Week 7: Weighing the Costs of Disaster

What is a disaster?

Natural or human-made events that cause sweeping damage, hardship or loss of life across one or more strata of society.

What is the human cost of disaster?

Psychological effects  PTSD • Depression and anxiety • Grief • Suicide • Substance abuse • Injury-related health problems • Stress-related (secondary) health problems. Well-conducted research suggest that most of these problems only occur in a minority of survivors, suggesting that it may not be best way to measure the human cost of disasters

What are methodological problems?

Convenience samples - only a certain number of people to survive a disaster, and only a certain type of person will come to participate in disaster, Random Surveying may be a solution to this – but may lead to conservative figures. Artifactory cut-offs - Criteria for clinically-significant distress determined with one sample, and then applied to another. For example, the cut-off for clinical PTSD symptoms with MVA survivors in Germany may not be applicable to the cut-off for clinical PTSD symptoms for flood survivors in Bangladesh.

What are some common approaches to measuring post-diaster distress?

Measure diagnosis, this allows for a focus on extreme or dysfunctional reactions, often binary or categorical. Investigate the most average responses, looking at the difference between disaster exposed and non-exposed groups. These often lead to investigations that change over time. Given that the majority of disaster-exposed individuals show low psychopathology, these approaches miss a lot of people!

What are the advantages and disadvantages of measure diagnosis?

Advantages useful in identifying the most affected by disasters and treating this population Quantified the harmful effects of diasters Useful for policy planning and resource allocation. Disadvantages Does not consider normative responsiveness.

What are the advantages and disadvantages of investigating the average response?

Advantages Allows for a comparison across conditions and types of disaster Looks at the duration of impact, and more sensitive way to investigate change Allows us to look at risk and resilience factors. Disadvantages Does not consider resilience

What is the difference outcome patterns research method?

Prototypical patterns

Research looking at the different trajectories of functioning across time. This allows for an in-depth look at the factors that may contribute to risk and resilience factors. Diagnostic approaches are only able to capture those most impacted by trauma and average approaches are only able to capture the most ‘normal’ Looking at different outcome patterns allows for a more well-rounded look into the influences of trauma over time.

What are risk and resilience factors?

Individual difference approaches allow for us to determine. Pre-disaster factors include - age, gender, race, prior exposure ( there may be a stress inoculation), social support, economic resources and personality Peri-disaster factors include - proximal exposure, geographic locations, life threat Post-disaster factors include - distal exposure, in terms of resource loss, displacement (mixed effects) , and media exposure. No single predictor for risk/resilence, may just have additive effect instead.

What are some methodological issues associated with looking at different outcome patterns/individual difference designs?

As most cross-sectional or retrospective designs – can’t determine causality, subject to memory biases The factors are investigated in isolation when they actually interrelate.

What is the effect of a disaster impacting a community?

Often after initial trauma, there is a lot of support, as survivor states brings people closer together, however, this doesn’t often continue. There is also a lot of research suggesting that disasters erode interpersonal relationships & sense of community, as sources of support are removed and structures broken, and more long term → the negative effects of intergenerational transmission of distress. Post-disaster social relations is, however, a strong predictor of coping success and resilience.

Are there remote effects of disaster?

Debate over the effects of post-disaster reactions in remote communities.  Data-collections after high-profile disasters show elevated distress. Prospective data suggest little or no change in distress outside the immediately-affected population. Suggest that those most affected show pre-existing vulnerabilities or actual remote exposure

Why do we see discrepancies in the remote effect of disaster?

Post-Disaster studies use screening instruments validated with other groups - meaning that the instruments may not be fit for practise With distress often being transient if measured in immediate, it will look high, but it will reduce over time. Therefore, data-collection after diameter shows elevated distress, but prospective samples disagree.

What is best to help people exposed to disaster in the acute period?

NOT - Prophylactic psychological interventions - wherein survivors are encouraged to discuss and process experiences – e.g. critical incident stress debreiding. Where there is no data to suggest effective – can even be considered to cause the worsening of individuals - NOT recommended by WHO. Providing individuals with safe environments, giving good information updates and letting people use their natural coping mechanisms

What is best to help people exposed to disasters in the aftermath?

if someone meets criteria for PTSD, may benefit in short to long-term structured treatments –e.g CBT. Note that there is an undertreatment of trauma survivors, and therefore reflect the need for outreach screening and assessment beyond PTSD. Community-level interventions may also be useful - taking the form of practical and informational support as well as fostering naturally occurring social resources.