User:JihunLyu/sandbox

Natural Disaster Trauma
Natural disasters are meteorological phenomena that occur from natural geological processes of the Earth. Some of these examples can include hurricanes, wildfires, earthquakes, floods, tornadoes, heat waves, blizzards, and other severe storms that can cause extreme loss of life, billions of dollars in property damage, leaving homes, communities, and even entire cities uprooted in their wake[1]. In the past 10 years, the National Climactic Data Center and the National Oceanic and Atmospheric Administration has found that over $810 billion dollars (CPI adjusted to 2020) of damage was wrought, with over 5,000 deaths occurring from various natural disasters[1]. Because of climate change, natural disasters have been occurring at higher frequency and intensity, meaning that more and more Americans are affected from the immediate and residual fallout that arise from the aftermath of a meteorological catastrophe[2]. Natural disasters can be understood to affect individuals in the form of mass trauma, or a collective experience of a traumatic event[3]. Disasters can therefore result in both physiological and psychological health consequences, with the latter potentially resulting in trauma or post-traumatic stress disorder (PTSD) [3].

Distinctions between subtypes of disaster trauma

Natural disasters can be understood to affect individuals in the form of mass trauma, or a collective experience to a shared traumatic event[3] [5]. However, natural disasters are distinct from technological disasters (e.g. Chernobyl) or man-made disasters (e.g. September 11th, 2001) as they do not discriminate between victims nor result from direct intervention. The prevalence of PTSD symptoms is lower than rates of man-made disasters or technological disasters, which is thought to be because of the lower average dosage of exposure among people exposed to a disaster[3] [4] [5]. Natural disasters carry both physiological and psychological health consequences, both of which can yield post-traumatic stress symptoms or even post-traumatic stress disorder (PTSD) [3] [5] [16]. Additionally, the disaster agent characteristics, such as scope, intensity, abruptness, degree of psychological terror, and overall duration of a natural disaster can directly impact the immediate and secondary sequelae across individuals and communities[20].

Variations in psychological response

Responses to psychological trauma can vary in the individual factors of whoever is experiencing the crises at hand. Individuals will naturally differ in their experience and reaction to a major traumatic event when considering the type of trauma, socio-economic factors, event exposure characteristics (direct/indirect), social support factors, and the overall duration of the natural disaster phenomena. [3] [4]  Individual characteristics, such as sex, age, marital status, education, interpersonal support, life experience, resources, psychiatric history, and personality matrices will all factor into how any given individual responds and copes with the impact of a natural disaster [15] [20]. Victims of these natural disasters can suffer from both acute and chronic psychological trauma, namely in the form of diagnostic presentations such as PTSD, major depression, anxiety disorders, substance abuse, and/or a sustained shift in personality that may yield a lower overall well-being[20]. This can further yield outcomes that impact victims’ ability to restabilize into their old lifestyles and stymie growth, leading to shifts in their overall functioning and way of life [20]. Secondary socioeconomic factors, such as financial or employment status and educational level may further be impacted and play a mitigating role in an individual’s ability to readjust after a natural disaster [3] [15] [20]. However, relatively few studies have actively studied longitudinal assessments of populations affected by natural disasters, and therefore data is limited in the prognosis of PTSD in post-disaster follow-ups[3]. While psychopathology can differ greatly following the aftermath of a natural disaster, studies indicate that post-traumatic stress disorder is the likely central psychopathology[4] [5].

Most assessments are conducted in adult survivors, or those impacted by the trauma directly. However, PTSD symptoms can also manifest in children and first responders, who may experience similarly high rates of PTSD symptoms given the similar situational intensity and exposure to a natural disaster[3] [4] [5]. Benign circumstances may affect prevalence but not the course or burden of PTSD[1] [7]. Meta-analyses assessing PTSD symptoms following several natural disasters indicate that overall PTSD prevalence ranges anywhere from 3.7% to 60% in the first 12-24 months after the occurrence of the disaster [6] [7] [8]. In spite of the large range, most studies also indicate that the prevalence estimates are in the lower half of said range[9] [10]. However, this figure changes when observing largely clinical samples or in population centers heavily impacted by the immediate and residual effects of a natural disaster[9] [10]. Studies in the 1989 Newscastle earthquake in Australia, which observed over 3,500 individuals, found that after 6 months, 11% of low exposed individuals and 18.3% of high exposed individuals met criteria for PTSD symptoms. At 2 years, this same group was assessed to have 3% of low exposed individuals experience PTSD symptoms[18]. It is theorized to an extent therefore that the greater exposure and physical proximity to a natural disaster, the higher the likelihood of PTSD symptoms will manifest and persist in affected populations for longer periods of time than compared to the general population[3]. Research indicates that children are thought to experience higher intensity and suffer from elevated rates of PTSD for longer periods of time following a natural disaster. One study found that in the aftermath of the Armenian earthquake of 1988, 95% of severely impacted and 26% of moderately impacted children had severe levels of PTSD symptoms up to 18 months following the disaster[14]. However, only few studies have longitudinally studied the long-term impact of natural disaster on PTSD symptoms in children[14].

Diagnostic considerations

Two issues that arises when trying to study the impact of natural disasters on PTSD symptoms are ontological and experiential. Trauma literature does not provide a consistent distinction between individual traumatic events and natural disasters [16]. Furthermore, each natural disaster can have varying definitions and effects on different populations[3]. Some definitions may be referring to a major loss of life, while others indicate to a profound amount of property damage[3] [4]. One proposed method of observing the impact of a natural disaster is to measure scale and outcome as two dimensions of the impact of a natural disaster[3] [16]. Long-term studies in PTSD following disasters are still lacking, however [17]. This is also in part due to the fact that certain circumstantial factors such as proactive response and resilience rates are more achievable with respect to the natural disaster in question and socioeconomic factors that may provide easier access to normalcy and treatment[17]. Most studies followed up PTSD assessments from 6 months to 36 months at the longest[9] [17]. Following the 1998-1999 floods in Hunan, China assessed over 33,000 individuals over 2.5 years, and found that 8.6% of individuals met criteria for PTSD symptoms[9]. Following the 1999 earthquake of Marmara, Turkey, prevalence of PTSD was assessed to be 19.2% after 3 years in roughly 700 victims[9]. Certain factors, such as socioeconomic status and where a disaster takes place (rural, sparsely inhabited terrain versus heavily populated metropolitan areas) will also lead to differences in emergency disaster relief efforts and therefore will affect easier access to normalcy and treatment[3]. Despite several follow up studies that exist on assessing PTSD symptoms following a natural disaster, several limitations still exist. Meta-analyses can omit other psychiatric conditions, such as depression, complicated grief or substance abuse in the wake of disasters, and other comorbidities to the burden and trajectory of PTSD after disasters 3] [4] [5]. Further considerations of cross-cultural factors may limit the validity of instruments applied in different countries when these instruments were primarily designed to assess psychopathology in developed countries, or majority populations, which therefore requires caution in interpreting data from studies across countries[3] [20]. The literature to date has yet to comprehensively discuss what the psychological, cultural, and biological factors might be that shape vulnerability to traumatic events.