Response: Learning from Research
"It's reasonable to expect that we are going to
have disasters time and time again. So it's essential
to think critically now about how we can prepare ourselves
for what history tells us is inevitable," said Sandro
Galea, Ph.D., Dr.P.H., at the SAMHSA-sponsored "Spirit
of Recovery" Conference in New Orleans in May.
Dr. Galea, an associate professor of epidemiology at
the University of Michigan School of Public Health, spoke
as part of the panel titled, "Understanding and
Addressing Mental Health and Substance Abuse Needs Over
Time: What Research Tells Us."
The panel, moderated by Farris Tuma, Sc.D., M.H.S.,
Chief of the Traumatic Stress Disorders Research Program
at the National Institute of Mental Health, presented
the available information about the epidemiology of disaster-related
trauma, the array of interventions, and the implications
for the Gulf State populations affected by the fall 2005
|Farris Tuma, Sc.D.,
Dr. Galea emphasized that the majority of people in
the proximity of the disaster are very resilient and
do not develop psychopathology. To understand the impact
of disasters, he said, "It's useful to conceptualize
a hierarchy of persons affected."
||Dr. Matthew Friedman (left), Dr.
Sandro Galea (center), and Dr. Farris Tuma (right)
talk with Spirit of Recovery conference participants.
The largest group in a pyramid of those affected is
the general population. The next levels, in ascending
order of proximity, are persons in the area of the disaster,
rescuers, family members of those killed or injured,
and people directly injured in the disaster (see Figure
Dr. Galea described a related pyramid for conceptualizing
the psychological consequences of disasters (see Figure
B). The emotional resilience of the majority of people
forms the base. The next tier includes people who have
concerns and may experience some behavior changes—a
reaction that he said is normal. This tier is followed
(again in ascending order) by people with non-specific
psychological distress, individuals with acute stress
disorder, those with short-term psychopathology, and
those with long-term psychopathology.
|Sandro Galea, Ph.D.,
According to this schema, the severity of the psychological
consequences in the second pyramid corresponds to the
level of proximity to the disaster in the first pyramid.
Because of this, research results that might at times
appear conflicting "are in fact different results
for different groups," Dr. Galea said.
He also noted that the bulk of clinical and research
resources "focus on the smallest group of people
at the top of the pyramid."
to view larger image d
to view larger imaged
|To explain the impact
of disasters, Dr. Sandro Galea created two related
pyramids. The level of proximity to a disaster in
the first pyramid corresponds to the severity of
the psychological consequences in the second.
Dr. Galea used data from a study he conducted after
the March 11, 2004, terrorist train bombing in Madrid
and from another study he conducted after the September
11, 2001, attacks in New York City to discuss differences
in psychological response following each event. He attributed
the much higher level of post-traumatic stress disorder
(PTSD) in the general population of New York City to
the highly visible nature of the 9/11 attacks and the
fact that the attacks took place in a busy downtown area.
Dr. Galea also said that populations already stressed
for any pre-existing reason—social, economic, or
health-related—have a higher incidence of PTSD
following a disaster. "The course of psychopathology
is complicated after disasters," he said, indicating
a need for more research.
« See Part 1: Hurricane Recovery Guides Preparedness
« See Part 2: Hurricane Recovery Guides Preparedness
Recovery Guides Preparedness Planning
See AlsoPost-Disaster Response: Learning
Part 2 »
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