1. Epidemiology of Psychiatric Consequences of Disaster Ibrahim Salmani Salmani@ssu.ac.ir

2. What is a Disaster? A disaster is an occurrence that causes human suffering or creates human needs that the victim cannot alleviate without assistance. 2

3. What is a Critical Incident? A natural or man-made event or situation that has the potential to temporarily overwhelm the ability to maintain psychosocial equilibrium. 3

4. Epidemiology and its applications in measuring the effects of disasters EpidemiologyEpidemiology -The quantitative study of the distribution and determinants of health related events in human populations

5. Epidemiology and its applications in measuring the effects of disasters Disaster Epidemiology- Disaster Epidemiology- The use of epidemiology in disaster situations. Epidemiologic methods can be used to measure and describe the adverse effects of natural and human-caused disasters.

6. Why Mental Health is Important Mental health is the leading cause of disability in the world Major economic and social costs Increasing demands on the health system following disaster Decreased resources following disaster Decreased ability to respond, recover and rebuild

7. Following Disaster Distress (normal reaction) Behavior Change (normal or problematic) Disorder (problematic, specific symptoms, illness) Distress Responses  Sense of vulnerability  Insomnia  Irritability, distraction  PTSD  Depression  Complex Grief  Smoking  Alcohol  Over dedication Center for the Study of Traumatic Stress

8. Following Disaster

9. Psychological Timeline 1 to 3 Days -------------------TIME-------------------------------1 to 3 Years Warning Threat Pre-disaster “Heroic” Honeymoon (Community Cohesion) (Coming to Terms) Working Through Grief Reconstruction A New Beginning Disillusionment Trigger Events and Anniversary Reactions Impact Inventory Zunin/Meyers Emotion

10. PTSD PTSD was first recognized as a diagnostic entity in 1980, when it was included in the DSM-III. PTSD was classified as an anxiety disorder, and diagnostic criteria for PTSD were introduced.

11. The diagnostic criteria for PTSD, ICD-10 Exposure to a stressful event or situation (either short or long lasting). Persistent remembering or "reliving" the stressor (by intrusive flash backs, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor). Actual or preferred avoidance of circumstances resembling or associated with the stressor. Either (1) or (2): 1.Inability to recall, either partially or completely 2.Persistent symptoms of increased psychological sensitivity shown by any two of the following: difficulty in falling or staying asleep irritability or outbursts of anger difficulty in concentrating hyper-vigilance exaggerated startle response.

12. The diagnostic criteria for PTSD, ICD-10 Additionally ICD-10 diagnostic guidelines state: In general, this disorder should not be diagnosed unless there is evidence that it arose within 6 months of a traumatic event of exceptional severity.

13. PTSD Epidemiology The United Nations' World Health Organization publishes estimates of PTSD impact for each of its member. Click HereClick Here

14. ‘‘Victims’’ of a Disaster Those who nearly escape death Those who are injured, family members of the deceased, and Those who witness a catastrophic event.

15. Remove from harm’s way. Remove from the scene. Provide safety and security. Provide shelter. Reduce stressors. SafetySecurityShelter What Survivors Need: What To Do: SAFETY SAFEGUARD SAFETY Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006. 15

16. Provide food, water, ice. Provide medical care, alleviate pain. Provide clothing. Provide power, light, heat, air conditioning. Provide sanitation. Basic survival needs What Survivors Need: What To Do: SAFETY SAFETY SUSTAIN Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006. 16

17. Establish a compassionate “presence.” Listen actively. Comfort, console, soothe, and reassure. Apply stress management techniques. Reassure survivors that their reactions are “normal” and expected Soothing human contact Validation that reactions are “normal”. What Survivors Need: What To Do: FUNCTION FUNCTION COMFORT Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006. 17

18. Keep survivor families intact. Reunite separated loved ones. Reunite parents with children. Connect survivors to available supports. Connect to disaster relief services, medical care. Social supports/keeping family together Reuniting separated loved ones Connection to disaster recovery services, medical care, work, school, vital services What Survivors Need: What To Do: FUNCTION FUNCTION CONNECT 18

19. ACTION Clarify disaster information: what happened what happened what will happen what will happen Provide guidance about what to do. Identify available resources. Information about the disaster Information about what to do Information about resources Reduction of uncertainty What Survivors Need: What To Do: ACTION EDUCATE Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006. 19

20. Set realistic disaster recovery goals. Problem solve to meet goals. Define simple, concrete tasks. Identify steps for resuming normal activities. Engage able survivors in helping tasks. Planning for recovery Practical first steps and “do-able” tasks Support to resume normal activities Opportunities to help others What Survivors Need: What To Do: ACTION ACTION EMPOWER Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006. 20