Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT January 23, 2004 "We can't all be heroes because somebody has to sit on the curb and clap as they go by." - Will Rogers
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
CRISES IN RURAL AMERICA
Crisis Interventions And
Critical Incident Stress Management:
Current Status and Future Directions
April 21-24, 2004
Casper, Wyoming
CALL FOR PAPERS
Registration: 1-800-442-2963 ext 2212
Society of Australasian
Social Psychologists 33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
27th National AACBT Conference
(Australian Association for
Cognitive and Behavior Therapy)
May 15 - 19, 2004
Location: Perth, Western Australia
AUSTRALIA
Society of Australasian Social Psychologists
33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
Contact: SASP@auckland.ac.nz
Deadline for submissions: 1 February 2004WFPHA 10th International Congress on
Public Health: Sustaining Public Health
in a Changing World: Vision to Action
April 19-22, 2004
Location: Brighton, ENGLAND
Contact: Allen K. Jones, PhD
Secretary General World Federation of
Public Health Associations
Email: stacey.succop@apha.orgXIV. IFTA World Family Therapy Congress
March 24 - 27, 2004
Location: Istanbul, TURKEY
14th Biennial Meeting of the Society
for Research in Human Development
(formerly the Southwestern Society for
Research in Human Development -- SWSRHD)
April 1 - 3, 2004
Location: Park City, Utah, USA
7th European Conference on Psychological Assessment
April 1 - 4, 2004
Location: Malaga, SPAIN
Contact: Antonio Godoy
Facultad de Psicologia
Universidad de Malaga
29071 Malaga.( SPAIN)
Tel. (34) 952 13 25 32
Fax (34) 95213 11 00
Email: godoy@uma.esAnnual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 2 - 4, 2004 Location: Chicago, Illinois, USA
Email: lhakel@siop.bgsu.edu
Homeland Security And Operation HOPE, Inc., Formalize Partnership In HOPE Coalition America
An Economic Recovery Service For Those Affected By Natural Disasters And Emergencies
The U.S. Department of Homeland Security and Los Angeles-based Operation HOPE, Inc., signed a Memorandum of Understanding today initiating a new financial advisory service to enhance the recovery process for those affected by natural disasters and national emergencies. The joint venture was established last November when thousands of Californians faced economic uncertainty as a result of the wildfires that devastated Southern California. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=10747
Federal Disaster Aid Ordered For American Samoa Storm Response
American Samoa High Winds, High Surf and Heavy Rainfall Associated With Tropical Cyclone Heta
The head of the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) announced today that federal disaster funds have been made available for American Samoa to supplement emergency response efforts on the island of Tutuila struck by heavy rains and high winds and surf spawned by Tropical Cyclone Heta. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=10391
Federal/Commonwealth Disaster Aid Surpasses $42 Million
More Information on Puerto Rico Severe Storms, Flooding, Mudslides, and Landslides
The Federal Emergency Management Agency (FEMA) and the Commonwealth of Puerto Rico have disbursed $42,270,654 dollars under the Individual and Household Program (IHP) to applicants who suffered damages resulting from the rains, flooding and landslides which occurred on November 10-23,2003. To date, some 44,155 residents have filed for disaster assistance in the twenty -one disaster declared municipalities. "Disaster aid has been delivered expeditiously to the affected families and individuals to help them on their way to recovery," said Federal Coordinating Officer Justo Hernandez. “Once families receive this assistance they are able to make key decisions with regards to their disaster-related housing and other personal needs”. The municipalities included under the Presidential disaster declaration were Aibonito, Arroyo, Cabo Rojo, Canóvanas, Fajardo, Guánica, Guayama, Juana Diaz, Lajas, Loiza, Luquillo, Maunabo, Naguabo, Naranjito, Patillas, Rio Grande, Salinas, Santa Isabel, Toa Baja, Yabucoa and Yauco. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=10128 En Espanol: http://www.fema.gov/spanish/news/newsrelease_spa.fema?id=10129
President Orders Disaster Aid For California Earthquake Recovery
The head of the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) announced today that President Bush has declared a major disaster for California, opening the way for the use of federal disaster funds to help people and communities recover from the effects of the earthquake that struck the state in late December. Michael D. Brown, Under Secretary of Homeland Security for Emergency Preparedness and Response, said the President authorized the aid following a review of FEMA's analysis of the state's request for federal relief. The declaration covers damage to private and public property from the magnitude 6.5 temblor beginning December 22. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=10390
Worsening hygiene threatens thousands of women survivors of Iran quake - UN
