The uniqueness of each disaster and the different methodologies employed in each study make it difficult to integrate the findings for adults and children, although a number of review papers have appeared [e.g., 5, 6,
18, 40-49]. Moreover, not only are disasters unique events, occurring in socio-culturally unique places, but their evolution and severity can be quite disparate. The number of deaths, extent of damage, organizational response, and post-disaster stressors will all influence the psychological impact. And, of course, studies that sample litigants or help-seekers will show stronger effects than studies of random samples of survivors.
Nevertheless, attempts have been made to assign a range in rates of psychopathology (e.g., PTSD/depression/somatization) to post-disaster survivors. Weisaeth  estimated that the 1-year post-disaster prevalence of psychological morbidity was about 20%, but it might be as high as 50%. Indeed, in some disaster studies, such as the Chowchilla bus kidnapping  and the Nazi Holocaust follow-ups, the rates have been 100%. We present these average estimates with caution, however, because, as noted earlier, many of the worst disasters occurred in developing countries [49, 51, 52] and in the former Soviet Union after these reviews appeared. The effects of these devastating disasters appear to be much worse and hence might increase the average figures substantially. For example, the rates of psychiatric morbidity reported in recent studies of natural disasters in Sri Lanka, Colombia, and India were 75%, 55%, and 59%, respectively .
The most frequently reported symptoms in adults in the aftermath of natural disasters and human-made disasters are somatic complaints, depression, anxiety, and post-traumatic stress symptoms, particularly intrusive and avoidant symptoms. These symptoms have been described in survivors of earthquakes [39, 53-63], floods [e.g., 64-66], hurricanes , volcanos , mudslides [34,35], cyclones and tornadoes [69-73], TMI [41, 74, 75], Chernobyl [28, 76, 77], industrial accidents [e.g., 78], and a food-poisoning epidemic (toxic rapeseed oil ). The clustering of such symptoms is sometimes referred to as the "disaster syndrome" or the "disaster-reactive psycho-pathological repertoire" . These symptoms may not reflect separate disorders , but rather may represent a complex trauma syndrome . While these symptom domains are elevated after natural and human-made disasters, somatic complaints and health-related anxiety are more common after technological incidents. Moreover, it appears that these symptoms are more enduring and chronic after technological catastrophes in which people come to believe that their health has been compromised by the exposure. This phenomenon has been particularly well documented in survivors of Hiroshima  and Chernobyl [76, 77, 82, 83].
Similar symptoms have been described in research on child survivors of disasters, such as floods , hurricanes [e.g., 85-88], cyclones and tornadoes [89, 90], a bush fire , and a blizzard [92, 93].
In addition to the presence of somatic and psychological symptoms in substantial proportions of survivors of disasters, several physiological manifestations of stress have now been reported in disaster studies, such as changes in blood pressure, catecholamine excretion in urine, and changes in immune function [94-96].
Although increased symptom rates and psychophysiological changes have been well documented, the clinical relevance of these findings is not entirely clear. Most studies have reported outcomes on dimensional parameters using self-report methodologies. Studies that have instead used clinical criteria such as DSM-IV or ICD-9 based on clinical interviews as outcome criteria have yielded more equivocal results. For example, in the prospective ECA sample in Missouri described above, only increased symptom rates were reported. No increased incidence or prevalence rates of clinical PTSD or other mental disorders were observed . As will be further discussed below, increased rates of disorders have thus far been mainly found among subjects from high-risk groups, notably mothers with young children and evacuees.
The same holds true for the biological parameters that have been measured. Most of these findings are well within the range of normal variation and, importantly, it should be remembered that even an abnormal laboratory finding is not tantamount to disease . One finding, however, underscores the public health importance of these phenomena. Specifically, no matter how subjective these health complaints are, they lead to marked changes in medical consumption and other health-related behaviors such as reproduction rates .
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