Risk and resilience after disaster.

Risk and resilience after disaster

Tragedy struck an Indianapolis hotel on the morning of Oct. 20, 1987. Literally from out of the blue, an Air Force jet fighter crashed into the lobby. Most of the hotel guests had already checked out and none of those remaining died. However, nine hotel employees perished as the wayward plane sprayed chunks of shrapnel and set off an inferno. The remaining 22 employees in the hotel survive. But they experienced the terror of watching the plane heading toward them, the horror of its impact and the agony of the helpless victims.

In such instances, disaster workers with limited resources are faced with an awesome task -- deciding which survivors are most in need of immediate mental health services. Prompt psychiatric help may be especially important for survivors with a history of severe depression, many of whom sink back into depression in the weeks following a sudden disaster, according to a preliminary report in the February AMERICAN JOURNAL OF PSYCHIATRY.

Between four and six weeks after the Indianapolis tragedy, Elizabeth M. Smith of the Washington University School of Medicine in St. Louis and her colleagues interviewed 17 of the surviving hotel employees and 29 additional hotel employees who were not at work when the crash occurred.

More than half of the sample -- a total of 25 -- had at least one of the following psychiatric disorders: post-traumatic stress, major depression,

generalized anxiety and alcohol abuse or dependence. The two employee groups had approximately the same rate of psychiatric disorders. Employees who reported the most emotional upset in the wake of the disaster were no more likely to receive a psychiatric diagnosis, the researchers note. But more than two-thirds of those with a mental disorder in the weeks after the crash reported a prior history of psychiatric problems.

Depression ranked as the most common diagnosis, affecting 19 people, including all 10 employees who reported prior bouts with depression. Curiously, five individuals said they had fully recovered from the incident despite describing clear signs of depression.

Seven of the 10 employees with post-traumatic stress arising after the disaster had no histories of the disorder.

There was plenty of emotional resilience as well as turmoil in the wake of the plane crash, the researchers add. Almost half of the hotel employees did not develop any psychiatric disturbances.