The Course of PTSD, Major Depression, Substance Abuse, and Somatization After a Natural Disaster

Abstract

Flood research has used a variety of methods, yielding inconsistent findings. Universal definitions of illness are paramount to the science of psychiatric epidemiology of disasters. St. Louis area survivors (N = 162) of the Great Midwestern Floods of 1993 received a structured diagnostic assessment at 4 and 16 months postdisaster, with 88% follow-up. The purpose of the assessment was to examine predisaster and postdisaster rates of disorders and symptoms. Flood-related posttraumatic stress disorder was diagnosed in 22% and 16% at index and follow-up, respectively. Comorbidity with major depression determined whether the posttraumatic stress disorder would have remitted by 1 year later. Nearly one half of the men in the sample had a pre-existing alcohol use disorder. Virtually no new substance abuse followed the floods, and hence, substance abuse did not develop in response to the disaster or as part of coping with its aftermath. Somatization disorder was not observed; new somatoform symptoms represented a fraction of postflood somatic complaints. Findings are inconsistent with causal attribution of floods in the etiology of alcohol abuse and somatization. Methodological differences may account for much of the apparent discrepancy of these findings, with recent reports of increased alcohol use and somatic symptoms observed after other disasters.

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

“…The high rates of comorbid conditions that occur with PTSD contribute to the chronicity of this disorder [93]. Findings of one recent study indicated that comorbid major depression predicted continuing PTSD 1 year after flood disaster, whereas in contrast with other investigations, comorbid substance abuse and somatization were not [94].…”

What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample

“…[11,13] Although much evidence suggests a strong relationship between trauma exposure and the presence of PTSD and AUDs (for review, see [14] ), reports of variability in alcohol-use [15] and PTSD symptoms [16] among those exposed to trauma appear throughout contemporary literature. The majority of studies to date have either defined trauma as a unitary construct, [4] or have examined only a few specific events [17] or a select group of events [18] irrespective of other adverse occurrences. In addition, extant literature has primarily focused on military [19] or treatment-seeking [20] populations.…”

Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies

“…A total of 39 studies were eligible for inclusion into the review. In 29 studies, the first baseline examination was performed 1-6 months after the trauma or the end of a potentially traumatic period (13, and in 10 studies, the baseline examination was performed >6 months after the trauma (9,10,(46)(47)(48)(49)(50)(51)(52)(53), see figure 2. Five studies included in the Smid et al (17) review were not included in the present study (two addressing children and adolescents, two with <25 participants and one in Polish), while three other studies published before 2009 were added (21,25,28).…”

“…Therefore the lack of appropriate reference groups in descriptive studies of PTSD becomes a fundamental methodological issue -in particular as time from traumatic event to development of symptoms increases. This may partly explain why some researchers have doubted the existence of delayed-onset PTSD (13)(14)(15) and that delayed-onset PTSD has not yet been included in the International Classification of Mental Disease.…”