Effects of Traumatic Stress
A Report By
The Center for the Study of Traumatic Stress
Henry M. Jackson Foundation for the Advancement
of Military Medicine
1401 Rockville Pike, Suite 600
Rockville, Maryland 20842
Telephone: 301-319-6965
Executive Summary
The effects of traumatic stress on individuals,
organizations, communities, and nations are of substantial and increasing
concern in the present world climate. Disasters
such as the Kobe Earthquake, the TWA Flight 800 Explosion, Hurricane
Andrew, Oklahoma City, and the Gulf War, as well as more common traumatic
events such as motor vehicle accidents, floods, tornadoes, and physical
assault are a health risk to a large number of our population.
In addition, these events carry national and international implications.
The monetary cost of such events to productivity as well as to health and
international affairs is enormous.
Overview
In the present world climate, traumatic stress is all too
common. Natural disasters take a large toll worldwide. The World
Health Organization estimates that from 1900-1998, hurricanes left nearly
2 million people without homes and directly affected the lives of 4
million people. Floods alone afflicted 300 million people, and left more
than 36 million homeless. Earthquakes, typhoons, and cyclones affected
another 30 million people each and rendered 10 million homeless. The year
1995 was the most expensive year for disasters internationally - $150
billion was lost primarily in developed countries. Scientists
predict that the frequency of disasters affecting humanity is climbing.
Sadly, those least prepared to deal with disaster often
suffer the most: the less
developed an area is economically, the greater the number of deaths,
injuries and amount of damage its population sustains in a disaster -
especially in more densely populated areas. Cities, states, and nations
often lack the resources and insurance coverage they need to help people
living in impoverished areas. Such traumatic events and their management
have major political economic consequences. They influence the
organization of communities and nations and frequently upset the economic
balance leading to social disruption, disorganization and mass relocation.
As the 1995 earthquake in Kobe, Japan (6,000 dead; 30,000 injured; 300,000
homeless) as well as Hurricane Andrew (49 dead; 200,000 homeless) in the
United States illustrated, even industrialized countries with extensive
disaster preparation are not immune.
In addition to natural disasters, human-made calamities
increasingly cause devastation. Industrial accidents such as
Chernobyl and Bhopal demonstrated the terrible consequences of such
catastrophes. Transportation accidents - particularly airline crashes -
are increasingly of concern. Terrorism also represents a potential source
of death and destruction through the use of weapons of mass destruction
(nuclear, biological and chemical agents). Tragedies such as these, to
name but a few, are major components of the stress of present day life.
Trauma and disasters are often defined as events that
would be markedly distressing to almost everyone. These include a serious
threat to one's life or physical integrity, serious threat or harm to
one's children, spouse or other close relative or friend or seeing another
person who has recently been or is being injured or killed as a result of
an accident or physical violence. In general , such events are dangerous,
overwhelming, and sudden and are marked by extreme or sudden force from an
external agent typically causing fear, anxiety, withdrawal, and avoidance.
These events include homicides, suicides, serious motor vehicle accidents,
robberies, physical or sexual assault, personal injury, property loss or
sudden relocation due to fire, tornadoes, hurricanes, or disasters (both
natural and man-made), war including terrorism and hostage and prisoner of
war events, exposure to mass casualities, chemical and biological warfare,
and airplane crashes. All of these events have high intensity, are
unexpected, infrequent, and vary in duration form acute to chronic.
Traumas and disasters have
substantial acute and long-term effects on individual health, creating
physical trauma and illness as well as psychiatric disease. The health
effects of disaster and traumatic stress are seen in both psychological
and physical health at the cellular, behavioral and community levels.
·
Studies following Three Mile Island have shown increased
rates of hypertension among populations most directly exposed to the
disaster.
·
Recently, studies have documented acute and long-term
changes in immune function as well as changes in brain anatomy.
·
Similarly, recent studies of veterans of combat trauma have
highlighted alterations in arousal and changes in physiologic tone
following combat experiences.