Worsening hygienic conditions and a critical lack of reproductive health services after last month’s deadly earthquake in the Iranian city of Bam continue to threaten the well-being of thousands of women, the United Nations Population Fund (UNFPA) warned today. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9539&Cr=Bam&Cr1=earthquake
First group of Iranian children in quake-devastated Bam return to school
The first 50 of the estimated 20,000 school-age children whose schools were damaged or demolished in quake-devastated Bam, Iran, return to school today, the United Nations Children's Fund (UNICEF) said. "The first of 26 temporary schools is scheduled to open in the city's Zone 10, catering for up to 50 primary school children in an inflatable tent provided by UNICEF," it said, adding, "An estimated 20,000 school-age children remain in Bam and, since the 26 December quake, most have been living in tents with little access to recreation and educational opportunities." For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9481&Cr=iran&Cr1=
5 years after launching Global Compact, Annan urges leaders in Davos to boost support
Five years after urging business leaders to join his initiative to encourage good corporate practices as a response to the challenges brought on by globalization, United Nations Secretary-General Kofi Annan called on executives to look again at ways their companies can help promote fair and far-reaching economic development around the world. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9537&Cr=economic&Cr1=forum
Middle East peace, Iraq and AIDS focus of Annan's talks with leaders in Davos
United Nations Secretary-General Kofi Annan met in Switzerland with officials and leaders from several countries for talks covering the Middle East peace process, developments in Iraq and the fight against HIV/AIDS. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9546&Cr=economic&Cr1=forum
UN security team in Iraq for talks with coalition
A two-person team from the United Nations is in Iraq for talks with the coalition on various security matters, a UN spokesman in New York confirmed. The team, comprising a military adviser and a security coordinator, arrived in Baghdad today with the primary purpose of liasing with the Coalition Provisional Authority (CPA) and the coalition forces, spokesman Stephane Dujarric said at a press briefing. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9548&Cr=iraq&Cr1=
Morning Headache Common in Depression, Anxiety Disorders
A telephone survey showed that this symptom may be a good indicator of depression and insomnia and is not specific to sleep-disordered breathing. For the Article, Go To: http://www.medscape.com/viewarticle/467092
Stroke Risk Linked to Risk of Cognitive Decline
Ten-year stroke risk based on the Framingham Stroke Risk Profile is associated with performance decrements in several cognitive skills. For the Article, Go To: http://www.medscape.com/viewarticle/467177
Sleep Disorders
Eight vignettes provide the basis for discussion of commonly encountered sleep disorders, including narcolepsy, idiopathic hypersomnia, obstructive sleep apnea, restless leg syndrome, and rapid eye movement disorders. Semin Neurol 23(3) 2003 For the Article, Go To: http://www.medscape.com/viewarticle/466405?mpid=23682
THE MEDICAL MINUTE: WHAT TO EAT IN 2004
What are your dinner plans -- a trip to South Beach? Supper in The Zone? Rice cakes and tofu? Too often we eat what we like or what is available without thinking much about it other than whether it tastes good. Then we eat to the point of being full and follow it with snacks and empty calories for entertainment. According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, the result is that a third of us are overweight while another third are obese, and diabetes rates are climbing. Eating well does not have to be hard, but you might have to rethink your menus a bit. Read the full story at http://live.psu.edu/story/5320
DISASTER IMPACTS IN RURAL AREAS
Background/Introduction
The mental health component of disaster relief was incorporated in Public Law 93-288 in the 1970's and mandated the National Institute of Mental Health to provide counseling services and training materials. Much attention has been devoted to this over the years. However, studies have shown that small rural communities require a different kind of attention because of their unique characteristics (Farberow, 1985). These include pride in independence, rejection of the unfamiliar, a tendency to take problems to family rather than professionals, a larger number of persons living well below the poverty line, and less acceptance of mental illness. The impact of disasters occurs in several major phases: pre-impact (knowledge of legislation, resources, services), immediate postimpact (information, coordination, crisis intervention techniques), and recovery (ongoing needs assessment). Those able to cope better have been found to be older and to have strong and stable relationships with a past reserve of emotional experience. Special attention is needed for children involved in disasters, especially if they lose a family member, and for staff in the immediate post-impact phase when burnout is common.
