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.

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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.

BACKGROUND: Literature and clinical experience suggest that some people experience atypical, complicated or pathological bereavement reactions in response to a major loss. METHOD: Three groups of community-based bereaved subjects--spouses (n = 44), adult children (n = 40), and parents (n = 36)--were followed up four times in the 13 months after a loss. A 17-item scale of core bereavement times was developed and used to investigate the intensity of the bereavement response over time. RESULTS: Cluster analysis revealed a pattern of bereavement-related symptoms approximating a syndrome of chronic grief in 11 (9.2%) of the 120 subjects. None of the respondents displayed a pattern consistent with delayed or absent grief. CONCLUSIONS: In a non-clinical community sample of bereaved people, delayed or absent grief is infrequently seen, unlike chronic grief, which is demonstrated in a minority.

The bereavement response: a cluster analysis.

Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.

Postdisaster morbidity of the bereaved. A possible role for preventive psychiatry

Suicidal Ideation, Suicide Attempts, and HIV Infection

There is virtually no literature detailing the effects of a disaster on the rescue workers. This paper reports the results of a questionnaire survey conducted one month after the Granville rail disaster on ninety-five of the personnel involved in the rescue work and a follow-up on thirteen of them one year later. Seventy-seven of the ninety-five found the experience stressful; in particular, the feelings of helplessness engendered by the disaster, the magnitude of the destruction, the sight and smell of mutilated bodies, the anguish of relatives, and the need to work under pressure were items highlighted by the respondents. While only about 20 percent experienced specific psychological sequelae as a result of the disaster (depression, anxiety, insomnia), approximately 70 percent of the helpers showed evidence of being temporarily strained (half of them being over this by the end of one week). Thirty-five percent felt more positive about their own lives as a result of their involvement. The utility of debr...

Who Helps the Helpers? The Effects of a Disaster on the Rescue Workers

Part I. Introduction: 1. Individual and community responses to disasters Robert J. Ursano, Carol S. Fullerton, Lars Weisaeth and Beverley Raphael Part II. Foundations of Disaster Psychiatry: 2. Epidemiology of disaster mental health Carol S. North 3. Children and disasters: public mental health approaches Robert Pynoos, Alan M. Steinberg and Melissa J. Brymer 4. Disaster ecology: implications for disaster psychiatry James Shultz, Zelda Espinel, Sandro Galea and Dori B Reissman 5. Neurobiology of disaster exposure: fear, anxiety, trauma and resilience Rebecca P. Smith, Craig L. Katz, Dennis S. Charney and Steven Southwick Part III. Clinical Care and Interventions: 6. Early intervention for trauma-related problems following mass trauma Patricia J. Watson 7. Acute stress disorder and posttraumatic stress disorder in the disaster environment David M. Benedek 8. Assessment and management of medical-surgical disaster casualties James R. Rundell 9. Interventions for acutely injured survivors of individual and mass trauma Douglas Zatzick 10. Non governmental organizations and the role of the mental health professional Joop de Jong Part IV. Special Topics: 11. Traumatic death in terrorism and disasters Robert J. Ursano, James McCarroll and Carol S. Fullerton 12. Weapons of mass destruction and pandemics: global disasters with mass destruction and mass disruption Robert J. Ursano, Carol S. Fullerton, Ann E. Norwood and Harry Holloway 13. Workplace disaster preparedness and response Nancy T. Vineburgh, Robert Gifford, Robert J. Ursano, Carol S. Fullerton and David M. Benedek 14. Health care systems planning Brian Flynn Part V. Public Health and Disaster Psychiatry: 15. Public health and disaster mental health: preparing, responding, and recovering Robert J. Ursano, Carol S. Fullerton, Lars Weisaeth and Beverley Raphael.

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Beverley Raphael

Papers

The bereavement response: a cluster analysis.

Postdisaster morbidity of the bereaved. A possible role for preventive psychiatry

Suicidal Ideation, Suicide Attempts, and HIV Infection

Who Helps the Helpers? The Effects of a Disaster on the Rescue Workers

Textbook of disaster psychiatry