Perspective

Tips for coping with natural disasters such as Hurricane Harvey, Irma

Charles R. Marmar, MD
Charles Marmar

A number of studies have shown that natural disasters increase risk for depression, anxiety, PTSD and substance use disorders.

Findings presented at the 2016 American Psychiatric Association Annual Meeting indicated alcohol abuse and emotional trauma were higher among adolescents with high exposure to natural disasters, compared with their peers with lower exposure.

A study in the CDC’s Preventing Chronic Disease showed substance use disorder hospitalizations increased following Hurricane Katrina and geographic patterns of hospitalizations shifted from flood-exposed areas to less exposed areas in the city center.

Survey results from more than 3,000 individuals exposed to Hurricane Sandy suggested strong relationships with neighbors had a protective effect on risk for PTSD among older adults exposed to the hurricane.

Mental health implications

In an interview with Healio/Psychiatry, Charles Marmar, MD, of the APA’s Committee on Psychiatric Dimensions of Disasters and New York University Medical Center and PTSD Research Program, discussed mental health implications of natural disasters such as Hurricane Harvey.

“There are three levels of response,” Marmar told Healio/Psychiatry. “The first level is for people whose lives are directly impacted; most profoundly if they’ve had personal losses or their home has been destroyed. These people are at very significant risk for stress, anxiety and depression symptoms, including PTSD. They need support.”

These individuals require psychological first aid and in more severe cases, formal mental health treatment, according to Marmar.

“Sometimes, if they can’t get resettled or get their basic needs met quickly, they’re going to need formal mental health treatment. But that’s for the smaller number of people who have really profound losses,” he said.

The second level of response focuses on individuals in the broader disaster area who experience stresses of being unsettled. These individuals should receive educational support and psychological first aid.

If they have a history of mental illness prior to the disaster, special care must be taken to ensure they are not experiencing illness reoccurrence or intensification.

The third level of response addresses the national population who deeply resonate with victims of a natural disaster, and “feel the suffering of other people and watch horrific images on TV.”

This group should receive education and support.

Recommendations for psychiatrists

For mental health professionals treating individuals affected by Hurricane Harvey, Marmar recommended a thorough evaluation to identify strengths and vulnerabilities and then a brief intervention

“If people don’t recover quickly, if they continue to have nightmares, flashbacks, depression, or intensification of alcohol or drug use, then they should receive a thorough evaluation and require evidence-based treatment for disaster-related stress,” Marmar said. “The best treatment available is a psychotherapy called CPT, Cognitive Processing Therapy, which helps people identify their troubled thoughts and feelings following a disaster without requiring them to vividly reconstruct, reimagine and relive the experience.”

APA support

In response to the devastating events caused by Hurricane Harvey, the American Psychiatric Association recently expressed sympathy for individuals affected by the natural disaster.

Anita Everett, MD
Anita Everett

“We offer our sympathy to the people affected by Hurricane Harvey and, in some cases, those experiencing painful memories of previous hurricanes,” APA President Anita Everett, MD, said in a statement. “We don’t know the full extent of the damage caused by Hurricane Harvey since it is still active. We do know the recovery process will be a long one, and we must be mindful that people who have been affected either directly or indirectly by this disaster may experience a number of reactions in the aftermath, including fear, anxiety and sadness. We implore anyone experiencing prolonged mental health symptoms to seek professional treatment. Treatment is available and it works.”

Marmar requested that we remind readers that “despite the enormity of the events, most people following disasters are resilient and most will recover with the passage of time, support from family and friends, if their basic needs for housing, work, and socioemotional support are met.” – by Amanda Oldt

For more information:

For resources on how to cope with disasters and how to talk to children about disasters, visit https://www.psychiatry.org/patients-families/coping-after-disaster-trauma.

Disclosures: Marmar reports no relevant financial disclosures.

 

Charles R. Marmar, MD
Charles Marmar

A number of studies have shown that natural disasters increase risk for depression, anxiety, PTSD and substance use disorders.

Findings presented at the 2016 American Psychiatric Association Annual Meeting indicated alcohol abuse and emotional trauma were higher among adolescents with high exposure to natural disasters, compared with their peers with lower exposure.

A study in the CDC’s Preventing Chronic Disease showed substance use disorder hospitalizations increased following Hurricane Katrina and geographic patterns of hospitalizations shifted from flood-exposed areas to less exposed areas in the city center.

Survey results from more than 3,000 individuals exposed to Hurricane Sandy suggested strong relationships with neighbors had a protective effect on risk for PTSD among older adults exposed to the hurricane.

