Disaster and its Impact on Mental Health: A Narrative Review

Psychological Effects of Disaster

Disasters and mental health are related to a large extent; the effects of disasters might have a negative impact on the affected population. Along with the social and economic losses, the individuals and communities experience a mental instability which might precipitate Post Traumatic Stress Disorder (PTSD), Anxiety and Depression in the population. Generally, the disasters are measured by the cost of social and economic damage, but there is no comparison to the emotional sufferings a person undergoes post-disaster.

Psychological distress is common in the victims, along with socio-economic distress. The psychological interventions have helped the victims to improve over time, but the most common mental disorders such as depression and anxiety are expected to increase as a result of negative impact on mental health.

Disasters are mostly unpredictable, which leaves the victims in a state of shock. The victims tend to deny the loss and try to escape from reality. Being in a denial state makes the victims more vulnerable to stress, anxiety and other different maladaptive reactions. Home is a place which provides safety and security to the people. But, when the unavoidable situations induced by disaster; such as damaged homes, properties other valuable assets, it leads to a feeling of insecurity in the victims. Death of a closed one also leaves the victim in a state of insecurity because the sense of love, attachment and belongingness is deprived. There are various factors which lead to the psychological vulnerabilities of the sufferers such as the displacement of the family, death of a loved one, socio-economic loss, environmental loss, and lack of mental preparedness for disaster, disruption in the family bond, lack of social support and negative coping skills.

The psychological effects of the disaster are more drastic among children, women and dependent elderly population. After any sudden disaster or chronic disaster, they become the most vulnerable population. Thus, they have special needs, which needs to be taken care. Peek states that there are various behavioural, psychological and emotional issues and instabilities observed in older children and adolescents after the disaster. The psychological impact on children due to disasters can be in the form of PTSD (post-traumatic stress disorder), Depression, Anxiety, Emotional Distress, and Sleep Disorders.

Effect of natural disasters on mental health

In this section, the impact on mental health post-natural disaster has been emphasised. Thus, the mental health consequences of natural disaster such as hurricane, floods and tsunami have been highlighted.

Hackbarth et al. state that disasters may put the victims in a state of despair and shock. This traumatic experience disrupts the fully-functioning life of the victims and brings loss for individuals, families and communities. Families experiencing natural disasters faced a loss of their identity by losing the work they have been engaged. Also, there is a lack of hope and a disturbance of their roles in the respective community post-disaster. The loss of resources, loss of daily routine, lack of control over one’s own possessions and loss of social support was associated with elevated levels of acute psychological distress following Hurricane Hugo.  These mental health outcomes developed various psychological symptoms such as severe stress after the traumatic experience, uncontrollable stress, and feelings of grief and sadness for a prolonged period of time, substance dependency, and adjustment problems which affects the proper functioning of the individual as well as the community resulting in family conflicts.

Various studies have explained the physical and psychological health effects of the flood. For instance, during and after flood situation people suffering from physical health effects like cold, cough, flu, sore throat, or throat infections and headaches, skin rashes, gastrointestinal illness, chest illness, high blood pressure, asthma which results in psychological stress.

Anxiety while rainfall was the most common psychological impact after the flood. Other psychological health effects such as increased stress levels, disturbance in sleeping, dependency on alcohol and other drugs and depression have been observed.

Jenkins and Meltzer explain the mental health impact of the Indian Ocean tsunami, 2004. The survivors showed a wide range of symptoms related to anxiety, depression and PTSD. The displaced victims, however, reported the symptoms to a great extent as compared to the non-displaced victims. Unnecessary fear and adjustment problems were common. The feeling of hopelessness and a constant state of despair was also seen in the victims. There were a lot of mental health issues in the survivors from the Nordic countries. The most commonly reported problems were persistent grief, a state of shock and fear, maladjustment and dysfunctionality. Several victims were diagnosed with mental disorders comprising of the symptoms such as avoiding a specific situation with a fear of being rejected or humiliated; a state of constant sadness and uncertainties; failing to understand the causes and reasons behind the grief; fear of socializing and persistently avoiding social situations.

Effect of man-made disasters on mental health

Nilamadhav Kar states that after the Mumbai riots in 1992-93, the victims were found to be in a state of fear, shock and helplessness. The psychological and behavioural symptoms observed were anger (especially of the females who tried to attempt suicide seeing the mangled bodies of their husbands), unnecessary fear, state of suspiciousness, paranoia, obsessed thoughts and sexual inactivity.