PTSD is often looked at in relation to disasters at various levels. Shore, Vollmer & Tatum (1989) analyzed lifetime rates for posttraumatic stress disorder (PTSD) in two rural Northwest US communities, one of which was affected by a major natural disaster, the eruption of Mount St Helens. Individuals from the affected community were divided into groups of 410 low-exposure and 138 high-exposure Ss; 477 Ss from the other community served as controls. Community-wide rates of PTSD related to the disaster and to other events (e.g., combat, sexual assault) were identified. The community lifetime rate of PTSD was about 3% when measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). A much higher rate of disaster stress response syndromes was obtained for disaster victims when a broader definition including generalized anxiety disorder and depression was used.
Some Types Of Disasters Affecting Rural Areas
There are many types of disasters and crises that occur in rural areas. Some are small and individual in impact whereas others affect much larger populations.
Fires
In September 1991, in the small rural town of Hamlet, NC, the fryer exploded at a chicken processing plant killing 25 employees and injuring many more. This disaster stirred national attention, influenced state laws and inspection policies, and profoundly affected the entire community. Derosa (1995) examined the relationship between PTSD and the survivors' subjective experiences of the trauma, their search for meaning and their perceptions of self, of others and of the world around them. They attempted to capture the survivor's experiences of themes such as rage, grief, and a belief in a benevolent world. They did this in conjunction with clinical diagnoses of PTSD (using the SCID interview) in order to assess the buffering or exacerbating influence on subjective experiences. Seventy-eight subjects included plant employees, relatives of employees, rescue personnel, and relatives of fire/rescue personnel. Several categories of variables were examined. These included unresolved trauma themes, 'pre-fire' variables including neuroticism, history of traumatic experiences and previous psychiatric treatment, 'peri-traumatic' variables including dissociation, fear of injury and level of exposure to the fire, as well as types of social support, and demographics. The most robust variables contributing to lifetime diagnosis of PTSD after the fire were having lower socio-economic status, being female, feeling little social support, fearing death/injury and dissociating during the fire. The only significant contribution to the model for chronic PTSD was number of unresolved trauma themes. Additionally, the degree to which the trauma themes remained maladaptive varied by severity of diagnosis. Exploratory cluster analyses of patterns of unresolved themes among survivors and their families suggested that in addition to the number of unresolved themes, the pattern of thematic resolution was associated with diagnosis.
Eyles, Taylor & Baxter (1993) studied the 1990 Hagersville (Ontario) tire fire. They described the accounts of 43 residents' affected by the fire, evacuation, and aftermath in terms of concerns, anxieties, and responses. Five themes emerged: economic, community, health, environmental, and governance.
Floods
In June 1981, south-eastern Kentucky experienced serious and widespread flooding. In May 1984, a storm system brought tornadoes, strong winds, and severe, extensive flooding to this same area. What impact did these two floods have upon the mental, physical, and social functioning of the rural Appalachian victims? Were these individuals able to take these events 'in stride' or did they present a serious challenge to their ability to cope? Did these floods leave a lasting impact upon the mental and physical well-being of these individuals or did they only result in relatively minor and short-lived emotional upset? Were some people more affected than others? Were these communities able to 'rally around' their members or were they shattered and split apart? These questions and others were the focus of a study of the psychosocial impact of the Kentucky floods by Norris, Phifer & Kaniasty (1994). This study had three features that hold particular promise for increasing what we know about the effects of disaster: (1) the study's prospective and longitudinal design; (2) its consideration of both individual and collective aspects of disaster exposure; and, (3) its focus on older people (aged 55 or older).
In another study of flood victims, Ginexi, Weihs & Simmens (2000) examined whether the 1993 Midwest floods increased depression symptoms and diagnoses in a statewide sample of 1,735 Iowa residents (aged 18-90 yrs), approximately half of whom were victims of the 1993 floods. The residents participated in interviews one year prior to, and thirty to ninety days after, the disaster. Employing a rigorous methodology including both control-group comparisons and predisaster assessments, Ginexi et al performed a systematic evaluation of the disaster's impact. Overall, the disaster led to true but small rises in depressive symptoms and diagnoses 60-90 days post-flood. The disaster-psychopathology effect was not moderated by predisaster depressive symptoms or diagnostically defined depression. Instead, predisaster symptoms and diagnoses uniquely contributed to increases in postdisaster distress. However, increases in symptoms as a function of impact were slightly greater among respondents with the lowest incomes and among residents living in small rural communities, as opposed to on farms or in cities.
