Zelde Espinel - Academia.edu (original) (raw)
Papers by Zelde Espinel
Prehospital and Disaster Medicine, May 1, 2011
the past three decades in India. The initial experiments' started in 1981 with a circus tragedy a... more the past three decades in India. The initial experiments' started in 1981 with a circus tragedy and documentation of prolonged grief reaction. In the Bhopal gas tragedy (1984) mental health services were integrated through primary care doctors. The Marathwada earthquake (1991) involved primary health care personnel in provision of mental health care to the survivors. The Orissa super cyclone (1999) saw the emergence of psychosocial support to the community using local resources like community level workers who were survivors by themselves. The feasibility study involving 40 such workers was expanded to a pilot model with 400 workers in the Gujarat earthquake (2001) and later to the level of a District model in the Gujarat riots (2002). These developments paved way for the State model when Tsunami struck the eastern coast of India affecting three States and two Union Territories in India. The experiences and experiments led to the development of standardized capacity building tools and intervention kits with level and limits of care being addressed. The Indian experiences has seen a striding change from psychiatry paradigm to public health model, to the development of a standardized psychosocial support models involving community at large. The lesson learnt has been helpful in developing the National Guidelines on Psychosocial Support and Mental Health Services by the National Disaster Management Authority of India. These service models could be adapted to the developing South East Asian countries where there is a paucity of trained professionals to attend the needs of the survivors.
Oxford University Press eBooks, Sep 1, 2018
This chapter reviews the psychobiological effects on children and adolescents upon exposure to a ... more This chapter reviews the psychobiological effects on children and adolescents upon exposure to a traumatic happening where there is a real or imaginary threat of bodily harm or death to the self and/or others. Morbidity may involve the classic symptoms associated with post-traumatic stress disorder such as a readiness to re-experience the psychological and physiological effects of trauma exposure, autonomic arousal, somatic ills and subsequent avoidant behavior as well as a host of other psychological morbidities such as depression, mood dysregulation and other internalizing and externalizing symptoms. Multimodal treatment approaches implementing family and social supports, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used, but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
International Journal of MS Care
Climate change is contributing to increasingly hazardous tropical cyclones that endanger persons ... more Climate change is contributing to increasingly hazardous tropical cyclones that endanger persons living in susceptible coastal and island communities. People living with chronic illness, including multiple sclerosis (MS), face unique challenges and vulnerabilities when exposed to hurricane hazards. Disaster and emergency preparedness requires a customized approach that considers the necessary adaptations to accommodate the mobility, self-care, sensory, cognitive, and communication impairments of persons living with MS. Related considerations include the potential for worsening neurologic signs and symptoms during and after a catastrophic storm. The impact of emotional and financial stresses, as well as disruptions in health care delivery, on this population are also key concerns. This paper addresses the challenges faced by individuals with MS in advance of, during, and in the aftermath of extreme storms. We propose new guidelines on how health care professionals can assist persons ...
Global Mental Health, 2019
Background Colombia's 6.5 million internally displaced persons (IDPs) have been exposed to tr... more Background Colombia's 6.5 million internally displaced persons (IDPs) have been exposed to trauma, loss, and hardships. Common mental disorders (CMDs) are prevalent in this group, yet there are few evidence-based psychosocial interventions for this population. We assessed the feasibility and acceptability of a stepped-care intervention for women IDPs in Bogota, Colombia. Methods Feasibility to recruit participants for an intervention trial, to screen for CMDs and displacement-related traumas, to refer high-risk cases to professional consultation, to implement evidence-based interpersonal counseling (IPC) for women with diagnosed CMDs, to retain participants in the intervention, and to conduct follow-up assessments was assessed. Assessment instruments were validated. The intervention was delivered by trained outreach personnel. Intervention acceptability was assessed by monitoring session attendance, dropout rates, and satisfaction. Potential efficacy was evaluated with pre- and ...