Kar further says that within ten days of a bomb blast in a bus in 1996 at Dausa, Rajasthan, which was the result of terrorist activity, people reported severe stress, state of helplessness, severe mood swings and forgetfulness. The most commonly reported symptoms were not being able to feel one’s own self, lack of awareness of the reality, lack of sleep, guilt, loss of interest, fear of encountering situations, emotional flatness, self-blame, suicidal ideations and consistent worry about future.

Man-made disasters significantly cause PTSD than natural disasters. Serious injury or death of someone close was also a significant predictor. Being displaced by the disaster, serious injury to the victim and the victims witnessing death further aggravate the problem.

Jenkins and Meltzer explain that the oil spill in the Gulf of Mexico in 2010 had a significant impact on mental health because of its continuation for three months. The intervention focused on four areas; the people who provided safety to the workers, the toxicity of the oil spill which affected the workers, the visitors who came to analyse the disaster and also tried to help the victims, socio-economic and mental health interventions. The victims reported psychological symptoms which had a negative impact on their behaviour and mental health. The social, personal and professional life of the victims were affected, resulting in a disturbance in their functioning.

Effect of industrial disasters on mental health

The biggest industrial disaster in human history is the Bhopal gas leak disaster. Murthy explains that the Bhopal disaster is an important landmark for understanding the mental health dimensions of disasters. There was an increase in the psychopathological symptoms leading to dysfunction in the day to day activities. Clinical help and care were needed for the people who had acute psychotic symptoms viz., confusional states, anxiety-depression reactions, reactive psychoses and grief reactions. The long term care was needed for the psychological problems which resulted from disabilities, uncertainties of future, broken social units and rehabilitation issues. The victims who had direct and indirect experiences of the disaster showed prolonged behavioural and cognitive symptoms for which psychological rehabilitation was needed.

Cullinan et al. after nine years of the disaster, conducted a study of a gas-exposed population. In this study some victims were subjected to detailed neurological testing including vestibular and peripheral sensory function and short-term memory tests. In this study, a high proportion of study participants were reported a wide variety of neuropsychiatric symptoms such as abnormal taste, an abnormal smell, abnormal balance, headache, faintness and difficulty to stay awake. The neurological examination showed that many study participants have central, peripheral and vestibular neurological diseases.

Kar says that the Bhopal disaster was associated with a variety of severe form of mental disorders. Most of the patients were females, and the main diagnoses were neurotic symptoms with severe anxiety and adjustment problems with disturbance of emotions where depressive symptoms were common. The patients were not able to adjust with their immediate environment even after treatment; most of them showed psychotic symptoms and demanded consistent clinical help.

Discussion and Conclusion

Emotional instability, stress reactions, anxiety, trauma and other psychological symptoms are observed commonly after the disaster and other traumatic experiences. These psychological effects have a massive impact on the concerned individual and also on communities. Resilience plays a vital role and acts as an effective measure. Most affected individuals recover with time, with the help of effective post-intervention techniques and their individual strengths. In some cases, recovery is incomplete leading to a number of persistent psychotic symptoms which are often severe in nature. PTSD is the most frequently encountered along with anxiety, depression and other behavioural and psychological abnormalities. PTSD often comorbid with a variety of psychiatric symptoms like unnecessary fear, hopelessness, worthlessness and helplessness and other physical symptoms which leads to the deterioration of their mental health.

The provided information suggests that there are a number of factors affecting different groups of population in their adaptability. Awareness about the importance of post-intervention techniques and their applicability in the affected population has helped the victims in their recovery. The supportive methods included the individual strengths and capabilities and community-based approaches consisting of the institutions like education, health, local and national governments.

So to conclude, Disaster, not only disrupts the quality of life but also creates a significant burden of mental health conditions on an individual and the community. Effective interventions should be given pre, peri and post-disaster period to improve the adverse mental health effects of the disaster. The psycho-social education and clinical interventions are expected to provide better outcomes because of the integration of various effective measures. Rehabilitations plans should be made by keeping in mind the cultural context of the community and the needs of the affected population. So that community is empowered in a holistic way to cope with future disasters.

Source: Journal of Family Medicine & Primary Care, 2020 (www.ncbi.nlm.nih.gov)

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