Sundet & Mermelstein (1996) examined why some survived the Great Flood of 1993 in the midwest and others did not and the relationship of those outcomes to classic crisis intervention theory. Qualitative case investigations were conducted from eight severely impacted river towns in Missouri. Graduate social work students began on-site data gathering approximately seven weeks after the flood's initial strike in the state. Results suggested specific, pre-disaster community characteristics were associated with post-disaster survival or failure. Among demographic variables, only the poverty rate appeared to have a strong association with outcome. Contrary to expectations, a vibrant economy was not a predictor of community survival. Communication skills, on the other hand, were invaluable aids in survival.
Following floods in France in 1996, Maltais, Lachance & Brassard (2002) studied qualitative and quantitative problems and emotions experienced by 122 male and female adults (mean age 48.4 yrs), victims of floods in rural areas, and 117 male and female adults living in an area unaffected by the flooding. Data on sociodemographic variables and physical, social, and mental symptoms experienced during the emergency phase and the recovery process were obtained by semistructured interview, conducted three years after the flood. The Impact of Event Scale (M. J. Horowitz et al, 1979), the Beck Depression Inventory, the General Health Questionnaire, and the Affect Balance Scale (N. M. Bradburn, 1969) were used. The results suggest that the health status was more delicate and financial situations more unstable among subjects affected by the flood than by those subjects not affected by the flood. This information has implications for developing intervention methods for victims of natural disasters.
Solomon & Smith (1994) discuss the impact of exposure to flooding and/or dioxin contamination on rural St. Louis residents experiencing these events in late 1982. This study was designed to describe the type and extent of psychiatric disturbance that followed these events, and to see if victims' reactions varied for the different types of disasters. They were also interested in learning how social support and family role affected victims' reactions and which victims were most likely to experience psychological problems following exposure. They explored why some people react more negatively to both disaster exposure and the lack of social support than others do. Toward this end, They explored perceived control as a possible explanation of victims' responses to disaster.
In summary, poverty levels, general economic conditions, perceived control, previous experience, and rurality all seem to have effects on responses and recovery and psychosocial adjustments from flooding disasters. These and other variables need to be considered when planning for post-disaster interventions and responses in rural environments.
Earthquakes
Wang, Gao & Zhang (2000) examined longitudinal change of quality of life (QOL) and psychological well-being in a community sample affected by an earthquake and examined the relationship between QOL and disaster exposure, post-disaster support and other related variables. The Ss, from two villages at different distances from the epicenter, were assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and three subscales of a symptoms checklist at three months (n = 335) and nine months (n = 253) after the earthquake, respectively. Exposure to the earthquake was associated with multidimensional impairment in QOL, including physical, psychological and environmental domains at three months, and psychological and environmental domains at nine months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. At both assessment points the group that experienced lower initial exposure but then received less post-disaster help reported poorer QOL and psychological well-being. The two victim groups also differed significantly in changing trend along time. The group that received more support showed a general improvement in post-disaster well-being from three months to nine months.
Wang, Zhang & Naotaka (1999) studied the quality of life in a rural community affected by a 6.2 degree earthquake in Hebei province, China, which occurred on January 10, 1998. Human Ss were 136 male and female Chinese adults (aged 18-60 yrs). Average education was 4.08 years. They lived in a village 0.5 miles from epicenter (Group A). A second group consisted of 199 male and female Chinese adults (aged 18-60 yrs). Average education was 4.42 years. They lived in a village 10 miles from epicenter (Group B). A control group consisted of 172 male and female Chinese adults (mean age: 39.84 yrs) from a village unaffected by the earthquake. Ss were investigated three months after the earthquake by using 5-point scales in individual and family-member interviews. Data of Ss' earthquake suffering and experiences (death of family member or friends, injury, and money or property lost, pressure, support, and worries), psychological symptomatic distress, and quality of life (physical and mental well-being, mentality, social relationship, and environment) were compared. The results show that the village with a higher level of initial exposure to the earthquake and a higher level of post-earthquake support had a lower frequency of PTSD than the village with a lower level of initial exposure and less post-earthquake support. The rate of onset of DSM-IV PTSD within nine months for the two villages was 19.8% and 30.3%, respectively. In both villages, the rate of onset of earthquake-related PTSD within nine months was 24.2% by using DSM-IV criteria and 41.4% by using DSM-III-R criteria.
