Survivors of deadly earthquakes must deal with lasting shock

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The major earthquake that hit Turkey and Syria last week killed tens of thousands and caused billions of dollars in damages. It also negatively affects the mental health of survivors.

Research has confirmed that natural hazards such as the magnitude 7.8 earthquake lead to acute trauma and increased risk of chronic diseases such as anxiety and depression in survivors. Ben Bighall is a psychiatrist and Senior Lecturer in the Department of Psychiatry at the University of Otago, Christchurch, in New Zealand. Bijlhall and colleagues studied the effects of the 2010-2011 Canterbury earthquakes in New Zealand on mental health as part of a more than 40-year study measuring the health and development of a group of more than 1,200 people born in the late 1970s. They found increased rates of anxiety disorder, post-traumatic stress disorder, and nicotine dependence one year after the earthquakes, and this increase was associated with increased exposure to the events. In other words, the closer a person is to the effects of more severe earthquakes, the more likely they are to develop a mental health disorder.

Scientific American spoke with Beaglehole about how deadly earthquakes and their aftermath affect mental health, the role of socioeconomic factors and cultural setting, and factors that increase resilience and growth after trauma.

[An edited transcript of the interview follows.]

How do you study these types of natural hazards? And what do we know about past disasters that could help in responding to the recent earthquake in Turkey and Syria?

The reason I started doing disaster research is because Christchurch, New Zealand [and nearby areas of the surrounding region of Canterbury] I had a severe series of earthquakes starting in 2010 and continuing through 2011, and I was a clinical psychologist at the time, with some notes on what was happening from our clinic. This got me interested in evidence about disasters and mental health.

As for how to study these things, first, you need to have disasters happen. Some research is very interactive: disaster strikes, then people decide they need to measure the impact, and they’ll take a survey. But there are things that can improve search quality. One ponders the question, “When is it important to measure impacts?” Ideally, you don’t want to measure the effects all at once. There may be little benefit in measuring the effects a week after a major disaster. It is important to measure effects over time. If you can, it’s a good idea to be able to compare any measurements with pre-disaster ones because it’s easy to assume that depression rates you see are, for example, caused by an earthquake. But if there were high rates before the disaster, this is a confounding factor.

People often don’t think about doing this research until after a disaster has occurred, but if there’s an underlying measurement, it’s important. If you don’t have a baseline measurement, you can manage this by comparing your results to results in a less exposed area – an area with less or no earthquake effects. Then the last thing you need to decide is the population in which you’re going to measure the impacts. It’s easy to find a group of people who want to tell their story, but are they representative of the population of interest? These things are important: when will you measure the effects? Who will you measure them for? What would any results compare to?

I have studied the psychological effects of the 2010-2011 Canterbury earthquake in New Zealand. what did you find?

One of the papers I wrote is based on data from the Christchurch Health and Development Study, a cohort study of childbirth that has been running for more than 40 years. [Editor’s Note: In a birth cohort study, researchers follow a group of people born in a certain period from infancy through adulthood.] [The researchers] Pre-earthquake measurements on multiple occasions, and they can also consider other factors such as previous exposure to trauma, sociodemographic factors, and the impact of prior mental illness. We can take these factors into account when trying to estimate the impact of the Canterbury earthquakes on mental health. If you don’t take these factors into account, you’ll come up with higher estimates than if you did, because some people are more likely to have mental health problems and are more likely to have bad earthquake experiences.

Who are the people most likely to develop trauma and other mental health problems after a severe earthquake?

When you think about the effects of an earthquake, you might think of earthquakes as having a random or uniform effect on everyone. But in fact, if you live in a poor part of the city, your buildings are more likely to be destroyed. You are also likely to have other factors that may increase your risk of depression. So it can appear that earthquakes cause more negative mental health effects than they actually are if you do not control for other factors.

What we do know about trauma and mental health is that although there is a possibility that people can grow through trauma, trauma is not recommended because it also causes negative effects. And those negative effects are that trauma interacts with risk factors for increased post-disaster mental health problems.

How do the environment and local conditions in which an earthquake occurs affect the likelihood that survivors will experience mental health effects?

