The Range, Magnitude, and Duration of Effects of Natural and
Human-Caused Disasters: A Review of the Empirical Literature,
2002
Fran H. Norris, Georgia State University, with the
assistance of Christopher M. Byrne and Eolia Diaz, Georgia State
University, and Krzysztof Kaniasty, Indiana University of
Pennsylvania
A total of 177 articles that described results for 130 distinct
samples composed of over 50,000 individuals who experienced 80
different disasters were coded as to:
Disaster type (62% natural disasters, 29% technological
disasters, and 9% mass violence)
Disaster location (60% Usa, 25% other developed country, 15%
developing country)
Sample type (73% adult survivors, 16% youths, 11%
rescue/recovery workers)
Several methodological variables
After a preliminary review of the studies, each sample was coded
as to the presence of 6 sets of outcomes and rated as to its
overall severity of impairment.
Range of Outcomes
Specific psychological problems were identified in 74% of
the samples. Posttraumatic stress or Ptsd was found in 65% of the
samples, depression or Major Depressive Disorder was found in 37%
of the samples, and anxiety or Generalized Anxiety Disorder was
found in 19% of the samples. Panic Disorder and specific phobias
were rare.
Non-specific distress, assessed by means of global indices
of psychological and psychosomatic symptoms, was identified in 39%
of the samples.
Health problems and concerns, such as self-reported somatic
complaints, verified medical conditions, increased taking of sick
leave, elevations in physiological indicators of stress, declines
in immune functioning, sleep disruption, increased use of
substances, and (if previously disabled) relapse and illness
burden, were identified in 25% of the samples.
Chronic problems in living, identified in 10% of the
samples, were assessed rarely, but they were generally found where
they were assessed. Such problems included troubled interpersonal
relationships, social disruption, family strains and conflicts,
excess obligations to provide financial and social support to
others, occupational stress, financial stress, and other concerns
about general living conditions and the community at large.
Psychosocial resource losses were also assessed less
frequently than the other factors but were nonetheless found in 10%
of the samples. Declines in perceived support, social embeddedness,
coping self-efficacy, and optimism were at least occasionally
observed.
Problems specific to youths included various behavioral
problems and separation anxiety among children and deviance and
delinquency among adolescent survivors.
Magnitude of Effects
To provide a rough estimate of the overall impact of the events
studied, each sample's results were classified on a 4-point scale
of severity:
9% showed
minimal impairment, meaning that the majority of the
samples experienced only transient stress reactions
52% showed
moderate impairment, wherein prolonged but subclinical
distress was the predominant result
23% showed
severe impairment, meaning that 25% to 49% of the samples
suffered from criterion-level psychopathology
16% showed
very severe impairment, meaning that 50% or more of the
samples suffered from criterion-level psychopathology
Variables That Predicted the Sample's Overall Severity of
Impairment
School-aged youths were most likely, and rescue/recovery
workers least likely, to show severe impairment: 62% of the
school-aged samples experienced severe impairment, compared to 39%
of the adult survivor samples and 7% of the rescue/recovery
samples.
Survivors in developing countries were at greatest risk when
the location of the disaster was considered. Severe effects were
observed in 27% of the U.S. samples, 46% of the samples from other
developed countries, and 79% of the samples from developing
countries.
Mass violence was, by far, the most disturbing type of
disaster. In the samples that experienced mass violence, 67% were
severely impaired, compared to 34% of the samples that experienced
technological disasters, and 42% of the samples that experienced
natural disasters.
Disaster type and disaster location interacted to predict
impairment. Almost all samples from developing countries
experienced natural disasters, many of which were catastrophic in
scope, involving high death tolls. Natural disasters in developing
countries yielded a higher mean severity rating than did either
natural or technological disasters elsewhere. However, within the
developed countries, technological disasters produced a
significantly higher aggregate severity rating than did natural
disasters. Thus, for the narrower purpose of understanding the
typical impact of disasters in the United States, it is reasonable
to expect that technological disasters, on average, will be more
psychologically stressful than natural disasters. Technological
disasters, however, were less disturbing than disasters of mass
violence in both the United States and other developed
countries.
Together, these 3 variables (disaster type, location, sample
type) explained 30% of the variance in the samples' severity of
impairment. The multiple correlation was .54.
Disasters in the United States
It was possible to identify several well-known events that were
illustrative of disasters that had atypically weak, typical, or
atypically strong effects on psychological outcomes. Common
denominators among events and samples are outlined below.
Atypically weakdisasters were associated mostly with minimal impairment in
the samples studied. These were exemplified by the 1989 Loma Prieta
earthquake, the 1994 earthquake in Northridge, California, and the
1982 flood/dioxin contamination in the St. Louis Epidemiologic
Catchment Area. Most samples in this group were not very seriously
exposed, experienced little social disruption, or had access to
substantial personal and community resources.
Typical disasters were associated with moderate impairment
in the samples studied. These were exemplified by the 1981 flood in
Kentucky, Hurricane Hugo in 1989 in the Carolinas, and the 1979
nuclear accident at Three Mile Island. The diversity of events in
this category points to a variety of processes that intersect to
produce or protect against prolonged stress and distress. The
effects of highly destructive events, such as Hurricane Hugo, may
be reduced by strong interpersonal and community supports, whereas
the effects of less destructive events, such as the Kentucky floods
in Appalachia, may be heightened by a low-resource context. Even in
the absence of trauma and actual property loss, the effects of
technological accidents may be comparable in magnitude to these
other types of events because of victims' residual uncertainties,
health concerns, and loss of trust.