The use of the diagnosis of post traumatic stress disorder (PTSD) has not been very useful across cultures as it is based on the western cultural discourse that stress is an outcome of loss of control over nature. Priya (2002) provides a glimpse of suffering and healing among the survivors of an earthquake that occurred in 2001. An ethnographic approach was used for this study. It was found that the faith of the people that discharging their duties (karma) would lead them to peace and harmony with nature has resulted in better healing among the survivors in rural areas than among those in urban areas where life is guided mainly by the materialistic goals. It is proposed that suffering and healing help to understand earthquake survivors better than PTSD.
Technological Disasters
Webb (1989) describes the accidental introduction of the fire retardant polybrominated biphenyl (PBB) into the food chain of Michigan in 1973 as an example of an insidious, slowly developing, and continuing technological catastrophe. D. M. Hartsough's (1985) transactional model of natural disasters is utilized to provide a conceptual framework for the psychological effects of the PBB crisis. Following this model, the event (toxic chemicals within the food chain) led to the quarantine of 576 farms, destruction of millions of animals and dairy products, and losses of $100-200 million. In spite of a high prevalence of depressive symptoms and somatic complaints, research results regarding psychological and physical effects of PBB poisoning have been equivocal and, at times, contradictory. Hartsough's model points to possible intervention points that may have improved the response to the event and yielded fewer negative outcomes for the victims.
Tornadoes and Cyclonic (hurricane) Disasters
Madakasira & O'Brien (1987) surveyed the mental health status of 116 disaster victims (aged 18-89 yrs) five months after a tornado devastated a rural community, using the Hopkins Symptom Checklist (HSCL) expanded to include most of Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for posttraumatic stress disorder (PTSD). 69 Ss met the criteria for acute PTSD, 19 of whom had a severe form. Although an inadequate degree of social support was more often noted in victims with severe PTSD, other demographic factors and degree of injury or property damage did not appear to be related to the presence of PTSD. Severity or presence of PTSD was supported by high scores on all HSCL subscale factors. Findings suggest a high incidence of acute PTSD in victims of natural disasters and the potential value of HSCL in screening for PTSD in large populations.
Patrick & Patrick (1981) conducted a longitudinal study of psychological disturbance in 667 persons from 10 villages in Sri Lanka after the cyclone disaster of 1978. The post-cyclonic stress identified among the rural communities after their return to the same destroyed environment was studied. Symptoms (e.g., anxiety and suicidal ideation) tended to be early or delayed in appearance, and the degree of unpreparedness is postulated as the cause of the former.
Families and Children
The importance of families and the responses of children to disasters in rural areas have been studied by a number of groups following natural disasters. In February 1955 tornadoes destroyed two rural schoolhouses in Mississippi, killing both teachers and many of the students. A case study of a limited number of the families involved was initiated to investigate the processes by which a family, in the context of its community and subculture, may deal with the traumatic experiences of disaster. In certain areas, the data of this study can be compared with data of a previous study of children in disaster, "The Child and his Family in Disaster: A Study of the 1953 Vicksburg Tornado" (Perry & Perry, 1959).
Earls, Smith & Reich (1988) report on a pilot study examining the reactions of children to a disaster of severe flooding in a circumscribed area of rural Missouri. Both parents and 6-17 yr old children (32 parent-child pairs) were interviewed separately approximately one year after the flood, using parallel versions of a structured diagnostic interview designed to identify children with Diagnostic and Statistical Manual of Mental Disorders (DSM-III) diagnoses. Results document the importance of interviewing children directly. Children reported more anxiety symptoms than parents reported for their children. Although symptoms of posttraumatic stress were reported, none of the children met full criteria for the disorder. Children most likely to be adversely affected were those with a pre-existing disorder and those with parents who also reported a high number of symptoms in themselves.
In another study of post-disaster effects on children, 32 mothers and their children (aged 6-17 yrs) who had been exposed to severe flooding in rural Mississippi were interviewed, using the Diagnostic Interview for Children and Adolescents. Other sources of information about the children included school reports and the teachers' version of the Child Behavior Checklist. Results indicate that in most cases of psychiatric disorder, the diagnosis could have been made from the child's report alone. Children as young as six years of age reported emotional problems of which the parent appeared unaware. The decision-making process used in the assignment of summary psychiatric diagnoses based on child and parent reports, as well as a number of other sources of information about the child are important factors to consider when doing assessments (Reich & Earls, 1987).
