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Indian Journal of Medical Sciences
Medknow Publications on behalf of Indian Journal of Medical Sciences Trust
ISSN: 0019-5359 EISSN: 1998-3654
Vol. 63, Num. 8, 2009, pp. 327-329

Indian Journal of Medical Sciences, Vol. 63, No. 8, August, 2009, pp. 327-329

Editorial

Natural disasters in developing countries: Mental health issues

Wolverhampton City Primary Care Trust, Wolverhampton

Correspondence Address:Corner House Resource Centre, 300 Dunstall Road, Wolverhampton, WV6 0NZ

nmadhab@yahoo.com

Code Number: ms09059

PMID: 19770522

DOI: 10.4103/0019-5359.55882

Natural disasters are not only more common in developing countries but also have greater devastating impact. Ninety percent of natural disasters and 95% of disaster-related deaths occur in developing countries. [1] There are various reasons for this, viz., poor warning systems, inadequate emergency response during disaster, poor preparedness and mitigation measures for the disasters. Besides, disasters in developing countries usually affect a comparatively large number of people. Poor connectivity to affected areas and deficit in resources for acute relief appear as important determinants of morbidity. Pre-disaster factors like lower economic status, poor housing quality and poor communication systems add to the misery.

Cultural differences regarding perception of stress, resilience and coping are well known. [2] These factors also affect the prevalence of psychiatric morbidity following disasters. Considering the above-mentioned factors, it is expected that there would be differences in post-disaster mental health outcomes in different cultures. There is a need for increasing awareness of mental health consequences of disasters all over the world, especially in the more vulnerable developing countries. The World Health Organization suggests that it is imperative to carry out extensive research on the population of developing countries that are most affected by natural and man-made disasters. [3]

The study by Telles et al. in this issue of Indian Journal of Medical Sciences adds several insights into the existing evidence on psychological sequelae of a natural disaster in a developing state where typically a large number of people were affected. [4] Studied within a month of the disaster, it highlighted the acute psychological effects, specifically the risk of post-traumatic stress disorders (PTSD) and depression, which was observed to be more in elderly people. Elderly people have been found to be one of the most vulnerable groups for post-disaster psychiatric morbidity. [5] There are many post-disaster studies in India reflecting psychiatric aspects both in acute and long-term settings. In the early post-disaster phases, significant mental health problems have been reported after the tsunami disaster in the Andamans. [6] Similarly 3 months after Orissa super-cyclone, 50% of victims were reported to have posttraumatic stress symptoms. [7] Long-term post-disaster studies in India also report considerable proportions of psychiatric morbidity in the victims, which comprises mainly posttraumatic stress, depression and anxiety disorders. [8]

Observations of the study by Telles et al. re-emphasize that systematic screening of victims in the disaster-affected areas is preferable to routine clinical evaluation, as otherwise, many victims may suffer silently rather than seek psychological help when they struggle even for the basic necessities. Systematic screening can provide critical information for a rational post-disaster public mental health program. Screening should be broad based to include not only trauma-related clinical syndromes but also other disorders; subclinical symptoms; and psycho-social, occupational/ educational and daily life impairments. It is important to develop assessment methods that are age appropriate, culturally sensitive and valid.

There is a great need for strengthening the disaster response system in developing counties. For management of disaster-related mental health issues, organizations should develop phase-appropriate responses and interventions, considering the 5 conceptual phases, namely, (-)1: pre-disaster warning phase; 0: disaster phase, during and immediately after the disaster; 1: early post-disaster phase; 2: recent post-disaster phase; and 3: remote post-disaster phase. [5],[8] There is also the need for intervention studies in post-disaster scenarios, involving both pharmacological and psychological methods to find out their effectiveness. The influence of phase-appropriate disaster response on the prevalence of psychiatric morbidity in the victims is another area for future studies.

While it is pertinent to conduct post-disaster studies, it should also be highlighted that arranging such studies is difficult considering the ground realities in the immediate aftermath of disasters. However, data-gathering should be an integral part of disaster relief and support work, which will improve the knowledge base for better care of disaster victims.

References

1.National Centre for Disaster Management. Manual on natural disaster management in India. New Delhi: National Centre for Disaster Management; 2001.  Back to cited text no. 1    
2.Marsella AJ, Christopher MA. Ethnocultural consideration in disasters: An overview of research, issues, and directions. Psychiatr Clin North Am. 2004;27: 521-39.  Back to cited text no. 2    
3.World Health Organisation. Psychosocial Consequences of Disasters: Prevention and management. Geneva: World Health Organisation; 1992.  Back to cited text no. 3    
4.Telles S, Singh N, Joshi M. Risk of posttraumatic stress disorder and depression in survivors of the Bihar Floods. Indian J Med Sci 2009;63:330-34.  Back to cited text no. 4  [PUBMED]  Medknow Journal
5.Kar N. Psychosocial issues following a natural disaster in a developing country: A qualitative longitudinal observational study. Int J Disaster Med 2006;4:169-76.  Back to cited text no. 5    
6.Math SB, Tandon S, Girimaji SC, Benegal V, Kumar U, Hamza A, et al. Psychological impact of the tsunami on children and adolescents from the Andaman and Nicobar islands. Prim Care Companion J Clin Psychiatry 2008;10:31-7.  Back to cited text no. 6    
7.Suar D, Khuntia R. Caste, education, family and stress disorders in Orissa supercyclone. Psychol Dev Soc 2004;16: 77-91.  Back to cited text no. 7    
8.Kar N, Misra BN. Mental health care following disasters: A handbook for disaster workers. Bhubaneswar: Quality of Life Research and Development Foundation; 2008.  Back to cited text no. 8    

Copyright 2009 - Indian Journal of Medical Sciences

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