Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT April 25, 2003 "Few things help an individual more than to place responsibility upon him and to let him know that you trust him." - Booker T. Washington
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CONFERENCES AND WORKSHOPS:
Rocky Mountain Region
Disaster Mental Health Institute -
SPRING WORKSHOP SERIES - Brochure
May 3 - Suicide Risk Assessment and Risk Reduction: Tactics For The Trenches
- Jon Richard, PsyD
Disaster Mental Health Services-I (DMHS-I)
(Red Cross Course)
Location: Salt Lake City, UT
Dates: May 6-7, 2003
Contact: Lucy Houser
Email: houserlc@crossnet.org
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers:
ammp@optushome.com.au
Conference Website:
http://www.acisa.org.au/ conference2003/Summer Intensive Program
Graduate Certificate in
Disaster Mental Health
Disaster Mental Health Institute (University of South Dakota)
Location: Union Building
University of South Dakota Campus Vermillion, SD
Contact: Disaster Mental Health Institute
University of South Dakota
SDU 114 414 East Clark St
Vermillion, SD 57069-2390
Phone: 605-677-6575 or 800-522-9684
Fax: 605-677-6604
http://www.usd.edu/dmhi/Third Biennial International Conference
on Intercultural Research (IAIR)
May 16 - 19, 2003
Location: Taipei, Taiwan Contact: 2003 IAIR International Conference
C/o College of Education
NTNU, PO Box 7-763
Taipei, Taiwan 106
Tel: +(886)2-2321-3142
Fax +(886)2-2394-9243
Email: t14004@cc.ntnu.edu.tw
VIII European Conference
on Traumatic Stress(ECOTS)
May 22 - 25, 2003
Location: Berlin, GERMANY
Contact: Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail: trauma-conference@kfb-berlin.de
6th Annual Conference
The University of South Dakota
Disaster Mental Health Institute
"Innovations in Disaster Psychology:
Time for a New Paradigm?
Reflecting on the Past:
Looking to the Future"
Radisson Hotel
Rapid City, SD
September 18-20, 2003
EXPERT SAYS FALL OF BAGHDAD WON'T ELIMINATE WEAPONS OF MASS DESTRUCTION
While Operation Iraqi Freedom began with a goal of eliminating weapons of mass destruction, a Penn State expert notes that the confluence of domestic economic pressures in the Middle East and regional confrontation is likely to further the proliferation of weapons of mass destruction and the means to deliver them. Fariborz Ghadar, director of the Center for Global Business Studies at Penn State, says spending on conventional arms probably will remain stable or decline in most countries. Some of the states that actively sponsor terrorism or terrorist groups today may decrease or even cease their support by 2025 because of regime changes, rapprochement with neighbors, or the conclusion that terrorism has become counterproductive. Weak states also could drift toward cooperation with terrorists, creating new state supporters. Read the full story at http://live.psu.edu/index.php?sec=vs&story=2641
DHS Announces $165 Million In Grants
The Department of Homeland Security's Emergency Preparedness and Response Directorate, known as FEMA, has provided $165 million in grants to help state and local governments better prepare to respond to all hazards preparedness activities and emergency management. For further information, go tp: http://www.fema.gov/nwz03/nwz03_epmg.shtm
The Federal Response Plan
The Federal Response Plan (FRP) outlines how the Federal Government implements the Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, to assist State and local governments when a major disaster or emergency overwhelms their ability to respond effectively to save lives; protect public health, safety, and property; and restore their communities. The FRP describes the policies, planning assumptions, concept of operations, response and recovery actions, and responsibilities of 25 Federal departments and agencies and the American Red Cross, that guide Federal operations following a Presidential declaration of a major disaster or emergency. To access online, go to: http://www.fema.gov/rrr/frp/
UN moves to assume key role coordinating relief effort in Iraq
27 April – The United Nations is preparing to assume a central role coordinating international efforts aimed at providing aid to war-ravaged Iraq, a spokesman for the world body said today. For the full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6858&Cr=Iraq&Cr1=
UN welcomes inauguration of Afghanistan's Constitutional Commission
27 April – Hailing the achievement of another political milestone in Afghanistan's transition to democracy, the United Nations today renewed its pledge of full support for the process. For the FULL STORY, go to: http://www.un.org/apps/news/story.asp?NewsID=6859&Cr=Afghanistan&Cr1=
Annan urges international community to remember victims of Chernobyl disaster
26 April – The United Nations Secretary-General, Kofi Annan, today made a special plea to the international community to remember the victims of the Chernobyl nuclear reactor explosion 17 years ago in Ukraine – an event which devastated the lives and health of many people for generations to come. For the FULL STORY, go to: http://www.un.org/apps/news/story.asp?NewsID=6857&Cr=Chernobyl&Cr1=
