Disasters and Health: Distress, Disorders, and Disaster Behaviors in Communities, Neighborhoods, and Nations

Robert J. Ursano, Carol S. Fullerton, and Artin Terhakopian Disasters and Health: Distress, Disorders, and Disaster Behaviors in Communities, Neighborhoods, and Nations DISASTERS ARE OF TWO MAJOR TYPES: NATURAL AND HUMAN-MADE. H um an-m ade disasters result from hum an error, such as technologi­ cal accidents, and intentional hum an acts, such as terrorism . Overall, hum an-m ade disasters cause m ore frequent and m ore persistent psychiatric symptoms and distress (for review see Norris et al., 2002). However, this distinction is difficult to make. The etiology and conse­ quences of natural disasters can be the result of hum an behaviors. For example, the damage caused by an earthquake can be intensified by poor construction. Similarly, hum ans may contribute to the damage and destruction caused by natural disasters through poor land manage­ m ent th at increase the probability of floods. Interpersonal violence social research Vol 75 : No 3 : Fall 2008 1015 betw een individuals or groups such as assault, war, and terrorism is in m any ways the m ost disturbing traum atic experience. A review of over 60,000 disaster victims found 67 percent of those exposed to mass violence were severely im paired com pared w ith 39 percent of those exposed to technological disasters and 34 percent of those exposed to natural disasters (Norris et al., 2002). THE NATURE OF DISASTERS AND THE DISASTER COMMUNITY Disasters overwhelm local resources and threaten the safety and func­ tioning of communities. W ith the advent of new technology, disasters are w itnessed in real tim e around the globe. Disaster com m unities can be overwhelmed by the media and people offering assistance. The norm al routine of the com m unity is altered not just by the disaster but by the influx of strangers, w hich affects norm al social supports, strain­ ing and disrupting com m unity functioning—the im portant elem ents in helping communities return to “norm al” functioning. Disaster impacts that includes threat to life, destruction of prop­ erty and society, as well as the stress events in the recovery environ­ m ent, are related to the degree of psychiatric m orbidity (Noji, 1997). Disruption of the com m unity and workplace increases distress, health risk behaviors, and risk of posttraum atic stress disorders (PTSD). In the im m ediate afterm ath o f a disaster or terrorist attack, individuals and communities may respond in adaptive, effective ways or they may m ake fear-based decisions, resulting in unhelpful behaviors. Knowledge of an individual’s and com m unity’s resilience and vulnerability before a disaster as well as understanding the specific com m unity’s psycho­ logical responses enables leaders and medical experts to talk to the public, to prom ote resilient healthy behaviors, sustain the social fabric of the community, and facilitate recovery (Ursano et al., 2003; Institute of Medicine, 2003). The adaptive capacities of individuals and groups w ithin a com m unity are variable and need to be understood before a crisis in order to target needs effectively after disaster. For example, com m unity embeddedness—the degree to which one belongs to and is 1016 social research connected in one’s neighborhood and com m unity—may be both a risk factor and a protective factor after com m unity level disasters (Sampson, 2003; Sampson et al., 1997). The economic im pacts of disasters are substantial. Loss of a job is a m ajor postevent predictor of negative psychiatric outcome (Galea et al., 2002; Nandi et al., 2004). These effects can be seen at the macro level—for example, in a dip in consum er confidence, w hich occurred during and after the sniper attacks in the W ashington, D.C. area in October 2002. Terrorism in particular targets the social capital of the nation—a nation’s cohesion, values, and ability to function. Economic impacts after terrorism may be substantial even w ith little destruction due to changed expectations and faith in leadership and community. C ounterterrorism and national continuity are crucially dependent upon our having effective interventions to sustain the psychological, behavioral, and social function of the nation and its citizens. Economic behaviors...