Earthquake in Armenia and beyond

This book provides a comprehensive overview of the most comprehensive research and research program for mental health restoration that has been implemented after a natural disaster.

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On December 7, 1988, a powerful earthquake measuring 6.9 on the Richter scale shook northwestern Armenia, causing widespread destruction and death. In Gomri, Armenia’s second largest city, more than half of the buildings were severely damaged or destroyed, and 7% of the population died. The city of Spitak near the epicenter was almost completely destroyed, and 16% of the population died. In the aftermath of the earthquake, Armin Guengyan, MD, LDFAPA, FACGS, started the Psychological Outreach and Mentoring Program, with a group of volunteer mental health professionals, providing services to survivors for more than two decades.

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Dr. Guengjian and colleagues from the University of California-Alan Steinberg, MD, and Robert Benos, studied the psychological consequences of the earthquake in Armenia and other major disasters in the United States, Greece, Nicaragua, Taiwan, Honduras, Thailand and Japan. They recently published the book Lessons learned in the mental health disaster: the earthquake in Armenia and beyond. The book provides a comprehensive overview of the most comprehensive research and research program for mental health restoration that has been implemented after a natural disaster.

The book covers the evolution of the program, from the acute phase of clinical fieldwork to its expansion as a 3-year educational and training program for local therapists to the construction of two mental health clinics in stricken cities. It provides a wealth of longitudinal data on the course of post-traumatic stress disorder (PTSD), depression, sadness, and separation anxiety among treated and untreated subjects.

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“One of the reasons these treatment studies are unique is that pre-teens were followed for up to 25 years after the earthquake,” according to Dr. Guengian, a full-fledged research psychiatrist at the Semmel Institute for Neurosciences and Human Behavior at UCLA.

“Almost all of the follow-up treatment outcome studies reported were conducted two years or less after a disaster. Only a few continued subjects up to 5 years old, said Dr. Steinberg, associate director of the UCLA/Duke National Center for Child Traumatic Stress Management.

In the controlled studies, adolescents who received treatment focused on trauma and grief at 1.5 years after earthquake, PTSD, and depressive symptoms had significantly fewer symptoms of depression than the control group at 5 years, and benefits were maintained at 25 years of follow-up. The new analyzes showed that symptoms in both the treatment and control groups stabilized between 4 and 5 years after the earthquake. “The findings point to the importance of providing clinical intervention within the first few years and subsequent monitoring for chronic psychiatric and medical problems among severely affected survivors,” said Dr. Guingyan. “Those with severe PTSD and/or depression have significantly more chronic medical conditions.”

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Another finding was the significant impact that post-disaster adversity (often called “disaster after disaster”) had on persistence of PTSD and depressive symptoms. The findings underscore the important role that governmental and non-governmental agencies can play in the recovery of survivors by providing timely housing, heating, electricity, transportation, and medical services. “These types of supportive measures complement the benefits of psychotherapy and are applicable to other types of natural and man-made disasters, wars, and violence, including domestic disasters,” said Dr. Guinjian.

Another valuable chapter on moral development and the work of conscience. “Adolescents from Spitak were subjected to severe seismic shock that manifested as pathological interference with conscientiousness,” said Dr. Steinberg. For example, “These young people felt that they had lost their conscience after the earthquake – that their conscience was no longer working – and they thought it was justified to act without regard for morality in order to survive.”

Multigenerational genetic studies have demonstrated heritability for susceptibility to PTSD, depression, and anxiety. They also showed polymorphisms — that is, the sharing of genes between PTSD, depression and anxiety, Dr. Guinjian said. They also identified two serotonergic genes (TPH1 and TPH2) and one dopamine gene (COMT) associated with PTSD. Full Exon sequencing results showed an association between OR4C3 (an olfactory receptor gene) and PTSD. Carriers of these genes were more likely to develop PTSD. “These findings give us hope that advances in psychological genetics will one day be translated into therapeutic and preventive approaches,” said Dr. Guengjian.

The book also discusses the significant organizational successes and pitfalls of disaster recovery program implementation. Regarding factors related to therapists’ performance and reduced burnout, helpful steps included screening applicants prior to enrollment; Hold regular pre-departure group meetings with new members to disseminate information accumulated from previous groups and adoption community spirit; Provide guidelines for decency, such as abstaining from political and religious activity; and respect for local religious traditions, customs and practices.

Therapists worked in pairs to provide support for each other. They had regular interrogations with peers or group leaders to discuss difficult cases and their own stress responses to painful facts. They also took weekly rest days. These measures helped reduce fatigue.

“Despite the many emotional and physical hardships of working out in the aftermath of the earthquake, nearly all therapists recognized that providing assistance to survivors was one of their most fulfilling life experiences,” said Dr. Guengyan.

He concluded by saying, “My favorite chapter that represents the spirit of the book is the one that includes heart-wrenching notes for therapists.”

Mr. Melman He is a Senior Media Relations Officer at UCLA Health. Dr. Steinberg He is associate director of the National Child Traumatic Stress Center in the University of California Department of Psychiatry. Dr. Junjian Board certified in Psychiatry. He is a research professor of psychiatry at the University of California, Geffen School of Medicine and chair of the department of medicine at CenExel-CNS.

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