UN opens new food corridor into Iraq, pledges aid to re-open schools
25 April – United Nations relief agencies opened a fourth food corridor into Iraq today while pledging help for re-opening schools and shifting focus from contingency preparations for a refugee exodus out of the country to the eventual repatriation of up to 500,000 people. For the FULL STORY, go to: http://www.un.org/apps/news/story.asp?NewsID=6847&Cr=iraq&Cr1=relief
Beyond Depression: The Somatic/Affective Interface
Depression has traditionally been viewed as a syndrome with an affective core accompanied by associated problems such as sleep, appetite, decreased concentration, loss of interest, fatigue, and suicidal behaviors. Yet somatic symptoms are often present and may be the primary presenting problem in some individuals. These physical symptoms are wide ranging and include complaints such as headache, constipation, back pain, chest pain, dizziness, musculoskeletal complaints, and weakness. The lack of recognition of depression in the face of physical symptoms has resulted in the tendency by medical practitioners to misdiagnosis and undertreat depression. Alternatively, the lack of attention by the psychiatrist to physical symptoms in the depressed individual has resulted in neglect of this important area. In both cases, optimal treatment and functioning of the individual are compromised unless both areas are included in the overall treatment. For the full text, go to: http://www.medscape.com/viewprogram/2170
NEW BOOK FOR PARENTS OFFERS ADVICE ON FREQUENTLY ASKED QUESTIONS
Penn State Children's Hospital pediatrician Mark Widome, M.D., offers useful and reassuring advice in a comprehensive, easy-to-use new book, "Ask Dr. Mark: Answers for Parents." Widome, a regular contributor to NBC's Today show and featured columnist for the National Safety Council's wellness magazine Family Safety & Health, addresses parents' most frequently asked questions. More than 150 topics were selected from Widome's academic pediatric practice at Penn State Children's Hospital, the pages of Family Safety & Health, and from Widome's popular child health and safety segments on the Today show. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=2677
Pennsylvania Case Holds Symbolic Importance on the Confidentiality of Patient Records
A Pennsylvania county judge has ruled that improper efforts were made to terminate a Pittsburgh psychiatrist from a provider network for refusing to release patient records to a managed behavioral health care company. Mental Health Weekly 13(12) 2003 For the full article, go to: http://www.medscape.com/viewarticle/451629?mpid=12183
RESILIENCY FOLLOWING WAR
The effects of war, torture, and disaster on the mental health problems of refugees, spouses, family members and military personnel are manifested in several ways, including adjustment problems, depression, anxiety disorders or posttraumatic stress disorder (PTSD). The stressful condition of a refugee could also worsen any underlying mental disorders such as psychotic illnesses. To address the mental health needs of the large number of refugees, specific management ability and approaches are required. Some basic tenets that should be followed are that interventions should be integrated with overall health care; they should be responsive to all severity and kinds of problems; they should be part of the redevelopment of mental health services; and they should be sustainable, culturally sensitive, evidence-based and cost effective. Saraceno, Saxena, Maulik, Sartorius, Gaebel, et al. (2002) describe some of the broad public health principles and strategies in mental health care in complex refugee emergencies, discuss the role of international agencies, and suggest areas for further research pertinent to the mental health of refugees. They address the mental health problems and care of asylum seekers, refugees, internally displaced and repatriated persons, and other non-displaced populations affected by war and organized violence.
Each refugee group experiences specific migration and resettlement experiences. For example, there are no epidemiological data on risk factors for psychiatric symptoms among adult Somalis in the UK. Bhui, Abdi, Abdi, Pereira, Dualeh, Robertson, Sathyamoorthy, & Ismail(Jan 2003) interviewed a community sample of 180 Somalis (aged 20-88 yrs). They assessed relationships between symptoms of psychosis (Brief Psychiatric Rating Schedule), anxiety and depression (Symptom and Complaints Checklist-90) and suicidal thinking (Beck Depression Inventory) and migration-related experiences such as traumatic events, immigration difficulties, employment and income. Anxiety and depression were incrementally more common with each pre-migration traumatic event. Shortages of food, being lost in a war situation, and being close to death and suffering serious injury were each related to specific psychiatric symptoms. Suicidal thinking was more common among Somalis who were unemployed before migration and those using Qat in the UK. War-related experiences, occupational status before migration and current Qat use are risk factors for psychiatric symptoms among Somali refugees.
