James M. Shultz

The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response

citingsymptomaticpatientsescap-ing from treatment units, families concealing sick rela-tives at home, preferential use of traditional healers,andphysicalcontactwithinfectiouscorpses.Neverthe-less, the Roadmap includes few recommendations toalleviate fear behaviors and address mental healthneedsinEbola-affectedcommunities.InWestAfrica,Ebolavirusdiseasearousesfearbe-haviors, in part because many have witnessed thegraphic hemorrhagic manifestations of those infectedandthebodiesofthosewhohavedied.Thecorpsesandbeddingofpatientswhohavediedposeinfectionhaz-ardstohealthcareworkersandfamilymembers.AsofDecember14,2014,649front-linehealthcareworkershavebecomeilland365havedied.

Welcome to Disaster Health

As Editors-in-Chief, and on behalf of our distinguished Editorial Board, we are thrilled to welcome you to this inaugural issue of Disaster Health. Disaster Health is uniquely focused on the intersection of disaster mental and behavioral health and disaster public health. In this multi-disciplinary arena, scientific advances are accelerating. Disaster Health provides a mechanism for expeditious sharing of research findings and a forum for collegial commentary and expert consensus building. Disaster Health investigates the linkage between exposure to the physical forces of harm in a disaster and the corresponding risks to mental and behavioral health. Disaster Health examines the continuum of human response to disaster threat and impact, ranging from psychological distress and psychopathology to resilience, wellness and post-traumatic growth. At the community and societal levels, Disaster Health explores the psychological and behavioral dimensions of disaster prevention, mitigation, risk reduction and resilience. As a rapid-publication, peer-reviewed journal, Disaster Health prioritizes the publication of well-designed and well-executed studies that solidify and enrich the scientific evidence base. We seek publications spanning the complete spectrum of natural, Welcome to Disaster Health

Mitigating flood exposure

Introduction. In 2011, following heavy winter snowfall, two cities bordering two rivers in North Dakota, USA faced major flood threats. Flooding was foreseeable and predictable although the extent of risk was uncertain. One community, Fargo, situated in a shallow river basin, successfully mitigated and prevented flooding. For the other community, Minot, located in a deep river valley, prevention was not possible and downtown businesses and one-quarter of the homes were inundated, in the city’s worst flood on record. We aimed at contrasting the respective hazards, vulnerabilities, stressors, psychological risk factors, psychosocial consequences, and disaster risk reduction strategies under conditions where flood prevention was, and was not, possible. Methods. We applied the “trauma signature analysis” (TSIG) approach to compare the hazard profiles, identify salient disaster stressors, document the key components of disaster risk reduction response, and examine indicators of community resilience. Results. Two demographically-comparable communities, Fargo and Minot, faced challenging river flood threats and exhibited effective coordination across community sectors. We examined the implementation of disaster risk reduction strategies in situations where coordinated citizen action was able to prevent disaster impact (hazard avoidance) compared to the more common scenario when unpreventable disaster strikes, causing destruction, harm, and distress. Across a range of indicators, it is clear that successful mitigation diminishes both physical and psychological impact, thereby reducing the trauma signature of the event. Conclusion. In contrast to experience of historic flooding in Minot, the city of Fargo succeeded in reducing the trauma signature by way of reducing risk through mitigation.

Triple Threat Trauma: Evidence-Based Mental Health Response for the 2011 Japan Disaster

1. Director, Center for Disaster & Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, Florida USA 2. Department of Adult Psychiatry, University College Dublin, Mater Miserlcodiae University Hospital, Dublin Ireland 3. Deputy Director, Australian Centre for Posttraumatic Mental Health (ACPMH), Department of Psychiatry, The University of Melbourne, East Melbourne, Victoria Australia 4. Teachers College and Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York USA 5. Department of Psychology, University of Minnesota, Minneapolis, Minnesota USA 6. Research Associate, Center for Disaster & Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, Florida USA 7. Professor of Clinical Psychology, Director, Trauma and PTSD Program, Columbia University, Department of Psychiatry, and the New York State Psychiatric Institute, New York, New York USA

Internal displacement in Colombia: Fifteen distinguishing features

This commentary aims to delineate the distinguishing features of conflict-induced internal displacement in the nation of Colombia, South America. Even as Colombia is currently implementing a spectrum of legal, social, economic, and health programs for “victims of armed conflict,” with particular focus on internally displaced persons (IDPs), the dynamics of forced migration on a mass scale within this country are little known beyond national borders. The authors of this commentary are embarking on a global mental health research program in Bogota, Colombia to define best practices for reaching the displaced population and implementing sustainable, evidence-based screening and intervention for common mental disorders. Presenting the defining characteristics of internal displacement in Colombia provides the context for our work and, more importantly, conveys the compelling and complex nature of this humanitarian crisis. We attempt to demonstrate Colombia’s unique position within the global patterning of internal displacement.