Atypically strong disasters were associated mostly with
severe or very severe impairment. These were exemplified by
Hurricane Andrew in 1992 in south Florida; the 1972 dam collapse in
Buffalo Creek, West Virginia; the 1989 Exxon Valdez oil spill off
the coast of Alaska; and the 1995 bombing of the Murrah Federal
Building in Oklahoma City. These events caused massive destruction
or threat to life and/or prolonged social and financial disruption
and resource loss.
Duration of Effects
Twenty-seven panel studies (studies in which the same
individuals are interviewed on multiple occasions) provided data on
the course of postdisaster distress. Three primary trends were
observed:
First, the general rule, observed in the vast majority of
studies, was for samples to improve as time passed. This was not
always simply linear, as some outcomes sometimes improved for a
while, then stabilized or worsened for a while, and then improved
again.
Second, the severity of symptoms in the early phases of
disaster recovery was an accurate predictor of symptoms in later
phases. Delayed onsets of psychological disorders were rare.
Third, symptoms usually peaked in the first year and were
less prevalent thereafter, leaving only a minority of communities
and only a minority of individuals within those communities
substantially impaired.
Summary and Conclusions
A substantial amount of research pertinent to understanding the
range, magnitude, and duration of the effects of disasters has been
published over the past 20 years. A variety of events were studied
in a variety of ways, the samples were impressively diverse, and
individuals' experiences ranged from little more than inconvenience
to severe trauma and loss. Accordingly, it is not surprising that
results varied, with some samples showing only minimal and
transient stress reactions and others showing prevalent and
persistent psychopathology. Several conclusions can be drawn based
on the literature reviewed:
The range and distribution of outcomes suggest that a quality
assessment of victims' mental-health should include, at
minimum:
1) A retrospective diagnostic assessment of PTSD, preferably one
that anchors the symptoms to the disaster
2) A brief measure of current nonspecific distress
3) An inventory of the acute and chronic stressors and resource
losses associated with the event
Allowing 20 questions for (1), 10 questions for (2), and 20
questions for (3), a 50-item screening tool could be developed for
use in the field. Most adults should be able to complete this
screen in 20 minutes or less.
The
relative risk associated with sample types, in which youths
were at the greatest risk and rescue/recovery workers the least,
points to an advantage associated with maturity and experience. In
light of recent events in the United States, the effects
experienced by recovery workers should be interpreted with caution.
While often exposed to horror, rescue and recovery workers seldom
experience direct losses or extensive bereavement. However, it is
also possible that we could learn from these workers' capacity to
support one another and to develop a meaningful narrative about
their experience.
That
samples from outside the United States tend to be more
severely impaired likely reflects the fact that disasters tend to
be more destructive when they occur in the developing world. Many
of the samples from developing countries survived disasters where
death tolls measured in the thousands or even in the tens of
thousands. If the greater severity of impairment experienced by
those outside the U.S. is due to the enormity of the disaster
rather than the location, we may expect U.S. survivors of September
11th to exhibit more severe impairment than we've seen in
this country in the past. The difference in severity between U.S.
survivors and survivors from other countries may also attest to the
fact that government services and other resources can make a
difference in the lives of disaster victims.
Findings were unequivocal regarding the
adverse consequences of experiencing disasters caused by
malicious human intent. In the United States, technological
disasters appear to be somewhat more stressful than natural
disasters. From a more global perspective, it may be time to
reexamine our ideas about the relative impacts of natural and
technological events. Literature in the field has changed markedly
in the past decade. International research has mushroomed, and many
of these studies have found quite severe effects as a result of
natural and technological disasters. Many of our ideas about the
course of recovery from natural disasters are based primarily on
western experience, where predisaster housing quality, controls
over land use, and warning systems are far superior to those in
developing countries.
It should also be recognized that
both natural and technological disasters varied considerably in
their effects, as we found examples of low impact, moderate
impact, and high impact events within each of these categories. Few
of the incidents of mass violence had anything other than severe
effects.
Overall, from these illustrative studies and others similar to
them, we may conclude that disasters should have
minimal long-term consequences for mental-health at the
population level when:
Injuries and deaths are rare
The destruction or loss of property is confined relative to
the size and resources of the surrounding community
Social support systems remain intact and function well
The event does not take on more symbolic meanings of human
neglect or maliciousness
Events with these characteristics may compose a minority of
those in the published literature, but they probably compose a
larger share of real life events in the United States. Such events
probably do not require large-scale professional or even
paraprofessional mental-health interventions, although crisis
intervention strategies that ameliorate the initial stress may be
helpful.
For disasters having a
moderate level of impact, the typical result of major
disasters in the United States, programs that can reduce stress,
enhance social support, and provide reassurance about future risk
are advisable at the community level. Such programs might encompass
mechanisms for identifying those with more serious impairment and
referring them to professional treatment.
Disasters that engender
severe, lasting, and pervasive psychological effects are
rare, but they do happen. Sample (and presumably population) level
effects were greatest when at least two of the following
event-level factors were present:
Extreme and widespread damage to property
Serious and ongoing financial problems for the community
Human carelessness or, especially, human intent caused the
disaster
High prevalence of trauma in the form of injuries, threat to
life, and loss of life
When such disasters occur, the need for professional
mental-health services will be widespread. Delivering them will
pose a tremendous challenge but seems to be required.
Persons who are most at risk for long-term distress can and
should be identified fairly early in the process, which therefore
points to a need for early screenings and interventions in disaster
mental-health.
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