Traumatic experiences associated with the war in Bosnia (1992-1995) impacted the lives of many Bosnian refugees and displaced people. Approximately 25% of Bosnians were forced to leave their homes and resettle in other areas of Bosnia or abroad. Plante, Simicic, Andersen, & Manuel (2002) describe war-related stress and the association of marital status, anxiety, depression, and sensitivity levels. 82 displaced Bosnians living in the area of Tuzla, Bosnia, and 53 refugees living in the San Francisco Bay area completed the same questionnaire in the Bosnian language. Better self-reported health was related to being single, having lower anxiety ratings, finding and adapting to a new environment easily, and moving on with life. Findings also revealed that being divorced or separated, better self-reported health, and lower anxiety, depression, and sensitivity ratings were predictors of more effective coping.
Tang & Fox (2001) conducted a preliminary investigation into the experiences and mental health of Senegalese refugees. They noted that although research has established that refugees are more prone to psychiatric illnesses than the general population, little has been written about West African refugees. 80 adult refugees (18 yrs of age and older) from the Casamance region of Senegal were randomly selected from refugee camps in The Gambia. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 were used to assess levels of traumatization and mental health status. Typical of refugees of war, participants reported suffering a large number of various traumas. High prevalence rates of anxiety, depression, and posttraumatic stress disorder were also found in this group. Tang & Fox conclude that a substantial mental health problem exists within the Senegalese refugee population that may signify a potential human crisis.
Van Ommeren, de Jong, Sharma, Komproe, Thapa & Cardena (2001) surveyed a population-based sample of 418 tortured and 392 nontortured Bhutanese refugees living in camps in Nepal. Trained interviewers assessed International Classification of Diseases and Related Health Problems (ICD--10) disorders through structured diagnostic psychiatric interviews. Except for male sex, history of torture was not associated with demographics. Tortured refugees, compared with nontortured refugees, were more likely to report 12-month ICD-10 posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders. In addition, tortured refugees were more likely to report lifetime posttraumatic stress disorder.
Bek, Buzov & Bilic (2001) evaluated differences in anxiety levels between groups of refugees and non-refugees in Croatia. Ss were 90 Ss (similar in age, gender, and education, and each with a history of missing family members) divided into 3 groups (30 Ss each). Group 1 included Ss who lost close family members, Group 2 included non-refugees Ss, and Group 3 comprised of Ss whose immediate family members were reported as "missing." Ss were assessed using the Hamilton Anxiety Scale (M. Hamilton, 1986). The results revealed the most significant differences in anxiety levels in Groups 2 and 3. Ss grief over "missing" family members manifested itself as psychosomatic illness, somatic depression, and anxiety.
(10-2)development & outcomes of program providing mental health services, 11-77 yr old family members of Vietnam veterans, New Zealand Deane, MacDonald, Chamberlain, Long & Davin(1998) reviewed research concerned with the association between combat-related posttraumatic stress disorder (PTSD) and interpersonal functioning, before describing the development of a pilot program established to provide mental health services for Vietnam veteran family members. The results of a brief program evaluation were also presented. 60 clients (aged 11-77 yrs) provided posttreatment and 6-mo follow-up data on a variety of outcome measures which were compared with independent ratings returned by 33 therapists. On average, clients reported that counseling had been beneficial and indicated satisfaction with services received. However, at posttest, therapists indicated that approximately 50% of clients were in need of continued treatment. There was a decrease in satisfaction with services over the posttest follow-up period, but no change on most measures of psychotherapy outcome.
In summary, across various cultures and populations affected by war situations, major mental health related problems include: depression, anxiety, posttraumatic stress (including PTSD), various somatic complaints (including psychosomatic illness and persistent somatoform pain disorders), and dissociative disorders.
Children and Families
Van Ommeren, de Jong, Joop, Sharma, Komproe,Thapa & Cardena(2001) provide an overview of the effects of war on children during the 20th century in specific countries in Latin America, Asia, Africa, and the Middle East. They argue that wars have both direct and indirect effects on the population. Wars have changed from being conventional to being of low intensity. Under these latter circumstances civilians become targets, whereas in the past, the targets were usually only military ones. The effects of the strategy used in low intensity conflicts is the disruption of the medical, social, educational, and public services of a country and the terrorization of the population. Under these circumstances children suffer inordinately. Their homes are destroyed, their families disrupted, and their chances of becoming mature productive members of society are compromised.
