Disaster Plans Should Include Those with Mental Illness

Disaster Plans Should Include Those with Mental IllnessWhen disaster strikes — whether a deadly supercell tornado, a flood, or man-made catastrophe — it is not just those with physical injuries and trauma-related disorders who suffer. Johns Hopkins University researchers say more attention should be devoted to triaging and managing those identified as having mental disorders. In a commentary appearing in the June issue of the journal Biosecurity and Bioterrorism, Peter Rabins, M.D., M.P.H., said, “Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves. “But little attention has been given to the ethical challenges that arise when resources are limited, to the importance of identifying these ethical issues ahead of time, and for establishing mechanisms to address these moral dilemmas.” The researchers said disaster-response planning has generally overlooked the special needs of people who suffer from pre-existing and serious mental conditions. Disaster survivors can include those diagnosed with conditions such as schizophrenia, dementia, addictions and bipolar disorder. In the article, Rabins and Nancy Kass, Sc.D., said many of the mentally ill are dependent on caretakers and aren’t fully capable of making sound decisions on their own. Emergency planners are ethically obligated to ensure that immediate and adequate mental health services are provided alongside more traditional triage. “Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders,” said Rabins. “But sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well.” One study the authors cited found that 22 percent of Hurricane Katrina survivors who had pre-existing mental disorders faced limited or terminated treatment after the disaster. Beyond patients with dementia and others who are mentally impaired, the authors say that this vulnerable group includes those who suffer from chronic pain and may be dependent on opiates, as well as substance abusers who receive treatment in the form of powerful sedatives classified as benzodiazepines. Withdrawal from these medications can be life threatening, the authors noted. As a first step, the authors recommend that disaster-response planners proactively identify and anticipate what needs might arise by meeting with clinicians and public health officials. Those discussions would then guide comprehensive advance planning. As licensed professionals are often unavailable (because of demand) immediately after a disaster, planners should consider training emergency medical technicians (EMTs) and other first-responders to identify those with pre-existing mental conditions and recognize those in need of prompt attention. The training should include volunteers from the community, such as religious leaders and trained civilians, to distribute basic materials and temporary services to at-risk individuals. In an effort to reduce adverse outcomes, the researchers advise that secondary prevention measures may take priority. This action could be in the form of EMTs distributing sedatives to manage short-term anxiety-related symptoms. But the authors say that policies would need to be developed to expand the list of those authorized to prescribe such drugs, as they are at present strictly regulated by federal law. The authors note that sedatives were distributed in New York City immediately after the Sept. 11, 2001, terrorist attacks. They also recommend that planners focus on ethical challenges likely to arise when assisting the mentally disabled during and after a disaster. These challenges may be partially addressed by adopting a “crisis standard of care” consistent with guidelines from the Institute of Medicine. Special attention should be given to assisted-living and long-term care facilities that house many residents with significant cognitive impairment, such as dementia. If these people are forced to evacuate, they may not fully comprehend the crisis and may be at risk for extreme emotional distress. Hence, disaster-preparedness training for first-responders should also include information about how to interact with such individuals in a way that respects their dignity, the authors said. Source: Johns Hopkins Medical Institutions

More Americans Praying for Health Reasons

More Americans Praying for Health ReasonsResearchers have discovered a dramatic increase among American adults in the use of prayer for health issues. Investigators analyzed data from the Centers for Disease Control and Prevention’s 1999, 2002 and 2007 National Health Interview Surveys and determined praying about health issues increased over the past three decades, rising 36 percent between 1999 and 2007. “The United States did have an increase in worship attendance across multiple religious faiths immediately after the 9/11 attack, but that has not stayed elevated. However, people continued to use informal and private spiritual practices such as prayer,” said lead author Amy Wachholtz, Ph.D., of the University of Massachusetts Medical School. “There is also a greater public awareness of Buddhist-based mindfulness practices that can include prayerful meditation, which individuals may also be using to address a variety of health concerns.” A change in health status, either a decline or an improvement, was linked with more reported prayer. This suggests prayer is used to cope with changing health status. While prayer about health issues increased across all groups, from 43 percent in 2002 to 49 percent in 2007, the data indicated that people with the highest incomes were 15 percent less likely to pray than those with the lowest incomes, and people who exercised regularly were 25 percent less likely to pray those who didn’t exercise. Women, African-Americans and the well-educated were most likely to pray about their health. “We’re seeing a wide variety of prayer use among people with good income and access to medical care,” Wachholtz said. “People are not exchanging health insurance for prayer.” A significantly greater proportion of women prayed compared to men, with 51 percent of women reporting prayer in 2002 and 56 percent in 2007, in contrast with 34 percent and 40 percent, respectively, among men. African-Americans were more likely to pray for their health than Caucasians, with 61 percent of African-Americans reporting having done so in 2002 and 67 percent in 2007, compared to 40 percent and 45 percent for Caucasians during the same periods. People who were married, educated beyond high school or had experienced a change in health for better or worse within the last 12 months were also more likely to pray about health concerns, the study found. The study, found in the APA journal Psychology of Religion and Spirituality, did not reveal the type of prayer people used, or which occurred first – prayer or the health issue. Source: American Psychological Association

Housework Increases Stress for Dual Wage Earners

Housework Increases Stress for Dual Wage EarnersA new study from the University of Southern California finds that among dual wage earners, the spouse who does the most housework has elevated levels of cortisol, the primary stress hormone. USC researchers looked at how male and female spouses recover from the burdens of work and how the couples balance their housework and leisure activity time. The report is found in the Journal of Family Psychology. In the study, researchers followed 30 double-income households. The couples were a median age of 41 and the families had at least one child between the ages of eight and ten. The results paint a pessimistic picture of marriage, said lead author Dr. Darby Saxbe, a postdoctoral fellow in the USC Dornsife College Psychology Department. “Your biological adaptation to stress looks healthier when your partner has to suffer the consequences – more housework for husbands, less leisure for wives,” Saxbe said. For both husbands and wives, doing more housework kept cortisol levels higher at the end of the day. In other words, doing chores seemed to limit a spouse’s ability to recover from a day of work. For wives, cortisol profiles were healthier if husbands spent more time doing housework. For husbands, in contrast, having more leisure time was linked with healthier cortisol level – but only if their wives also spent less time in leisure. “The result shows that the way couples spend time at home – not just the way you spend time, but the way your partner spends time as well – has real implications for long-term health,” Saxbe said. Cortisol levels can affect sleep, weight gain, burnout and weakened immune resistance. One of Saxbe’s earlier studies focused on marital relationships, stress and work. Her research found that more happily married women showed healthier cortisol patterns, while women who reported marital dissatisfaction had flatter cortisol profiles, which have been associated with chronic stress. Men’s marital satisfaction ratings, on the other hand, weren’t connected to their cortisol patterns. “The quality of relationships makes a big difference in a person’s health,” Saxbe said. “Dividing up your housework fairly with your partner may be as important as eating your vegetables.” Source: University of Southern California
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