Pandemic Stress Management

Several factors can influence psychiatric risks after disasters and mass public health emergencies. The nature of the event can contribute at both individual and community levels. Small-scale or localized events (eg, aviation disaster, mass shooting) may be time-limited; others (such the aftermath of a hurricane, ongoing terrorism or a pandemic)-may persist over a longer period. The resulting number of deaths, severity of injuries and illness, and property destruction, as well as the size of the affected geographic area and level of social destruction, can influence how at-risk individuals and communities fare. A history of psychiatric disorder or trauma potentially increases psychiatric risks. The prevalence of major depressive disorder, PTSD, and substance abuse is increased in communities that have experienced traumatic events. The most commonly reported symptoms after a disaster or mass public health emergency are sleeplessness, anxiety, depression, and constant, overwhelming bereavement.

People experience a spectrum of reactions as a result of trauma. These may include loss of family members, friends, pets, home, work; direct or indirect injuries that may be physical or psychiatric; displacement because of evacuation or inability to evacuate; feelings stemming from the actual event; frustrations from response and recovery efforts; disruptions of their lives and communities; and overall chaos.

For many patients, stress may not be directly related to the event itself but rather to post-event chaos. Stress reactions may result in physical symptoms, such as nausea, GI distress, sweating, shivering, faintness, dizziness, muscle tremors, weakness, elevated blood pressure, elevated heart and respiration rates, uncoordinated movements, feeling overwhelmed, extreme fatigue, exhaustion, headache, and narrowed visual field.  In a pandemic, this may be especially pronounced especially with respiratory and GI symptoms.

Emotional reactions include numbness, anxiety, fear, rapid shifts, guilt, survivor guilt, exhilaration, survivor joy, anger, sadness, helplessness, feelings of detachment, feeling unreal, disorientation, feeling out of control, denial, constriction of feelings, strong identification with victims. To mitigate further self-trauma, licensure and credentialing represent an important medicolegal challenge for psychiatrists who do disaster work. Know the requirements of the state where you will be doing the volunteer work. The American Psychiatric Association can provide information regarding licensure in disasters as well as the local state medical authority.

There should be an awareness of the differing expressions of grief among various cultural groups. Effective assessment of and intervention for psychiatric needs require an awareness of cultural strengths and confines. Past individual and community trauma history among cultural groups should also be appreciated. Language barriers require the use of translators. Other cultural factors include perception and receptiveness toward mental health as well as variations in help-seeking behavior. Additionally, significant stigma may arise for particular groups especially if there is misperception of blame.  This may be traumatizing to the impacted groups.

Children and the elderly also have special needs after a disaster and public health emergency. Children’s reactions to and distress following disasters may be atypical relative to those of adults. Sudden arrests of developmental progress; loss of developmental achievements; and changes in sleep, appetite, family and peer relationships, and academic performance can all suggest psychiatric distress. In addition, children’s distress may reflect parental distress. Any post-disaster psychiatric intervention ideally includes what remains of the pre-disaster family unit.

Many become more isolated and have significant medical comorbidity as well as other disabilities. They may be at greater risk medically as well in a pandemic.  Cognitive processing is often slowed, and as a result, the elderly have difficulty in understanding and navigating post-disaster health and human services. There are numerous other special populations; they include first responders, individuals with disabilities, and rural versus urban populations because the respective populations may have varying degrees of social support and identity. Psychiatrists need to appreciate strengths, resiliencies, and challenges that influence the effects of disasters on these highly vulnerable populations

Psychiatrists continue to play significant roles for individuals who present with post-disaster psychiatric symptoms. Diagnoses may include MDD, anxiety disorders, PTSD, and substance abuse. Psychiatrists provide much needed interventions, including trauma counseling, cognitive-behavioral therapy, and psychopharmacological management.

It is advisable to contact your malpractice insurance provider regarding coverage while doing volunteer work. Despite the chaotic nature of disaster psychiatric work, it is important for psychiatrists to maintain confidentiality. Some patients might worry about being stigmatized because they sought psychiatric care. Although efforts to maintain confidentiality should be made, the exchange of information with disaster response agencies will help individuals who need post-disaster services. Obtain the patient’s permission to exchange such information. Lastly psychiatrists may also be needed to be redeployed to roles that they are not accustomed to.  For example, adult psychiatrists may need to see children and adolescents or psychiatrists may be redeployed to work in medical settings. It is important that some level of training and supervision be associated with those changes.