Psychological Effects of a Large Scale Disaster

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Psychological Effects of a Large Scale Disaster

• Dr. Igor Khripunov
• Associate Director
• Center for International Trade and Security
• University of Georgia
• 29 January 2008
• Athens, GA

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Definition

• A major disaster is a catastrophic,
  high-consequence event that a) overwhelms or
  threatens to overwhelm local and regional
  response capability, and b) is caused by natural
  phenomenon, massive infrastructure failure,
  industrial accident, or malevolent action.
  Indicators of capacity overload include the
  following
• inability to adequately manage immediate rescue
  of survivors
• significant backlog of victims waiting to get
  medical care or other essential support
• inability to protect vital infrastructure or
  prevent significant property damage
• signs of uncontrolled societal breakdown and
  psychological trauma

Dr. Igor Khripunov, CITS/UGA
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Background

• In October 1948, a combination of hazardous
  chemical fumes in an industrial accident killed
  25 persons and sickened 43 of the residents in a
  small town in Pennsylvania. Military personnel
  observed that some residents not directly exposed
  exhibited the same physical symptoms as had
  victims who had been directly exposed.
• The evidence prompted the military in January
  1950 to turn to social scientists and draw up a
  master plan for the study of psychological
  effects of disasters (one of the early major
  projects focused on a series of devastating
  tornadoes in March 1952).

Dr. Igor Khripunov, CITS/UGA
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International Dimension

• In September 2007, the World Health Organization
  released The Guidelines on Mental Health and
  Psychosocial Support in Emergency Settings
  clearly stating that protecting and promoting
  mental health and psychosocial well-being is the
  responsibility of all humanitarian agencies and
  people involved and not only the exclusive role
  of mental health professionals.

Dr. Igor Khripunov, CITS/UGA
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Are We Prepared to Face Disasters?

• 13 states do not have adequate plans to
  distribute vaccines, antidotes, and medical
  supplies from the National Strategic Stockpile
• 12 states do not have a disease surveillance
  system that is compatible with the Centers for
  Disease Control and Preventions system
• 7 states have not purchased their share of the
  federal stockpile of antivirals to use during a
  pandemic flu
• (Report Ready or Not? Protecting the Publics
  Health from
• Disease, Disasters, and Bioterrorism, December
  2007)

Dr. Igor Khripunov, CITS/UGA
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Are We Prepared to Face Disasters?

• Question In thinking about preparing yourself
  for a major disaster, which best represents your
  preparedness?
• (Report Commissioned by the National Center for
  Disaster Preparedness
• at the Mailman School of Public Health, National
  Survey, July 2007)

Dr. Igor Khripunov, CITS/UGA
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Lessons to Be Learned

• Hurricane Katrina was the worst natural disaster
  in the U.S. in the past 75 years, affecting a
  land area the size of England, killing more than
  1,000 people, displacing 500,000 people, and
  causing 100 billion in property damage
• More than 30 of the New Orleans residents met
  diagnostic criteria for post-traumatic stress
  disorder
• Efficient provision of practical and logistical
  assistance in future disasters are important not
  only on humanitarian grounds, but also as a way
  to minimize the adverse mental effects of
  disasters leading to substantial human, economic
  and intellectual losses

Dr. Igor Khripunov, CITS/UGA
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Disasters and Hazards
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Nuclear Facilities in the Southeast
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U.S. Nuclear Facilities
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Radioactive Waste

• Total Shipments Through Georgia
• Highway 1,267 Truck Casks
• Rail 1,383 Rail Casks
• RT2 - CSXT from Greenwood, SC to Atlanta to
  Chattanooga, TN 431 Rail Casks Brunswick,
  Robinson, Harris
• (2) RE2 - NS from Vogtle NPP to Atlanta to
  Anniston, AL 259 Rail Casks

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Sensitive UGA Facilities

• School of Pharmacy
• Chemistry Building
• Veterinary Medicine
• Poultry Science Building
• Biological Sciences Building
• East Campus Research Labs (Genetics, CCRC, etc)