If I can compare an earthquake in Syria to an earthquake in Christchurch, then I think Christchurch is the place for you. We have good building codes here, so even though some of our buildings collapsed and people lost their lives, our buildings didn’t kill people. We have a lot of insurance – most homeowners were insured. We have a completely sound and free healthcare system. And we were able to provide additional support financially, with counselling, doctors visits, etc. It is not the vibration that is so important. It really is everything [that happens during the recovery period]. Some of these things are going to be very difficult in Syria in particular, but I can see from afar in Turkey as well that there are some real problems with the buildings. You can compare that to Japan as another example of a country that suffers from very large earthquakes, but they designed their buildings not only to keep people alive but also to keep using them.

How can people deal with the very immediate trauma of experiencing an earthquake and losing their loved ones, as well as the long-term effects of the destruction of one’s city’s physical infrastructure and the inability to receive ongoing medical care?

Maslow’s hierarchy of needs is quite relevant. Priorities are clean water, shelter and rescue. If there is some sort of psychological need right now, it’s psychological Band-Aid, rather than therapy – with a lot of focus on providing for social needs, but maybe just reassuring, helping people get some sleep, helping people connect and talk to them Loved ones instead of health professionals saying, “We need to provide CBT” [a type of talk therapy used to treat mental health disorders].

Such assistance does not require experts to be provided. I think the idea of ​​too many outside experts without local knowledge trying to impose themselves is not right. The enormity of the physical reform that needs to happen is the priority. And any psychological support should be relatively low-key and supportive rather than trying to staging and treating illnesses at this time.

What qualities make a society more resilient to these types of shocks? What are the factors that make things worse?

The more trauma a society goes through, the more likely people are to experience mental health problems. And the more cohesive the society, the greater the protection. I think community structure is important: the ability to respond in a caring way requires a well-organized community.

We wrote a paper on post-traumatic growth following the Canterbury earthquakes. and the [Christchurch] The H&D study also yielded previous papers on post-traumatic stress that attempted to use complex mathematics to predict who thrives through adversity and who develops mental health problems. One of the factors that came out of this research was ‘narrowing of the peritoneum’: at the time of earthquakes, would you have thought you were going to die? Or did you think, “This is just an earthquake, and I’ll be fine”? This was one of the factors. The other was called “turbulence turmoil”: how much of a problem did earthquakes continue to cause in your life in the days and months that followed? Were you able to work, were you able to live normally, etc.? These factors predict posttraumatic stress. If you had a very difficult experience during and after the earthquake, you are more likely to develop post-traumatic stress symptoms, but you are also more likely to get through the experience – you are more likely to see positive development, new relationships, and new spirituality. The vast majority of people will be resilient. So even though this is a devastating disaster, we should not assume that people will inevitably struggle with their mental health.

Among the elements of post-disaster effects is the notion of intensity of experience or intensity of exposure. In Christchurch, for example, the central city has been hardest hit. If I had been there, I would have seen people die, and seen buildings collapse. But if you live in the western part of the city – the wealthiest part – the buildings will be fine. Infrastructure was good. The exposure there was much less; The eastern part of the city was hit the hardest. So greater exposure predicts greater effects. The media footage you’ve seen of the earthquakes in Syria and Turkey seems to show severe exposure on a large scale, so there will be a lot of people who are more vulnerable to the harmful effects.

How do people deal with survivor guilt—the guilt that they survived when so many around them did not?

This isn’t really an area that I know much about. But I think from a psychological point of view, people often move through different stages of thinking in response to life events. Maybe you remember people talking about the stages of grief, for example. My suspicion is that survivor’s guilt might be a little like that. You may have some disbelief. You may feel guilty, you may feel grateful. You are likely to have swirling emotions, not necessarily well organized or going in a regular way, and this will be something you will have to adapt to. If you struggle with guilt, this may be an area you may need to see a therapist about. But there are likely to be much larger priorities.

Are there factors specific to Turkey and Syria that will shape the impact of the earthquake on people’s mental health?

Syria may feel very left out. This is a part of the world that has had a very hard time in a civil war. And [people there] He’ll think, “Why is this happening to us?” In Turkey, at least, I think it would be much easier to respond, albeit still with the difficulties we saw in the media. But it will be more difficult in Syria to get things right.

It seems there will be very serious implications for some, though the majority are resilient, given the extent of that disaster.

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