Oxford Medicine Online, 2018
This chapter reviews the psychobiological effects on children and adolescents upon exposure to a ... more This chapter reviews the psychobiological effects on children and adolescents upon exposure to a traumatic happening where there is a real or imaginary threat of bodily harm or death to the self and/or others. Morbidity may involve the classic symptoms associated with post-traumatic stress disorder such as a readiness to re-experience the psychological and physiological effects of trauma exposure, autonomic arousal, somatic ills and subsequent avoidant behavior as well as a host of other psychological morbidities such as depression, mood dysregulation and other internalizing and externalizing symptoms. Multimodal treatment approaches implementing family and social supports, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used, but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
Psychiatric Services, 2019
BJPsych. International, 2015
Mental health law in Colombia has evolved over the past 50 years, in concert with worldwide recog... more Mental health law in Colombia has evolved over the past 50 years, in concert with worldwide recognition and prioritisation of mental healthcare. Laws and policies have become increasingly sophisticated to accommodate the ongoing transformations throughout Colombia's healthcare system and improvements in mental health screening, treatment and supportive care. Mental health law and policy development have been informed by epidemiological data on patterns of mental disorders in Colombia. Colombia is distinguished by the fact that its mental health laws and policies have been formulated during a 60-year period of continuous armed conflict. The mental health of Colombian citizens has been affected by population-wide exposure to violence and, accordingly, the mental health laws that have been enacted reflect this feature of the Colombian experience.
BJPsych. International, 2015
A hallmark of Colombia is population-wide exposure to violence. To understand the realities of me... more A hallmark of Colombia is population-wide exposure to violence. To understand the realities of mental health in Colombia requires attention to the historical context of 60 years of unrelenting armed conflict overlaid upon high rates of homicide, gang activity and prevalent gender-based and intra-familial violence. The number of patients affected by trauma is extremely large, and the population burden of alcohol misuse and illicit drug use is significant. These patterns have brought the subspecialties of trauma and addiction psychiatry to the forefront, and highlight the need for novel treatments that integrate psychotherapeutic and psychopharmacological modalities.
Disaster Health, 2016
This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exp... more This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exploring the dynamics of fear-related behaviors in situations of mass threat. Fear-related behaviors are individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. Importantly, fearrelated behaviors modulate the future risk of harm. Disaster case scenarios are presented to illustrate how fear-related behaviors operate when a potentially traumatic event threatens or endangers the physical and/or psychological health, wellbeing, and integrity of a population. Fear-related behaviors may exacerbate harm, leading to severe and sometimes deadly consequences as exemplified by the Ebola pandemic in West Africa. Alternatively, fear-related behaviors may be channeled in a constructive and life-saving manner to motivate protective behaviors that mitigate or prevent harm, depending upon the nature of the threat scenario that is confronting the population. The interaction between fear-related behaviors and a mass threat is related to the type, magnitude, and consequences of the population encounter with the threat or hazard. The expression of FRBs, ranging from risk exacerbation to risk reduction, is also influenced by such properties of the threat as predictability, familiarity, controllability, preventability, and intentionality.
Disaster Health, 2016
Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin s... more Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin season, bringing severe impacts to multiple nations including direct landfalls in Cuba, Haiti, Bahamas, and the United States. However, Haiti experienced the greatest loss of life and population disruption. Methods. An established trauma signature (TSIG) methodology was used to examine the psychological consequences of Hurricane Matthew in relation to the distinguishing features of this event. TSIG analyses described the exposures of Haitian citizens to the unique constellation of hazards associated with this tropical cyclone. A hazard profile, a matrix of psychological stressors, and a "trauma signature" summary for the affected population of Haiti-in terms of exposures to hazard, loss, and change-were created specifically for this natural ecological disaster. Results. Hazard characteristics of this event included: deluging rains that triggered mudslides along steep, deforested terrain; battering hurricane winds (Category 4 winds in the "eye-wall" at landfall) that dismantled the built environment and launched projectile debris; flooding "storm surge" that moved ashore and submerged villages on the Tiburon peninsula; and pummeling wave action that destroyed infrastructure along the coastline. Many coastal residents were left defenseless to face the ravages of the storm. Hurricane Matthew's slow forward progress as it remained over super-heated ocean waters added to the duration and degree of the devastation. Added to the havoc of the storm itself, the risks for infectious disease spread, particularly in relation to ongoing epidemics of cholera and Zika, were exacerbated. Conclusions. Hurricane Matthew was a ferocious tropical cyclone whose meteorological characteristics amplified the system's destructive force during the storm's encounter with Haiti, leading to significant mortality, injury, and psychological trauma.
