Mental wellbeing of vulnerable groups following a crisis

Definition

 A vulnerable population refers to a group of individuals that include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus(HIV), and those with other chronic health conditions, including severe mental illness (Managed Markets Network, 2006). Factors such as ethnicity, age, sex and income may augment the vulnerability of such populations. Vulnerable populations’ health domains can be allocated into three main categories. First is the psychological domain that includes individuals with schizophrenia, bipolar disorder, major depression, and attention-deficit/hyperactivity disorder as well as those with a history of alcohol and/or substance abuse. Second, there is the physical domain that includes individuals with hypertension, diabetes, HIV, heart disease, dyslipidemia and any other chronic disorder. Finally is the social domain, which includes those living in abusive families, the immigrants, the homeless and even refugees.

Implications of a Disaster to Vulnerable Population

 Following a given disaster, individuals may suffer trauma, which varies in both intensity as well as duration from one individual to another. How an event affects an individual depends on many factors including the event type and characteristics, sociocultural factors, the individual’s characteristics as well as developmental processes, (Center for Substance Abuse Treatment, 2014). Effects of a disaster on an individual’s personality may present emotionally, socially, mentally and even socially.

Characteristics that increase vulnerability to long term mental issues

Low economic status

 Individuals with low incomes are more likely to delay or not receive the necessary psychological, medical and mental healthcare necessary after a disaster and this can lead to long term mental issues. “Low income, no health insurance coverage, and lacking a regular source of care are closely related risk factors that build upon each other to influence the likelihood of having an unmet health need due to cost.” (Managed Markets Network, 2006)

Emotional dysregulation

 The extent to which people maintain to balance their emotions after a disaster varies from one individual to the other. Persons that associate strong feelings with trauma resulting from a past disaster may reach an extent of feeling out of control or going crazy. There are still those that, in an effort to forget their past, end up being numb or rather detached from their emotions, (Center for Substance Abuse Treatment, 2014). Either of these conditions may lead to long-term mental issues such as mania or depression.

Poor life skills and coping capabilities

 Individuals with history of few mental and emotional resources against trauma, those with a low tolerance for frustration or those with a tendency of over depending on others may experience a lot of mental pressure following a disaster. They may feel that the experience is getting out of hand and may tend to lose it mentally. These individuals may turn to substance abuse in an attempt to escape reality.

Dissociation

 This is a mental process that helps one detach from  thoughts, memories, feelings, actions and even sense of identity with a particular past experience. It can also happen after a disaster as a protective element from the associated trauma. However, the dissociation may at times become very pervasive and symptomatic of a mental disorder such as dissociative identity disorder. This is a disorder characterized by disruption in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.

Age

 Vulnerability to the stresses of a disaster and hence their impact on one’s mental health is unique to each age group. Children and the elderly are at the highest risk. The elderly may experience prolonged periods of withdrawal and insomnia, reluctance to leave home, confusion, depression and fear. Young children may display generalized fear, nightmares, heightened arousal and confusion.

Social/interpersonal relationships

 A key element in overcoming post-disaster stresses is the involvement of social support groups and relationships. Survivors who rely on family members, friends, or other social support are more likely to recover fast. However, in cases of natural disasters, social and community supports can be severed and difficult to rebuild. This is because the survivors may avoid support either because they believe that no one will be understanding and trustworthy enough, or they feel that their concerns may be an additional burden for people who have had a similar experience. They may experience strong emotional, physical and mental outbursts including nightmares, may pull away from others in fear of being unable to protect their own reactions or to protect their own safety and that of others. (Center for Substance Abuse Treatment, 2014).Such outrage can lead to gradual decline in mental health.

Neurobiological development

 Research shows that the first stage in a cascade of events produced by early trauma/ maltreatment involves the disruption of neurotransmitters e.g. cortisol, norepinephrine and dopamine thus causing escalation of the stress response.  Oxytocin, a neuropeptide important for social affiliation and support, attachment, trust, and management of stress and anxiety was markedly decreased in the cerebrospinal fluid of women who had been exposed to childhood maltreatment. The more early disasters one had in their childhood, the lesser is their current ability to cope with disasters and hence a heightened vulnerability to prolonged mental issues.

References

Center for Substance Abuse Treatment. (2014). Trauma-Informed Care in Behavioural Health Services. US: Substance Abuse and Mental Health Services Administration (US).

Managed Markets Network. (2006). Vulnerable Populations: Who Are They? Published Online. Retrieved from http://www.ajmc.com/journals/supplement/2006/2006-11-vol12-n13suppl/nov06-2390ps348-s35