Ann E. Norwood

Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence

Abstract Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence–based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid–term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid–term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid–term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self– and community efficacy, 4) connectedness, and 5) hope.

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) h...

Deployment and the Probability of Spousal Aggression by U.S. Army Soldiers

OBJECTIVE To determine the relationship between length of soldier deployment and self-reports of moderate and severe spousal violence. METHODS The Conflict Tactics Scale was used to measure self-reports of behaviors exhibited in marital conflict. Surveys were administered to a 15% random sample of 26,835 deployed and nondeployed married active duty U.S. Army men and women in the 50 United States during the period 1990 to 1994. Multinomial logistic regression and ordered probit analysis were used to estimate the probabilities of moderate and severe violence by length of deployment. RESULTS After controlling for demographic variables, the probability of severe aggression was significantly greater for soldiers who had deployed in the past year compared with soldiers who had not deployed. CONCLUSIONS Deployment contributes a significant but small increase to the probability of self-reported spousal aggression during a 1-year period. Although deployment is a military operation, similar effects may be observed in certain civilian occupations.

Psychiatric Dimensions of Disaster: Patient Care, Community Consultation, and Preventive Medicine

&NA; The majority of persons exposed to a disaster do well and have only mild, transitory symptoms. However, some individuals develop psychiatric illness postdisaster. Such illnesses include those that are secondary to physical injury and sickness as well as specific trauma‐related psychiatric disorders such as acute stress disorder. The extent of the psychiatric morbidity and mortality that develops in individuals in the community depends on the type of disaster, the degree of injury sustained, the amount of life threat, and the duration of community disruption. In this paper we examine the posttraumatic responses of direct concern to psychiatrists working in a community exposed to a disaster. We review the epidemiology of posttraumatic responses, the interface of psychiatry and traumatic stress, the psychiatric disorders associated with trauma, and psychiatric consultation to the disaster community. Overall, psychiatric intervention after a disaster is based on the principles of preventive medicine and includes community consultation and outreach programs with the goals of identifying high‐risk groups, promoting community recovery, and minimizing social disruption.

The Psychological Impacts of Bioterrorism

SINCE SEPTEMBER 11, 2001, federal, state, and local government agencies’ emergency response planning has focused on possible terrorist attacks using chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) weapons. Shortly after the destruction of the World Trade Center and the attack on the Pentagon, letters containing anthrax spores were mailed to media outlets and government officials. Twenty-two people became ill and five died. Although these acts of bioterrorism were limited, millions of people were made anxious and the routine act of opening the mail became dangerous. The U.S. Postal Service was disrupted, a Senate office building was shut down, and widespread psychological, behavioral, and social impacts were felt in affected communities. Before September 11, 2001, government agencies and public health leaders in states from representative regions of the country had not incorporated mental health as a component of their overall response plan to bioterrorism.1 Anticipating the psychological and behavioral consequences of a bioterrorist attack is now an urgent task facing our government’s leaders and our nation’s healthcare system. Understanding and planning for the public’s psychological response to terrorism has far-reaching implications for the practical management of a bioterrorist event. Bioterrorism raises special issues such as administering vaccination programs, distributing prophylactic medication, evacuation, isolation, and quarantine, all of which demand skilled psychosocial management. Developing a risk communication and public education program that addresses these concerns is essential to sustain the public trust and ensure people will follow directions that help control the spread of disease. CBRNE terrorist acts may be motivated by any number of objectives: wielding power to achieve a political goal, exacting revenge, punishing nonbelievers, or enacting an apocalyptic vision. The victims who are killed, injured, or even directly affected are rarely the primary target.2 It is the fear and terror instilled in the public’s psyche, the loss of one’s sense of personal and community safety, and the disruption of critical social infrastructure that can cripple a nation’s economy and leadership. In the immediate aftermath of a terrorist attack, individuals and communities may respond in adaptive, effective ways based on information and directions from trusted leaders or they may make fear-based decisions, resulting in unhelpful behaviors or even panic. Understanding the psychological responses to a CBRNE attack enables leaders and medical experts to talk to the public, promoting resilient healthy behaviors and sustaining the social fabric of the community. Recognizing the influence that psychological distress has on physical symptoms, illness, and injury allows medical personnel to more effectively triage and treat patients. Managing psychological distress that will be ubiquitous, as distinct from psychiatric illness, is appropriate and restorative and decreases the likelihood of future mental health problems.