Disaster Health, 2016
Colombia, South America is currently transitioning to post-conflict status following 6 decades of... more Colombia, South America is currently transitioning to post-conflict status following 6 decades of armed conflict. The population has experienced extensive exposures to potentially traumatic events throughout the lifespan. Sources of trauma exposure include the prolonged armed insurgency, narco-trafficking violence, urban gang violence, violent actions of criminal bands, intra-familial violence, gender-based violence, and sex trafficking. Exposure to potentially traumatic events is related to a variety of psychiatric outcomes, in particular, posttraumatic stress disorder. Given this context of lifetime trauma exposure, socio-demographic patterns of posttraumatic stress disorder were explored in a sample of residents of Medellin, Colombia, the nation's second largest city and a nexus for multiple types of trauma exposure.
Intervention, 2016
The signing of the truce on 23 June 2016 and the ¢nalisation of peace negotiations on 24 August 2... more The signing of the truce on 23 June 2016 and the ¢nalisation of peace negotiations on 24 August 2016 marked the end of more than 50 yearsofcontinuous armed con£ict in Colombia, South America and the transition to ' post con£ict'status. According to annual reports from the Internal Displacement Monitoring Centre based in Geneva, Switzerland, Colombia has ranked ¢rst or second in numbers of internally displaced persons every year for the past 12 years, making forced migration a de¢ning characteristic of the country.This is based on the personal re£ections of a mother and daughter (ER and AdPGR) who were displaced from rural Colombia and resettled in the nation' s urban capital of Bogota¤. They survived the rigors and hardships of displacement and became capable counsellors on a global mental health project, bringing evidence based interventions to a highly traumatised population of internally displaced women in Bogota¤. Their account speaks to the lived experiences of more than six million Colombian internally displaced 'victims of the armed con£ict'. Particularly notable is the description of myriad trauma exposures prior to the moment of displacement. This ¢eld report demonstrates how personal accounts are a useful tool for educating clinicians working with these populations.
Disaster Health, 2016
This disaster complexity case study examines Spain's deadliest train derailment that occurred on ... more This disaster complexity case study examines Spain's deadliest train derailment that occurred on July 24, 2013 on the outskirts of Santiago de Compostela, Galicia, Spain. Train derailments are typically survivable. However, in this case, human error was a primary factor as the train driver powered the Alvia train into a left curve at more than twice the posted speed. All 13 cars came off the rails with many of the carriages careening into a concrete barrier lining the curve, leading to exceptional mortality and injury. Among the 224 train occupants, 80 (36%) were killed and all of the remaining 144 (4%) were injured. The official investigative report determined that this crash was completely preventable.
Encyclopedia of Earth Sciences Series, 2013
ABSTRACT SynonymsDisaster behavioral health; Disaster health; Disaster mental and behavioral heal... more ABSTRACT SynonymsDisaster behavioral health; Disaster health; Disaster mental and behavioral health; Disaster mental healthOverviewAt 4:53 PM local time (21:53 GMT) on January 12, 2010, a magnitude 7.0 earthquake devastated the Haitian capital city of Port-au-Prince and surrounding area, killing an estimated 222,570–316,000 persons (Inter Agency Standing Committee, 2010; CBC News, 2011). The Haiti 2010 earthquake is noteworthy among natural disasters that subject the affected human population to intense psychological stressors (Table 1).Norris and colleagues (2002) posit that disasters that possess two or more of the following four characteristics are likely to create significant mental health consequences for the affected community: (1) large numbers of deaths and/or injuries, (2) widespread destruction and property damage, (3) disruption of social support and ongoing economic problems, and (4) “human” contribution to the disaster’s causation. By the numbers, the Haiti 2010 ear ...
