The Impact of Disasters and Political Violence on Mental Health in Latin America

S continued De la Fuente, R. (1990) The mental health consequences of the1985 earthquakes in Mexico. International Journal of MentalHealth, 19, 21-29. one-two months after the 1985 Mexico Cityearthquake, the author evaluated the reactions of a random sampleof 573 adults housed in shelters. on the basis of the StructuredClinical Interview for DSM-III, 32% of participants showed PTSD,19% GAD, 13% MDD, and 2% panic disorder. Women showedhigher prevalences than men (38% vs. 18% for PTSD; 24% vs. 9%for GAD, 16% vs. 7% MDD). The authors observed that shelterresidents bonded with one another and shunned external intervention. Eisenman, D. P., Gelberg, L., Liu, H., & Shapiro, M. F. (2003) Mentalhealth and health-related quality of life among adult Latinoprimary care patients living in the United States with previousexposure to political violence. Journal of the American MedicalAssociation, 290, 627-634. To determine (1) rates of exposure topolitical violence among Latino adult primary care patients whohave immigrated to the United States from Central America, SouthAmerica, and Mexico and its impact on mental health and health-related quality of life and (2) frequency of disclosure of politicalviolence to primary care clinicians. Two-stage cluster design surveyof a systematic sample of Latino immigrant adults in 3 community-based primary care clinics in Los Angeles, conducted from July2001 to February 2002. A total of 638 (69%) of 919 eligible patientsparticipated. In weighted analyses, 54% of participants reportedpolitical violence experiences in their home countries, including 8%who reported torture. of those exposed to political violence, 36%had symptoms of depression and 18% had symptoms of PTSD vs.20% and 8%, respectively, among those not exposed to politicalviolence. Controlling for age, sex, country, years lived in the UnitedStates, acculturation, income, health insurance status, and recruit­ment site in a subsample of 512 participants (56%), those whoreported political violence exposure were more likely to meetsymptom criteria for PTSD and to have symptoms of depressionand panic disorder than participants not reporting political violence.Those exposed to political violence reported more chronic pain androle limitations due to physical problems, as well as worse physicalfunctioning and lower perceptions of general health than those whowere not exposed to political violence. only 3% of the 267 patientswho had experienced political violence reported ever telling aclinician about it after immigrating; none reported their currentphysician asking about political violence. [Abstract Adapted] Goenjian, A. K., Molina, L., Steinberg, A. M., Fairbanks, L. A.,Alvarez, M. L., Goenjian, H. A., et al. (2001) Posttraumatic stressand depressive reactions among Nicaraguan adolescents afterHurricane Mitch. American Journal of Psychiatry, 158, 788-794.This study determined the severity of posttraumatic stress anddepressive reactions in 158 Nicaraguan adolescents 6 months afterHurricane Mitch and the relationship of these reactions to objectiveand subjective features of hurricane exposure, death of a familymember, forced relocation, and thoughts of revenge. Severe levelsof posttraumatic stress and depressive reactions were found amongadolescents in the two most heavily affected cities. Severity ofposttraumatic stress and depressive reactions and features ofobjective hurricane-related experiences followed a “dose-of-exposure”pattern that was congruent with the rates of death and destructionacross cities. Level of impact (city), objective and subjective features,and thoughts of revenge accounted for 68% of the variance inseverity of posttraumatic stress reaction. Severity of posttraumaticstress reaction, death of a family member, and sex accounted for59% of the variance in severity of depression. These findings stronglyindicate the need to incorporate public mental health approaches,including systematic screening and trauma/grief-focused interven­tions, within a comprehensive disaster recovery program. [AbstractAdapted] Guarnaccia, P. J. (1993) Ataques de nervios in Puerto Rico:Culture-bound syndrome or popular illness? Medical Anthropology,15, 157-170. Ataque de nervios is a popular illness category amongPuerto Ricans and other Latinos written about in anthropologicaland psychiatric literature for over thirty years. This paper discussesthe issue of categorizing ataque de nervios as a “culture-boundsyndrome” using data from the first community-based study of thisphenomenon using epidemiological methods. The paper summarizesthe social and psychological correlates of ataques de nervios andprovides a preliminary overview of the situations which provokeataques and the symptoms people experience. The paper criticallyexamines the use of the “culture-bound syndrome” framework foranalyzing ataques de nervios and suggests that the term “popularillness” is a more effective label for categorizing this syndrome.[Author Abstract] Kohn, R., Levav, I., Donaire Garcia, I., Machuca, M. E., & Tamashiro,R. (2005) Prevalence, risk factors and aging vulnerability forpsychopathology following a natural disaster in a developingcountry. International Journal of Geriatric Psychiatry, 20, 835-841.800 respondents of both genders aged 15 years and above, ofwhich 103 were 60 and over, were selected from high, middle, andlow residential status areas in Tegucigalpa that had suffered highand low exposure to the devastating effects of Hurricane Mitch.PTSD, depression, and SRQ-caseness were found, respectively in13.6%, 18.8%, and 21.4% of the elderly. Their reactions did notdiffer in frequency from those of younger adults. Among the elderly,pre-hurricane psychological problems and the intensity of exposurewere associated with increased risk for all outcomes measuredexcept for alcohol misuse. No evidence was found for a differentialvulnerability on the part of the elderly as compared with youngeradults. Among the elderly, increasing age was not a factor. [AbstractAdapted] Lima, B. R., Pai, S., Santacruz, H., & Lozano, J. (1991) Psychiatricdisorders among poor victims following a major disaster:Armero, Colombia. Journal of Nervous and Mental Disease, 179,420-427. We evaluated 102 adult victims of low socioeconomicstatus living in tent camps 8 months following the Armero disasterin Colombia to ascertain the level of psychiatric morbidity. 91% ofthe subjects identified by the screening instrument as being emotion­ally distressed met DSM-III criteria for a psychiatric disorder. Themost frequent diagnoses were PTSD and major depression. Thesefindings indicate that a simple screening instrument can be reliablyused for the detection of significant emotional problems amongdisaster victims. Interventions for their adequate management needto be designed, implemented, and evaluated. The general health PAGE 4P T S D R E S E A R C H Q U A R T E R LY