O. M. Ali, G. Milstein, & P. M. Marzuk, "The Imam's Role in Meeting the Coun- seling Needs of Muslim Communities in the United States," Psychiatry Services, ...
The Adverse Psychological Outcomes of Natural Disasters: How Religion May Help to Disrupt the Connection Mohsen Rezaeian, Ph.D.' Epidemiologist and Associate Professor Rafsanjan MedicalSchool SocialMedicineDepartment Enghelab Sq.
Rafsanjan, Iran
ar th qu akes, floods, tropical cyclones, etc. are natural disasters that happen almost daily.',2,3 For instance, floods are the most common natural disaster in both developed and developing countries which may sporadically have devastating impact.' Furthermore, each year from almost 3000 human perceptible earthquakes 7 to 11 result in considerable loss of life.' It has been documented that mental distress, including post-traumatic stress disorder (PTSD), depression, anxiety disorders, etc. occur between a third and half of all the persons who have been exposed to such disasters." Different studies highlight that due to loss of family members or loved ones, personal threats to life, massive destruction, property loss, and the failure of social security systems, the effects of the catastrophic disasters on mental health are larger than mild ones.'-",9,1O.1l.12,13 Since one of the strongest risk factors for suicide and suicidality (i.e., suicidal ideation, plans and deliberate self harm (DSH» tends to be mental disorders,":" theoretically a relation between exposure to natural disasters and suicide behavior would also be possible. There are a number of studies that highlight the relation between being exposed to a natural disaster and increasing rates of suicide ' 6,'7,'8,'9,2o,21,22 or suicdality,23,24,25 although one of these studies, i.e. Krug et aL26 later retracted some of its initial findings," There are a number of variables, including age, sex, race, ethnicity, socio-economic status, past history (e.g., being exposed to a previous traumatic event), social supports and cultural background that may significantly contribute to the extend of the adverse psychological outcomes of the natural disasters." For instance, women, children, elderly, and lowincome people are more prone to develop such adverse psychological outcomes" while those people who received social support may manifest a lower adverse psychological outcomes." The results of a large systematic review also reveal that higher levels of religious involvement (e.g., "how often someone attends religious meetings" or "time spent in private religious activities such as prayer") are positively related with more life satisfaction, more happiness, less depression, and less suicidal thoughts." Similarly, as far as committing suicide at the far end of mental distress is concerned, it has been well documented that religious countries have lower suicide rates compared with secular ones." Given that the positive impact of religious involvement on mental health is stronger among people under stressful conditions," it follows that the
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relation between exposure to natural disaster and developing adverse psychological outcomes might also be significantly influenced by religion. It seems that not only the religious beliefs of the affected people but also the activity of the religious establishment of the affected area could alleviate the psychological outcomes of the natural disasters. It has been pointed out that five decades of research highlight that under normal circumstances clergy frequently provide first-line mental health care," even to a greater extent that psychiatrists." Therefore, in the aftermath of a disaster when people feel lost and helpless, conducting religious ceremonies or providing counseling opportunities by clergy may substantially help people to heal their mental distress. Furthermore, in case of large-scale catastrophic natural disasters, basic human needs of the surviver, e.g., shelter, clothing, and food, may not be met by the Red Cross, Red Crescent, and local emergency management systems (EMS) .36 In this case, many disaster victims may stay in desperate need and therefore they become more prone to develop mental distress. In such circumstance, too, the community religious establishment-e.g., churches, mosques, temples, and synagogues-eould become immensely involved in providing those basic needs." As Chester observed "during the International Decade for Natural Disaster Reduction (1990-2000) a consensus emerged that, if responses to disasters are to be successfully managed, then an awareness of local culture is vitally important. In many disaster prone regions, religion is an essential element of culture and must be carefully considered in the planning process, and not simply dismissed as a symptom of ignorance, superstition, and backwardness.?" At the very least religion could help to alleviate the psychological outcomes of the natural disasters by either providing counseling opportunities or fulfilling basic human needs. .Itt Endnotes *1 would like to express appreciation to Dr. Paul Ward for the valuable comments he made on the earlier draft of this article. 1. E. K. Noji, "Disaster Epidemiology," Emergency Medicine Clinics of North America, 1999, Vol. 14, pp. 289-300. 2. E. K. Bohannon, "Disaster: Searching for Lessons from a Bad Year," Science, 2005, Vol. 310, p. 1883. 3. A. Shaikh and A. Musani, "Emergency Preparedness and Humanitarian Action: The Research Deficit. Eastern Mediterranean Region Perspective," Eastern Mediterranean Health Journal, 2006, Vol. S2, pp. 54-63. 4. M. Ahem, R. S. Kovats, P. Wilkinson, R. Few, & F. Matthies, "Global Health Impacts of Floods: Epidemiologic Evidence," Epidemiologic Reviews, 2005, Vol. 27, pp.36-46. 5. M. Ramirez and C. Peek-Asa, "Epidemiology of Traumatic Injuries from Earthquakes," Epidemiologic Reviews, 2005, Vol. 27, pp. 47-55. 6. World Health Organization, The World Health Report 2001 Mental Health: New Understanding, New Hope (Geneva, Switzerland: World Health Organization, 2001). 7. YJ. Chou, N. Huang, C. H. Lee, S. L. Rsa,J. H. Tsay, L. S.Chin, & P. Chou, "Suicide after the 1999 Taiwan Earthquake," International Journal of Epidemiology, 2003, Vol. 32, pp. 1007-1014. 8. H. E. Vehid, B. Alyanak, & A. Eksi, "Suicide Ideation after the 1999 Earthquake in Marmara.Turkey," The Tohoku Journal of Experimental Medicine, 2006, Vol. 208, pp.19-24. 290
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