Vector Volume 11 Issue 1 - 2017

Mental illness following disasters in
Low Income Countries
[Review]
Rose Brazilek
Rose Brazilek is a PhD candidate studying through the Australian Centre for Blood Disease
at the Alfred Hospital. She has a keen interest in translational medical research and blood
disorders. In the future, she hopes to specialise in haematology with a special interest in
thrombosis and haemostasis.
Abstract
Disasters test the capacity of health infrastructure to act in a well-coordinated and adaptable manner, due to the unique
nature of each event. While immediate provision of healthcare focuses on the physical consequences, the long term mental
health ramifications of such events are often forgotten, and services are ill-equipped to deal with the mental illnesses
arising from them. The inherent challenges to the public health response are compounded by the limitations experienced
by Low to Middle Income Countries (LMIC). These countries may lack the fiscal resources to fund such interventions and
have unstable socio-political environments, which may further complicate disaster response. It is by consideration of these
limitations, risk factors specific to such countries, and cultural sensitivity then that effective, long-standing mental health
interventions can be implemented. This paper will review the predisposing factors to mental illness development following
disaster, particularly in respect to at-risk subpopulations, the impact of socio-political climate and low GDP on disaster
response, and the development of effective, culturally-specific interventions. The intersection between low national GDP
and poor mental health infrastructure often translates to poorer mental health outcomes following disaster. Women,
people of low educational status and low income are especially predisposed to development of mental illness. Common
mental health disorders include Post Traumatic Stress Disorder, depression and anxiety
Introduction
In Low and Middle Income Countries (LMIC), mental
health care considerations of disaster survivors have taken
a proverbial back seat, as the establishment of basic needs
take priority.[1] Unfortunately, overwhelming evidence of
causality between natural disasters and mental health issues
has confirmed that provision of culture-specific mental
health care is an integral part of the public health response
following massive loss of life and injury to minimise longterm
recovery ramifications, and a lack of these services
negatively impacts survivors.[2]
Psychosocial and mental health support programmes
are increasingly being recognised as a crucial component
of the humanitarian response to disasters.[3] However,
disaster response coordination is notoriously complicated
with numerous factors to consider, and lack of funding
and resources in low income countries further limits health
responses.[4] This paper will examine the predisposing
factors to the development of mental illness in those affected
by disaster in LMIC, and suggests potential preventative
actions.
Common mental health disorders arising from disasters
Poor mental health in the immediate aftermath following
disasters is to be expected in most survivors, the degree
of suffering is affected by the nature of the experience,
support networks, coping skills and the community response.
[4] This suffering includes distress –situations in which the
individual feels anger, fear, sadness or shame – emotional
dysregulation, or emotional numbing, however these typically
resolve without long-term consequences.[5] It is when they
are sustained, and impact on daily functioning, that they
are defined as a ‘mental illness’. The most common of
these are the anxiety disorders, particularly Post Traumatic
Stress Disorder (PTSD), in which the individual experiences
heightened arousal, avoidance of triggers, and flashback
episodes.[5] Other mood disorders commonly experienced
include abnormal grief reactions and depression.
Due to the decreased utilisation of health services,
particularly mental health services around the world and
especially in Low to Middle Income Countries (LMIC),
individuals may attempt to self-medicate with alcohol
and other substances.[4] This may lead to substance use
disorders as a way to deal with stressors, by avoiding or
displacing difficult emotions associated with disasters. This
is especially common in patients with a history of substance
use disorder in remission, as relapse is common following
stressful events.
Somatisation disorders also show increased incidence
following disasters; a way for survivors to express emotional
distress.[2] They are more likely to occur in individuals
with other concurrent mental health diagnoses, such as
PTSD. Various cultures approach emotional distress as
irrational, and thus there are a number of culture-specific
disorders that manifest in this way.[3] These include Latah,
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