Care of children exposed to the traumatic effects of disaster

Preface. Acknowledgments. Disaster, stress, and trauma. Natural and human-generated disasters. The context of trauma. Childrens psychological responses to disasters. Children with special needs during disasters. Traumatic bereavement. Child and family assessment. Interventions. Generally accepted truths: the psychological effects of trauma on children. Index.

Trauma Signature Analysis of the Great East Japan Disaster: Guidance for Psychological Consequences

OBJECTIVES On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japans eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event. METHODS The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis. RESULTS Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japans timely, expert-coordinated, and unified activation of an evidence-based mental health response. CONCLUSIONS The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience.

Fatal school shootings and the epidemiological context of firearm mortality in the United States

Background The December 14, 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, USA, vaulted concerns regarding gun violence to the forefront of public attention. This high-visibility incident occurred within the epidemiological context of U.S. firearm mortality that claims more than 88 lives daily. Methods National epidemiologic data on firearm deaths over two decades were analyzed along with data registries on school shootings in order to place the tragedy at Sandy Hook in perspective. School shootings were classified as random or targeted. Results The U.S. has the highest rates of firearm deaths, suicides, and homicides among the world’s 34 “advanced economies.” Seventy percent of U.S. homicides and more than 50% of U.S. suicides are committed using a firearm. U.S. firearm homicide rates first declined, and then stabilized, during the past 23 years, 1990-2012. “Shooting massacres” in school settings, a new phenomenon within the past 50 years, are extremely rare events. Over 23 years, 1990-2012, 215 fatal school shooting incidents resulted in 363 deaths, equivalent to 0.12% of national firearm homicides during that time period. Most episodes were “targeted” shootings in which the perpetrator intentionally killed a specific individual in a school setting. Only 25 of these 215 events (11.6%) were “random” or “rampage” shootings, resulting in 135 deaths (0.04% of national firearm homicides). Among these, just three shooting rampages – Columbine High School, Virginia Tech University, and Sandy hook Elementary School – accounted for 72 (53.3%) of these 135 deaths. The frequency of random/rampage shooting incidents in schools has remained within the narrow range of 0 to 3 episodes per year. Conclusions Each year, more than 32,000 Americans die by firearms and more than 70,000 are wounded, representing a volume of preventable deaths and injuries that the U.S. government describes as a “public health crisis.” School massacres, such as Sandy Hook, occur periodically, galvanizing public reaction and bringing forth a collective call for intervention. Epidemiological analyses position these rare, but uniquely compelling, incidents within the broader national patterns of gun violence. The intention is to inform the selection of a balanced, comprehensive set of effective remedies to address the daily death toll from firearm suicides and “targeted” firearm homicides that account for more than 99% of firearm fatalities; as well as the rare, random, and sporadic rampage shootings in school or community settings.

Psychological consequences of indirect exposure to disaster due to the haiti earthquake

INTRODUCTION Few studies have focused on the mental health consequences of indirect exposure to disasters caused by naturally occurring hazards. The present study assessed indirect exposure to the 2010 earthquake in Haiti among Haitian-Americans now living in Miami; these subjects had no direct exposure to the earthquake, but retained their cultural identity, language, and connection to family and friends in Haiti. METHODS Two months following the earthquake a sample of Haitian-Americans was surveyed inquiring about: (1) their psychological reactions to the quake; (2) types of exposures experienced by their family members and friends in Haiti; and (3) symptom levels of (a) major depression, (b) generalized anxiety disorder, (c) complicated grief, (d) mental health status, and (e) physical health status. RESULTS Haitian-Americans living in Miami experienced a broad spectrum of indirect exposures to the 2010 earthquake in Haiti. These exposures were strongly associated with psychological distress, trauma-related mental health consequences, and diminished health status. Most notable was the multiplicity of indirect exposures to the on-scene experiences of multiple family members and friends in Haiti. CONCLUSIONS Consideration should be given to the psychological impact and needs for support among indirectly-exposed populations with strong affiliation to directly-impacted victims.

Mitigating the Mental and Physical Health Consequences of Hurricane Harvey

The complexity of the disaster risk landscape and the exposure of large human populations to prolonged and potentially traumatizing events were on full display during Hurricane Harvey. During the 5 days of Hurricane Harvey, more than 33 trillion gallons of rain fell on Texas and Louisiana and set a continental US record for rainfall at 51.88 in (131.78 cm). Among 13 million persons directly affected by the storm, more than 22 000 were rescued from floodwaters, an estimated 32 000 displaced survivors were temporarily housed in shelters, and at least 450 000 will apply for Federal Emergency Management Agency (FEMA) disaster assistance.1 More than 100 000 homes were damaged and only 17% of the affected residents had flood insurance. Damage and recovery estimates are projected to exceed those incurred during Hurricane Katrina (