Fifteen Years of Research on the Consequences of Disaster

1. Fifteen Years of Research on the Consequences of Disaster Danielle Maltais, Ph.D. Université du Québec à Chicoutimi (UQAC) Prague, Juin 2012 danielle_maltais@uqac.ca

2. Initial Objectives • Find out the consequences of disaster on the biopsychosocial health status of the victims and the relief workers who help the family to recovery . • Provide regional authorities with tools to obtain a better distribution of provincial healthcare funds.

3. Completed Research Projects • Effects of a disaster on concept of home for people who lost their home (concept du chez-soi) (qualitative study) • Short and midle consequences of the 1996 floods on the biopsychosocial health of survivors living in an urban setting (qualitative and quantitative studies) . • Middle Consequences of the 1996 floods on the bio-psychosocial health of victims living in a rural setting (qualitative and quantitative study) and impacts on their community dynamic. • Social support and post-disaster health status. (qantitative study) • Long-term consequences of the St-Jean-Vianney mudslide of 1971 (qualitative study).

4. CompletedResearchProjects Consequences of the ice storm on the biopsychosocial health of individuals : farmers, elderly, families with young children (qualitative study) and on relief workers from Monterégie and Saguenay. Long-term effects of the 1996 floods on the health of individuals who live on rural or urban community (qualitative and quantitative study). Effect of crisis intervention on the health of social worker (study in course: qualitative and quantitative study)

5. Someexamples of results: Main Stresses Experienced by the Victims.

6. Floods: 11 StressfulEvents • When water is rising: fear comes progressively. • When leaving the home: distraught victims instinctively seek familiar places to go. • When waiting for information: uncertainty brings doubts in victims – what will happen to them?

7. Floods: A String of Stressful Events • When the damage is assessed: the moment of truth triggers acute emotional reactions. The loss of a house and most significant objects/belongings are shocks which brings desolation, discouragement, and sadness. • When people must temporarily relocate to several places: their residential itinerary is punctuated with uncertainty, embarrassment, worries, and adaptation difficulties.

8. Floods: A String of Stressful Events • Taking steps to obtain compensation from community and government authorities: agitation, anger, embarrassment (of asking for help), and dissatisfaction. • Waiting for compensation decisions: financial insecurity lingers on and becomes irritating.

9. Floods: A String of Stressful Events • Taking bank loans and contracting debts: brings about disappointment, irritation, anxiety, and important changes in plans (eg. postponing retirement) • Relocating to a new apartment or house: grieving for their losses, and initiating numerous legal or administrative actions.

10. Floods: A String of Stressful Events • Managing discomfort and grief: once they are almost done cleaning or repairing their home, survivors become conscious of their own physical and psychological health. They also modify their recreational and social activities (decreasing their social interactions and dropping certain leisure activities).

11. Floods: A String of Stressful Events • Adapting to a new life: the change in one’s place of residence requires a complete reorganization of one’s family life. Survivors must adapt to a new environment, new neighbours, anda new home.

12. Disasters and the Concept of Home

13. Loss of the House and Concept of Home • Involuntary relocation = major crisis for elderly • Source of health issues • Considerable sadness • Persisting nostalgia • Major difficulties in finding comfort in a new home • Idealizing of the lost house

14. Loss of the House and Concept of Home • Involuntary relocation = major irritants. • Loss of belongings and sentimental objects = difficulty in finding comfort in the new home.

15. Obstacles to Finding Comfort and well-being in theNewHome • Attachement to the previous home • Significance of one’s old neighbourhood • Magnitude of damage and losses

16. Concept of Home:The Previous Residence • Place of paradise, refuge • Reflection of their personality • Retirement money • “Real” home • Attachment to the house, neighbours, and neighbourhood • Place of belonging, where roots are

17. Concept of Home:The Actual Residence • The house is no more than a refuge against the weather • Meets the basic needs of shelter, food, and sleep. • Feelings of eeriness • Feels like it is a place of transition. • Functional and practical shelter • Not the “real” home

18. Informations about preoccupation and the Short and Medium-TermConsequences of Disasters on the BiopsychosocialHealth of Elderly

19. Main Preoccupations of Elderly During the Floods • Get to a shelter • Find a place to stay • Fear of drowning • Fear of vandalism • Obtain essential supplies • Save their pets’ lives

20. Main Feelings of Elderly During the Floods • Fear, panic facing water or helicopters • Anguish, disbelief • Fear for their lives or the life of kins • Feelings of isolation due to collapsed bridges, loss of electricity, and phone service

21. Overview • Two or three years after the event, in urban or rural area the physical and psychological health of victims are more fragile than those of the control group’s. • Physical and psychological consequences of the floods are as significant for men as for women victims. • Health consequences are not a function of age (elderlies vs. others)

22. Overview (2) • Several aspects of the lives of victims are different from those of the control group’s. • Concerning physical health, differences beetwen victims and non-victims were observed in the perception of health status, the outbreak of new health problems, the deterioration of health status, the exacerbation of existing health problems, the development of new problems in kins, the use of prescribed and over-the-counter medication.

23. Overview (3) • Concerning psychological health, differences were observed in PTSD symptoms, in psychological well-being, in the presence of depression, anxiety and insomnia symptoms, in social functioning difficulties, and in somatic symptoms. • Concerning living conditions, more survivors than control group individuals had contracted debts following the floods, and more victims experienced financial difficulties in the two weeks before the research interview.

24. Long term effects of floods(longitudinal study)

25. Results In general, there is a long-term reduction of psychological symptoms in both urban and rural areas. In urban areas, there are many significant differences between victims and non-victims for the psychological variables: PTSD symptoms, psychological well-being, somatic symptoms, anxiety and insomnia and social dysfunction . In rural areas, there are no significant difference between victims and non-victims for all the psychological variables except for PTSD.

26. The Links Between Perceived and Received Social Support and Post-Disaster Health Status.

27. Observations • Two years post-disaster, survivors claiming to have received less help than they hoped for generally show poorer physical and psychological health than control group individuals (non-victims) and survivors who received as much or more help than they hoped for. • Impacts on: PTSD symptoms, anxiety, depression and severe depression, somatic symptoms and social dysfonction

28. Observations (2) • In their psychological health status, individuals who received as much or more help than hoped for obtain similar scores than control group individuals on the various scales, exept on those measuring PTSD symptoms.

29. Observations (3) • The scale of damage is significantly linked to PTSD symptoms, while social support and coping strategies are more linked to depression symptoms and psychological distress.

30. Conclusion It is necessary to complete other studies in the field of gerontology on different subgroups of elderly because we don’t really know how their reactions are influenced by their previous conditions, previous health, their level of autonomy and their losses. Also we don’t know what kind of difficulties the social workers and nurses have during disaster when they work with elderly.