Mental health implications

In an interview with Healio/Psychiatry, Charles Marmar, MD, of the APA’s Committee on Psychiatric Dimensions of Disasters and New York University Medical Center and PTSD Research Program, discussed mental health implications of natural disasters such as Hurricane Harvey.

“There are three levels of response,” Marmar told Healio/Psychiatry. “The first level is for people whose lives are directly impacted; most profoundly if they’ve had personal losses or their home has been destroyed. These people are at very significant risk for stress, anxiety and depression symptoms, including PTSD. They need support.”

These individuals require psychological first aid and in more severe cases, formal mental health treatment, according to Marmar.

“Sometimes, if they can’t get resettled or get their basic needs met quickly, they’re going to need formal mental health treatment. But that’s for the smaller number of people who have really profound losses,” he said.

The second level of response focuses on individuals in the broader disaster area who experience stresses of being unsettled. These individuals should receive educational support and psychological first aid.

If they have a history of mental illness prior to the disaster, special care must be taken to ensure they are not experiencing illness reoccurrence or intensification.

The third level of response addresses the national population who deeply resonate with victims of a natural disaster, and “feel the suffering of other people and watch horrific images on TV.”

This group should receive education and support.

Recommendations for psychiatrists

For mental health professionals treating individuals affected by Hurricane Harvey, Marmar recommended a thorough evaluation to identify strengths and vulnerabilities and then a brief intervention

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“If people don’t recover quickly, if they continue to have nightmares, flashbacks, depression, or intensification of alcohol or drug use, then they should receive a thorough evaluation and require evidence-based treatment for disaster-related stress,” Marmar said. “The best treatment available is a psychotherapy called CPT, Cognitive Processing Therapy, which helps people identify their troubled thoughts and feelings following a disaster without requiring them to vividly reconstruct, reimagine and relive the experience.”

APA support

In response to the devastating events caused by Hurricane Harvey, the American Psychiatric Association recently expressed sympathy for individuals affected by the natural disaster.

Anita Everett, MD
Anita Everett

“We offer our sympathy to the people affected by Hurricane Harvey and, in some cases, those experiencing painful memories of previous hurricanes,” APA President Anita Everett, MD, said in a statement. “We don’t know the full extent of the damage caused by Hurricane Harvey since it is still active. We do know the recovery process will be a long one, and we must be mindful that people who have been affected either directly or indirectly by this disaster may experience a number of reactions in the aftermath, including fear, anxiety and sadness. We implore anyone experiencing prolonged mental health symptoms to seek professional treatment. Treatment is available and it works.”

Marmar requested that we remind readers that “despite the enormity of the events, most people following disasters are resilient and most will recover with the passage of time, support from family and friends, if their basic needs for housing, work, and socioemotional support are met.” – by Amanda Oldt

For more information:

For resources on how to cope with disasters and how to talk to children about disasters, visit https://www.psychiatry.org/patients-families/coping-after-disaster-trauma.

Disclosures: Marmar reports no relevant financial disclosures.

 

    Perspective
    Maria A. Oquendo

    Maria A. Oquendo

    In the setting of a disaster like Hurricane Harvey, affected communities often suffer psychological consequences in addition to the dire physical ones. Individuals may have many different feelings including fear, confusion, anxiety, anger, grief, helplessness and guilt, to name a few.

    The American Psychiatric Association recommends the use of “Psychological First Aid” to promote a sense of: (1) safety, (2) calm, (3) connectedness to others, (4) empowerment, and (5) hope.

    1. A sense of safety can be promoted by helping people access food, shelter, and emergency medical attention by offering simple and accurate information.
    2. People generally feel calmer when they can share their stories and emotions to a friendly and compassionate person, who can remain so even when people are being difficult. Accurate information about the disaster and relief efforts also has a calming effect.
    3. Connectedness is enhanced when people can find ways to contact friends or loved ones and when families are kept together.
    4. Practical suggestions that encourage people to meet their own needs help them develop feelings of empowerment.
    5. Hope derives from advising people about where they can obtain services (government and nongovernment) and if accurate, knowing that more help and services are forthcoming.

    If you are doing ok, helping others can be extremely gratifying and useful to your community. By being in touch with friends and neighbors frequently, especially those who may need assistance, donating food, money or your time, and finding ways to help others help themselves, you can be immensely helpful. If you get to know those who live around you as you work together to rebuild your community, you will gain resilience.

    • Maria A. Oquendo, MD, PhD
    • Ruth Meltzer Professor and Chairman of Psychiatry, Perelman School of Medicine, University of Pennsylvania

    Disclosures: Oquendo reports receiving royalties for the commercial use of the Columbia Suicide Severity Rating Scale and family owned stock in Bristol Myers Squibb.