fifteen years of research on the consequences of disaster danielle maltais, ph.d. université du...

Fifteen Years of Fifteen Years of Research on the Research on the Consequences of Consequences of

DisasterDisaster

Danielle Maltais, Ph.D.Danielle Maltais, Ph.D.

Université du Québec à Chicoutimi Université du Québec à Chicoutimi (UQAC) (UQAC)

Prague, Juin 2012Prague, Juin 2012

danielle_maltais@uqac.cadanielle_maltais@uqac.ca

Initial ObjectivesInitial Objectives

Find out the consequences of disaster on Find out the consequences of disaster on the biopsychosocial health status of the the biopsychosocial health status of the victims and the relief workers who help victims and the relief workers who help the family to recovery .the family to recovery .

Provide regional authorities with tools to Provide regional authorities with tools to obtain a better distribution of provincial obtain a better distribution of provincial healthcare funds.healthcare funds.

Completed Research Completed Research ProjectsProjects

Effects of a disaster on concept of home for people who lost their home (concept du chez-soi) (qualitative study)

Short and midle consequences of the 1996 floods on the biopsychosocial health of survivors living in an urban setting (qualitative and quantitative studies) .

Middle Consequences of the 1996 floods on the bio-psychosocial health of victims living in a rural setting (qualitative and quantitative study).

Social support and post-disaster health status. (qantitative study)

Long-term consequences of the St-Jean-Vianney mudslide of 1971 (qualitative study).

Completed Completed Research ProjectsResearch Projects

Consequences of the ice storm on the biopsychosocial health of individuals : agriculturists, elderlies, and families with young children (qualitative study).

Consequences of the ice storm on thebiopsychosocial health of relief workersin the Montérégie area (qualittive study).

Consequences of the ice storm on Saguenay-Lac-St-Jean relief workers (social workers and nurses) (quantitative study).

Long-term effects of the 1996 floods on the health of individuals and on community dynamics (qualitative and quantitative study).

Effect of crisis intervention on the health of social worker (study in course: qualitative and quantitative study)

Examples of Examples of IInformation nformation OObtainedbtained

Major stresses experienced by the victims. Short, medium and long-term health

consequences of disasters. Impacts of emergency measures on the

health of relief workers and their performance at work.

Consequences of a disaster on the dynamics of local communities.

Examples of Examples of IInformation nformation OObtainedbtained

The impact of the loss of the house on individuals’ concept of home.

Links between perceived and received social support and post-disaster health status.

Main Main SStresses tresses EExperienced by the xperienced by the

VictimsVictims..

Floods: Floods: A A SString of tring of SStressful tressful

EEventsvents When water is rising: fear comes

progressively. When leaving the home: distraught victims

instinctively seek familiar places to go. When waiting for information:

uncertainty brings doubts in victims – what will happen to them?

Floods: Floods: A A SString of tring of SStressful tressful

EEventsvents When the damage is assessed: the moment of

truth triggers acute emotional reactions. The loss of one’s house and most significant objects/belongings is another shock which brings desolation, discouragement, and sadness.

When people must temporarily relocate to several places: their residential itinerary is punctuated with uncertainty, embarrassment, worries, and adaptation difficulties.

Taking steps to obtain compensation from community and government authorities: agitation, anger, embarrassment (of asking for help), and dissatisfaction.

Waiting for compensation decisions: financial insecurity lingers on and becomes irritating.

Floods: Floods: A A SString of tring of SStressful tressful

EEventsvents

Taking bank loans and contracting debts: brings about disappointment, irritation, anxiety, and important changes in plans (eg. postponing retirement)

Relocating to a new apartment or house: grieving for their losses, and initiating numerous legal or administrative actions.

Floods: Floods: A A SString of tring of SStressful tressful EEventsvents

Managing discomfort and grief: once they are almost done cleaning or repairing their home, survivors become conscious of their discomfort and their physical and psychological health issues. They also modify their recreational and social activities (decreasing their social interactions and dropping certain leisure activities).

Floods: Floods: A A SString of tring of SStressful tressful EEventsvents

Adapting to a new life: the change in one’s place of residence requires a complete reorganization of one’s family life. Survivors must adapt to a new environment, new neighbours, anda new home.

Floods: Floods: A A SString of tring of SStressful tressful EEventsvents

Disasters and the Disasters and the CConcept of oncept of HHomeome

Involuntary relocation = major crisis for victims

Source of health issues Considerable sadness Persisting nostalgia Major difficulties in finding comfort in a

new home Idealizing of the lost house

Loss of the Loss of the HHouse ouse and and CConcept of oncept of

HHomeome

Involuntary relocation = major irritants. Loss of belongings and sentimental

objects = difficulty in finding comfort in the new home.

