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Here are a couple of general resources that may be helpful in preparing a preventive mental health response to the disasters in Japan.
First I must say the single most important mental health tool at this point is accurate information from authorities to all people.
For a general overview of disasters including references to the Kobe earthquake, Chernobyl and Three Mile Island here is a link to a 25 page article from Dr Ursano?s group.
http://www.uic.edu/classes/psych/psych270/disaster.htm
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For a description on the 1995 Kobe earthquake here is a brief excerpt:
Case Study: Kobe Earthquake
http://designintentions.wordpress.co...be-earthquake/
From the [USA] National Center for PTSD ???
http://www.ptsd.va.gov/public/pages/...aiwan-ptsd.asp
I conclude by saying again the single most important mental health tool at this point is accurate information from authorities to all people.
Joe Thornton, M.D.
First I must say the single most important mental health tool at this point is accurate information from authorities to all people.
For a general overview of disasters including references to the Kobe earthquake, Chernobyl and Three Mile Island here is a link to a 25 page article from Dr Ursano?s group.
http://www.uic.edu/classes/psych/psych270/disaster.htm
Psychiatric Dimensions of Disaster: Patient Care, Community Consultation, and Preventive Medicine
Robert J. Ursano, M.D. Carol S. Fullerton, Ph.D. Ann E. Norwood, M.D.
The majority of persons exposed to a disaster do well and have only mild, transitory symptoms. However, some individuals develop psychiatric illness postdisaster. Such illnesses include those that are secondary to physical injury and sickness as well as specific trauma-related psychiatric disorders such as acute stress disorder. The extent of the psychiatric morbiditv and mortality that develops in individuals in the community depends on the type of disaster, the degree of injury sustained, the amount the type of disaster, the degree of injury sustained, the amount of life threat, and the duration of community disruption. In this paper we examine the posttraumatic responses of direct concern to psychiatrists working in a community exposed to a disaster. We review the epidemiology of posttraumatic responses, the interface of psychiatry and traumatic stress, the psychiatric disorders associated with trauma, and psychiatric consultation to the disaster community. Overall, psychiatric intervention after a disaster is based on the principles of preventive medicine and includes community consultation and outreach programs with the goals of identifying high-risk groups, promoting community recovery, and minimizing social disruption. (Harvard Rev Psychiatry 1995;3:196-209.)
Robert J. Ursano, M.D. Carol S. Fullerton, Ph.D. Ann E. Norwood, M.D.
The majority of persons exposed to a disaster do well and have only mild, transitory symptoms. However, some individuals develop psychiatric illness postdisaster. Such illnesses include those that are secondary to physical injury and sickness as well as specific trauma-related psychiatric disorders such as acute stress disorder. The extent of the psychiatric morbiditv and mortality that develops in individuals in the community depends on the type of disaster, the degree of injury sustained, the amount the type of disaster, the degree of injury sustained, the amount of life threat, and the duration of community disruption. In this paper we examine the posttraumatic responses of direct concern to psychiatrists working in a community exposed to a disaster. We review the epidemiology of posttraumatic responses, the interface of psychiatry and traumatic stress, the psychiatric disorders associated with trauma, and psychiatric consultation to the disaster community. Overall, psychiatric intervention after a disaster is based on the principles of preventive medicine and includes community consultation and outreach programs with the goals of identifying high-risk groups, promoting community recovery, and minimizing social disruption. (Harvard Rev Psychiatry 1995;3:196-209.)
For a description on the 1995 Kobe earthquake here is a brief excerpt:
Case Study: Kobe Earthquake
http://designintentions.wordpress.co...be-earthquake/
Situation
On January 17, 1995, a 6.8 Richter earthquake struck Kobe, Japan, killing 6,434 and causing US$102.5 billion in damages. Ten spans of the Hanshin Expressway Route 43 in three locations in Kobe and Nishinomiya were knocked over, blocking a link that carried forty percent of Osaka-Kobe road traffic. Most railways in the region were also damaged. Only 30% of the Osaka-Kobe railway tracks were operational.
Mental Health Response
Kobe has the highest psychiatric clinic to local population ratio in Japan. These one-person clinics are organized by a ikyoku system where local university departments serve as the professional organization that manages the patient care of psychiatrists in the local area. It is this highly centralized network that allowed for the biggest psychological response to a natural disaster in Japanese history. Information needs in each area were gathered through clinics and public health centers and psychiatrists were sent to areas such as schools, which had become shelters for earthquake victims.
The first priority for the psychiatric response was to establish and maintain contact with known patients who were living on their own or with their families. The earthquake undermined the treatment of these patients who lost their medications or had to adjust to living in overcrowded shelters. Given the stigma of mental illness in Japan, doctors were surprised to find patients come with medication requests on their own accord. Other common symptoms included psychomotor excitement, including newly diagnosed cases of mania. To accommodate new patients in overcrowded local hospitals, stabilized patients were transferred to hospitals in nearby cities.
