Many individuals cope with the initial disaster only to become depressed six or twelve months later but certain routines can aid survivors in the process of moving forward.
Over the last 50 years, mental health interventions and research have clearly demonstrated that various mental health conditions are commonly experienced following natural disasters. It will surprise no one that depression and grief reactions are very common. For many, post-traumatic stress disorder (PTSD) and various types of anxiety will also occur.
The number of people who develop a mental health condition varies according to disaster type. For example, after cyclones, floods and wildfires around 10 percent of children develop significant disaster-related emotional health conditions. A key predictive factor is threat perception - whether you thought you were going to die during the event.
Some studies have demonstrated an increased likelihood of PTSD of 5-8 times if the individual experienced severe threat. Earthquakes usually result in higher rates of post-disaster mental health problems. This is due to the relatively higher death rate and associated realistic increase in threat perception, the often greater evidence of destruction and the frightening nature of after-shocks.
Research findings also report higher rates of mental health problems in children and adolescents compared to adults, high rates in women, and people who have lower social connections. Importantly, anyone can develop these post-disaster mental health syndromes. It is not restricted to those who have pre-existing mental health challenges.
On a more positive note, there are now very effective interventions for post-disaster mental health conditions. Following this earthquake disaster, the number of those requiring care has the potential to overwhelm any service system. However, newly developed brief interventions that can be delivered by a wide range of professionals may hold the key to more people receiving an intervention.
Recovery always takes longer than expected, and in light of Türkiye's earthquake, it will take many years given the size of the disaster and the tragic number of deaths.
Earthquakes are also known for extensive infrastructure and residential damage, which will all take time to rectify, and this leads to secondary emotional challenges. Many individuals cope with the initial disaster only to become depressed six or twelve months later, following the combination of ongoing grief and chronic stress related to the hardship of getting their lives back together.
In terms of key principles of emotional recovery; after the initial phase of search and rescue which dominates the first month, there is a benefit in encouraging people to return to as many routines as possible. For example, children returning to some form of schooling. Routines are very beneficial from an emotional perspective and allow us to put aside the trauma for a brief period of time.
Following a return to routines, is a phase of promoting community connectedness. There are clear emotional benefits in sharing adversity, thinking and caring for others and being involved in community recovery projects. One particular psychological intervention at this time is helping the individual to not see the world as one of ongoing and imminent risk. This position only helps to maintain hypervigilance and a nervous system constantly ready for ‘fight or flight’ rather than recovery.
The application of this intervention is more difficult in the face of the unpredictable nature of earthquakes and the constant reminders of after-shocks. Another key psychological task is to counter phobic avoidance, by returning to former places and activities. Again, this is a difficult task following earthquakes when reminders of the frightening event are everywhere to be seen.
Approximately six months following the event there should be a strong emphasis on preparing for the “long haul”. Such an emphasis encourages people to understand that the possibility of becoming physically overwhelmed is great, and that the adrenaline of the initial response cannot be sustained for months.
We have to emotionally and physically prepare for chronic adversity and stress, and this mindset is somewhat protective against the inevitable setbacks around delays in rebuilding and re-establishing services. Finally, after negotiating emotional challenges such as anniversaries, some in the community will experience post-traumatic growth - a sense of greater mastery, having negotiated such a tragic event.
Others unfortunately will be not so fortunate.
From a service delivery perspective, I would encourage colleagues to reach out, as there is much expertise in terms of education, training, and service implementation around the world.
Any professional who has been through such an event knows the value of passing on this wisdom and resources to help those starting the journey of recovery.
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