This book provides a comprehensive overview of the most sustainable comprehensive mental health recovery and research program conducted after a natural disaster.
On December 7, 1988, a powerful earthquake measuring 6.9 on the Richter scale struck northwestern Armenia, causing widespread destruction and death. In Gumri, Armenia’s second largest city, more than half of the buildings were badly damaged or destroyed and 7% of the population died. The town of Spitak near the epicenter was almost completely razed and 16% of the population died. After the earthquake, Armen Goenjian, MD, LDFAPA, FACGS initiated and directed the Psychiatric Outreach Program and, with a group of dedicated volunteer psychiatric professionals, provided service to survivors for more than two decades.
dr Goenjian and his UCLA colleagues — Alan Steinberg, PhD, and Robert Pynoos, MD — have studied the psychological aftermath of the Armenian earthquake and other major disasters in the United States, Greece, Nicaragua, Taiwan, Honduras, Thailand and Japan. You recently published the book Lessons from Disaster Mental Health: The Earthquake in Armenia and Beyond. The book provides a comprehensive overview of the most sustainable comprehensive mental health recovery and research program conducted in the aftermath of a natural disaster.
The book covers the development of the program, from the initial acute phase of clinical field research, through its expansion as a three-year teaching and training program for local therapists, to the construction of two mental health clinics in the devastated cities. It provides a wealth of longitudinal data on the course of post-traumatic stress disorder (PTSD), depression, grief and separation anxiety in treated and untreated subjects.
“One of the reasons these treatment studies are unique is that adolescents were followed up to 25 years after the earthquake,” said Dr.
“Almost all reported studies of follow-up treatment outcomes were conducted 2 years or less after a disaster. Only a handful have followed issues up to 5 years,” said Dr. Steinberg, associate director of the UCLA/Duke University National Center for Child Traumatic Stress.
In controlled studies, adolescents who received trauma- and grief-focused therapy 1.5 years after the earthquake had significantly fewer PTSD and depressive symptoms than controls at 5 years, and the benefits persisted at 25 years of follow-up. The new analyzes showed that symptoms plateaued between 4 and 5 years after the earthquake in both the treatment and control groups. “The results demonstrate the importance of providing clinical intervention within the first few years and then monitoring severely affected survivors for chronic psychiatric and medical problems,” said Dr. goenjian “People with severe PTSD and/or depression at baseline had significantly more chronic medical conditions.”
Another finding was the significant impact that post-disaster adversity (often referred to as “the disaster after the disaster”) played in maintaining PTSD and depressive symptoms. The findings underscore the important role that governmental and non-governmental organizations could play in survivors’ recovery by providing timely housing, heat, electricity, transportation and medical care. “These types of supportive measures complement the benefits of psychotherapy and apply to other types of natural and man-made disasters, wars and violence, including domestic ones,” said Dr. goenjian
Another valuable chapter deals with moral development and the functioning of conscience. “Spitak youth exposed to severe earthquake trauma showed pathological disorders of conscience function,” said Dr. Steinberg. For example: “These youth felt that after the earthquake they lost their conscience – that their conscience no longer works – and felt that acting without regard for morality was justified in order to survive.”
“Multigenerational genetic studies demonstrated the heritability of susceptibility to PTSD, depression and anxiety. They also showed pleiotropy — i.e., sharing of genes between PTSD, depression, and anxiety,” said Dr. goenjian They also identified 2 serotonergic genes (TPH1 and TPH2) and 1 dopaminergic gene (COMT) associated with PTSD. Whole exon sequencing results showed an association between OR4C3 (the gene for olfactory receptors) and PTSD. Carriers of these genes had a higher risk of PTSD. “Such results give us hope that advances in psychiatric genetics will one day be translated into therapeutic and preventive approaches,” said Dr. goenjian
The book also discusses key organizational successes and pitfalls in implementing the post-disaster recovery program. Regarding factors related to therapist performance and minimizing burnout, helpful steps included pre-enrollment screening of applicants; Holding regular pre-departure group meetings with new members to disseminate and promote information gathered from previous groups spirit of the corps; Providing guidelines for decency, such as B. Refraining from political and religious activism; and respect for local traditions, customs and religious practices.
The therapists worked in pairs to support each other. They had regular debriefings with colleagues or group leaders to discuss challenging cases and their own stress responses to the painful realities. They also took weekly rest days. These measures helped to minimize burnout.
“Despite the many emotional and physical hardships of working in the aftermath of the earthquake, almost all therapists acknowledged that helping survivors was one of their most rewarding life experiences,” said Dr. goenjian
He concluded, “My favorite chapter, which represents the soul of the book, is the heartbreaking, compassionate memoir of the two therapists.”
Mr Mühlmann is Senior Media Relations Officer at UCLA Health. Mr. Steinberg is Associate Director of the National Center for Child Traumatic Stress in UCLA’s Department of Psychiatry. dr goenjian is a specialist in psychiatry. He is Research Professor of Psychiatry at the UCLA Geffen School of Medicine and Chief Medical Officer of the CenExel-CNS Network.