Five years after the military operation "Anfal" in Iraqi Kurdistan, 45 families were randomly selected among the survivors in two displacement camps (Ahmad, Sofi, Sundelin-Wahlsten & von Knorring, 2000). The Posttraumatic Stress Symptoms for Children and the Harvard Trauma Questionnaire were administered to the oldest child and the caregiver in each family, respectively. Posttraumatic stress disorder (PTSD) was reported in 87% of children (aged 7-17 yrs) and 60% of their caregivers (aged 17-91 yrs). While childhood PTSD was only significantly predicted by child trauma score and the duration of captivity, it was neither predicted by maternal PTSD nor did it disappear after the reunion with the PTSD-free father (Ahmad et al. 2000). However, the small sample size makes the results hypotheses rather inconclusive.
Ford, Shaw, Sennhauser, Greaves et al. (1993) obtained interview and questionnaire data 2-6 mo after demobilization from Operation Desert Storm (ODS) from 26 veteran/veteran or veteran/civilian spouse couples who received conjoint time-limited therapy and 30 veterans from the same Reserve and National Guard units who received 1-to-1 time-limited therapy. 31 nontreatment-seeking control veterans and 7 nontreatment-seeking civilian spouses were also included in the sample. Further assessments were conducted 12-15 mo after demobilization from veterans deployed during ODS with the same military units. Their findings indicate that the trauma and strain of war-zone military service, family separation, and subsequent family and community readjustment take a toll on a significant minority of ODS veterans and their families. With timely psychosocial intervention, veterans and families in distress are able to substantially resolve symptoms of psychosocial malfunctioning.
Apellaniz (1999) studied the impact of war deployment & enforced separation during the Persian Gulf conflict on family & coping strategies, and wives of civilian soldiers from Puerto Rico. This study documents how spouses of Puerto Rican National Guard soldiers appraise the impact of war deployment and separation on their family lives. It examines the coping strategies they found most useful in adjusting to the demands of separation during 1989's Persian Gulf conflict. A combination of quantitative and qualitative methods was used. Emotional tension, concern about their husband's safety and having to assume new family roles and full care taking and household responsibilities without their husbands' support and for such a prolonged period of time were reported by wives as the most distressing aspects of separation. In contrast to women who reported having a satisfactory marital relationship, informants who described their marital relationship as poor evaluated the actual period of separation as less distressing than previous periods of military enforced separation. Overall, women in this study were resourceful and strongly committed to overcome the obstacles faced by their families during separation. Coping strategies aimed at maintaining families united were found to be extremely helpful in adapting to separation. Religious values, a positive outlook on life events, and support from family members also contributed to strengthen their capacity to endure separation. Cultural values and social expectations related to the role that traditionally Puerto Rican women play in the family served the respondents as instrumental guidelines for adapting to the demands and strains of prolonged separation. These findings have implications for planning intervention and support services for military families.
In summary, major factors affecting families with military members include war-zone military service, family separation, and readjustment back into the community by service members. Posttraumatic stress (including PTSD) and psychosocial malfunctioning are among problems encountered. Strengths that contribute to resiliency by all family members include religious values, a positive outlook on life events, family support and various forms of psycho-social interventions. Children living and surviving in war zones are affected adversely in a number of developmental ways and are at severely increased risk of becoming unproductive members of their society.
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REFERENCES Ahmad, A., Sofi, M. A., Sundelin-Wahlsten, V. & von Knorring, A. -L. (2000). Posttraumatic stress disorder in children after the military operation 'Anfal' in Iraqi Kurdistan. European Child & Adolescent Psychiatry, Vol 9(4), pp. 235-243. Journal URL: http://link.springer.de/link/service/journals/00787/index.htm
Apellaniz, Ilia Maria (April 1999). Coping with war enforced separation: A pilot study on the account of wives of Puerto Rican civilian soldiers. Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(10-B),pp. 5567.
Bek, Renata, Buzov, Ivan & Bilic, Vedran (Mar 2001). Anksiozne reakcije u ratu. Translated Title: Anxiety reactions in war. Socijalna Psihijatrija, Vol 29(1). pp. 3-8.
