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Practice

Disasters, pandemics and mental health

Clare Pain and Ruth Lanius
CMAJ July 13, 2020 192 (28) E803; DOI: https://doi.org/10.1503/cmaj.200736
Clare Pain
Department of Psychiatry (Pain), University of Toronto; Psychological Trauma Program (Pain), Mount Sinai Hospital, Toronto, Ont.; Department of Psychiatry (Lanius), Western University, London, Ont.
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Ruth Lanius
Department of Psychiatry (Pain), University of Toronto; Psychological Trauma Program (Pain), Mount Sinai Hospital, Toronto, Ont.; Department of Psychiatry (Lanius), Western University, London, Ont.
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Mental distress is common in public health emergencies

After a disaster, population rates of psychological distress tend to double or triple. Acute-phase reactions and disorders generally resolve within a year; however, there is considerable variation in recovery times.1 Subsequent to the accident at the Fukushima Daiichi Nuclear Power Plant, for example, 6% of people affected remained severely distressed 3 years after the incident.2

Prolonged exposure to war and conflict increases the prevalence of mental illness

Among people who have experienced war in the previous 10 years, 21% have a mental health disorder, and 9% meet standardized criteria for moderate or severe mental illness.3 However, focusing exclusively on psychiatric disorders overlooks a range of health risk behaviours, such as substance misuse, which is associated with increased domestic violence and accidents.1

Clinicians can focus their attention on those at risk for mental health disorders

Much of the initial distress in a population is self-limiting. Risk factors for prolonged and more intense distress include a pre-existing psychiatric disorder, poverty and inadequate housing.4 Subjective sleep insufficiency, substance overuse and poor social support are associated with more severe psychological distress.1,2

Misinformation can contribute to distress

Without access to relevant and accurate information about the disaster there is increased community distress, leading to a reduction in positive health behaviours, which can strain public health systems.1

Safety and security are first priorities

Addressing personal, family and workplace safety is fundamental to a competent response to disaster. Maintaining a regular schedule for sleep, exercise and eating helps regulate emotions. Connecting at both the individual and community level is key to optimizing health.5

CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc.manuscriptcentral.com/cmajeditornote

Footnotes

  • CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/200736-five

  • Competing interests: None declared.

  • This article was solicited and has been peer reviewed.

References

  1. ↵
    1. Morganstein JC,
    2. Ursano RJ
    . Ecological disasters and mental health: causes, consequences, and interventions. Front Psychiatry 2020;11:1.
    OpenUrl
  2. ↵
    1. Oe M,
    2. Maeda M,
    3. Nagai M,
    4. et al
    . Predictors of severe psychological distress trajectory after nuclear disaster: evidence from the Fukushima Health Management Survey. BMJ Open 2016;6:e013400.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Charlson F,
    2. van Ommeren M,
    3. Flaxman A,
    4. et al
    . New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet 2019;394: 240–8.
    OpenUrl
  4. ↵
    1. LeardMann CA,
    2. Smith B,
    3. Ryan MA
    . Do adverse childhood experiences increase the risk of postdeployment posttraumatic stress disorder in US marines? BMC Public Health 2010; 10:437.
    OpenUrlCrossRefPubMed
  5. ↵
    The psychological needs of healthcare staff as a result of the coronavirus pandemic [news]. Leicester (UK): The British Psychological Society; 2020.
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Canadian Medical Association Journal: 192 (28)
CMAJ
Vol. 192, Issue 28
13 Jul 2020
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Disasters, pandemics and mental health
Clare Pain, Ruth Lanius
CMAJ Jul 2020, 192 (28) E803; DOI: 10.1503/cmaj.200736

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CMAJ Jul 2020, 192 (28) E803; DOI: 10.1503/cmaj.200736
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