IMPACT OF RECURRENT DISASTERS ON MENTAL HEALTH

Apurva KandicuppaM2013DM004

AbstractThis study explores the mental health impacts of recurrent disasters based on the review of existing literature collated from diverse sources. A framework is proposed which could provide a theoretical understanding of various interwoven relationships between consequences of recurrent disasters which could potentially affect mental health and prove as a stepping stone for further research into this significant area of study.IntroductionA recurrent disaster is a term that has been used for a single hazard that recurs in the same geographical area over the period of one year (Ferris et.al 2013), instances being the Haiti hurricane that struck four times in 2008 and the Pakistan floods that occurred annually from 2010, 2011 and 2012 to name a few. Though recurrent disasters are not a new phenomenon as they have spread havoc in the ancient times as well, people adapted to them then, but in this day and age with alarming population growth and the haphazard patterns of human settlement, as well as the looming concerns over global warming and climate change, it is postulated that far more people are vulnerable and could be impacted adversely by the fury of recurrent disasters if they occur (Ferris et.al 2013). In this context it becomes extremely important to try and understand how these disasters could affect the population residing in areas where disasters occur recurrently. Though the material, infrastructural and economic impacts have been explored to some extent in various studies (Sarangi and Penthoi 2005), the impact on mental health has not been explored in much detail, the only links being established present in the case of single disasters, treating it as an external stressor that alters peoples natural ability to cope and affects their psychological well being (Satapathy 2012; Van der Velden et.al 2013). But the impact of disasters occurring repeatedly in a particular area on the mental health of the people of the place is not well documented, especially the cumulative impact of the multitude of secondary stressors that could significantly alter ones ability to cope with the circumstances. The study aims to provide a theoretical framework that takes into account various consequences of recurrent disasters that could affect mental health and offer insights that could significantly shape the nature of long term mental health interventions that could be carried out for recurrent disasters.

