The September 1999 Earthquake in Taiwan and Posttraumatic Stress

Background

The earthquake that struck Taiwan on September 21, 1999 left over 2,000 people dead and more than 4,000 injured (as of September 22). More than 100,000 were left homeless in the island's rugged central regions. Clinical and research information collected from previous earthquakes has helped us to understand that survivors face both the danger of death or physical injury and the loss of their loved ones, homes, possessions, and communities.

The effects of these traumas are immeasurable and long lasting. Survivors are at high risk for behavioral and emotional readjustment problems. Psychiatrists in Turkey reported high rates of "nervous reactions" and "reactive depression" in the immediate aftermath of the earthquake there.

The traumatic effects of earthquakes

Posttraumatic Stress Disorder occurs in 32% to 60% of the adult survivors and 26% to 95% of the children survivors who have been evaluated after earthquakes. Rather than being a circumscribed event with a defined endpoint, earthquakes tend to produce a series of events that continue to affect people's lives over a prolonged period.

Persistent or recurring disruptions from the earthquake substantially contribute to continued mental-health problems. General psychological distress levels following an earthquake appear to stabilize after about 12 months, but posttraumatic stress reactions do not stabilize until 18 months after the earthquake.

In some individuals, there is a high likelihood of permanent psychological symptomatology following earthquake exposure. This is particularly true of those who have the highest level of exposure and the greatest concentration of personal loss and damage associated with the earthquake. Coping with stress by using avoidance measures (e.g., withdrawal from the situation, isolation, trying to avoid further stressors) appears to contribute to continued distress and posttraumatic stress.

Older people and those with a prior history of mental-health problems seem to be at greater risk than others for experiencing posttraumatic stress following an earthquake (1). Also at risk are (1) rescue workers with high levels of catastrophic exposure and (2) individuals who, in reaction to the earthquake, tend to "dissociate," or become "numb," and have a sense of being detached from their emotions and bodily experiences for a prolonged period of time (2).

Research on earthquakes in Asia

A study specific to the Chinese population was conducted following the Yunnan earthquake of November 6, 1988, which measured 7.6 on the Richter scale. Although statistics show that 643 people were killed and 3,558 injured (one-third of them seriously), the earthquake affected over 430,000 people.

In the most severely affected regions, psychiatric morbidity rates doubled, with 60% of the population scoring 5 or greater on the 28-item General Health Questionnaire. Because these rates of morbidity were seen 6 months after the disaster, it seems likely that researchers were detecting an enduring pattern of psychiatric morbidity rather than the acute distress one might expect to see immediately following a major disaster.

Similar findings were observed twelve months after a major bush fire in Australia. In this rural Chinese population, much of the posttraumatic morbidity expressed itself as somatic symptoms (3).

Large-scale epidemiological surveys of the urban Japanese population affected by the Kobe earthquake in January 1995 have not yet been published. Therefore, knowledge of the earthquake's effects is based largely on smaller studies and anecdotal observations.

Most of the victims experienced emotional numbness soon after the earthquake. During the first week, there was widespread general anxiety and fear of aftershocks, together with survivor's guilt among those who had lost family members.

After ten days of living in shelters, many victims found life extremely stressful, with anxiety reactions and sleep disorders common. Depression was common, and some survivors experienced acute stress symptoms such as flashbacks.

An eyewitness reported, "Three years after the earthquake, victims are still suffering from psychological difficulties resulting mostly from living isolated lives in temporary housing." (This also led to such physical consequences as increased alcohol use and greater risk of coronary and respiratory disease.) The groups most vulnerable to long-term consequences included the elderly who lost relatives, fatherless families, physically and mentally handicapped people, and foreigners from developing countries (4).

In the immediate wake of the earthquake, assisting survivors with obtaining shelter and getting information on financial assistance for rebuilding their homes and lives does more to reduce stress than providing psychological counseling, which is not effective until one month after the disaster (5).

The consequences of traumatic stress

Immediate consequences of trauma, affecting the majority of people who experience severe stress, include:

• Emotional symptoms: shock, intense fear, tearfulness, anger, shame, helplessness, nervousness, numbness
• Mental symptoms: confusion, disorientation, unwanted memories, decreased concentration
• Physical symptoms: bodily injury, muscular tension, fatigue, edginess, change in sleep and appetite, gastrointestinal problems, racing heart, bodily aches and pains

Long-term consequences of severe stress can be complex and severe, including marked interpersonal changes such as apathy, anger, and isolation. Long-term consequences can also include psychiatric disorders such as:

• Posttraumatic Stress Disorder (PTSD): Reexperiencing the trauma in memories and dreams, avoiding anything reminiscent of the event, memory loss, emotional numbing, sleep disturbance, anxiety
• Depression: loss of hope, self-worth, motivation, or purpose in life; fatigue; decreased pleasure in previously enjoyed activities; changes in sleep and appetite; suicidal thoughts or actions
• Alcohol and Substance Abuse

Treatment

While the consequences of traumatic stress are severe and complex, treatments are available that significantly reduce symptoms and improve quality of life. See the National Center for PTSD fact sheet on treatment for further information.

Sources

Carr, V.J., Lewin, T.J., Webster, R.A., & Kenardy, J.A. (1997). A synthesis of the findings from the Quake Impact Study: A two-year investigation of the psychosocial sequelae of the 1989 Newcastle earthquake. Social Psychiatry, 32, 123-136.

Marmar, C., Weiss, D., Metzler, T., Delucchi, K., Best, S., & Wentworth, K. (1999). Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. Journal of Nervous and Mental Disease, 187, 15-22.

McFarlane, A. C. & Hua, C. (1993). Study of a major disaster in the People's Republic of China: The Yunnan earthquake. In J.P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 493-498). New York: Plenum Press.

Shinfuku, N. (1999). To be a victim and a survivor of the great Hanshin-Awaji earthquake. Journal of Psychosomatic Research, 46, 541-548.

Joh, H. (1997). Disaster stress of the 1995 Kobe earthquake. Psychologia, 40, 192-200.