Surprisingly after the quake, the news media focused on the psychological effect of the earthquake on ordinary people. Graduate psychology students visited primary schools, where they asked children to draw pictures. This was seen as a therapeutic intervention, offering students a way to express their thoughts and feelings about the disaster. The term attributed to this field of intervention came to be known as kokoro no kea or, roughly translated, ?care for the heart.? In the first weeks after the quake, virtually all major newspapers ran editorials emphasizing the long-term need for kokoro no kea. Before the earthquake, dissociative disorders and alcohol dependence had been the flagship diagnoses after a disaster. The concept of kokoro no kea suggested that mental illness is a possibility for anyone involved in a traumatic event, opening up the discussion for PTSD, a previously unacknowledged diagnosis in the Japanese system.
On January 17, 1995, a 6.8 Richter earthquake struck Kobe, Japan, killing 6,434 and causing US$102.5 billion in damages. Ten spans of the Hanshin Expressway Route 43 in three locations in Kobe and Nishinomiya were knocked over, blocking a link that carried forty percent of Osaka-Kobe road traffic. Most railways in the region were also damaged. Only 30% of the Osaka-Kobe railway tracks were operational.
Mental Health Response
Kobe has the highest psychiatric clinic to local population ratio in Japan. These one-person clinics are organized by a ikyoku system where local university departments serve as the professional organization that manages the patient care of psychiatrists in the local area. It is this highly centralized network that allowed for the biggest psychological response to a natural disaster in Japanese history. Information needs in each area were gathered through clinics and public health centers and psychiatrists were sent to areas such as schools, which had become shelters for earthquake victims.
The first priority for the psychiatric response was to establish and maintain contact with known patients who were living on their own or with their families. The earthquake undermined the treatment of these patients who lost their medications or had to adjust to living in overcrowded shelters. Given the stigma of mental illness in Japan, doctors were surprised to find patients come with medication requests on their own accord. Other common symptoms included psychomotor excitement, including newly diagnosed cases of mania. To accommodate new patients in overcrowded local hospitals, stabilized patients were transferred to hospitals in nearby cities.
Surprisingly after the quake, the news media focused on the psychological effect of the earthquake on ordinary people. Graduate psychology students visited primary schools, where they asked children to draw pictures. This was seen as a therapeutic intervention, offering students a way to express their thoughts and feelings about the disaster. The term attributed to this field of intervention came to be known as kokoro no kea or, roughly translated, ?care for the heart.? In the first weeks after the quake, virtually all major newspapers ran editorials emphasizing the long-term need for kokoro no kea. Before the earthquake, dissociative disorders and alcohol dependence had been the flagship diagnoses after a disaster. The concept of kokoro no kea suggested that mental illness is a possibility for anyone involved in a traumatic event, opening up the discussion for PTSD, a previously unacknowledged diagnosis in the Japanese system.
From the [USA] National Center for PTSD ???
http://www.ptsd.va.gov/public/pages/...aiwan-ptsd.asp
The traumatic effects of earthquakes
Posttraumatic Stress Disorder occurs in 32% to 60% of the adult survivors and 26% to 95% of the children survivors who have been evaluated after earthquakes. Rather than being a circumscribed event with a defined endpoint, earthquakes tend to produce a series of events that continue to affect people's lives over a prolonged period. Persistent or recurring disruptions from the earthquake substantially contribute to continued mental-health problems. General psychological distress levels following an earthquake appear to stabilize after about 12 months, but posttraumatic stress reactions do not stabilize until 18 months after the earthquake. In some individuals, there is a high likelihood of permanent psychological symptomatology following earthquake exposure. This is particularly true of those who have the highest level of exposure and the greatest concentration of personal loss and damage associated with the earthquake. Coping with stress by using avoidance measures (e.g., withdrawal from the situation, isolation, trying to avoid further stressors) appears to contribute to continued distress and posttraumatic stress. Older people and those with a prior history of mental-health problems seem to be at greater risk than others for experiencing posttraumatic stress following an earthquake (1). Also at risk are (1) rescue workers with high levels of catastrophic exposure and (2) individuals who, in reaction to the earthquake, tend to "dissociate," or become "numb," and have a sense of being detached from their emotions and bodily experiences for a prolonged period of time (2).
Research on earthquakes in AsiaA study specific to the Chinese population was conducted following the Yunnan earthquake of November 6, 1988, which measured 7.6 on the Richter scale. Although statistics show that 643 people were killed and 3,558 injured (one-third of them seriously), the earthquake affected over 430,000 people. In the most severely affected regions, psychiatric morbidity rates doubled, with 60% of the population scoring 5 or greater on the 28-item General Health Questionnaire. " Because these rates of morbidity were seen 6 months after the disaster, it seems likely that researchers were detecting an enduring pattern of psychiatric morbidity rather than the acute distress one might expect to see immediately following a major disaster. Similar findings were observed twelve months after a major bush fire in Australia. In this rural Chinese population, much of the posttraumatic morbidity expressed itself as somatic symptoms (3).
