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Natural disasters in developing countries: Mental health issues

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Natural disasters in developing countries: Mental health issues
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   VOLUME63NUMBER 8 AUGUST 2009 EDITORIAL Natural disasters in developing countries: Mental health issues Nilamadhab Kar   ........... ........... 327 ORIGINAL ARTICLES Risk of posttraumatic stress disorder and depression in survivors of thefloods in Bihar, India Shirley Telles, Nilkamal Singh, Meesha Joshi   ........... ........... 330Paraoxonase 1 GENE polymorphisms contribute to coronary artery disease risk among north Indians S. Agrawal, Gaurav Tripathi, R. Prajnya, Nakul Sinha, A. Gilmour  , L. Bush, S. Mastana  ........... ........... 335 Acute childhood morbidities in rural Wardha: Some epidemiological correlates and health care seeking P. R. Deshmukh, A. R. Dongre, N. Sinha, B. S. Garg   ........... ........... 345 CASE REPORTS Simultaneous isolated bilateral facial palsy: A rare vincristine-associated toxicity Supriya Sarkar, Asit Ranjan Deb, Kaushik Saha, Chandra Shekhar Das  ........... ........... 355Type 1 leprosy reversal reaction treated with topical tacrolimus along with systemic corticosteroids Gilles Safa, Laure Darrieux, Alain Coic, Laurent Tisseau  ........... ........... 359 LETTERS TO EDITOR  Asystole during dipyridamole administration Vikas Veeranna, Kavitha Potluri, Syed Mahmood, Lawrence MacDonald   ........... ........... 363Hyoscine-B butyl bromide in labor: A randomized controlled trial Rajesh Jacob  ........... ........... 364 Authors’ reply Pakhee Aggarwal, Vijay Zutshi, Swaraj Batra  ........... ........... 365 Aspergillus endophthalmitis: Pars plana vitrectomy is an alternative Luis Ignacio Gonzalez-Granado  ........... ........... 366 PRACTITIONERS’ SECTION Leptospirosis in children: A review for family physicians Milind S. Tullu, Sunil Karande  ........... ........... 368  Indian J Med Sci, Vol. 63, No. 8, August 2009 327  ndian Journal of Medical Sciences Indian Journal of Medical Sciences (INCORPORATING THE MEDICAL BULLETIN)  VOLUME 63 AUGUST 2009 NUMBER 8 EDITORIAL NATURAL DISASTERS IN DEVELOPING COUNTRIES: MENTAL HEALTH ISSUES NILAMADHAB KAR Natural disasters are not only more common in developing countries but also have greater devastating impact. Ninety percent of natural disasters and 95% of disaster-related deaths occur in developing countries. [1]  There are various reasons for this, viz., poor warning systems, inadequate emergency response during disaster, poor preparedness and mitigation measures for the disasters. Besides, disasters in developing countries usually affect a comparatively large number of people. Poor connectivity to affected areas and de Þ cit in resources for acute relief appear as important determinants of morbidity. Pre-disaster factors like lower economic status, poor housing quality and poor communication systems add to the misery. Cultural differences regarding perception of stress, resilience and coping are well known. [2]  These factors also affect the Wolverhampton City Primary Care Trust, Wolverhampton, UK Correspondence: Dr. Nilamadhab Kar, Corner House Resource Centre, 300 Dunstall Road, Wolverhampton, WV6 0NZ, United KingdomE-mail: nmadhab@yahoo.com prevalence of psychiatric morbidity following disasters. Considering the above-mentioned factors, it is expected that there would be differences in post-disaster mental health outcomes in different cultures. There is a need for increasing awareness of mental health consequences of disasters all over the world, especially in the more vulnerable developing countries. The World Health Organization suggests that it is imperative to carry out extensive research on the population of developing countries that are most affected by natural and man-made disasters. [3]  The study by Telles et al.  in this issue of Indian Journal of Medical Sciences adds several insights into the existing evidence on psychological sequelae of a natural disaster in a developing state where typically a large number of people were affected. [4]  Studied within a month of the disaster, it highlighted the acute psychological effects, speci Þ cally the risk of post-traumatic stress disorders (PTSD) and depression, which was observed to be more in elderly people. Elderly people have been found to be one of the most vulnerable groups for post-disaster psychiatric morbidity. [5]  There are  Indian J Med Sci, Vol. 63, No. 8, August 2009 328 INDIAN JOURNAL OF MEDICAL SCIENCES many post-disaster studies in India re ß ecting psychiatric aspects both in acute and long-term settings. In the early post-disaster phases, signi Þ cant mental health problems have been reported after the tsunami disaster in the Andamans. [6]  Similarly 3 months after Orissa super-cyclone, 50% of victims were reported to have posttraumatic stress symptoms. [7]  Long-term post-disaster studies in India also report considerable proportions