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Disaster Domino Effect
Anxiety, anger and stress
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Natural Events

• Natural disasters have been associated with an
  intense but short-term impact and have a
  clearer end point than human-made disasters.
  People usually perceive them on the basis of
  their prior knowledge and after living through
  one event the next is unlikely to cause a serious
  psychological trauma. Global warming as a
  contributor to, and multiplier of, natural events
  has become a strong stressor.
• Earthquakes occur with virtually no warning
  limiting the ability of disaster victims to make
  the psychological adjustment that can facilitate
  coping and lessening feelings of controllability
• Tornadoes move on an unpredictable path,
  devastate houses and structures on their way and
  make survivor guilt an especially common coping
  challenge
• Wildfires often lead to evacuations and loss of
  property. The sights, sounds and smells of
  wildfire often generate fear and anxiety

Dr. Igor Khripunov, CITS/UGA
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Man-Made Unintentional Events

• Man-made disasters often have an unclear end
  point, violate expectations of control, and
  result in distrust of authorities. The perception
  of threat does not always end with the
  termination of a human-made accident and there
  remain lingering chronic stress and fear.
• Industrial and infrastructure accidents are
  expected to rise. The American Society of Civil
  Engineers assessed the condition and capacity of
  the U.S. public works with an overall grade of D
  (ASCEs 2005 Report Card for Americas
  Infrastructure). According to the same source,
  the Georgia Department of Transportation has
  projected a 74 billion shortfall in
  transportation infrastructure funding over the
  next 30 years.

Dr. Igor Khripunov, CITS/UGA
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Man-Made Intentional (Malicious) Events

• There is no single, universally accepted
  definition of terrorism. This term is usually
  used to describe violence that is political,
  social, religious, or ideological in nature and
  that is designed to influence an audience beyond
  the immediate target or victims of the attack
• One widely quoted definition of terrorism is the
  one used by the FBI, which describes terrorism as
  the unlawful use of force and violence against
  persons or property to intimidate or coerce a
  government, the civilian population, or any
  segment thereof, in furtherance of political or
  social objectives. (U.S. FBI, 28 Code of Federal
  Regulations, Section O.85)

Dr. Igor Khripunov, CITS/UGA
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Man-Made Intentional (Malicious) Events

• The trauma of terrorism differs in several
  critical ways from traumas caused by disasters
  and accidents
• The impact of terrorism is chronic. Unlike
  single-incident traumas, the threat of terrorism
  is not a contained experience with a clear-cut
  beginning and end. Terrorism can induce a
  generalized vigilance to the point of paranoia
  across a community.
• Terrorism is a shared experience because attacks
  are most often directed against groups of people
  rather than individuals. The particular group of
  people attacked is often chosen based on their
  highly-visible membership in a larger racial,
  ethnic, or sociopolitical community.

Dr. Igor Khripunov, CITS/UGA
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Known Risks and Unknown Risks

• Prior knowledge and/or experience are important
  for people to assess unknown risks. Hence, known
  risks are associated with unknown risks for four
  different reasons
• They are used to characterize the possible
  severity and consequences of the unknown risks
• They are applied to show that similar risks have
  been tolerated and dealt with before
• Associations serve to indicate that risky events
  and/or activities can also have benefits
• Associations illustrate that previous risks have
  been resolved

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Known Risks and Unknown Risks
Stress and PTSD
Unknown
Unknown
Unknown
Known
Unknown
Known
Known
Known
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Known Risks and Unknown Risks
Unknown
Unknown

• Within 2 months after 9/11 in Manhattan
• 7.5 increase in PTSD (67,000)
• 9.7 increase in depression (87,000)
• Nation-wide
• 20 of Americans new someone who was missing,
  hurt, or killed
• 64 had a shaken sense of safety and security
• Secondary trauma via TV and other media correlate
  with PTSD symptoms 60 witnessed via live TV

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What Does It Take for the Hazard/Disaster to
Become a Psychological Trauma-Causing Event

