematic, specific symptoms, illness)

Behavioral Changes

Psychiatric Illness

DistressResponses

Sense of vulnerability Insomnia Irritability, distraction

PTSD DepressionComplex Grief

Smoking Alcohol Over dedication

Center for the Study of Traumatic Stress

Following Disaster

Psychological Timeline

1 to 3 Days -------------------TIME-------------------------------1 to 3 Years

WarningThreat

Pre-disaster

“Heroic”

Honeymoon (Community Cohesion)

(Coming to

Term

s) Work

ing

Through G

rief

Reconstruction A New Beginning

Disillusionment

Trigger Events and Anniversary Reactions

Impact

Inventory

Zunin/Meyers

Em

otio

n

PTSD

• PTSD was first recognized as a diagnostic entity in 1980, when it was included in the DSM-III.

• PTSD was classified as an anxiety disorder, and diagnostic criteria for PTSD were introduced.

The diagnostic criteria for PTSD, ICD-10• Exposure to a stressful event or situation (either short or long lasting).• Persistent remembering or "reliving" the stressor (by intrusive flash backs, vivid

memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor).

• Actual or preferred avoidance of circumstances resembling or associated with the stressor.

• Either (1) or (2):1. Inability to recall, either partially or completely2. Persistent symptoms of increased psychological sensitivity shown by any two of the

following:• difficulty in falling or staying asleep• irritability or outbursts of anger• difficulty in concentrating• hyper-vigilance• exaggerated startle response.

The diagnostic criteria for PTSD, ICD-10• Additionally ICD-10 diagnostic guidelines state:

In general, this disorder should not be diagnosed unless there is evidence that it arose within 6 months of a traumatic event of exceptional severity.

PTSD Epidemiology

• The United Nations' World Health Organization publishes estimates of PTSD impact for each of its member. Click Here

‘‘Victims’’ of a Disaster

• Those who nearly escape death• Those who are injured, family members of the deceased, and• Those who witness a catastrophic event.

Remove from harm’s way.Remove from the scene.Provide safety and security.Provide shelter.Reduce stressors.

SafetySecurityShelter

What Survivors Need:

What To Do:

SAFETYSAFETY, FUNCTION, ACTION:Psychological First Aid for Disaster Survivors

SAFEGUARD

SAFETY

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

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Provide food, water, ice.Provide medical care, alleviate pain.Provide clothing.Provide power, light, heat, air conditioning.Provide sanitation.

Basic survival needs

What Survivors Need:

What To Do:

SAFETY

SAFETYSAFETY, FUNCTION, ACTION:Psychological First Aid for Disaster Survivors

SUSTAIN

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

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Establish a compassionate “presence.”Listen actively.Comfort, console, soothe, and reassure.Apply stress management techniques.Reassure survivors that their reactions are“normal” and expected

Soothing human contactValidation that reactions are “normal”.

What Survivors Need:

What To Do:

FUNCTIONSAFETY, FUNCTION, ACTION:Psychological First Aid for Disaster Survivors

FUNCTION

COMFORT

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

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Keep survivor families intact.Reunite separated loved ones.Reunite parents with children.Connect survivors to available supports.Connect to disaster relief services, medical care.

Social supports/keeping family together Reuniting separated loved onesConnection to disaster recovery services,medical care, work, school, vital services

What Survivors Need:

What To Do:

FUNCTIONFUNCTION

SAFETY, FUNCTION, ACTION:Psychological First Aid for Disaster Survivors

CONNECT

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ACTION

Clarify disaster information:• what happened• what will happenProvide guidance about what to do.Identify available resources.

Information about the disasterInformation about what to doInformation about resourcesReduction of uncertainty

What Survivors Need:

What To Do:

ACTIONSAFETY, FUNCTION, ACTION:Psychological First Aid for Disaster Survivors

EDUCATE

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

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SAFETY, FUNCTION, ACTION:Psychological First Aid for Disaster Survivors

Set realistic disaster recovery goals.Problem solve to meet goals.Define simple, concrete tasks.Identify steps for resuming normal activities.Engage able survivors in helping tasks.

Planning for recoveryPractical first steps and “do-able” tasksSupport to resume normal activitiesOpportunities to help others

What Survivors Need:

What To Do:

ACTION

ACTION

EMPOWER

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

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