Biomedical Engineering Reference
In-Depth Information
of a mental health or social service professional
who also was not a direct responder in this inci-
dent but is experienced in conducting CISM.
As co-leaders, the peer and mental health/social
service professionals can consult with facility
or team administrators and supervisors to deter-
mine the best timing, group composition, place,
manner of invitation, and precautions for CISM
discussion sessions (see Young et al. [22] for
detailed guidelines). There is no predetermined
“formula” for when, where, with whom, or how
to provide CISM, but there is a universal goal:
to enable staff and responders to come away
from traumatic deployments with a sense of
being a valued, effective member of a team
that made a difference in the wake of terrorism
for victims, patients, family members, and their
communities.
Table 11.3
Risk factors for persistent psychosocial
and vocational impairment in individuals directly or
indirectly exposed to disaster or terrorism
Pre-traumatic vulnerability
Female gender
Low educational or socioeconomic status
Unattached marital status (single, divorced, separated, or
unmarried but co-habiting—but not widowed, unless
acutely bereaved)
History of anxiety or mood disorders or anxiety proneness,
PTSD, and family history
History of life stressors and disruptions
Traumatic exposure
Exposure to life threat or extreme violence
Physical injury
Witnessing death, extreme violence, or destruction
Working in the rescue operations
Exposure to graphic media coverage (e.g., repeated
television viewing of disaster)
Traumatic Loss
Death of a family member or close friend
Job or financial loss
Loss of home or possessions
11.2.6 Coordinating the Acute Crisis
Response Effort with Ongoing Care for
Psychiatric Patients
Several studies found that poor mental health was
associated with reporting post-disaster psycholog-
ical problems (Jehel et al., 2003; North et al., 1999;
Shariat et al., 1999; Silver et al., 2002; Rosen-
heck, & Fontana; 2003a, 2003b) and receiving
formal services for those problems (Boscarino
et al; 2002; Moyers, 1999; Rosenheck et al.,
2003a, 2003b; Weissman, Kushner, Marcus, &
Davis; 2003). However, Help-seeking by psychi-
atric patients did not increase greatly after 9/11
(Rosenheck et al., 2003a, 2003b; Weissman et al.,
2003), but prior mental health problems were asso-
ciated with mental health service utilization in
New York City (Boscarino et al., 2002) and with
requests for psychotropic medications (Boscarino,
Galea, Ahern, Resnick, & Vlahov, 2003; Kettl,
& Bixler, 2002; McCarter, & Goldman, 2002).
Psychiatric services thus must not only assist
victims, responders, and affected families but also
ensure that resources are allocated in the wake of
disaster so that persons with pre-existing psychi-
atric disorders are able to continue to receive
services in timely and measured manner.
Peri-traumatic reactions
A panic attack
Extreme initial distress or dissociation
Post-traumatic coping
Coping via increased substance use
Avoidant approaches to coping
Post-traumatic alienation and bitterness
Over-identification with victims
Post-traumatic Symptoms, life functioning, and experiences
Persistent or new intrusive re-experiencing or hyperarousal
symptoms one month later
Persistently impaired psychosocial functioning and mental
health treatment seeking
Additional life stressors (e.g., financial, housing,
employment, and family separations)
Complicated bereavement
Protective factors
Social support (e.g., spousal, family, peers, neighbors,
school, and co-workers)
Conservation of socio-environmental resources (e.g., home,
employment, and relationships)
For children, parental post-traumatic adjustment
Psychological preparedness, active coping, and coping
self-efficacy
Optimism and trust in relation to other people and social
institutions