The farm crisis in the 1980's provided some insights into how rural families cope with crises. For example, data from 77 adolescents in farm and ranch families were used to examine the relationship of demographic variables, family stressor events, and family coping strategies to adolescent adaptation (Plunkett, Henry & Knaub, 1999). Results indicated that adolescent age and family transitions were positively related to individual stress. Males reported less family stress than did females. Seeking spiritual support was negatively related to family stress, while the perceived impact of the farm crisis was positively related to family stress. Family support was positively related, and family substance use issues were negatively related, to adolescent satisfaction with family life.
Hargrove (1986) examined the myth of rural communities uniting under stress and suggested clinical and community activities for mental health workers during the farm crisis of the 1980's. He maintained that a model for understanding human response to natural disasters is useful for understanding response to farm crises. He offered recommendations at the community level and suggested that the clinical/advocate model developed by G. B. Melton (1983; see also PA, Vol 61:9256) provides a useful perspective from which to operate.
Forrest (1988) contends that the rural family, with its particular stressors, is increasingly vulnerable to overwhelming crises. She hypothesizes that adolescent suicide, although rare, may result from or add to that stress.
Thompson & McCubbin (1987) outline resource materials available to help educators, counselors, and others to support rural familes in crises and facilitate decision making, long-range planning, and problem solving. Counseling programs, workshops, publications, support groups for coping with stress, and computerized decision aids are reviewed.
Cultural Factors
Socio-demographic and cultural factors have been reported to shape help-seeking behavior. However, not much effort has been made to determine the effects of these factors on help-seeking among rural populations. Aderibigbe, Bloch & Pandurangi (2003) employed a telephone survey using random-digit dialing to explore socio-demographic characteristics and ethnic differences in the types of professionals sought for unexplained somatic and emotional problems (N=1161) in rural eastern North Carolina. Ethnic differences in comfort with participating in support groups were also examined. The effect of a large natural disaster, Hurricane Floyd and subsequent flooding, on help-seeking choices and comfort with support groups was also assessed. Results suggested that the rural population makes a sharp distinction between somatic symptoms and stress-related symptoms. This distinction seemed more pronounced for European-Americans than for African-Americans. In general African-Americans selected help-seeking from clergy more often than European-Americans, although for unexplained somatic symptoms this difference was fostered by Hurricane Floyd with its flooding. African-Americans showed markedly increased comfort with support groups after the hurricane, while European-Americans showed no changes in comfort with support groups.
Sharan, Chaudhary & Kavathekar (1996) examined psychiatric morbidity after a natural disaster in rural India. Semi-structured interviews were used to gather information from 56 individuals older than 14 yrs from 23 households in three villages affected by an earthquake. Diagnoses based on Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria were assigned on the basis of the interviews, and nonparametric tests were applied to comparisons of Ss who were or were not given a psychiatric diagnosis. 33 Ss (59%) received a psychiatric diagnosis. The most common diagnoses were posttraumatic stress disorder (PTSD) (13 Ss) and major depression (12 Ss). Psychiatric morbidity was associated with female sex, and destruction of house and possessions. The mental health needs of disaster survivors in third world countries is indicated as an area needing further attention.
Crighton, Elliott & van der Meer (2003) researched the contribution of an environmental disaster to the psychosocial health of people living in Karakalpakstan, a semi-autonomous Republic in Uzbekistan. An interview survey was carried out by Medecins Sans Frontieres, with the assistance of the McMaster Institute of Environment and Health, local Universities and local health care workers, on a random sample of 1118 individuals aged 18 years and older in three communities in Karakalpakstan in May/June 1999. The communities were chosen according to distance from the former seashore, urban/rural characteristics and ethnic composition. The survey included questions about perceived general health, the General Health Questionnaire, the somatic symptom checklist of the Symptom Check List-90, questions about perceptions of the environmental disaster, social support as well as sociodemographic and socioeconomic characteristics. Findings show that 41% of all respondents reported environmental concern while 48% reported levels of somatic symptoms (SCL-90) associated with emotional distress, above the normalized cut-point. Significant differences in levels of emotional distress were reported between men and women as well as between ethnic groups.
