The prevention and management of the psychiatric morbidity of natural disasters: An australian experience

Post traumatic stress disorder symptoms in prisoners following a cell mate's hanging

Post traumatic stress disorder (PTSD) is a well recognised condition which occurs in people who have been exposed to severe trauma as victims, potential victims or witnesses. A review of case notes of all prisoners transferred since 1988 to a national forensic psychiatric hospital following traumatic hanging events in prison revealed that all patients had psychological symptoms and four had symptoms probably fulfilling PTSD according to DSM III R criteria. Our findings are discussed with reference to the literature on PTSD, the nature of the prison environment, the premorbid personality of prisoners, and the implications for dealing with the effect of suicide within a prison setting.

Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome

Posttraumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. U.S. population surveys reveal lifetime PTSD prevalence rates of 7% to 8%. Potential reasons for varying prevalence rates across gender, cultures, and samples exposed to different traumas are discussed. Drawing upon a conditioning model of PTSD, we review risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and posttrauma social support. Characteristics of the trauma, particularly peritraumatic response and related cognitions, and posttrauma social support appear to confer the greatest risk for PTSD. Further work is needed to disentangle the interrelationships among these factors and elucidate the underlying mechanisms. Based upon existing treatment outcome studies, we recommend use of exposure therapies and anxiety management training as first-line treatment for PTSD. Among psychopharmacological treatments, selective serotonin reuptake inhibitors evidence the strongest treatment effects, yet these effects are modest compared with psychological treatments.

Wisdom from the drought: Recommendations from a consultative conference

OBJECTIVE

Drought is a serious and recurring problem for rural and remote Australia. This paper reports the proceedings of a consultative conference concerning the mental health effects of drought held at the Centre for Rural and Remote Mental Health, Orange, in December 2003. The conference objective was to record the collective experience of government and non-government agencies dealing with the effects of drought in rural areas and to collate information for the development of a mental health strategy for future drought.

DESIGN

Participants were recruited in consultation with rural mental health organisations. Questions about mental health service strategies to minimise and respond to the mental health impact of the drought were posed to participants. Qualitative data were collected using a Nominal Group Technique.

SETTING

The Centre for Rural and Remote Mental Health, Bloomfield Hospital, Orange, New South Wales.

PARTICIPANTS

Twenty-three professionals participated, including representatives from New South Wales Health, Mental Health, and Agriculture; the Department of Community Services, and Rural Financial Counsellors.

MAIN OUTCOME MEASURE

Qualitative analysis of participant responses.

RESULTS

Three general strategies emerged as the most beneficial in minimising adverse mental health outcomes in times of drought: community-building and education about the physical, financial and mental health effects of drought; co-operation between and co-ordination of agencies in delivering mental health and other drought support; and continuity and planning of improved mental health services.

CONCLUSIONS

Drought has a serious effect on the mental health of communities. It is important to plan a response beyond the end of the drought, bringing together different government and non-government agencies to build community capacity to address common mental health needs.

Posttraumatic sequelae in a community hit by an avalanche

The posttraumatic sequelae for 104 adult inhabitants from the town of Flateyri, Iceland, were studied 10 weeks after an avalanche hit the town killing 20 people. Eighty-seven adults from the neighboring town of Thingeyri constituted a control group. On the basis of the General Health Questionnaire (GHQ-30), 25% of the Flateyri group (twice as many than in Thingeyri) reached a level of psychiatric caseness. The most common symptoms were intrusive thoughts and feelings, tension, sadness, and anxiety. The loss of family members was associated with symptomatology. A high number of former life events correlated more strongly with distress symptoms than with the individual appraisal of these events. Distress symptoms were related to gender, age, and education.

Psychological debriefing: controversy and challenge

OBJECTIVE

The efficacy of psychological debriefing following potentially traumatising events has become extremely controversial. This review aims to identify the issues underlying this controversy and their theoretical, social and political ramifications which are important in other areas of psychiatry and the social sciences.

METHOD

The historical background to the debriefing debate and the (largely negative) results of recent randomised controlled trials (RCTs) are reviewed.

RESULTS

Despite the negative results of recent RCTs, psychological debriefing remains the most widely used structured intervention following potentially traumatising events, designed to reduce the incidence of long-term psychiatric morbidity. The clinical relevance these trials and their applicability in vivo is questioned. There are implicit difficulties in conducting rigorous randomised controlled trials of group debriefing, and such trials may be unachievable.

CONCLUSIONS

Demonstrating the efficacy of debriefing or other preventive interventions presents major challenges to investigators and it is unlikely the controversy will be resolved in the near future.

A research method for the study of psychological and psychiatric aspects of disaster

This paper attempts to draw together some of the current questions related to the methodology of exploring the psychological and psychiatric aspects of human response to disaster. It sets out some of the key areas in which research questions might be mounted. A range of relevant instruments are suggested. The value of a structured interview which can explore issues of relevance to disaster victims is demonstrated. Early screening measures and proposals regarding these, as well as the particular instruments for longer term follow-up and assessment of outcome, are discussed in considerable detail. The article concludes with an overview of the principal issues to be addressed in methodology research, and emphasises the need for a collaborative approach using core items so that studies embracing different disasters and different countries can have some comparative basis.