The psychological impact of quarantine and how to reduce it: rapid review of the evidence.

Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology’s knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological. The author challenges these assumptions by reviewing evidence that resilience represents a distinct trajectory from the process of recovery, that resilience in the face of loss or potential trauma is more common than is often believed, and that there are multiple and sometimes unexpected pathways to resilience. M ost people are exposed to at least one violent or life-threatening situation during the course of their lives (Ozer, Best, Lipsey, & Weiss, 2003). As people progress through the life cycle, they are also increasingly confronted with the deaths of close friends and relatives. Not everyone copes with these potentially disturbing events in the same way. Some people experience acute distress from which they are unable to recover. Others suffer less intensely and for a much shorter period of time. Some people seem to recover quickly but then begin to experience unexpected health problems or difficulties concentrating or enjoying life the way they used to. However, large numbers of people manage to endure the temporary upheaval of loss or potentially traumatic events remarkably well, with no apparent disruption in their ability to function at work or in close relationships, and seem to move on to new challenges with apparent ease. This article is devoted to the latter group and to the question of resilience in the face of loss or potentially traumatic events. The importance of protective psychological factors in the prevention of illness is now well established (Taylor, Kemeny, Reed, Bower, & Gruenewald, 2000). Moreover, developmental psychologists have shown that resilience is common among children growing up in disadvantaged conditions (e.g., Masten, 2001). Unfortunately, because most of the psychological knowledge base regarding the ways adults cope with loss or potential trauma has been derived from individuals who have experienced significant psychological problems or sought treatment, theorists working in this area have often underestimated and misunderstood resilience, viewing it either as a pathological state or as something seen only in rare and exceptionally healthy individuals. In this article, I challenge this view by reviewing evidence that resilience in the face of loss or potential trauma represents a distinct trajectory from that of recovery, that resilience is more common than often believed, and that there are multiple and sometimes unexpected pathways to resilience.

/pdf/loss-trauma-and-human-resilience-have-we-underestimated-the-2kd7sl9mfq.pdf

Loss, Trauma, and Human Resilience Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?

Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.

Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.

* Caring for children * The origins of attachment theory * Psychoanalysis as art and science * Psychoanalysis as a natural science * Violence in the family * On knowing what you are not supposed to know and feeling what you are not supposed to feel * The role of attachment in personality development * Attachment, communication, and the therapeutic process * Developmental psychiatry comes of age

A Secure Base. Parent-Child Attachment and Healthy Human Development. New York (Basic Books) 1988.

From social integration to health: Durkheim in the new millennium.

Mawson’s valuable review (2005) adds sponse, dealt with in depth. These issues will be further addressed in this commentary. to the growing body of literature highlighting the adaptive and positive responses of individIt is very important that positive and adaptive responses are recognized, mobilized, uals and populations in response to threat, disaster, and terrorism, (e.g., Perry and Linand strengthened. They constitute an invaluable resource from a public health point of dell, 2003). Responses to the threat of combat, to a wide range of disasters, and even more view. When disasters, by definition, may exceed a community’s capacity to deal with the recently in terms of September 11, are encompassed. Contrary to popular belief, mass panic threat and destruction, and terrorism may constitute a similar or even greater challenge, is rare, and in terms of collective behaviors most people behave positively, helping others, all resources need to be understood and brought to bear, to deal with what has hapnot giving way to fear, but rather dealing with their circumstances adaptively. These conpened. To do this, the complex issues involved in collective behaviors, both positive and negcepts are drawn together in the framework of “social attachment” as the driver for such ative, need to be analyzed and understood, both in terms of emergency response and the behaviors. Mawson further hypothesizes four quadrants of reaction, depending on predislonger-term aftermath (Fullerton, Ursano, & Norwood, 2004). posing valuables, such as preexisting social groupings, and precipitating variables, such as A full picture shows that not all respond positively, and that some responses are dyslevel of perceived physical threat or damage. These do not, however, fully encompass some functional, both for individuals and populations. Tyhurst’s (1951) original report on diof the variables, such as the primary attachments of family, as compared to broad social saster behavior suggested that 12 to 25% of adults responded by flight when threatened attachments; the non-adaptive behaviors identified in some significant studies; the other by fire or flood, but that up to 75% engaged in aimless or irrelevant movements, which drivers for collective behavior in such circumstances; the response to uncertain and invisible may or may not have been problematic. This aimless and stunned wandering, perhaps in a threat, or prolonged threat; and the relationship or lack of relationship between the behavdissociated state, meant that people might place themselves or others at risk, for instance iors at the time and subsequent adaptations and outcomes. Nor are crowd behaviors and those trying to rescue them. Of particular interest is Weisath’s (1989a) detailed study of “crowd disasters,” as forms of collective re-