Current Psychiatry Reports, 2014
Prehospital and Disaster Medicine, May 1, 2011
the past three decades in India. The initial experiments' started in 1981 with a circus tragedy a... more the past three decades in India. The initial experiments' started in 1981 with a circus tragedy and documentation of prolonged grief reaction. In the Bhopal gas tragedy (1984) mental health services were integrated through primary care doctors. The Marathwada earthquake (1991) involved primary health care personnel in provision of mental health care to the survivors. The Orissa super cyclone (1999) saw the emergence of psychosocial support to the community using local resources like community level workers who were survivors by themselves. The feasibility study involving 40 such workers was expanded to a pilot model with 400 workers in the Gujarat earthquake (2001) and later to the level of a District model in the Gujarat riots (2002). These developments paved way for the State model when Tsunami struck the eastern coast of India affecting three States and two Union Territories in India. The experiences and experiments led to the development of standardized capacity building tools and intervention kits with level and limits of care being addressed. The Indian experiences has seen a striding change from psychiatry paradigm to public health model, to the development of a standardized psychosocial support models involving community at large. The lesson learnt has been helpful in developing the National Guidelines on Psychosocial Support and Mental Health Services by the National Disaster Management Authority of India. These service models could be adapted to the developing South East Asian countries where there is a paucity of trained professionals to attend the needs of the survivors.
Oxford University Press eBooks, Sep 1, 2018
This chapter reviews the psychobiological effects on children and adolescents upon exposure to a ... more This chapter reviews the psychobiological effects on children and adolescents upon exposure to a traumatic happening where there is a real or imaginary threat of bodily harm or death to the self and/or others. Morbidity may involve the classic symptoms associated with post-traumatic stress disorder such as a readiness to re-experience the psychological and physiological effects of trauma exposure, autonomic arousal, somatic ills and subsequent avoidant behavior as well as a host of other psychological morbidities such as depression, mood dysregulation and other internalizing and externalizing symptoms. Multimodal treatment approaches implementing family and social supports, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used, but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
International Journal of MS Care
Climate change is contributing to increasingly hazardous tropical cyclones that endanger persons ... more Climate change is contributing to increasingly hazardous tropical cyclones that endanger persons living in susceptible coastal and island communities. People living with chronic illness, including multiple sclerosis (MS), face unique challenges and vulnerabilities when exposed to hurricane hazards. Disaster and emergency preparedness requires a customized approach that considers the necessary adaptations to accommodate the mobility, self-care, sensory, cognitive, and communication impairments of persons living with MS. Related considerations include the potential for worsening neurologic signs and symptoms during and after a catastrophic storm. The impact of emotional and financial stresses, as well as disruptions in health care delivery, on this population are also key concerns. This paper addresses the challenges faced by individuals with MS in advance of, during, and in the aftermath of extreme storms. We propose new guidelines on how health care professionals can assist persons ...
Global Mental Health, 2019
Background Colombia's 6.5 million internally displaced persons (IDPs) have been exposed to tr... more Background Colombia's 6.5 million internally displaced persons (IDPs) have been exposed to trauma, loss, and hardships. Common mental disorders (CMDs) are prevalent in this group, yet there are few evidence-based psychosocial interventions for this population. We assessed the feasibility and acceptability of a stepped-care intervention for women IDPs in Bogota, Colombia. Methods Feasibility to recruit participants for an intervention trial, to screen for CMDs and displacement-related traumas, to refer high-risk cases to professional consultation, to implement evidence-based interpersonal counseling (IPC) for women with diagnosed CMDs, to retain participants in the intervention, and to conduct follow-up assessments was assessed. Assessment instruments were validated. The intervention was delivered by trained outreach personnel. Intervention acceptability was assessed by monitoring session attendance, dropout rates, and satisfaction. Potential efficacy was evaluated with pre- and ...