Review of LiteraturePsychological impact of recurrent disastersThe psychological impact of recurrent disasters suggests considerable psychiatric impairment observed through the presence of physical symptoms like anxiety and insomnia as well as problems in performing social activities and depression symptoms (Wind et.al 2013). The gendered nature of differences is evident with women scoring much higher on these scores (Omori and Fujimori 2010). Secondary stressors like lack of proper housing, employment and quality of living were identified as putting people at a high risk for mental distress, the results for which showed that the number of high risk people was considerably more in areas of repeated disasters even several years after the last one and the gendered differences suggested that in the case of men, the recovery of job was a bigger stressor compared to women for whom the concern for loss of human relationships was more. Homelessness is particular has been associated with increased risk for mental disorders like depression, schizophrenia, emotional issues, substance abuse, anxiety and suicidal tendencies as per authors Khurana, Kerfoot, Techakasem, Kolkijkovin, Henry et.al (Funk et.al 2012) . The subsequent comparison of number of high risk people as a result of large scale singular disasters suggests that the psychological risk carried by recurrent disasters is significantly larger (Omori and Fujimori 2010). Though some studies, one of them by Matthies in 2006, suggested that the adaptive strategies adopted by the people would act as buffer against mental health problems (Wind et, al 2013), other theories by Hobfoll in 1989, indicate that the resource loss cycles that are created by the impact of recurrent disasters could potentially impact mental health (Wind et, al 2013). Extreme recurrent events that occur with little or no warning could reduce the resilience of communities as they destroy their carefully rebuilt life leaving them with little incentive to invest again (Ferris et.al 2013). The psychological and functional impairment is a possible function of the erosion of the material; environment and the social context post the recurrent disasters as much as the direct impact of the event (Wind et, al 2013). Intergenerational transmission of traumaThe studies on the intergenerational transmission of trauma give significant insights into how people respond to recurrent stress and its impact on their wellbeing and how the negative impacts could carry over several generations. It also gives insights into how recurrent disasters could impact on societies that have endured intergenerational trauma. A conceptual model explaining the process of intergenerational transmission of trauma has been prepared by Sotero by incorporating the various theories. The first phase involves the dominant group subjugating a population through various forms like segregation, physical/psychological violence, economic destruction or cultural dispossession. This constitutes the mass trauma experience. The first generation sufferers then experience various reactions to the trauma which are the physical response, social response and the psychological response which are then transmitted on to the secondary or subsequent generations through physiological, genetic, environmental, psychosocial, social or legal and social discrimination means (Soreto 2006). According to Brunello et. al and Green, the first generation of sufferers experience physical symptoms like injuries, infectious and chronic diseases along with significant psychological and physical trauma in which one could lead to the other (Sotero 2006). Authors like Jankowsi, Felitti et. Al and Boyd also noted symptoms of PTSD, depression, anxiety, guilt, chronic bereavement and self destructive behavior (Sotero 2006). The transmission to the subsequent generation could happen through impairments in parenting capacity, genetic changes, propagation of mental disorders like PTSD and depression as postulated by Danieli, The Aboriginal Healing Foundation, McClellen et. Al, Benyshek and Daniel, Ravelli et. Al, Emanuel et. Al and Barker (Sotero 2006). Authors like Eisenb, Lupen et. Al found links between the malnutrition state of the mother and the quality of her breast milk leading to low birth weight babies and maternal care combined with depressive state has also been shown to contribute significantly to stress responses in the child (Sotero 2006). As per Barker, the stress that a woman experiences during pregnancy has a significant bearing on the state of the fetus. The way it adapts could potentially impact its health outcomes later in life which could lead to type-2 diabetes by the time they are adults according to Benychak (Sotero 2006). It has also been observed by Kendall and Tackett that those who have experienced trauma before have faster reactions to new stresses and the cortisol and the epinephrine are released at a faster rate (as cited in Brown-Rice 2014). Learned behavior also transmits social problems like substance abuse, sexual abuse, and suicidal tendencies which perpetuates the cycle of trauma as per Danieli, Manson et. Al, Koss et.al, DeBruyn et. Al, Ehrensaft et.al (Soreto 2006). Collective recollection of the trauma and sharing stories and anecdotes perpetuates the trauma by vicarious traumatizaton as per Brave Heart, Williams et. Al (Sotero 2006). Impact of recurrent disasters on PovertyRecurrent disasters and poverty are observed to have a bilateral relationship. Being poor makes people vulnerable to repeated disasters and these disasters further exacerbate poverty (Anwar 2008; Ferris et.al 2013), which could then potentially become a vicious cycle. There are studies that have determined the direct impact of recurrent disasters on poverty through consumption pattern changes including expenditures as well as own produced (Silbert and Useche 2012), while others have arrived at the linkages between repeated disasters and poverty through a theoretical approach (Anwar 2008).The theoretical approach looks at two major aspects of disasters. The foremost are the material losses involving damage to the infrastructure, physical assets as well as agricultural output losses while the non material losses involve impact on the social relations, norms, values which constitute the essential aspects of culture (Anwar 2008). The unequal access to resources post disasters is mainly unfair towards the marginalized section of society like poor women and children and this is seen by the increased cases of malnutrition, exclusion, violence, unemployment and illiteracy along with exploitation (Anwar 2008). This affects their capability which involves a lack of economic, political, human, socio-political capabilities leading to further problems of equity, lack of good governance and property right. Other factors like the power structure, gender, class, ethnic and racial identity, location and community strength affect the poverty vulnerabilities and these when carried over subsequent generations contribute towards chronic poverty (Anwar 2008). Impact of Poverty and inequality on Mental HealthThe impact of poverty on mental health problems has been explored in a number of studies. It has been observed that there are three times more chances that a child or youth would develop mental health problems of he/she is born in a poor family than if he/she were born in a family not living in poverty, poverty being measured not just in terms of income but also of employment and education. The links between poverty and in utero growth retardation, injuries, exposure to toxins, complications in the perinatal stage, poor dental health and respiratory illnesses in childhood have been established by authors like Bradley et. Al and McLoyd (Lipman and Boyle 2008). Childhood poverty has also shown to impact mental health in late childhood and adolescence and the negative effects are worse when the child is young (Lipman and Boyle 2008). It has been observed that as the number of years lived in poverty by the family increases, so does the chances of mental health disadvantages in children as per Duncan et.al (Lipman and Boyle 2008). Authors like McLoyd, Grant et. Al have identified the mediating factors between poverty and mental health as repeated exposure to trauma and other authors like Larson et.al observed maternal mental health, depression, family conflict, no health insurance to be important mediators which suggests that the difficult circumstances which could include community violence could potentially lead to improper or harsh practices of parenting and therefore difficulties in adjustment for the child (Lipman and Boyle 2008). The level of isolation of the person is also a mediating factor as per Bruce and Hoff (Murali and Oyebode 2004). The level of parental involvement which decreases due to poverty could also be a significant factor that contributes to the child psychological distress. Other authors like Bradley et.al and McLoyd have identifies factors such as nutrition, housing, physical health of child, materials and experiences that stimulate cognitive experiences in child, expectations of parents and teachers, stress reactions and healthy behaviors (Lipman and Boyle 2008). Adult health outcomes of childhood poverty have also been identified as liability of the family to ill health, substance abuse, low childhood IQ, maltreatment by authors like Melichior et.al (Lipman and Boyle 2008). Moderating variables that decide the conditions under which poverty influences mental health outcomes include single female parent households, children of recent immigrants, children who are recipients of social assistance, children who left schooling midway, disabled children and youth as noted by authors like Lipman et.al, Offord et.al, Georgiades et.al (Lipman and Boyle 2008). The study also stresses that though income has been shown to be a causal factor to mental health problems in one longitudinal study by Costello, it has been recognized to be a complex interplay of factors that are difficult to isolate (Lipman and Boyle 2008). The determination of mental health problems in children also differs across studies and it is suggested that it is important to have a knowledge as well as understanding of the normal development of children in order to identify mental problems accurately in them by authors like Scott (Lipman and Boyle 2008). The poor are at greater risk for poor health because of the dangerous environments they work in, the nature of work they do which is mostly depersonalizing, highly stressful and one that is far less rewarding (Murali and Oyebode 2004). Lower economic status is associated with higher prevalence of mood disorders especially depression as per Dohrenwend, Murphy (Murali and Oyebode 2004). The kind of symptoms that are shown also varies with the socioeconomic status wherein it is seen that the anxiety and somatic symptoms were apparent in lower income class people while symptoms pertaining to cognition were observed more in higher income groups (Murali and Oyebode 2004). Suicide is also observed more in people from the lower economic background (Murali and Oyebode 2004).Inequality especially in terms of income also leads to psychocial stress and affects mental health which is also observed to lead to disruption in family, higher crime rates and violence as per Wilkinson (Murali and Oyebode 2004). The inverse link between mental illness and poverty has also been determined wherein being mentally ill also pushes one to poverty by hindering employment and education. The restricted access to health care, community health care, affordable housing, inadequate income support also contribute towards isolating the mentally ill and depriving them their share of resources (Canadian Mental Health Association 2007).

