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Next hurdle for Haitians: coping with PTSD

When I came across this ABC News article today on the emotional trauma being experienced by Haitian earthquake survivors, I immediately contacted David Spiegel, MD. The Stanford psychiatrist has done extensive research on post-traumatic stress disorder (PTSD), and I was eager to get his expert opinion on the situation in Haiti. Here's our brief Q&A.

What do you expect we’ll see in terms of PTSD and depression among earthquake survivors?

There should be plenty of it. Virtually everyone was exposed to a life-threatening stressor (the earthquake and many aftershocks); many were injured or witnessed death or serious injury and now face threats to survival based on lack of food and water, disease, and violence. I would expect at least 1/4 of the population to have PTSD on that basis alone.

Then there are the many losses - home, possessions with memories attached, loved ones, work, neighborhoods, routines, lack of identification of bodies and proper burials - total disruption of personal and social networks, as well as injury and medical illness. Rates of depression increase with concomitant stressors, including medical illness, especially for people with a past history of depression or genetic vulnerability to it. And as the outlook for much relief gets grimmer, depression will increase. I would expect at least another 1/4 of the population to be depressed.

The ABC article notes that “months may pass before symptoms of PTSD or clinical depression emerge.” Does it typically take that long for symptoms to appear after a major event like this?

Yes, PTSD can emerge months later, and by our definition it cannot begin before a month after the initial traumatic stressor. Acute Stress Disorder can begin within two days of the stressor. Some hide symptoms as well, but even if careful diagnosis is done now (and it won't be), more people will be affected over time.

Right now the focus in Haiti is on people’s basic needs. At what point should the focus turn to mental health?

Even now, behavioral problems are hampering the rescue efforts: violence breaking out around food distribution points, doctors withdrawing because security was not provided. Obviously, keeping people alive is paramount, but planning for emotional support and social organization will help survival. People with PTSD and depression are less likely to get needed food, water, and medical attention.

In terms of treating survivors with PTSD, what sorts of lessons have we learned from Hurricane Katrina and other major disasters?

High rates of PTSD in New York after 9/11 (12% throughout the city, 20% below Canal Street near the World Trade Center) resolved pretty quickly - about 6 months - largely because there was much emotional and social support, treatment was available, and people could resume their lives quickly. In New Orleans, the biggest long-term problem was depression, as people realized their city was pretty much lost, and it wasn't coming back any time soon. The poor government response contributed, I think, to pervasive hopelessness and depression. I expect plenty of that in Haiti, since the goverment has all but evaporated.

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