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The importance of secondary trauma exposure for post-disaster mental disorder

Published online by Cambridge University Press:  10 January 2012

R. C. Kessler ,
K. A. McLaughlin ,
K. C. Koenen ,
M. Petukhova  and
E. D. Hill
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
K. A. McLaughlin
Affiliation:
Division of General Pediatrics, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
K. C. Koenen
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
M. Petukhova
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
E. D. Hill
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: R.C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: [email protected])
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Abstract

Background.

Interventions to treat mental disorders after natural disasters are important both for humanitarian reasons and also for successful post-disaster physical reconstruction that depends on the psychological functioning of the affected population. A major difficulty in developing such interventions, however, is that large between-disaster variation exists in the prevalence of post-disaster mental disorders, making it difficult to estimate need for services in designing interventions without carrying out a post-disaster mental health needs assessment survey. One of the daunting methodological challenges in implementing such surveys is that secondary stressors unique to the disaster often need to be discovered to understand the magnitude, type, and population segments most affected by post-disaster mental disorders.

Methods.

This problem is examined in the current commentary by analyzing data from the WHO World Mental Health (WMH) Surveys. We analyze the extent to which people exposed to natural disasters throughout the world also experienced secondary stressors and the extent to which the mental disorders associated with disasters were more proximally due to these secondary stressors than to the disasters themselves.

Results.

Lifetime exposure to natural disasters was found to be high across countries (4.4–7.5%). 10.7–11.4% of those exposed to natural disasters reported the occurrence of other related stressors (e.g. death of a loved one and destruction of property). A monotonic relationship was found between the number of additional stressors and the subsequent onset of mental disorders

Conclusions.

These results document the importance of secondary stressors in accounting for the effects of natural disasters on mental disorders. Implications for intervention planning are discussed.

Keywords

Natural disastersneeds assessmentpost-disaster intervention planning
Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 21 , Issue 1 , March 2012 , pp. 35 - 45
Copyright
Copyright © Cambridge University Press 2012

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