On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.

60,000 Disaster Victims Speak: Part II. Summary and Implications of the Disaster Mental Health Research

Disasters typically strike quickly and cause great harm. Unfortunately, because of the spontaneous and chaotic nature of disasters, the psychological consequences have proved exceedingly difficult to assess. Published reports have often overestimated a disaster's psychological cost to survivors, suggesting, for example, that many if not most survivors will develop posttraumatic stress disorder (PTSD); at the same time, these reports have underestimated the scope of the disaster's broader impact in other domains. We argue that such ambiguities can be attributed to methodological limitations. When we focus on only the most scientifically sound research--studies that use prospective designs or include multivariate analyses of predictor and outcome measures--relatively clear conclusions about the psychological parameters of disasters emerge. We summarize the major aspects of these conclusions in five key points and close with a brief review of possible implications these points suggest for disaster intervention. 1. Disasters cause serious psychological harm in a minority of exposed individuals. People exposed to disaster show myriad psychological problems, including PTSD, grief, depression, anxiety, stress-related health costs, substance abuse, and suicidal ideation. However, severe levels of these problems are typically observed only in a relatively small minority of exposed individuals. In adults, the proportion rarely exceeds 30% of most samples, and in the vast majority of methodologically sound studies, the level is usually considerably lower. Among youth, elevated symptoms are common in the first few months following a high-impact disaster, but again, chronic symptom elevations rarely exceed 30% of the youth sampled. 2. Disasters produce multiple patterns of outcome, including psychological resilience. In addition to chronic dysfunction, other patterns of disaster outcome are typically observed. Some survivors recover their psychological equilibrium within a period ranging from several months to 1 or 2 years. A sizeable proportion, often more than half of those exposed, experience only transient distress and maintain a stable trajectory of healthy functioning or resilience. Resilient outcomes have been evidenced across different methodologies, including recent studies that identified patterns of outcome using relatively sophisticated data analytic approaches, such as latent growth mixture modeling. 3. Disaster outcome depends on a combination of risk and resilience factors. As is true for most highly aversive events, individual differences in disaster outcomes are informed by a number of unique risk and resilience factors, including variables related to the context in which the disaster occurs, variables related to proximal exposure during the disaster, and variables related to distal exposure in the disaster's aftermath. Multivariate studies indicate that there is no one single dominant predictor of disaster outcomes. Rather, as with traumatic life events more generally, most predictor variables exert small to moderate effects, and it is the combination or additive total of risk and resilience factors that informs disaster outcomes. 4. Disasters put families, neighborhoods, and communities at risk. Although methodologically complex research on this facet of disasters' impact is limited, the available literature suggests that disasters meaningfully influence relationships within and across broad social units. Survivors often receive immediate support from their families, relatives, and friends, and for this reason many survivors subsequently claim that the experience brought them closer together. On the whole, however, the empirical evidence suggests a mixed pattern of findings. There is evidence that social relationships can improve after disasters, especially within the immediate family. However, the bulk of evidence indicates that the stress of disasters can erode both interpersonal relationships and sense of community. Regardless of how they are affected, postdisaster social relations are important predictors of coping success and resilience. 5. The remote effects of a disaster in unexposed populations are generally limited and transient. Increased incidence of extreme distress and pathology are often reported in remote regions hundreds if not thousands of miles from a disaster's geographic locale. Careful review of these studies indicates, however, that people in regions remote to a disaster may experience transient distress, but increased incidence of psychopathology is likely only among populations with preexisting vulnerabilities (e.g., prior trauma or psychiatric illness) or actual remote exposure (e.g., loss of a loved one in the disaster). Finally, we review the implications for intervention. There is considerable interest in prophylactic psychological interventions, such as critical incident stress debriefing (CISD), that can be applied globally to all exposed survivors in the immediate aftermath of disaster. Multiple studies have shown, however, that CISD is not only ineffective but in some cases can actually be psychologically harmful. Other less invasive and more practical forms of immediate intervention have been developed for use with both children and adults. Although promising, controlled evaluations of these less invasive interventions are not yet available. The available research suggests that psychological interventions are more likely to be effective during the short- and long-term recovery periods (1 month to several years postdisaster), especially when used in combination with some form of screening for at-risk individuals. Such interventions should also target the maintenance and enhancement of tangible, informational, and social-emotional support resources throughout the affected community. Language: en

https://journals.sagepub.com/doi/pdf/10.1177/1529100610387086

Weighing the Costs of Disaster: Consequences, Risks, and Resilience in Individuals, Families, and Communities

The effect of lifetime victimization on the mental health of children and adolescents.

Family issues in child anxiety: attachment, family functioning, parental rearing and beliefs.

Quantitative and qualitative research evidence is reviewed and synthesized with regard to the family-centeredness of early intervention, preschool, and elementary and secondary school practices. Early intervention and school practices are not as family-centered as is generally claimed, and one finds less presumption of being family-centered at each level from early intervention to preschool to elementary school to secondary school programs. The need for better research is noted, and research that would advance our understanding of family-centered practices is suggested.

Family-Centered Practices Birth Through High School

Fourteen months after a hurricane, young children who had experienced the storm showed significantly higher anxiety and withdrawal and more behavior problems than did children who had not. Behavioral problems decreased steadily over the six months following the storm. Mothers' distress in the hurricane's aftermath was associated with the longevity of their children's emotional and behavioral difficulties.

Impact of a natural disaster on preschool children: adjustment 14 months after a hurricane.

Parenting stress as it pertains to the families of medically fragile children of different ethnic backgrounds has been understudied. Possible correlates of change in parenting stress such as child development, family support, resources and income were examined in the families of 105 infants with intraventricular hemorrhage #opIVH#cp participating in an early intervention program between one and three years of age. Correlational analyses showed that slower developmental progress, along with declines in family resources and social support coincided with increases in parenting stress. Subgroup analyses separately examining these relationships in the 66 white and 39 nonwhite families revealed different correlates for the two populations. Unlike the full sample and the white sample, the non‐white families’ stress changes over the course of intervention seemed correlated only to income change, but not to child's developmental progress or changes in social support. Commonly cited findings regarding parents’ stre...

Ethnicity and Parenting Stress Change during Early Intervention.

A unique environment in which to capture the effects of stress and coping in children is the aftermath of disaster. At a basic level the disaster environment provides an opportunity to learn how essentially well-adjusted children and families cope with the short- and long-term effects of a sudden, unanticipated, monumental set of stressors. At an applied level, there is a compelling and widespread need for supportive interventions throughout the stages of the disaster and its aftermath if psychological sequelae are to be minimized. The purposes of this chapter are: to define disaster as it pertains to children and families; to examine the nature of stressors associated with various types of disasters; to highlight key findings from the growing literature on disaster’s impact on children; to review recent literature pertaining specifically to stress and coping by children in disasters; and to introduce intervention techniques that have been developed to minimize the ill effects of disasters on their young victims.

Children and Families Coping with Disaster

One purpose of this study was to examine the differences in behavior of children exposed to trauma versus no trauma. Another goal was to compare different types of traumatic events in terms of their effects on behaviors. Our analysis indicated significant differences between trauma and no trauma groups. Additional analyses indicated that those children who were allegedly sexually abused were rated as exhibiting higher levels of symptomatology on all three factors of the Pediatric Emotional Distress Scale (PEDS) as well as the Total PEDS score than the other three groups.

Sherri J. Stokes

Papers

Impact of a natural disaster on preschool children: adjustment 14 months after a hurricane.

Ethnicity and Parenting Stress Change during Early Intervention.

Children and Families Coping with Disaster

A comparison of children's behaviors following three types of stressors