The Impact of Disasters and Political Violence on Mental Health in Latin America: (571982010-002)

S continued De la Fuente, R. (1990) The mental health consequences of the 1985 earthquakes in Mexico. International Journal of Mental Health, 19, 21-29. one-two months after the 1985 Mexico City earthquake, the author evaluated the reactions of a random sample of 573 adults housed in shelters. on the basis of the Structured Clinical Interview for DSM-III, 32% of participants showed PTSD, 19% GAD, 13% MDD, and 2% panic disorder. Women showed higher prevalences than men (38% vs. 18% for PTSD; 24% vs. 9% for GAD, 16% vs. 7% MDD). The authors observed that shelter residents bonded with one another and shunned external intervention. Eisenman, D. P., Gelberg, L., Liu, H., & Shapiro, M. F. (2003) Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. Journal of the American Medical Association, 290, 627-634. To determine (1) rates of exposure to political violence among Latino adult primary care patients who have immigrated to the United States from Central America, South America, and Mexico and its impact on mental health and healthrelated quality of life and (2) frequency of disclosure of political violence to primary care clinicians. Two-stage cluster design survey of a systematic sample of Latino immigrant adults in 3 communitybased primary care clinics in Los Angeles, conducted from July 2001 to February 2002. A total of 638 (69%) of 919 eligible patients participated. In weighted analyses, 54% of participants reported political 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 political violence. Controlling for age, sex, country, years lived in the United States, acculturation, income, health insurance status, and recruit­ ment site in a subsample of 512 participants (56%), those who reported political violence exposure were more likely to meet symptom criteria for PTSD and to have symptoms of depression and panic disorder than participants not reporting political violence. Those exposed to political violence reported more chronic pain and role limitations due to physical problems, as well as worse physical functioning and lower perceptions of general health than those who were not exposed to political violence. only 3% of the 267 patients who had experienced political violence reported ever telling a clinician about it after immigrating; none reported their current physician 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 stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch. American Journal of Psychiatry, 158, 788-794. This study determined the severity of posttraumatic stress and depressive reactions in 158 Nicaraguan adolescents 6 months after Hurricane Mitch and the relationship of these reactions to objective and subjective features of hurricane exposure, death of a family member, forced relocation, and thoughts of revenge. Severe levels of posttraumatic stress and depressive reactions were found among adolescents in the two most heavily affected cities. Severity of posttraumatic stress and depressive reactions and features of objective hurricane-related experiences followed a “dose-of-exposure” pattern that was congruent with the rates of death and destruction across cities. Level of impact (city), objective and subjective features, and thoughts of revenge accounted for 68% of the variance in severity of posttraumatic stress reaction. Severity of posttraumatic stress reaction, death of a family member, and sex accounted for 59% of the variance in severity of depression. These findings strongly indicate the need to incorporate public mental health approaches, including systematic screening and trauma/grief-focused interven­ tions, within a comprehensive disaster recovery program. [Abstract Adapted] 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 among Puerto Ricans and other Latinos written about in anthropological and psychiatric literature for over thirty years. This paper discusses the issue of categorizing ataque de nervios as a “culture-bound syndrome” using data from the first community-based study of this phenomenon using epidemiological methods. The paper summarizes the social and psychological correlates of ataques de nervios and provides a preliminary overview of the situations which provoke ataques and the symptoms people experience. The paper critically examines the use of the “culture-bound syndrome” framework for analyzing ataques de nervios and suggests that the term “popular illness” 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 for psychopathology following a natural disaster in a developing country. International Journal of Geriatric Psychiatry, 20, 835-841. 800 respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle, and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. PTSD, depression, and SRQ-caseness were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency from those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly, increasing age was not a factor. [Abstract Adapted] Lima, B. R., Pai, S., Santacruz, H., & Lozano, J. (1991) Psychiatric disorders 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 socioeconomic status living in tent camps 8 months following the Armero disaster in Colombia to ascertain the level of psychiatric morbidity. 91% of the subjects identified by the screening instrument as being emotion­ ally distressed met DSM-III criteria for a psychiatric disorder. The most frequent diagnoses were PTSD and major depression. These findings indicate that a simple screening instrument can be reliably used for the detection of significant emotional problems among disaster victims. Interventions for their adequate management need to be designed, implemented, and evaluated. The general health PAGE 4 P T S D R E S E A R C H Q U A R T E R LY