Spectrum of Consequences of Disasters
Comprehensive reviews of the literature have consistently revealed a wide range of adverse outcomes following disasters (see, for example, Katz et al., 2002; Norris et al., 2002b; Rubonis and Bickman, 1991; Solomon and Green, 1992). Results of a review of 49 research articles and books conducted by Solomon and Green (1992) revealed that most authors reported negative psychological consequences of disasters. Norris and colleagues (2002b) reviewed 177 articles that examined 80 different disasters.1 The authors organized the most frequently documented negative sequelae of disasters into five categories:
The authors suggest that children were the segment of the population at greatest risk for psychological trauma, behavioral changes, and impairment. Research suggests that disasters experienced at a younger age may have long-term psychological consequences. One study followed a group of adolescents who experienced the sinking of a ship, and found that more than a third of those adolescents who developed PTSD subsequent to the disaster still had PTSD at either five or eight years follow-up (Yule et al., 2000).
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It is important to note that many psychological reactions to disasters are considered ordinary responses to stress. For example, almost half of the survivors of an earthquake in Northridge, California, exhibited distress symptoms of reexperiencing the disaster and hyperarousal, but these symptoms alone were not associated with psychiatric illness and were considered “normal” (McMillen et al., 2000). Regardless of psychiatric illness, it is critical to consider functional impairment when evaluating the psychological consequences of a disaster or other traumatic event. Box 2-3 presents examples of other ordinary and expected psychological responses to a disaster.
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In addition to psychiatric illness and distress reactions, experiencing a disaster may result in alterations in health-related behaviors and produce general life changes. Substance use is one health-related behavior commonly thought to increase in the aftermath of a disaster. Cigarette smoking and alcohol use may increase in individuals with PTSD after any kind of traumatic event (Shalev et al., 1990). In their extensive review of disaster studies, Norris and colleagues (2002b) observed increased substance use in 25 percent of the populations under study. However, increased substance use does not necessarily develop into substance use disorders, and Katz and colleagues (2002) noted that only a small number of studies have looked at substance use as an outcome. Family interactions constitute another area of behavior that may be influenced by disasters. For example, Adams and Adams (1984) found increased domestic violence and family problems in a population of survivors of the Mount Saint Helens eruption. Family relationships and other social variables are an area not as frequently studied as other areas discussed here and are in need of further investigation.
Evidence suggests that adverse psychological consequences of disaster dissipate over time for the majority of people. The studies included in Norris and colleagues’ review suggested that symptoms measured shortly after the disaster were predictive of symptoms at subsequent points in time, and the greatest severity of symptoms was usually experienced within one year following the disaster; only a minority of disaster survivors had any significant and persistent impairment after the first year.
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