Oxford Medicine Online, 2018
This chapter reviews the psychobiological effects on children and adolescents upon exposure to a ... more This chapter reviews the psychobiological effects on children and adolescents upon exposure to a traumatic happening where there is a real or imaginary threat of bodily harm or death to the self and/or others. Morbidity may involve the classic symptoms associated with post-traumatic stress disorder such as a readiness to re-experience the psychological and physiological effects of trauma exposure, autonomic arousal, somatic ills and subsequent avoidant behavior as well as a host of other psychological morbidities such as depression, mood dysregulation and other internalizing and externalizing symptoms. Multimodal treatment approaches implementing family and social supports, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used, but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
Psychiatric Services, 2019
BJPsych. International, 2015
Mental health law in Colombia has evolved over the past 50 years, in concert with worldwide recog... more Mental health law in Colombia has evolved over the past 50 years, in concert with worldwide recognition and prioritisation of mental healthcare. Laws and policies have become increasingly sophisticated to accommodate the ongoing transformations throughout Colombia's healthcare system and improvements in mental health screening, treatment and supportive care. Mental health law and policy development have been informed by epidemiological data on patterns of mental disorders in Colombia. Colombia is distinguished by the fact that its mental health laws and policies have been formulated during a 60-year period of continuous armed conflict. The mental health of Colombian citizens has been affected by population-wide exposure to violence and, accordingly, the mental health laws that have been enacted reflect this feature of the Colombian experience.
BJPsych. International, 2015
A hallmark of Colombia is population-wide exposure to violence. To understand the realities of me... more A hallmark of Colombia is population-wide exposure to violence. To understand the realities of mental health in Colombia requires attention to the historical context of 60 years of unrelenting armed conflict overlaid upon high rates of homicide, gang activity and prevalent gender-based and intra-familial violence. The number of patients affected by trauma is extremely large, and the population burden of alcohol misuse and illicit drug use is significant. These patterns have brought the subspecialties of trauma and addiction psychiatry to the forefront, and highlight the need for novel treatments that integrate psychotherapeutic and psychopharmacological modalities.
Disaster Health, 2016
This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exp... more This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exploring the dynamics of fear-related behaviors in situations of mass threat. Fear-related behaviors are individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. Importantly, fearrelated behaviors modulate the future risk of harm. Disaster case scenarios are presented to illustrate how fear-related behaviors operate when a potentially traumatic event threatens or endangers the physical and/or psychological health, wellbeing, and integrity of a population. Fear-related behaviors may exacerbate harm, leading to severe and sometimes deadly consequences as exemplified by the Ebola pandemic in West Africa. Alternatively, fear-related behaviors may be channeled in a constructive and life-saving manner to motivate protective behaviors that mitigate or prevent harm, depending upon the nature of the threat scenario that is confronting the population. The interaction between fear-related behaviors and a mass threat is related to the type, magnitude, and consequences of the population encounter with the threat or hazard. The expression of FRBs, ranging from risk exacerbation to risk reduction, is also influenced by such properties of the threat as predictability, familiarity, controllability, preventability, and intentionality.
Disaster Health, 2016
Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin s... more Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin season, bringing severe impacts to multiple nations including direct landfalls in Cuba, Haiti, Bahamas, and the United States. However, Haiti experienced the greatest loss of life and population disruption. Methods. An established trauma signature (TSIG) methodology was used to examine the psychological consequences of Hurricane Matthew in relation to the distinguishing features of this event. TSIG analyses described the exposures of Haitian citizens to the unique constellation of hazards associated with this tropical cyclone. A hazard profile, a matrix of psychological stressors, and a "trauma signature" summary for the affected population of Haiti-in terms of exposures to hazard, loss, and change-were created specifically for this natural ecological disaster. Results. Hazard characteristics of this event included: deluging rains that triggered mudslides along steep, deforested terrain; battering hurricane winds (Category 4 winds in the "eye-wall" at landfall) that dismantled the built environment and launched projectile debris; flooding "storm surge" that moved ashore and submerged villages on the Tiburon peninsula; and pummeling wave action that destroyed infrastructure along the coastline. Many coastal residents were left defenseless to face the ravages of the storm. Hurricane Matthew's slow forward progress as it remained over super-heated ocean waters added to the duration and degree of the devastation. Added to the havoc of the storm itself, the risks for infectious disease spread, particularly in relation to ongoing epidemics of cholera and Zika, were exacerbated. Conclusions. Hurricane Matthew was a ferocious tropical cyclone whose meteorological characteristics amplified the system's destructive force during the storm's encounter with Haiti, leading to significant mortality, injury, and psychological trauma.