Loss of the Loss of the HHouse ouse and and CConcept of oncept of

HHomeome

Attachement to the previous home

Significance of one’s old neighbourhood

Magnitude of damage and losses

Obstacles to Obstacles to Finding Comfort in Finding Comfort in

thethe NNew ew HHomeome

Place of paradise, refuge Reflection of their personality Retirement money “Real” home Attachment to the house,

neighbours, and neighbourhood Place of belonging, where roots are

Concept of Concept of HHome:ome:The The PPrevious revious

RResidenceesidence

The house is no more than a refuge against the weather

Meets the basic needs of shelter, food, and sleep.

Feelings of eeriness Feels like it is a place of transition. Functional and practical shelter Not the “real” home

Concept of Concept of HHome:ome:The The AActual ctual RResidenceesidence

Informations on the Informations on the Short and Short and MMedium-edium-

TTerm erm CConsequences of onsequences of DDisasters on the isasters on the

BBiopsychosocial iopsychosocial HHealth ealth of of IIndividualsndividuals

Get to a shelter Find a place to stay Fear of drowning Fear of vandalism Obtain essential supplies Save their pets’ lives

Main Thoughts and Main Thoughts and Preoccupations of Preoccupations of

Survivors During the Survivors During the FloodsFloods

Fear, panic facing water or helicopters Anguish, disbelief Fear for their lives or the life of kins Feelings of isolation due to collapsed

bridges, loss of electricity, and phone service

Main Feelings of Main Feelings of SurvivorsSurvivors

During the Floods During the Floods

OOverviewverview

Two or three years after the event, the physical and psychological health of victims are more fragile than those of the control group’s.

Physical and psychological consequences of the floods are as significant for men as for women victims.

Health consequences are not a function of age (elderlies vs. others)

Overview Overview (2)(2)

Several aspects of the lives of victims are different from those of the control group’s.

Concerning physical health, differences beetwen victims and non-victims were observed in the perception of health status, the outbreak of new health problems, the deterioration of health status, the exacerbation of existing health problems, the development of new problems in kins, the use of prescribed and over-the-counter medication.

Overview Overview (3)(3)

Concerning psychological health, differences were observed in PTSD symptoms, in psychological well-being, in the presence of depression, anxiety and insomnia symptoms, in social functioning difficulties, and in somatic symptoms.

Concerning living conditions, more survivors than control group individuals had contracted debts following the floods, and more victims experienced financial difficulties in the two weeks before the research interview.

Long term effects of floodsLong term effects of floods(longitudinal study)(longitudinal study)

ResultsResults In general, there is a long-term reduction In general, there is a long-term reduction

of psychological symptoms in both urban of psychological symptoms in both urban and rural areas.and rural areas.

In urban areas, there are many significant In urban areas, there are many significant differences between T2 victims and non-differences between T2 victims and non-victims for the psychological variables: victims for the psychological variables: PTSD symptoms, psychological well-being, PTSD symptoms, psychological well-being, somatic symptoms, anxiety and insomnia somatic symptoms, anxiety and insomnia and social dysfunction .and social dysfunction .

In rural areas, there are no significant In rural areas, there are no significant difference between T2 victims and non-difference between T2 victims and non-victims for all the psychological variables.victims for all the psychological variables.

The The LLinks inks BBetween etween PPerceived and erceived and

RReceived eceived SSocial ocial SSupport and upport and PPost-ost-DDisaster isaster HHealth ealth

SStatus.tatus.

Two years post-disaster, survivors claiming to have received less help than they hoped for generally show poorer physical and psychological health than control group individuals (non-victims) and survivors who received as much or more help than they hoped for.

Impacts on: PTSD symptoms, anxiety, depression and severe depression, somatic symptoms and social dysfonction

ObservationsObservations

In their psychological health status, individuals who received as much or more help than hoped for obtain similar scores than control group individuals on the various scales, exept on those measuring PTSD symptoms.

Observations (2)Observations (2)

The scale of damage is significantly linked to PTSD symptoms, while social support and coping strategies are more linked to depression symptoms and psychological distress.

Observations (3)Observations (3)

The The CConsequences of onsequences of EEmergency mergency MMeasures easures on the on the HHealth of ealth of RRelief elief WWorkers (social worker orkers (social worker

and nurse) and nurse) and and

TTheir heir PPerformance at erformance at WWorkork

Stressful ElementsStressful ElementsOrganizational Stress

Conflicts between workers

Organizational and inter-organization conflicts

Ambiguity of roles Family vs. commitment

conflicts Confusion in relief

centres Weight of responsibilities

Stress as Survivors

Worries about family well-being

Fears of accidents, theft or vandalism

Lack of means of communication

Damages at home Presence of live-in

survivors

Physical Health Physical Health Issues Issues

During the Ice StormDuring the Ice Storm

Flu Overwork Muscular problems Respiratory problems Pulmonary problems

Physical Health Physical Health Issues Issues

After the Ice StormAfter the Ice Storm Significant physical fatigue Exhaustion Loss of drive and energy for professional

and social activities Flu, gastroenteritis, stomach ulcers,

hypertension, heart problems, viruses