Crowds and Other Collectives: Complexities of Human Behaviors in Mass Emergencies

When disaster strikes: Managing emotional reactions in rescue workers.

Objective:The objective of this preliminary study was to evaluate the perceptions of internationally deployed Disaster Medical Assistance Team (DMAT) personnel regarding the psychosocial support needs of these teams.Methods:The DMAT questionnaire was sent to 34 members of Australian medical teams involved in deployments to the 2004 Southeast Asian tsunami and the 2006 Java earthquake. Twenty personnel (59%) completed this survey, which reviewed key deployment stressors, specific support strategies, and the support needs of team members, their families, and team leaders. A key aspect of the survey was to determine whether the perceived psychosocial needs would be supported best within with existing provisions and structures, or if they would be enhanced by further provisions, including the deployment of mental health specialists.Results:There was strong support for brief reviews of stress management strategies as part of the pre-deployment briefing, and access to written stress management information for both team members and their families. However, more comprehensive provisions, including pre-deployment, stressmanagement training programs for personnel and intra-deployment family support programs, received lower levels of support. The availability of mental health-related training for the team leader role and access to consultation with mental health specialists was supported, but this did not extend to the actual deployment of mental health specialists.Conclusions:In this preliminary study, clear trends toward the maintenance of current mental health support provisions and the role of the DMAT leader were evident. A follow-up study will examine the relationship between teamleader, psychosocial support strategies and team functioning.

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Disaster medical assistance teams: what psychosocial support is needed?

The vulnerability of children has long been recognized in terms of their development needs and the importance of protecting their physical health. The extent, severity and impact of their mental health problems, including the particular vulnerabilities associated with such problems in both childhood and through to adult life, have been less of a public health priority. Vulnerabilities come in many forms, all of which may impact on the mental health and wellbeing of children and may do so in complex ways. These include the diversity of family structures, of cultures, of childrearing practices, the influence of developmental trajectories, experiences of illness and disability in child or parent and multiple strengths, resilience and protective factors. In understanding the patterns and sources of vulnerability, several themes need to be taken into account. Advocacy is also a central issue. Children do not have a political voice. The most vulnerable children from the most vulnerable families are rar...

Vulnerability and mental health

Psychological distress among volunteer AIDS counsellors. Beverley Raphael, Brian Kelly, Michael Dunne, Russell Greig . Elbow angle and blood pressure readings. Edward L. Ryan . Is antenatal screening for syphilis worth while? Alan J. Gijsbers, Greg Whelan . Suzanne M. Garland . Serious interactions of sotalol with amiodarone and necainide. Roderic Warren, Jitu Vohra, David Hunt, Angas Hamer . Enteric pathogens in mentally handicapped patients in hospital. A.L.C. Hunt, J.M. Goldsmid, M. Pasha . False positive reactions in a salt-aesculin test for Enterococcusspp. 275 Robert T.J. Phua, Garry R. Douglass . 275 Dangerous marine creatures. Carl Edmonds . Reduction of selected forearm fractures in the emergency department. 276 J. Hendrie . 277 Anticonvulsant agents and osteomalacia. B.R. Nair . 277 Yersinia enterocoliticabacteraemia after blood transfusion. Rosemary Munro, Audrey Lye . 277 Double Christmas issue. Edward W. Gibson . 278 278

Beverley Raphael

Papers

Crowds and Other Collectives: Complexities of Human Behaviors in Mass Emergencies

When disaster strikes: Managing emotional reactions in rescue workers.

Disaster medical assistance teams: what psychosocial support is needed?

Vulnerability and mental health

Psychological distress among volunteer AIDS counsellors