Disaster psychiatry: Principles and practice

Increasingly, trauma and disasters are part of everyday life. Psychiatrists can play an important role in assisting individuals and communities to recover. They bring a unique set of skills and experiences that can be invaluable in minimizing morbidity and facilitating recovery. This paper discusses psychological, physiological, behavioral, and community responses encountered in the aftermath of a disaster. A preventive medicine model of understanding disaster response is discussed in which the psychiatrist delineates traumatic stressors and high-risk populations. The importance of psychiatric participation in disaster preparedness is emphasized. Psychiatric interventions targeted at the various longitudinal phases of disaster response are reviewed.

Postdeployment Domestic Violence by U.S. Army Soldiers

The objective of this study was to determine whether a military deployment of 6 months predicted domestic violence against the wives of deployed and nondeployed soldiers during the postdeployment period. The method involved the completion of an anonymous questionnaire by a sample of the spouses of soldiers deployed from a large U.S. Army post. The Conflict Tactics Scale identified incidents of domestic violence by the soldier husbands, and a logistic regression model predicted domestic violence during the postdeployment period. The results indicate that deployment was not a significant predictor of domestic violence during the first 10 months of the postdeployment period. Younger wives and those who were victims of predeployment domestic violence were more likely to report postdeployment domestic violence. The conclusion was that interventions for domestic violence in the U.S. Army should address risks among younger couples and those with a previous incident of domestic violence.

Spouse abuse recidivism in the U.S. Army by gender and military status

Recidivism by spouse abusers was investigated using records of offenders in the U.S. Army Central Registry. Recidivism by gender and military status (active-duty or civilian spouse) was compared over a 70-month period. Between fiscal years 1989-1997, 48,330 offenders were identified in initial and recidivist incidents. Recidivism was analyzed by means of a Cox proportional hazard rate model, controlling for age, race, number of dependents, education, and substance abuse. Two different sets of survival curves were obtained: (a) Men were much more likely than women to have a recurrence and (b) within gender, civilians were more likely to have a recurrence than were active-duty military personnel. At 70 months, 30% of the male civilian offenders and 27% of the male active-duty offenders had committed a subsequent spouse abuse incident compared with 20% of the female civilian offenders and 18% of the female active-duty offenders, controlling for other variables.

Scarce resources for nuclear detonation: project overview and challenges.

Aterrorist nuclear detonation of 10 kilotons would have catastrophic physical, medical, and psychological consequences and could be accomplished with a device in a small truck. Tens of thousands of injured and ill survivors and uninjured, concerned citizens would require medical care or at least an assessment and instructions. In proximity to the incident location, there would be a huge imbalance between the demand for medical resources and their availability.1-3 Beyond the immediate blast area, much of the infrastructure would remain intact. Most people would reach medical care by selfreferral and require sorting and assessment to determine what medical intervention is necessary, appropriate, and possible.

Belief in exposure to terrorist agents: reported exposure to nerve or mustard gas by Gulf War veterans.

September 11 brought increased awareness that even the threat of chemical and biological terrorism can overwhelm this country’s health care system. Belief in exposure to toxic agents, even when none is documented, is not uncommon in crisis and merits vigilant health care evaluation and services. This study examined risk factors (demographics, physical symptoms, clinical diagnosis, exposures, and health status) for belief in exposure to potential terrorist agents (nerve or mustard gas) using a large sample of Gulf War veterans who reported belief in exposure to nerve or mustard gas. We found that females, nonwhites, and those who were older (age 32 to 61 years) were more likely to report exposure. When adjusting for demographics and military service, these veterans reported more exposures (nonnerve or mustard gas) to potentially toxic agents and traumatic events (odds ratio [OR], 6.80; p < .001), reported more physical symptoms during the Gulf War (OR, 2.38; p < .001), were more likely to be diagnosed with a mental disorder (OR, 1.72; p < .001), and reported poorer current health status (OR, 3.47 to 1.22; p < .001). Not unlike previously reported studies of disasters, traumatic exposures, or risk exposures, belief in exposure to toxic agents suggests that certain people are at a greater health care risk. This knowledge will aid in better responding to rapid demands that may be placed on our health care delivery systems in times of potential terrorist activity.