·
A wide range of psychiatric disturbances have been related
to traumatic events, in particular, Posttraumatic Stress Disorder,
depression, and alcoholism.
·
The immediate problems of disaster victims include anxiety,
depression, anger, guilt , and sleep disturbance.
·
Studies of the Coconut Grove nightclub fire in 1943, the
Buffalo Creek Dam Collapse in West Virginia, and the Mount St. Helen's
eruption have consistently indicated high rates of psychiatric disturbance
following such events.
·
Communities struck by tornadoes show 20 percent of the
population suffering from posttraumatic stress disorder following the
tornado.
·
Similarly, victims of emergencies involving toxic waste,
such as Love Canal, appear to experience high levels of stress with
long-term consequences.
·
Studies of combat veterans - individuals exposed to the
human made disaster of war - from the Vietnam War, and more recently the
Gulf War, show increased rates of Post-traumatic Stress Disorder as well
as changes in endocrine function.
Problem
A large proportion of our nation is affected by disasters
which are extremely costly as well as traumatic. Weather disasters in the
US alone between 1980 and 1997 cost approximately $140 billion. From
August 1992 to May 1997, floods, hurricanes and other storms resulted in
911 deaths and over $90 billion in damages/costs. In 1996, the American
Red Cross responded to 236 major disasters in 48 states, spending a total
of $216 million in assistance. The Red Cross noted that virtually every
community across the nation was affected by disaster. For example, during
one weekend in April 1996, 70 tornadoes hit 10 Midwestern and southern
states. Forest fires destroyed hundreds of home in California, New Mexico,
Arizona, and Alaska. And there was widespread flooding in the
eastern U.S. due to a rapid spring meltdown of snow. There were also two
major aviation disaster in 1996: the ValuJet and TWA Flight 800 crashes. It
is estimated that in the year 2000 over 1700 deaths will occur in the
United States due to major disasters and property and income loss will
total more than $17 billion. These events impact hundreds and thousands of
relatives, friends, and witnesses.
Particular areas of the country and particular
populations - police, firemen, rescue operators, military personnel, as
well as international travelers, high ranking members of private
corporations, the federal government, and members of the State Department
are at increased risk of disasters or traumatic events. Norris (1988) has
highlighted the fact that even low
prevalence traumatic events translate to large numbers of individuals when
there is a large population at risk. It has been estimated that
6.8 percent of the population is exposed annually to traumatic events
(Norris, 1988). Although this frequency indicates these are rare events,
it must be noted that in the American population alone this amounts to
nearly 17 million people exposed annually to trauma and disaster.
As one gets older, the probability that one would have
experienced a trauma or disaster increases. In one community in Kentucky,
39 percent of the elderly have survived a natural disaster; 13 percent
have been in a serious motor vehicle accident, 12 percent have been in a
fire, and six percent have been physically assaulted. In addition,
15 percent report some other terrifying experience during their lives
(Norris, 1988).
The effects of traumatic stress on individuals,
organizations, communities, and nations are of substantial and increasing
concern in the present world climate. Terrorism, hostage events, disasters
such as the Kobe Earthquake, the Oklahoma City Bombing, the poison gas
attack on the Tokyo subway as well as more common traumatic events such as
motor vehicle accidents, hurricanes, tornadoes, and physical assaults are
a health risk to a large number of our population. In addition, these
events carry national and international health and policy implications. The
monetary cost of such events to health as well as productivity and
international affairs is enormous. Because of the large number of
individuals at risk for traumatic stress and the frequent national and
international implications of these events, resources to better understand
the health effects of traumatic stress on individuals, organizations, and
communities and to provide consultation to private organizations and the
Federal Government on policies related to traumatic stress are needed.
The health implications of traumatic stress are a focused
interest following each trauma or disaster but tend to be lost from
institutional memory because of the lack of an organized center for the
maintenance and development this knowledge.
For further
information about this website please email jstecklein@usuhs.mil.
Telephone:
301-295-2470