Women's Health: Tsunamis, Natural Disasters, Resilience and Coping Revisited: A Little Help is Good

A few weeks ago, I posted an article that largely agreed with a researcher's findings that people are naturally resilient and many coping interventions are minimally useful or potentially harmful.  A reader responded, and I promised to go back and look at my sources.  This article summarizes some positive aspects of coping interventions following natural disasters.

Psychosocial support and professional care can be a strong, effective intervention after disasters.  In the case of natural disasters, such as the Orissa cyclone of 1999 and the 2004 tsunami that affected many areas including India, psychological support after the event was crucial in recovery and constitutes a meaningful public health intervention in the final stage of disaster response.

Cyclone 05B, the Orissa supercyclone, struck many areas in the North Indian basin.  It made landfall in India on October 29, 1999.  Approximately 16,000 human deaths were directly attributed to the cyclone.  Of course, millions were affected in ways ranging from homes destroyed, critical livestock killed and the sanitation and supply problems as aftermath of such events.  One positive (and resilient) event to come from the disaster was a training program to assist in providing psychosocial support to survivors of natural disasters.  Individuals were taught how to provide support, but also how to train others as well.  For better or worse, that program was useful in 2004, when the so-named Indonesian Tsunami struck many places, including India.  The presence of trained workers skilled in rebuilding social support allowed for scientific testing of the hypothesis regarding the usefulness of support programs as public health interventions.

What does effective psychosocial care in disasters involve?  The treatment paradigm revolves around not labeling emotional reactions as mental diseases.  Rather than focusing on the potential for depression, anxiety and post-traumatic stress syndrome, a strong treatment program views such emotional reactions as normal responses to the worst-case abnormal events possible.

Humans are social beings, and accordingly a focus on social relations after disaster is important.  A primary aspect is reliance on community, especially trained community workers skilled in providing emotional support and helping survivors who may have lost many important connections re-establish social connections that are accessible and available.  The next most important aspect, according to Dr. Susan Becker, is providing skills to mitigate the potential for adverse, long-term psychological damage.  Relaxation techniques might sound impossible to somebody mired in loss and destruction, but they apparently work and are recommended.

How does one know this works?  Dr. Susan Becker's peer-reviewed article in the American Journal of Public Health (April 2009, Vol. 99, No. 4) compared a control group of 100 Indian women who did not receive psychosocial care after the 2004 tsunami with 100 women who did receive such care.  All women were recruited volunteers.  Women were chosen as opposed to a cohort consisting of both men and women as previous research indicates that women are approximately three times as likely to report more depression, anxiety and post-traumatic stress responses in response to negative life events than men.  This does not mean men are unaffected.  For any public health intervention, one has to target individuals most likely to be affected by a given condition whether that is influenza or psychological responses.

The intervention by mental health teams lasted three months.  Based on self-report scores on a valid and reliable scale (the Impact of Events scale), women who received the psychosocial treatment showed statistically meaningful less emotional distress than women who did not receive such trained support.  Subscale measures included hypervigilance, avoidant behavior and intrusive thoughts relative to the disaster, and women receiving treatment had lower scores on the respective subscales than their control group counterparts.

Research shows that up to one-third of individuals can show negative psychological symptoms up to one year after a disastrous event.  While there may be equivocal research surrounding long-term coping, it is clear that whether through their own means or with skilled assistance, people have the capability to recover from disasters.  By itself, that is both impressive and admirable.

Image courtesy of U.S. National Oceanic and Atmospheric Administration