• Experiences that involved serious risk of death
  (DSM-IV)
• Death of a loved one (DSM-IV)
• Personal victimization (DSM-IV)
• Victimization of a loved one (DSM-IV)
• Physical illness or injury
• Extreme physical adversity
• Major property loss
• Income loss
• Ongoing housing-related difficulties

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Probability of Unconventional Terrorism
U.S. News and World Report July 3, 2006
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Scenarios of WMD Terrorism
Probability vs. Impact
Nuclear Weapon
Improvised Nuclear Device
Radiological Dispersal/Emission Device
Attack with Chemical Weapons or Industrial Toxic
Substances
Impact
Biological Weapon Attack
Conventional Terrorist Attack
Probability
open-ended effect
share of psychological effect
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Fear of Radiation Exposure

• Radiation is colorless, odorless and tasteless
  (real or perceived?)
• Effect is not immediate, leaving affected people
  in a stressful state of anticipation and dread
• Potential impact of exposure on descendants can
  leave the affected people feeling guilty and
  depressed
• Radiophobia can be defined as the irrational
  belief that any level of ionizing radiation is
  highly dangerous, if not immediately deadly.

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Risk Perception Professionals v. the Public

• The objective is to achieve a common risk
  perception built on objective and transparent
  risk communication, which means an interactive
  process of exchange of information and opinion
  among individuals, groups and institutions. Risk
  and crisis communication is designed to achieve
  this objective.
• Some risks are more accepted by the public than
  others
• Voluntary risks are more readily accepted than
  imposed risks
• Risks controlled by individuals or a community
  are treated with less fear and concern than those
  outside their control
• Risks caused by human action are less tolerated
  than risks generated by nature
• Risks that narrowly target an individual or a
  small group are more readily accepted than
  widely-spread and indiscriminate risks

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Risk Perception Professionals v. the Public

• Perception of risk by the public, prior and
  mostly during the event, is based on such factors
  as
• proximity to the ground zero or substance release
• perceived magnitude of the consequences
• ignorance about the nature of the hazard
• the degree of physical harm that comes to oneself
  or fellow citizens
• exposure to grotesque scenes of injury or death
• suddenness of the event
• distrust of the institution attempting to manage
  the hazard

Dr. Igor Khripunov, CITS/UGA
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Risk Perception Professionals v. the Public
Threat
Risk
Vulnerability
Consequences
Preparedness

• Threat The probability that a specific area or
  group of people is targeted in a specific way
• Vulnerability The probability that damages
  occur, in a specific event, on a specific target
• Preparedness The probability that damages are
  prevented, in a specific event, on a specific
  target
• Consequences The expected magnitude of
  consequences, given a specific event and specific
  target

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Effects of Large-Scale Disasters

• The stress arising from the direct impact and the
  aftermath of a major event, particularly man-made
  malicious events can spawn serious physiological
  and psychological consequences. Traumatic life
  experience (cumulative stress) may exceed
  individuals coping ability, resulting in lasting
  changes in brain chemistry.
• Physiological effects of stress
• Increased risk of infections as a result of
  weakened immune system
• Susceptibility to ulcers
• Increased chances of blood clot formation and
  hypertension
• Onset of diabetes and lupus
• Chronic pain conditions such as arthritis and
  rheumatism
• Nasal allergies such as asthma and skin allergies
  such as eczema
• Risk factor for chronic fatigue syndrome (CFS)

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Psychological Reaction to Large-Scale Disasters

• Sadness
• Insomnia
• Sense of vulnerability
• Domestic or interpersonal violence
• Loss of trust
• Survival guilt
• Fear for the future
• Multiple Idiopathic Physical Symptoms (MIPS)
• Vegetative Dystonia

Distress Responses

• Changes in everyday patterns
• Smoking
• Drug abuse
• Alcohol consumption
• Use of prescribed medication

Behavior Changes
Psychiatric Illness

• Post Traumatic Stress Disorder (PTSD)
• Acute Stress Disorder (ASD)
• Severe depression

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Post-Traumatic Stress Disorder