Large-scale epidemiologic surveys of the urban Japanese population affected by the Kobe earthquake in January 1995 have not yet been published. Therefore, knowledge of the earthquake's effects is based largely on smaller studies and anecdotal observations. Most of the victims experienced emotional numbness soon after the earthquake. During the first week, there was widespread general anxiety and fear of aftershocks, together with survivor's guilt among those who had lost family members. After ten days of living in shelters, many victims found life extremely stressful, with anxiety reactions and sleep disorders common. Depression was common, and some survivors experienced acute stress symptoms such as flashbacks. An eyewitness reported, "Three years after the earthquake, victims are still suffering from psychological difficulties resulting mostly from living isolated lives in temporary housing." (This also led to such physical consequences as increased alcohol use and greater risk of coronary and respiratory disease.) The groups most vulnerable to long-term consequences included the elderly who lost relatives, fatherless families, physically and mentally handicapped people, and foreigners from developing countries (4). In the immediate wake of the earthquake, assisting survivors with obtaining shelter and getting information on financial assistance for rebuilding their homes and lives does more to reduce stress than providing psychological counseling, which is not effective until one month after the disaster (5).
Posttraumatic Stress Disorder occurs in 32% to 60% of the adult survivors and 26% to 95% of the children survivors who have been evaluated after earthquakes. Rather than being a circumscribed event with a defined endpoint, earthquakes tend to produce a series of events that continue to affect people's lives over a prolonged period. Persistent or recurring disruptions from the earthquake substantially contribute to continued mental-health problems. General psychological distress levels following an earthquake appear to stabilize after about 12 months, but posttraumatic stress reactions do not stabilize until 18 months after the earthquake. In some individuals, there is a high likelihood of permanent psychological symptomatology following earthquake exposure. This is particularly true of those who have the highest level of exposure and the greatest concentration of personal loss and damage associated with the earthquake. Coping with stress by using avoidance measures (e.g., withdrawal from the situation, isolation, trying to avoid further stressors) appears to contribute to continued distress and posttraumatic stress. Older people and those with a prior history of mental-health problems seem to be at greater risk than others for experiencing posttraumatic stress following an earthquake (1). Also at risk are (1) rescue workers with high levels of catastrophic exposure and (2) individuals who, in reaction to the earthquake, tend to "dissociate," or become "numb," and have a sense of being detached from their emotions and bodily experiences for a prolonged period of time (2).
Research on earthquakes in AsiaA study specific to the Chinese population was conducted following the Yunnan earthquake of November 6, 1988, which measured 7.6 on the Richter scale. Although statistics show that 643 people were killed and 3,558 injured (one-third of them seriously), the earthquake affected over 430,000 people. In the most severely affected regions, psychiatric morbidity rates doubled, with 60% of the population scoring 5 or greater on the 28-item General Health Questionnaire. " Because these rates of morbidity were seen 6 months after the disaster, it seems likely that researchers were detecting an enduring pattern of psychiatric morbidity rather than the acute distress one might expect to see immediately following a major disaster. Similar findings were observed twelve months after a major bush fire in Australia. In this rural Chinese population, much of the posttraumatic morbidity expressed itself as somatic symptoms (3).
Large-scale epidemiologic surveys of the urban Japanese population affected by the Kobe earthquake in January 1995 have not yet been published. Therefore, knowledge of the earthquake's effects is based largely on smaller studies and anecdotal observations. Most of the victims experienced emotional numbness soon after the earthquake. During the first week, there was widespread general anxiety and fear of aftershocks, together with survivor's guilt among those who had lost family members. After ten days of living in shelters, many victims found life extremely stressful, with anxiety reactions and sleep disorders common. Depression was common, and some survivors experienced acute stress symptoms such as flashbacks. An eyewitness reported, "Three years after the earthquake, victims are still suffering from psychological difficulties resulting mostly from living isolated lives in temporary housing." (This also led to such physical consequences as increased alcohol use and greater risk of coronary and respiratory disease.) The groups most vulnerable to long-term consequences included the elderly who lost relatives, fatherless families, physically and mentally handicapped people, and foreigners from developing countries (4). In the immediate wake of the earthquake, assisting survivors with obtaining shelter and getting information on financial assistance for rebuilding their homes and lives does more to reduce stress than providing psychological counseling, which is not effective until one month after the disaster (5).
Joe Thornton, M.D.
to P Courtney and C Yoes of the Univ Texas Medical Branch for sharing the link.
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