Hutton (2003) examined the impact of riverine hazards and displacement upon displacees, both males and females, in Bangladesh. The specific objectives of the study were to: (a) determine the magnitude of psychological distress associated with riverine hazards and displacement in Bangladesh, (b) examine patterns and predictors related to the economic, social, and psychological adaptation of male and female displacees, and (c) identify patterns of psychological coping common to displaced persons. Research was conducted during the 1998 flood season in Bangladesh. Subjects consisted of 238 displacees randomly sampled from four squatter settlements in the city of Serajganj in Bangladesh. A comparison group of 223 demographically comparative non-displacees was drawn from three rural villages in the thana (sub-district) of Shariakandi. Structured interviews were conducted at the respondents' households over a six week period using trained university students. The findings show that the constant threat of riverbank erosion has contributed to the development of a distinct set of characteristics related to disaster-induced displacement in Bangladesh. Although frequent displacement is common among the floodplain residents, less than one-fifth of the displacees had perceived riverbank erosion to be a serious problem and just one-tenth believed they would eventually be permanently displaced. Although displacees exhibited significantly higher level of distress than non-displacees, this was related primarily to socioeconomic deprivation rather than displacement per se. The commonly hypothesized factors such as loss of land and frequency and duration of displacement were not found to have a significant association with distress levels. Among both displacees and non-displacees, chronic survival concerns, daily hunger, and marginal living conditions were predictive factors of psychological distress. The need to integrate disaster management within a social, cultural and psychological context was emphasized. Popular development and psychological theory usually associates low personal control with maladaptive passivity and dependency. In this study, displacees more often responded to their difficulties with active problem-solving efforts, with fatalism being among the least utilized forms of coping. It appears that low aspirations and self-efficacy generated by poverty may in some instances be psychologically adaptive. These attributes can reduce levels of frustration and distress, without diminishing determination and perseverance.
McDowell (2002) notes that research on impoverishment risks arising out of development-induced involuntary population displacement is improving the understanding of rural development processes more generally. Following comparative studies of the process of livelihood destruction and re-establishment dynamics among communities re-settled as a result of planned development and war, McDowell develops a methodological framework for post-disaster reconstruction research. He outlines a research methodology to conduct and organize theory-led fieldwork on the socio-economic and cultural impacts of forced population displacement, involuntary resettlement, and livelihood reconstruction. Combining recent Sustainable Livelihoods research and the concept of Impoverishment Risks and Reconstruction, McDowell suggests that a focus on institutions and sustainability will help shape research to better understand the impacts of disasters and induced-displacement processes on the livelihoods of affected populations.
Conclusions And Approaches
Psychologists are encouraged to broaden their skills to include training in disaster intervention as global awareness of the need for disaster mental health increases. As members of the Association of Virgin Islands Psychologists, Dudley-Grant, Mendez & Zinn (2000) recount their experiences as professionals and as individuals when violent hurricanes hit the U.S. Virgin Islands. They provide suggestions for individual and community-level interventions as well as potential collaborations with disaster relief agencies such as the American Red Cross and the Federal Emergency Management Agency. They discuss unique concerns related to working in multicultural settings, rural service delivery, and research opportunities.
Zargar, Najarian & Roger (1993) focused on the association between psychological aspects of disasters and the process of reconstructing both dwellings and the community infrastructure. They took into account the existing literature on the subject as well as the results of survey data obtained from re-settled rural survivors of the Iraq-Iran conflict. They suggest that two theoretical models are particularly relevant to disasters: life events and learned helplessness. It is important to review the factors affecting the implementation of reconstruction policies. This includes focusing on the provision of emergency and temporary shelter, examining factors which govern the timing of the return of the survivors to the new site and including consideration of the role of the survivors themselves during the reconstruction process (in relation to decision-making and to physical rebuilding).
Silver & Goldstein (1992) introduced a model for the classification of crisis intervention and disaster services as being clinic-based, ad hoc, school-oriented, disaster service based, and integrative. An example is presented of an integrative-collaborative model that was developed to cope with situations of suicide, accidental death, or natural disaster when they occur in rural areas and small towns. The Community Crisis Intervention Team (CCIT) was developed with characteristics specific to a collaborative model. This is somewhat similar to the CISM Teams set up in other communities.
Hessen (1989) discusses the psychosocial support provided by a psychiatric outpatient clinic at a small rural hospital in Norway in connection with a plane crash that produced 36 casualties. The disaster training of human service workers, psychiatric emergency plans, emotional support, cooperation between health and social services, long-term support functions, use of the media, responsibility for support work, use of experts on psychosocial intervention in crisis work, and work routines for and psychological debriefing of psychiatric personnel are considered.
The use of laptop computers for data gathering and resource searches has become very valuable as a tool in many settings in recent years. Adaptation to uses in disaster aftermaths and other crisis and critical incident situations is just beginning to become more common. Echterling & Hoschar (1989) describe the use of the personal computer in a rural mental health program designed to address disaster-induced psychological problems following a flood. The computer was used in the desktop publication of pamphlets for disaster survivors; for managing data to assess the needs of survivors, set priorities, plan interventions, keep records, and generate reports. The computer also was used in mailing letters to survivors, providing them with updated information regarding available services and continuing concerns, and evaluating effectiveness.
