mental health in a time of terror
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Mental Health in a Time of Terror. Robert K. Schneider, MD Assistant Professor Departments of Psychiatry, Internal Medicine and Family Practice Virginia Commonwealth University The Medical College of Virginia Campus. Outline. Review Studies of Terror Disease Model Health Model - PowerPoint PPT PresentationTRANSCRIPT
Mental Health in a Time of Terror
Robert K. Schneider, MDAssistant ProfessorDepartments of Psychiatry, Internal Medicine and Family PracticeVirginia Commonwealth UniversityThe Medical College of Virginia Campus
Outline
• Review Studies of Terror • Disease Model• Health Model• What can we do?
Models of Coping
Disease ModelTrauma/Stressor + Person = Disease
Health Model:Trauma/Stressor + Person = Health
Disease Model
PTSD: Posttraumatic Stress DisorderReexperiencesHyperarousabilityAvoidance
Major DepressionDepressionAnhedonia
Oklahoma City BombingNorth et. al. JAMA 1999
April 19, 1995167 dead684 injured“the most severe incident of terrorism
ever experienced on American soil”
Oklahoma City BombingNorth et. al. JAMA 1999
• 45% postdisaster psychiatric disorder34.5% PTSD22.5% Major Depression9.4% Alcohol Use Disorder
Oklahoma City BombingNorth et. al. JAMA 1999
• Predictors–Any predisaster diagnosis: 66%–Female sex: 55% vs. 34%–94% of PTSD had early avoidance
and numbing symptoms
SCUD Missile Attacks Israel, 1991 Gulf WarLaor et. al. Am J Psychiatry 2001
• 107 families exposed• Half of the families displaced• Mother’s functioning and Children’s
Symptoms • 3 studies: 6 and 30 months and 5 years
SCUD Missile Attacks
• Over time symptoms decrease in residentially stable children
• Mothers’ reaction correlated with young children’s symptoms most
• Family cohesion highly correlated with children’s well being
SCUD Missile Attacks
• Mother’s functioning:– Ability to relate to child– Coping skills– Symptoms
• Children’s symptoms– PTSD symptoms– Avoidance
SCUD Missile Attacks• Younger children highly correlated with
mother’s symptoms• Displaced families had more symptoms
(longer time: more problems)• Family functioning impacted displaced more
than residentially stable children • Mothers coping with adaptive defenses
correlated with resolution of children’s symptoms
PTSD in the Community Breslau et. al. Arch Gen Psychiatry 1998
• 90%: one or more traumas
• Most prevalent trauma: unexpected death of a loved one
Categories: traumatic events• Personally experienced assaultive violence
– 37.7%• Other personally experienced injury or
shocking experience – 59.8%
• Learning about traumas to others– 62.4%
• Sudden unexpected death of a loved one – 60.0%
Conditional Risk• Rape 40-60%• Combat 35%• Violent Assault 20%• Sudden death of a loved one 14%• Witnessing a traumatic event 7%• Learning about trauma to others 1-2%
Rick Factors for PTSDBrewin et al J Consult Clinical Psych 2000
Meta analysis Civilian and Military(Weighted averages)–Lack of Social Support: 0.40–Post trauma life stresses: 0.32–Trauma Severity: 0.23
Health Model
• No predisaster disorder (OCB)–70% remained without disorder
• Stability and High Functioning (SMA)–No children had symptoms at five
years
Health Model – DefensesAdaptive Coping
AnticipationAffiliationAltruismHumor
Self-assertionSelf-observationSublimationSuppression
Adaptive CopingSCUD Missile Attacks
• “Mother’s capacity to control mental images had a direct effect on her symptoms”
Health Model – DefensesMaladaptive Coping
DevaluationDenialDissociationDisplacement
Acting OutOmnipotenceApathyComplaining
What can we do?
SelfFamilyCommunity
What can we do?SELF
• We are in a time of stress and transition• Use our adaptive defenses• Avoid our maladaptive defenses• Regulate our exposure to potentially
traumatic information:– Television, Internet, Newspaper
• Be where you need to be
What can we do?FAMILY
• Model adaptive behavior• Be present and available• Maintain Boundaries
– Clarity– Rules
• Monitor
What can we do?Community
• Model adaptive behavior• Be present and available• Maintain Boundaries
– Clarity– Rules
• Monitor
Conclusions• We are living in a time of stress and
transition• Diseases to prevent include PTSD
and Major Depression• Young children are particularly
vulnerable• Coping is an active, conscious
process that occurs on multiple levels