• PTSD was first recognized as a diagnostic entity
  in 1980, when it was included in the DSM-III. The
  symptoms include psychological numbing, amnesia
  of certain aspects of the stressful event,
  inability to experience pleasure, isolation,
  reduced interest in activities, sleeplessness,
  agitation.
• The prevalence of PTSD among
• direct victims of disasters 30-40
• rescue workers and first responders 10-20
• general population 5-10
• Long-term patterns
• A latency period of delayed onset of some
  symptoms
• Symptoms may wax and wane
• Significant psychiatric symptomatology may remain
  for as long as 14 years
• There is evidence of recurrence under the impact
  of similar events (lapsing-relapsing pattern)

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Vulnerable Groups

• Several categories of the population are likely
  to experience more serious psychological effects
  that others. People belonging to these categories
  require specialized care in the pre- and
  post-event stages if they are to avoid long-term,
  often irreversible consequences. These categories
  include
• Children
• Pregnant women
• Older adults
• People with serious mental illnesses
• Ethnic groups
• First responders
• Primary care providers
• Social workers and volunteers
• It would be a challenge to develop and implement
  any differentiated approach, because the
  population in American cities changes
  dramatically during a typical workday. U.S.
  Census data are readily available but the source
  can facilitate only the assessment of where the
  public resides and the demographics of
  neighborhoods.

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Vulnerable Groups Children

• After the Armenian earthquake of 1988, 95 of
  children from a severely exposed city and 26 of
  children from a moderately exposed city had
  severe levels of PTSD 18 months after the event
• Childrens inexperience, their incapacity to
  assess and respond appropriately to sudden
  dangers, and slow reaction times render them even
  more vulnerable than most other groups.
  Evacuation and separation from family are the
  most serious stressors for them.
• In a 2006 study of the American Academy of
  Pediatrics, half the schools surveyed admitted
  that parents of their students do not know where
  their children would be evacuated in the event of
  a major disaster including terrorism

Dr. Igor Khripunov, CITS/UGA
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Vulnerable Groups First Responders

• After the 1983 bush fires in southeastern
  Australia, a 50 prevalence of PTSD was observed
  among firefighters during the first 2 years of
  follow-up
• First responders and rescue workers are at a risk
  of adverse psychological outcomes, largely
  because of direct, extended exposure to the
  perils of a disaster. The terms compassion
  fatigue and vicarious traumatization describe
  the gradual psychological and physical decline
  that can occur when first responders are
  overloaded with traumatic events , causing their
  professional management and personal coping
  strategy to falter.
• The same is true of members of the armed forces
  involved in post-event operations. The experience
  of treating civilian casualties, particularly
  children, can markedly increase the psychological
  impact on soldiers

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Vulnerable Groups Ethnic Minorities

• A number of studies found that African-Americans
  were more likely that European Americans to
  develop PTSD despite their having fewer
  experiences of what is traditionally considered
  trauma. Latinos/Hispanics experience more PTSD
  than any other ethnic groups.
• Their psychological response is not only
  individually-based, but also influenced by
  poverty and latent racism. Survivors who are
  illegal immigrants are likely to live under
  stress for fear of being deported and in the
  context of poverty, discrimination, and
  marginalization. Survival instinct in a hostile
  environment and exposure to chronic community
  violence influences how an individual responds
  to a specific, large-scale events.

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Vulnerable Groups Athens-Clarke County

• Population (2006) 111,300
• Male 53,000
• Female 58,300
• School enrollment 50,500
• Preschool 1,960
• Kindergarten 1,500
• Grades 1-12 3,700
• Students 35,900
• People with disabilities11,300
• Non-U.S. citizens 8,100
• Age groups 111,300 (total)
• 20-60 years 66,400
• 60 years 11,900
• Note the share of the 60 age group across
  Georgia is expected to rise from 13.1 in 2000 to
  15.2 in 2010

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Vulnerable Groups Students

• When surveyed in 2006 to identify the top ten
  impediments to academic performance, eight of
  them bore some relationship to potential health
  concerns
• The number of students diagnosed with depression
  has been accelerating at an alarming rate. In
  2006, their number increased by 56 from 10 in
  2000 to 16 in 2005