Disaster Health, 2016
Colombia, South America is currently transitioning to post-conflict status following 6 decades of... more Colombia, South America is currently transitioning to post-conflict status following 6 decades of armed conflict. The population has experienced extensive exposures to potentially traumatic events throughout the lifespan. Sources of trauma exposure include the prolonged armed insurgency, narco-trafficking violence, urban gang violence, violent actions of criminal bands, intra-familial violence, gender-based violence, and sex trafficking. Exposure to potentially traumatic events is related to a variety of psychiatric outcomes, in particular, posttraumatic stress disorder. Given this context of lifetime trauma exposure, socio-demographic patterns of posttraumatic stress disorder were explored in a sample of residents of Medellin, Colombia, the nation's second largest city and a nexus for multiple types of trauma exposure.
Intervention, 2016
The signing of the truce on 23 June 2016 and the ¢nalisation of peace negotiations on 24 August 2... more The signing of the truce on 23 June 2016 and the ¢nalisation of peace negotiations on 24 August 2016 marked the end of more than 50 yearsofcontinuous armed con£ict in Colombia, South America and the transition to ' post con£ict'status. According to annual reports from the Internal Displacement Monitoring Centre based in Geneva, Switzerland, Colombia has ranked ¢rst or second in numbers of internally displaced persons every year for the past 12 years, making forced migration a de¢ning characteristic of the country.This is based on the personal re£ections of a mother and daughter (ER and AdPGR) who were displaced from rural Colombia and resettled in the nation' s urban capital of Bogota¤. They survived the rigors and hardships of displacement and became capable counsellors on a global mental health project, bringing evidence based interventions to a highly traumatised population of internally displaced women in Bogota¤. Their account speaks to the lived experiences of more than six million Colombian internally displaced 'victims of the armed con£ict'. Particularly notable is the description of myriad trauma exposures prior to the moment of displacement. This ¢eld report demonstrates how personal accounts are a useful tool for educating clinicians working with these populations.
Disaster Health, 2016
This disaster complexity case study examines Spain's deadliest train derailment that occurred on ... more This disaster complexity case study examines Spain's deadliest train derailment that occurred on July 24, 2013 on the outskirts of Santiago de Compostela, Galicia, Spain. Train derailments are typically survivable. However, in this case, human error was a primary factor as the train driver powered the Alvia train into a left curve at more than twice the posted speed. All 13 cars came off the rails with many of the carriages careening into a concrete barrier lining the curve, leading to exceptional mortality and injury. Among the 224 train occupants, 80 (36%) were killed and all of the remaining 144 (4%) were injured. The official investigative report determined that this crash was completely preventable.
Encyclopedia of Earth Sciences Series, 2013
ABSTRACT SynonymsDisaster behavioral health; Disaster health; Disaster mental and behavioral heal... more ABSTRACT SynonymsDisaster behavioral health; Disaster health; Disaster mental and behavioral health; Disaster mental healthOverviewAt 4:53 PM local time (21:53 GMT) on January 12, 2010, a magnitude 7.0 earthquake devastated the Haitian capital city of Port-au-Prince and surrounding area, killing an estimated 222,570–316,000 persons (Inter Agency Standing Committee, 2010; CBC News, 2011). The Haiti 2010 earthquake is noteworthy among natural disasters that subject the affected human population to intense psychological stressors (Table 1).Norris and colleagues (2002) posit that disasters that possess two or more of the following four characteristics are likely to create significant mental health consequences for the affected community: (1) large numbers of deaths and/or injuries, (2) widespread destruction and property damage, (3) disruption of social support and ongoing economic problems, and (4) “human” contribution to the disaster’s causation. By the numbers, the Haiti 2010 ear ...
Current Psychiatry Reports, 2014