The Prevalence Of Disasters

A report of the Red Cross highlighted the differential impact of disasters in Third World countries. In the period 1967 to 1991, an average of 17,000,000 people living in developing countries were affected by disasters each year, as compared to about 700,000 in developed countries (a striking ratio of 166 to 1) [28]. These communities are particularly at risk in the face of disasters, because they are already under strain and with few resources in reserve to bring to bear at times when rescue and protection are required. Their health systems tend to be rudimentary and to have little mental health capability.

In the last decade, there have been some important investigations of major disasters in non-Western cultures [29]. These initiatives are important to the field, because they provide a test of how culturally specific the earlier findings of disasters in Western cultures are to the broader world community. One of the difficulties is having adequate access to this broader literature that is not readily available through the large electronic databases. Of particular note are the studies conducted into the recent earthquakes that have impacted Kobe in Japan [30,31], China [32], Taiwan [33], India and Turkey [34]. These research projects represent important introductions of the concepts of traumatic stress into these communities and provide valuable data about large-scale events. This volume addresses the consequences of a number of these disasters.

The boundaries between the effects of war and those of disaster are becoming less easy to define, with the onset of more widespread terrorism that targets civilians. For example, the terrorist attacks in Israel, Palestine and Bali and in New York on September 11, 2001 could be considered as acts of war. Another perspective is that these are man-made disasters that are characterised by extreme malevolence. The argument for the latter categorisation is that the victims of these events had no anticipation of the events that unfolded, in contrast to the combatants in a more typical armed conflict.

The threshold of exposure that is required for an individual to be included in a study is one of the issues that are difficult to determine in disaster studies. For instance, the commonsense idea that the trauma due to human negligence or error has a greater capacity to disrupt an individual's psychological assumptions than events such as hurricanes and floods does not appear to be substantiated by the objective evidence. However, this conclusion may be a consequence of differences in the thresholds of inclusion in these studies. Furthermore, the recourse to litigation in man-made disasters will generally result in a degree of financial compensation that is not available to the victims of natural disasters. It may be that adequate financial relief may provide a buffer against some of the negative effects of these events.

The emergence of a more general interest in post-traumatic stress disorder (PTSD) since the publication of DSM-III [35] has led to a dramatic increase in the attention to the impact of disasters. In the past, these events were believed to be outside the range of normal human experience, but systematic examination has now shown that they are more common than previously thought. Norris [19], in a study of 1,000 adults in southern United States, found that 69% of the sample had experienced a traumatic stressor in their lives and this included 21% in the past year alone. In this year, 2.4% of households in the southern United States were subjected to disaster or damage, with a lifetime exposure to disasters of 13%.

Kessler et al. [36], in a stratified population sample in the USA, found that 60.7% of males and 51.2% of females had experienced an event that met the DSM-IV stressor criterion. 18.9% of men and 15.2% of women had been exposed to a natural disaster, with the respective rates of lifetime PTSD being 3.7% and 5.4%. Creamer et al. [37], in a stratified sample of 10,641 Australians, found a similar percentage of lifetime exposure to traumatic experiences, with 19.9% of men and 12.7% of women reporting that they had experienced a disaster. However, of the 158 cases of PTSD in the last 12 months, in only four was a natural disaster nominated as the stressor.

Such studies demonstrate that approximately one in six out of the population has had a lifetime exposure to a natural disaster, but this accounts for a very small component of the post-traumatic morbidity within these communities. When asked to select the most traumatic event in their lives, fewer than 5% nominated their disaster experience. These figures demonstrate the problem of much of research in this area, as they are based on the simple question as to whether the individual has or has not been exposed to a natural disaster, with no definition of threshold given. These definitions about the level of exposure are critical in attempting to make estimates of the risk associated with such events.

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