Information about clergy responses to crises and disasters in rural areas is not very extensive, especially in areas of the rural American west. Echterling, Bradfield & Wylie (1988) contrasted the roles, activities, and stresses of 24 urban and rural ministers in responding to the November 1985 flood in West Virginia and Virginia. Ss completed questionnaires 7-26 months after the flood that assessed the challenges they faced, the special contributions they offered survivors, and the problems they experienced in their disaster work. Urban and rural Ss faced similar challenges, such as helping people to integrate disasters into the theological context of their religious beliefs. However, they often differed in the resources available to them, in the variety of disaster relief roles they took, and in the strategies they pursued in ministering to the needs of their communities.
Southeast Wyoming Mental Health Center in Wyoming sponsored a workshop in crisis intervention as a means of training nonmental-health professionals (mainly ministers) in abilities to deal more adequately with mental health problems (Oetting, Cole & Adams, 1969). Several techniques frequently used in eliciting and recording proceedings were unacceptable to this group because of their professional orientation, so some aspects of the workshop were incomplete. It was concluded that participants need to know the worth of evaluation, that all staff participants should have a positive view about the project and be thoroughly familiar with the evaluation plan. This should include more than one kind of information gathering.
Different approaches following disasters in rural areas need to be tailored to the communities and groups affected. Heffron (1977) discusses Project Outreach, a specially designed crisis intervention program funded by the National Institute of Mental Health following the devastating 1972 Agnes flood disaster in the Wyoming Valley of northeastern Pennsylvania. The project was in operation for 32 months and employed 60 individuals, primarily specially trained, indigenous nonprofessionals. Utilizing a neighborhood canvassing effort, Human Service Counselors encountered individuals with a wide range of problems ranging in severity and difficulty from those requiring limited assistance from community resources to those involving the need for direct mental health services. Over 25,000 client contacts were made. The project demonstrated that a cadre of local residents can be recruited, selected, and trained within a very short period of time to provide crisis intervention services to disaster victims. Further, Project Outreach has shown that an active, community-based, outreach/case-finding effort can be a highly effective approach in dealing with the problems of disaster victims.
The National Institute of Mental Health (NIMH) emphasizes improved mental health and mental health services in rural areas through funding for research projects and research centers (Hutner & Windle (1991). The five research areas include the epidemiology of mental disorders, behavioral and psychological factors of mental illness and health, mental health services, community support demonstration programs, and child and adolescent service system demonstration programs. NIMH also supports related activities including state planning, improvement of state data systems, protection of and advocacy for mentally ill individuals, disaster relief, professional training, and education concerning depression. It is suggested that those planning work in these areas contact NIMH for more current and up-to-date information.
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To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
American Dreams, Rural Realities: Family Farms in Crisis
by Peggy F. Barlett
Book Description
From Library Journal This study of family farms in Dodge County, Georgia, examines the social and economic factors that determine success in farming today. Bartlett, a professor of anthropology at Emory University, presents an agrarian history of Dodge County and its changes and transformations from frontier times to the present. The key period of her study is the boom-and-bust decade of the 1980s when the nation was in the grip of a farm crisis. Using data derived from interviews and personal observations of 124 small and medium-scale farm families, Bartlett describes in detail the coping strategies and management approaches of those who were determined to stay in farming and those who left. She explores family histories, personal aspirations, and attitudes about farming as a livelihood. Her interviews with farm women reveal a variety of role definitions and spousal relationships that enable farm families to remain intact. The aftermath of the crisis and its impacts on farm size, resource conservation, and management style offer insights for family farm survival in other communities. Recommended for agricultural economics and rural sociology collections. - Irwin Weintraub, Rutgers Univ. Libs., Piscataway, N.J. Copyright 1993 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.
From Book News, Inc.
Through a long-term (1982-1989) study of 156 farm families in Dodge County, Georgia, Barlett takes the measure of the damage from a decade of crisis, and provides a critical look at trends in American farming, their impact on rural community vitality, and the effects of federal farm legislation. Paper edition (unseen), $18.95. Annotation copyright Book News, Inc. Portland, Or. --This text refers to an out of print or unavailable edition of this title.
Additional Readings at:
Also try looking here for September 11, 2001: A Simple Account for Children.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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