Other impacts of recurrent disasters Recurrent disasters also have a detrimental effect on the productivity of crops especially in the event of floods which have been associated with increased instances of child malnutrition (Rodriguez et.al 2011). Malnutrition has been shown to cause children to become apathetic, less exploratory and active than children with other illnesses. Cognitive function and behavior is also known to be affected of children who had suffered severe malnutrition in early life which also plays a part in mental health and poverty can exacerbate the effects of malnutrition and lead to mental problems (Mc-Gregor 1993). Life Course perspectiveThe life course approach suggests that the age and the life course that the person is in also determine his/her mental health in significant ways. Attaining adulthood itself is stressful, involving hardship and stresses of job, possible marriage and pressures of keeping household name and acquiring recognition. It is no wonder associated with a feeling of unhappiness, anxiety, depression, anger or distrust in a lot of people (Scheid and Brown 2010). These feelings decrease as people age and it is often seen that with age, the depression associated with the economic hardships reduces as per Mirowsky and Ross (Murali and Oyebode 2004). Emotional agitation, anxiety and anger all decline from after adulthood and anger in particular declines sharply between the ages of 40 and 60. Women are said to experience more depression compared to men though they tend to live longer and married people are observed to be one third less depressed than their non-married counterparts as they experience increased emotional and economic security, with recently widowed or separated people expressing two or three times more symptoms than their married peers (Scheid and Brown 2010). Having children adds to the stress if the circumstances are not conducive, especially when the parents and children are younger (Scheid and Brown 2010).The level of education also has a bearing on the level of distress in the sense that the higher the number of years in education, lower is the level of mental distress. The children who have experienced their parents separation, those living with single parents, those whose parents may have died experience greater levels of depression than other children. Health conditions that affect day to day functioning also contribute to stress (Scheid and Brown 2010). The life course perspective helps one understand that life events themselves could create potential stress scenarios. When people experience disasters, the stage in life that they are in and their circumstances would contribute significantly to their mental health and hence should also be accounted for in the overall understanding of the impact of recurrent disasters on mental health.

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