of psychiatric morbidity in the victims, which comprises mainly posttraumatic stress, depression and anxiety disorders. [8] Observations of the study by Telles et al.  re-emphasize that systematic screening of victims in the disaster-affected areas is preferable to routine clinical evaluation, as otherwise, many victims may suffer silently rather than seek psychological help when they struggle even for the basic necessities. Systematic screening can provide critical information for a rational post-disaster public mental health program. Screening should be broad based to include not only trauma-related clinical syndromes but also other disorders; subclinical symptoms; and psycho-social, occupational/ educational and daily life impairments. It is important to develop assessment methods that are age appropriate, culturally sensitive and valid. There is a great need for strengthening the disaster response system in developing counties. For management of disaster-related mental health issues, organizations should develop phase-appropriate responses and interventions, considering the 5 conceptual phases, namely,   (-)1: pre-disaster warning phase; 0: disaster phase, during and immediately after the disaster; 1: early post-disaster phase; 2: recent post-disaster phase; and 3: remote post-disaster phase. [5,8]  There is also the need for intervention studies in post-disaster scenarios, involving both pharmacological and psychological methods to Þ nd out their effectiveness. The in ß uence of phase-appropriate disaster response on the prevalence of psychiatric morbidity in the victims is another area for future studies.While it is pertinent to conduct post-disaster studies, it should also be highlighted that arranging such studies is dif Þ cult considering the ground realities in the immediate aftermath of disasters. However, data-gathering should be an integral part of disaster relief and support work, which will improve the knowledge base for better care of disaster victims. REFERENCES 1. National Centre for Disaster Management. Manual on natural disaster management in India. New Delhi: National Centre for Disaster Management; 2001.2. Marsella AJ, Christopher MA. Ethnocultural consideration in disasters: An overview of research, issues, and directions. Psychiatr Clin North Am. 2004;27: 521-39.3. World Health Organisation. Psychosocial Consequences of Disasters: Prevention and management. Geneva: World Health Organisation; 1992.4. Telles S, Singh N, Joshi M. Risk of posttraumatic stress disorder and depression in survivors of the Bihar Floods. Indian J Med Sci 2009;63:330-34.5. Kar N. Psychosocial issues following a natural disaster in a developing country: A qualitative longitudinal observational study. Int J Disaster Med 2006;4:169-76.6. Math SB, Tandon S, Girimaji SC, Benegal V,  Indian J Med Sci, Vol. 63, No. 8, August 2009 329 Kumar U, Hamza A, et al  . Psychological impact of the tsunami on children and adolescents from the Andaman and Nicobar islands. Prim Care Companion J Clin Psychiatry 2008;10:31-7.7. Suar D, Khuntia R. Caste, education, family and stress disorders in Orissa supercyclone. Psychol Dev Soc 2004;16:77-91. Source of Support: Nil, Con fl ict of Interest:  None declared. 8. Kar N, Misra BN. Mental health care following disasters: A handbook for disaster workers. Bhubaneswar: Quality of Life Research and Development Foundation; 2008. DOI: 10.4103/0019-5359.55882 NATURAL DISASTERS IN DEVELOPING COUNTRIES Author Help: Online submission of the manuscripts Articles can be submitted online from http://www.journalonweb.com. For online submission, the articles should be prepared in two files (first page file and article file). Images should be submitted separately.1) First Page File: Prepare the title page, covering letter, acknowledgement etc. using a word processor program. All information related to your identity should be included here. Use text/rtf/doc/pdf files. Do not zip the files.2) Article File: The main text of the article, beginning with the Abstract to References (including tables) should be in this file. Do not include any information (such as acknowledgement, your names in page headers etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to 400 kb. Do not incorporate images in the file. If file size is large, graphs can be submitted separately as images, without their being incorporated in the article file. This will reduce the size of the file.3) Images: Submit good quality color images. Each image should be less than 1024 kb (1 MB) in size. The size of the image can be reduced by decreasing the actual height and width of the images (keep up to about 6 inches and up to about 1200 pixels) or by reducing the quality of image. JPEG is the most suitable file format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always retain a good quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised article.4) Legends: Legends for the figures/images should be included at the end of the article file.
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