Behavioral consequences of disasters: a timely reminder.

The psychological and psychopathological consequences of disasters (mainly anxiety, depression, acute stress reactions, post-traumatic stress disorder) have remained undernoticed for a long period of time. After the Vietnam War, however, their significance has been highlighted and following the Twin Towers disaster the extent to which they affect the lives of not only the victims but also their relatives and society as a whole can no longer be overlooked. The WPA has established a Special Program on Disasters, headed jointly by the present author and J.J. Lopez- Ibor, to coordinate the Association's efforts in this important area and to collaborate with our very active section on Military and Disaster Psychiatry. At the Yokohama World Congress, the above section, in collaboration with the section on Anxiety and Obsessive Compulsive Disorders, has organized a full day of presentations (symposia, discussion groups, courses, poster presentations) dealing with the behavioral effects of disasters. Additionally, the development of training centers (initially in France, Spain, Israel and Argentina, but later on in other countries) in the area of stresstrauma and disaster interventions is being scheduled. It is felt by many that not only professionals but also the general public and the decision-makers should be aware of the potentially catastrophic behavioral effects of disasters and that measures should be taken not only to manage these effects but also to prevent them. Since primary prevention is an area in which psychiatrists have only a marginal role, other players must be involved. These include politicians, non-governmental organizations, volunteers, policemen, priests, firemen, teachers, journalists and society as a whole. The obligation of our profession (and our professional associations) is to increase the awareness of the public on the behavioral effects of disasters, and to increase the citizens' motivation and eventual involvement. In my own country, Greece, as well as in other countries of the area, notably Turkey, natural disasters are occurring with, comparatively speaking, great frequency. These disasters adversely affect the lives of great portions of the population and may produce considerable psychopathology. Earthquakes are among the natural disasters that occur with great frequency in Greece, a country with considerable seismic activity. The earthquake that hit Athens Metropolitan area on September 7, 1999 had a magnitude of 5.9 on the Richter scale and was the second largest in the last twenty years. The death toll was 152, and more than 25,000 persons were evacuated, mainly in nearby tents. The special service of Athens University Department of Psychiatry for the psychological support to earthquake victims was mobilized immediately after the event. The service consisted of two mobile psychosocial support units, one central unit at Eginition Hospital and a telephone helpline unit. During the 6 weeks of operation of the unit, 159 subjects contacted the facility. A proportion as high as 85% of the subjects fulfilled ICD-10 criteria for acute stress reaction. The most frequently reported symptoms were: exaggerated responses to being startled, difficulty in getting to sleep because of worrying, and pounding heart or accelerated heart rate. It is important to note that some early symptoms (extroverted or introverted aggression, narrowing of attention and some symptoms of autonomic hyperarousal) can have a predictive value as to the probability of developing acute stress reactions. Additionally, subjects who had been exposed to catastrophic events in the past and subjects who developed an acute stress reaction were found to be more prone to the development of posttraumatic stress disorder. Raquel Cohen's review and similar comprehensive and knowledgeable contributions come at a good time. They serve the purpose of alerting physicians to the need for acquisition of more knowledge and better skills in the prevention and management of the behavioral consequences of disasters.