ABSTRACT
In a national study of the U.S. population, 15% of women and 19% of men reported exposure to a natural disaster during their lifetime.(1) Although a range of psychopathologies can occur after these events (2, 3), posttraumatic stress disorder (PTSD) is the most commonly studied and likely the sentinel psychopathology after exposure to a disaster.(3-6) In this chapter we present (a) an overview of the current evidence in the field regarding PTSD and disasters, (b) the challenges of postdisaster research with consideration of how these may influence our understanding of the consequences of disasters, and (c) future research directions to strengthen the field of PTSD and disasters. Before we embark on the chapter, we note two limitations. First, we do not intend this chapter to be a comprehensive review of all current evidence in the field of PTSD and disasters; instead, we provide a summary of some of this evidence, largely drawing from previous reviews in the field.(3-6). Second, substantial debate exists in the peerreviewed literature as to what constitutes a disaster. We refer the reader to other work that has considered this question in greater detail.(7) In the context of this chapter, we consider disasters to be unexpected and acute events that can be human made, technological, or natural.(3, 7)
SUMMARY OF EVIDENCE REGARDING PTSD AFTER DISASTERS
We first consider the prevalence of PTSD after disasters among specific groups that are largely defined by their type and intensity of exposure: survivors, rescue workers, the general population, and children. This is followed by evidence from the literature regarding various sociodemographic covariates of PTSD after disasters-gender, social support, age, socioeconomic status, and race or ethnicity. We also note-reflecting the predominant analytic mode of most disaster literature-that we use the term prevalence rather than incidence to document the burden of PTSD after disasters because very few studies have ensured predisaster PTSD was absent in their participants. This convention is consistent with previous reviews in the literature.(4, 5)
Studies of human-made and technological disasters In general, a high prevalence of PTSD has been documented among survivors of human-made or technological disasters, ranging from approximately 20% to 75%.(4, 5) For example, a study of the 1993 religious uprisings in Sivas, Turkey, found that the prevalence of PTSD 1 month postdisaster was 20.3% among survivors.(8) At the other extreme, by retrospectively assessing survivors of the 1998 Piper Alpha oil rig disaster 10 years postdisaster, Hull and colleagues showed that the prevalence of PTSD was 73% among survivors 3 months postdisaster.(9) Another study that assessed PTSD around 6 months after the 1995 Oklahoma City bombing found that 34.3% of survivors had PTSD (10); a similar burden of PTSD was found 1 month after the 1991 mass shooting in Killeen, Texas (11), 6 months after the 1992 Biljermeer plane crash (12), and 13 months after the 1998 Lockerbie plane crash.(13)
A substantial burden of PTSD has also been found among rescue workers after disasters. For instance, a substantial proportion of police officers were found to exhibit PTSD symptoms 1 to 2 years after the 1989 Hillsborough football stadium disaster in Sheffield, UK-44.3% exhibited severe symptoms, while an additional 41.4% exhibited moderate symptoms.(14) Studies of rescue workers after the September 11 terrorist attacks in New York City found that the prevalence of PTSD ranged from 22.5% at 2 weeks (15) to 20% 10 to 15 months after exposure.(16) After the 1989 USS Iowa gun turret explosion, 11% of volunteer disaster workers suffered from PTSD 1 month postdisaster.(17) Potentially complicating cross-study comparability of these
results, the percent of rescue workers with PTSD may differ depending on the type of work performed. A study that assessed the prevalence of PTSD among rescue workers 2 to 3 years after the September 11 terrorists attacks in New York City found that the overall prevalence of PTSD was 12.4% but that of unaffiliated volunteers and construction/engineer workers was especially high-21.2% and 17.8%, respectively.(18)
Studies that have assessed the psychological burden of disasters among the general population have generally found, not surprisingly, a lower prevalence of PTSD than that of survivors or rescue workers.(4) After the Los Angeles civil disturbances, Hanson and colleagues estimated that the prevalence of PTSD 6 to 8 months after these disturbances was 4.1% in the general population.(19) Subsequent work of general populations collected within 12 months of disasters such as the September 11 terrorist attacks in New York City (20-22), the 1989 Exxon Valdez oil spill (23), and the 2004 train bombings in Madrid (24), found a similar burden of PTSD in relevant areas.
