RESUMO
BACKGROUND: According to the stress inoculation hypothesis, successfully navigating life stressors may improve one's ability to cope with subsequent stressors, thereby increasing psychiatric resilience. AIMS: Among individuals with no baseline history of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), to determine whether a history of a stressful life event protected participants against the development of PTSD and/or MDD after a natural disaster. METHOD: Analyses utilised data from a multiwave, prospective cohort study of adult Chilean primary care attendees (years 2003-2011; n = 1160). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument, and the List of Threatening Experiences, a 12-item questionnaire that measures major stressful life events. During the study (2010), the sixth most powerful earthquake on record struck Chile. One year later (2011), the CIDI was re-administered to assess post-disaster PTSD and/or MDD. RESULTS: Marginal structural logistic regressions indicated that for every one-unit increase in the number of pre-disaster stressors, the odds of developing post-disaster PTSD or MDD increased (OR = 1.21, 95% CI 1.08-1.37, and OR = 1.16, 95% CI 1.06-1.27 respectively). When categorising pre-disaster stressors, individuals with four or more stressors (compared with no stressors) had higher odds of developing post-disaster PTSD (OR = 2.77, 95% CI 1.52-5.04), and a dose-response relationship between pre-disaster stressors and post-disaster MDD was found. CONCLUSIONS: In contrast to the stress inoculation hypothesis, results indicated that experiencing multiple stressors increased the vulnerability to developing PTSD and/or MDD after a natural disaster. Increased knowledge regarding the individual variations of these disorders is essential to inform targeted mental health interventions after a natural disaster, especially in under-studied populations.
Assuntos
Transtorno Depressivo Maior/psicologia , Desastres , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , Adulto , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: Natural disasters are associated with a variety of negative health consequences, including enhanced suicide risk. Factors that moderate the relationship between disaster exposure and enhanced suicide risk are unknown. The aim of the current study was to determine whether pre-disaster PTSD moderates the association between change over time in thoughts of death, suicidal ideation (SI), suicide plans, and suicide attempts (SA) from pre- to post-disaster. METHODS: Participants (n = 2832) were recruited from Chile as part of the larger PREDICT study and completed a measure of lifetime PTSD and panic disorder at baseline and a lifetime death/suicide measure at baseline in 2003 and again 6, 12, and 24 months later (i.e. "pre-disaster"). One year following a major earthquake and tsunami in 2010 (i.e., "post-disaster"), participants completed another death/suicide measure. RESULTS: Both those with and without pre-disaster PTSD experienced significant increases in SI from pre- to post-disaster. However, pre-disaster PTSD was associated with significantly accelerated increases in thoughts of death and SI from pre-to post-disaster. At nearly all time-points, pre-disaster PTSD was associated with higher thoughts of death and SI, suicide planning, and SA. In contrast, panic disorder did not moderate the association between time and changes in SI. LIMITATIONS: There was a long time-gap between pre-disaster and post-disaster, with limited data about what occurred during this time. CONCLUSION: Pre-disaster PTSD is an important predictor of increased SI following a natural disaster, and groups with pre-disaster PTSD should be prioritized for receipt of mental health resources following a natural disaster.
Assuntos
Desastres , Terremotos , Transtorno de Pânico/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Fatores de Tempo , Tsunamis , Adulto , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Background: With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that pre-existing psychopathology plays in developing PTSD after a disaster. Methods: This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres ( N = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD. Results: The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65). Conclusions: This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.