Bhui, Kamaldeep, Abdi, Abdisalama, Abdi, Mahad, Pereira, Stephen, Dualeh, Mohammed, Robertson, David, Sathyamoorthy, Ganesh, Ismail, Hellena (Jan 2003). Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees: Preliminary communication. Social Psychiatry & Psychiatric Epidemiology, Vol 38(1). pp. 35-43. Journal URL: http://link.springer.de/link/service/journals/00127/index.htm
Benjamin, Jessica (2002). Terror and guilt: Beyond them and us. Psychoanalytic Dialogues, Vol 12(3). pp. 473-484. Journal URL: http://www.analyticpress.com/psychoanalytic_dialogues.html
Deane, Frank P., MacDonald, Carol, Chamberlain, Kerry, Long, Nigel & Davin, Lorna (Mar 1998). New Zealand Vietnam veteran's family programme, nga whanau a tu(families of war): Development and outcome. Australian & New Zealand Journal of Family Therapy, Vol 19(1), pp. 1-10. Journal URL: http://www.blackwellpublishers.co.uk/asp/journal.asp?ref=0814-723X
Ford, Julian D., Shaw, David, Sennhauser, Shirley, Greaves, David et al. (Win 1993). Psychosocial debriefing after Operation Desert Storm: Marital and family assessment and intervention. Journal of Social Issues, Vol 49(4), pp. 73-102. Journal URL: http://www.blackwellpublishers.co.uk/asp/journal.asp?ref=0022-4537
Goldson, Edward (Sep 1996). The effect of war on children. Child Abuse & Neglect, Vol 20(9), pp. 809-819. Journal URL: http://www.elsevier.com/inca/publications/store/5/8/6/
Mateczun, John M., Holmes, Elizabeth K. (1996). Return, readjustment, and reintegration: The three R's of family reunion. In Ursano, Robert J. (Ed); Norwood, Ann E. (Ed); Emotional aftermath of the Persian Gulf War: Veterans, families, communities, and nations. pp. 369-392.
Plante, Thomas G., Simicic, Azra, Andersen, Erin N. & Manuel, Gerdenio (Jan 2002). Stress and coping among displaced Bosnian refugees: An exploratory study. International Journal of Stress Management, Vol 9(1). pp. 31-41.
Saraceno, Benedetto, Saxena, Shekhar, Maulik, Pallab K., Sartorius, Norman (Ed); Gaebel, Wolfgang (Ed); et al. (2002). Mental health problems in refugees. Psychiatry in society. New York, NY, US: John Wiley & Sons Ltd.. pp. 193-220
Salter, Charles A. (Dec 2001). Psychological effects of nuclear and radiological warfare. Military Medicine, Vol 166(12,Suppl 2). pp. 17-18.
Tang, Sharon S. & Fox, Steven H. (Aug 2001).Traumatic experiences and the mental health of Senegalese refugees. Journal of Nervous & Mental Disease, Vol 189(8). pp. 507-512. Journal URL: http://www.jonmd.com/
Van Ommeren, Mark, de Jong, Joop T. V. M., Sharma, Bhogendra, Komproe, Ivan, Thapa, Suraj B., Cardena, Etzel (Jul 2001). "Psychiatric disorders among tortured Bhutanese refugees in Nepal": Erratum. Archives of General Psychiatry, Vol 58(7). pp. 707. Journal URL: http://archpsyc.ama-assn.org/
Van Ommeren M, Sharma B, Prasain D, Poudyal BN. Helping torture survivors in Nepal: a public mental health perspective. In: de Jong JTVM, ed. Trauma and War: A Public Mental Health Approach. New York, NY: Plenum Publishing Corp. In press."
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
http://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
Stress, Risk, and Resilience in Children and Adolescents : Processes, Mechanisms, and Interventions
by Robert J. Haggerty (Editor), Lonnie R. Sherrod (Editor), Norman Garmezy (Editor), Michael Rutter (Editor)
Book Description
Stress, Risk, and Resilience in Children and Adolescents recognizes the complexity of the developmental processes that impact on coping and resilience and the importance of sociocultural factors. In this respect, the relation between a stressor and an outcome depends on many factors, including the individual's previous experience, perception of the event, coping skills and social supports. In turn, each of these factors displays meaningful variation by developmental status, social background, and cultural context. The examination of individual differences in vulnerability to stress and risk factors has grown substantially over the past decade as it has become clearer that some children do, in fact, 'beat the odds.' In order to understand why some children succumb to even modest stress while others remain resilient in the face of what appear to be overwhelming stressors, research has increasingly examined the processes and mechanisms by which children of different ages deal with adverse life experiences, rather than merely studying the stressors themselves. Many problem behaviors have multiple causes, and most children with one problem behavior also have others. The co-occurrence and/or interrelatedness of risk factors and problem behaviors is, therefore, an important area of research.
Additional Readings at: Terrorism and Stress in the search engine. Also try looking here for Psychology and Terrorism.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: http://www.angelfire.com/biz3/news
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