Tsunami and Mental Health: What Can We Expect?

Following the tsunami in Southern Asia, we were aware of the staggering scope of the destruction of this disaster. The damage, confusion and chaos caused by the tsunami were reflected in news reports that scrambled to convey the enormity of the event.

Early reports were of a tsunami that had killed thousands of people, but later, the toll still rising, it was confirmed that the tsunami had killed over 200,000. Whole towns and villages have been wiped off the coast of Indonesia, victims count in the millions, communities have lost entire economic livelihoods and families have been broken apart by death, many children dead and orphaned. Dozens of countries have been affected.

The tsunami has not only killed thousands of people, destroyed buildings and towns and damaged the physical health of survivors but has also severely affected their psychological well-being. Faced with the overwhelming knowledge of this vast devastation it is natural to wonder how the survivors of disasters will cope as a result, what they are at risk for psychologically and how they can be helped.

Mental illness and risk factors

What research has shown

Millions of people have been directly affected by this tsunami and yet according to percentages, the vast majority of them will recover due to the resiliency of human nature. At the same time, many of those people will develop psychological disorders such as major depression, generalized anxiety, and posttraumatic stress disorder. Many more will experience non-specific distress, somatic complaints and other medical health conditions.

If the rate of psychological problems turns out similar to previous severe natural disasters studied (e.g., Armenian earthquake, mudslides in Mexico, Hurricane Andrew in the United States) 50% or more of those effected could suffer from clinically significant distress or psychopathology.

Although we do not have extensive knowledge of the mental health consequences of tsunamis in particular, we do know from other large-scale disasters (such as the earthquakes in Asia, floods, volcanoes, and hurricanes in North and Central America) that the impact on the mental health of survivors is sometimes enormous. Thus the mental health consequences of a disaster on the scale of this tsunami promise to be massive and severe. Studies of these other natural disasters have identified the following factors that indicate individuals more at risk

Severity of exposure

The amount of exposure to the disaster is highly related to risk of future mental problems. Both individual and community exposure will play a role. Those that directly experienced the tsunami, followed by those in close contact with victims will experience more lasting impact than those who only had indirect experiences, such as news of the enormity of the devastation. The current literature shows that injury and life threat are most predictive of likelihood of psychological impairment.

Gender and family variables

Almost always, women or girls were affected more adversely than were men or boys. The presence of children in the home increases the stressfulness of disaster recovery. Marital stress has been found to increase after disasters.

Children

At least 30% of the survivors of the tsunami are children. Past research on the reactions of children to natural disasters is limited, yet this proportion of children survivors is especially troubling since children generally exhibit more severe distress after disasters than do adults. This is an especially relevant concern for the tsunami disaster where the United Nations estimates 50,000 children have died in the disaster and that tens of thousands have been orphaned. In some countries hit by the tsunami half the population affected is under 19 years old.

Individual risk factors

We know also that the rates of mental illness could potentially be even higher than from other disasters studied previously because the victims of the 2004 tsunami are likely to have experienced multiple intense stressors. Pre-disaster functioning, secondary stressors and psychological resources are important in determining resilience.

Factors such as bereavement, injury to self or another family member, life threat, panic or similar emotions during the disaster, horror, separation from family (especially among youth), extensive loss of property, and displacement have been found to predict adverse outcomes.

Higher risk for developing countries

Compounding these individual risk factors is the fact that disasters occurring in developing countries cause more numerous and severe mental health consequences than do disasters in developed countries.

After completing a comprehensive review of the literature on disasters, Dr. Fran Norris said, "The location of the disaster had an even stronger influence on the severity of its psychosocial outcomes than did its type. On average, natural disasters in developing countries had more severe effects than did incidents of mass violence in developed countries although usually human-caused disasters are thought of as being more serious." Most areas affected by this tsunami were economically underdeveloped.

Social support

Social support is one of the key ingredients to recovery. Yet throughout Asia the various systems and structures of social support have been damaged by this tsunami. Whole communities were pulled apart, families and friends lost and separated, physical community centers and hospitals destroyed, and roads to connect people washed away. It will be even more difficult for communities to rally around survivors and aid in recovery.

"Attending to the social needs of disaster victims could go a long way towards protecting them from long-term adverse psychological consequences," Dr. Norris said.

Despite these estimates we still do not know the exact numbers that will develop serious and entrenched psychological problems or the number of individuals that will recover in the next few months.

Based on previous studies of disasters human resilience dictates that a large number of individuals will naturally recover from the event and move on, without experiencing debilitating mental health issues.