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Does the Public Have Enough Trust in the
Government?
(Report Commissioned by the National Center for
Disaster Preparedness at the Mailman School of
Public Health, National Survey July 2007)
Dr. Igor Khripunov, CITS/UGA
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Getting the Public on Board

• Risk and crisis communication can be defined as a
  two-way process of information exchange with the
  public that includes multiple types of
  information with multiple purposes
• Gaining public support requires a realistic
  portrayal of risk that is accurate and draws a
  fine line between
• Hyping the threat to spur people to action and
• Trivializing the threat to provide them with
  reassurances
• Partnership with the public provides a way for
  the public to translate risk awareness into
  action and can consist of a range of activities,
  including developing and practicing contingency
  plans, such as communication, evacuation and
  sheltering
• As an important benefit, risk communication has
  the potential to build public trust and
  resilience in times of crisis.

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Resilience

• Resilience is usually defined as the ability to
  handle disruptive changes, characterized as
  emergencies that can lead to or result in a
  crisis.
• Resilience is an interactive product of belief,
  attitudes, approaches, behaviors, and physiology
  that helps people fare better during adversity.
• The aim of building resilience among the public
  would be to reduce susceptibility to challenges
  by reducing the probability of the likely effects
  of a disaster, whatever its nature might be, and
  responding effectively to such effects as they do
  occur.

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Resilience

• Effective and durable resilience in the face of
  large-scale disasters must be built on three
  tiers
• organizational for reassuring the public that the
  federal government has been doing everything
  possible to support and assist the public, when
  needed, by protecting critical infrastructure,
  improving border control, providing state-of
  the-art first aid means, dispatching appropriate
  hardware and personnel to disaster-stricken
  areas, etc.)
• social for integrating the public in local
  community planning, providing relevant
  information, and soliciting public input to make
  the arrangements as effective and palatable as
  possible. Social resilience makes society more
  coherent and cohesive but, above all, more
  confident in its objectives and values.

Dr. Igor Khripunov, CITS/UGA
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Resilience

• personal for building human qualities and traits
  enabling people to survive (resilient people bend
  rather than break during stressful conditions,
  and they return to their previous level of
  psychological and social functioning following
  misfortune)
• strengthening close relationships
• offering help and support to others
• involvement in civic, faith-based, or other local
  groups to gain social support
• developing an optimistic outlook
• encouraging the belief that people can cope and
  are robust

Dr. Igor Khripunov, CITS/UGA
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Support Pyramid for Mental Health in Emergencies
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Our Ultimate Objective

• Mental health is defined as the successful
  performance of mental functions, resulting in
  productive activities, fulfilling relationships,
  the ability to adapt to change, and successfully
  coping with adversity
• A mind is a terrible thing to waste

Dr. Igor Khripunov, CITS/UGA
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Select Sources

• Irwin Redlener, Americans at Risk Why We Are
  Not Prepared for Megadisasters and What We Can Do
  Now, (New York Alfred Knopf, 2006)
• Leon A. Schein et al, eds., Psychological
  Effects of Catastrophic Disasters Group
  Approaches to Treatment, (New York The Haworth
  Press, 2006)
• Tener Goodwin Veenema, ed., Disaster Nursing and
  Emergency Preparedness for Chemical, Biological,
  and Radiological Terrorism and Other Hazards,
  (New York Springer Publishing Company, 2003)
• Lee Clarke, Worst Cases Terror and Catastrophe
  in the Popular Imagination, (Chicago The
  University of Chicago Press, 2003)
• George D. Haddow and Jane A Bullock,
  Introduction to Emergency Management, Second
  Edition (Burlington, MA Elsevier, 2006)
• Michael K. Lindell, Carla Prater and Ronald W.
  Perry, Introduction to Emergency Management,
  (Wiley, 2006)
• Charles R. Figley, ed., Trauma and Its Wake,
  (New York Brunner/Mazel, 1985)

Dr. Igor Khripunov, CITS/UGA