Weighing the Costs of Disaster

Psychological Science in the Public Interest Weighing the Costs of Disaster: 11(1) 1–49 ª The Author(s) 2010 Reprints and permission: Consequences, Risks, and Resilience in sagepub.com/journalsPermissions.nav DOI: 10.1177/1529100610387086 Individuals, Families, and Communities http://psi.sagepub.com George A. Bonanno1, Chris R. Brewin2, Krzysztof Kaniasty3,4, and Annette M. La Greca5 1Teachers College, Columbia University, 2University College London, 3Indiana University of Pennsylvania, 4Opole University, 5University of Miami Summary only transient distress and maintain a stable trajectory of healthy functioning or resilience. Resilient outcomes have been Disasters typically strike quickly and cause great harm. evidenced across different methodologies, including recent Unfortunately, because of the spontaneous and chaotic nature studies that identified patterns of outcome using relatively of disasters, the psychological consequences have proved sophisticated data analytic approaches, such as latent growth exceedingly difficult to assess. Published reports have often mixture modeling. overestimated a disaster’s psychological cost to survivors, sug- 3. Disaster outcome depends on a combination of risk and gesting, for example, that many if not most survivors will resilience factors. As is true for most highly aversive events, develop posttraumatic stress disorder (PTSD); at the same time, individual differences in disaster outcomes are informed by a these reports have underestimated the scope of the disaster’s number of unique risk and resilience factors, including vari- broader impact in other domains. We argue that such ambigu- ables related to the context in which the disaster occurs, vari- ities can be attributed to methodological limitations. When we ables related to proximal exposure during the disaster, and focus on only the most scientifically sound research—studies variables related to distal exposure in the disaster’s aftermath. that use prospective designs or include multivariate analyses Multivariate studies indicate that there is no one single domi- of predictor and outcome measures—relatively clear conclu- nant predictor of disaster outcomes. Rather, as with traumatic sions about the psychological parameters of disasters emerge. life events more generally, most predictor variables exert small We summarize the major aspects of these conclusions in five key to moderate effects, and it is the combination or additive total points and close with a brief review of possible implications of risk and resilience factors that informs disaster outcomes. these points suggest for disaster intervention. 4. Disasters put families, neighborhoods, and communities 1. Disasters cause serious psychological harm in a minority at risk. Although methodologically complex research on this of exposed individuals. People exposed to disaster show myriad facet of disasters’ impact is limited, the available literature psychological problems, including PTSD, grief, depression, suggests that disasters meaningfully influence relationships anxiety, stress-related health costs, substance abuse, and suici- within and across broad social units. Survivors often receive dal ideation. However, severe levels of these problems are typi- immediate support from their families, relatives, and friends, cally observed only in a relatively small minority of exposed and for this reason many survivors subsequently claim that individuals. In adults, the proportion rarely exceeds 30% of the experience brought them closer together. On the whole, most samples, and in the vast majority of methodologically however, the empirical evidence suggests a mixed pattern sound studies, the level is usually considerably lower. Among of findings. There is evidence that social relationships can youth, elevated symptoms are common in the first few months improve after disasters, especially within the immediate fam- following a high-impact disaster, but again, chronic symptom ily. However, the bulk of evidence indicates that the stress of elevations rarely exceed 30% of the youth sampled. 2. Disasters produce multiple patterns of outcome, including psychological resilience. In addition to chronic dysfunction, other patterns of disaster outcome are typically observed. Some Corresponding Author: survivors recover their psychological equilibrium within a George A. Bonanno, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 218, New period ranging from several months to 1 or 2 years. A sizeable York, NY 10027 proportion, often more than half of those exposed, experience E-mail: [email protected] 1 2 Bonanno et al. disasters can erode both interpersonal relationships and Answering these questions has proved surprisingly difficult. sense of community. Regardless of how they are affected, Studies of disasters encounter a number of formidable metho- postdisaster social relations are important predictors of cop- dological obstacles, and as a result, the literature on disaster has ing success and resilience. struggled to present an accurate picture of their consequences. 5. The remote effects of a disaster in unexposed popu- Indeed, somewhat ironically, the disaster literature has tended lations are generally limited and transient. Increased inci- to minimize disasters’ social–psychological scope while dence of extreme distress and pathology are often reported overestimating their psychological impact. It is not uncommon, in remote regions hundreds if not thousands of miles from a for example, to read reports suggesting that many if not most disaster’s geographic locale. Careful review of these studies people exposed to a disaster will develop posttraumatic stress indicates, however, that people in regions remote to a disaster disorder (PTSD). However, disaster studies often fail to consider may experience transient distress, but increased incidence of other potentially more sweeping aspects of disasters’ impact. psychopathology is likely only among populations with preex- The minimization of the scope of a disaster occurs when the isting vulnerabilities (e.g., prior trauma or psychiatric ill- focus of inquiry is too narrow, emphasizing only specific ness) or actual remote exposure (e.g., loss of a loved one in aspects of mental or physical health outcomes. Despite the the disaster). undeniably multifaceted nature of disaster, surprisingly little Finally, we review the implications for intervention. There research has addressed its broader consequences. The vast is considerable interest in prophylactic psychological interven- majority of published studies on disaster have focused primar- tions, such as critical incident stress debriefing (CISD), that ily on individuals and their reactions. Moreover, most of these can be applied globally to all exposed survivors in the immedi- studies have restricted their assessments almost exclusively to ate aftermath of disaster. Multiple studies have shown, how- trauma reactions and most typically to PTSD (McFarlane, van ever, that CISD is not only ineffective but in some cases can Hooff, & Goodhew, 2009). actually be psychologically harmful. Other less invasive and A historical perspective shows, however, that this limited more practical forms of immediate intervention have been focus was not always the case. As Raphael and Maguire (2009) developed for use with both children and adults. Although pro- noted, prior to the formal introduction of the PTSD diagnosis in mising, controlled evaluations of these less invasive interven- the Diagnostic and StatisticalManualofMentalDisorders—third tions are not yet available. The available research suggests edition (DSM–III; American Psychiatric Association, 1980), pre- that psychological interventions are more likely to be effective vious research had ‘‘distilled the multiple and diverse stressors during the short- and long-term recovery periods (1 month to that may arise with disasters—life threat, loss and bereavement, several years postdisaster), especially when used in combina- dislocation, loss of resources’’(p. 9). With the advent of the PTSD tion with some form of screening for at-risk individuals. Such diagnosis, however, ‘‘the field ... became almost overwhelmed interventions should also target the maintenance and enhance- by the evolving concepts of psychological trauma and traumatic ment of tangible, informational, and social–emotional support stress as the principal paradigm’’ (Raphael & Maguire, 2009, resources throughout the affected community. p. 9). As a result, until relatively recently, the focus on PTSD has nearly engulfed all other considerations about the consequences and implications of disaster, including investigation of other patterns of outcome, such as a more gradual recovery trajectory Introduction and a pattern of stable healthy adjustment or resilience (Bonanno, During the course of a normal lifespan, most people are 2004; Bonanno & Mancini, 2008). confronted with any number of aversive events. Accidents Clearly, however, there is more to disaster than PTSD. happen, loved ones die, health gives out, money disappears, Disasters can be shockingly lethal, often claiming the lives of or property is damaged. These events can be distressing and, hundreds if not thousands of people and spreading a wide web for some, debilitating. Fortunately, most people are usually of loss and grief over a vast geographical range. Disasters often able to survive isolated aversive events with no lasting cause other types of losses beyond

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