Nicaragua's adolescents struggle with post-traumatic stress and depression caused by death, destruction of 1988's Hurricane Mitch

Heavy psychological toll must be addressed if country is to fully recover

The staggering death toll and massive destruction caused by Hurricane Mitch in 1998 left tens of thousands of Nicaragua's adolescents with chronic and severe post-traumatic stress disorder and depression, and few options for care, according to a new UCLA study.

The UCLA Trauma Psychiatry Program study, published in the May edition of the American Journal of Psychiatry, also found that the severity of post-traumatic stress disorder (PTSD) and depression correlated directly with the severity of destruction, injury and death across the three Nicaraguan cities studied.

PTSD symptoms include recurrent intrusive thoughts about the traumatic experience, nightmares and flashbacks, extreme psychological and physical reactions to reminders of the experience, feelings of numbness and estrangement from others, exaggerated startle reactions, sleep disturbance, and trouble concentrating. Among adolescents, these reactions can greatly interfere with family and peer interactions, and ability to function in school.

"These traumatized adolescents in Nicaragua are suffering deeply with few options for treatment and potentially severe long-term consequences," said Dr. Armen K. Goenjian, an associate research professor of psychiatry at UCLA and lead author of the report. "The recovery of these young people is vital to the social and economic recovery of a country already ravaged by years of political violence and poverty. These findings emphasize the need to incorporate public mental health approaches, including systematic diagnosis and care, within comprehensive disaster recovery programs."

Hurricane Mitch, a Category 5 hurricane, was the most deadly storm to strike the Western Hemisphere in 200 years, pounding Central America from Oct. 26 to Nov. 4, 1998, with winds of up to 200 mph and rainfall of up to two feet per day. Mudslides and massive flooding killed approximately 10,000 people and wiped out most food and cash crops. The storm left hundreds of thousands of people without work, as damage to basic infrastructure, agriculture and industry virtually destroyed more than two decades of progress in the region.

While many international non-governmental aid agencies provided physical relief - housing, food, clothing and medical supplies - after Hurricane Mitch, few were financially able to mount long-term psychosocial programs designed to assist and counsel victims.

"Disasters in Third World countries are typically associated with much higher rates of destruction, morbidity, mortality and disabling mental health consequences, as compared with disasters in industrialized nations," said Dr. Alan Steinberg, director of research for the Trauma Psychiatric Program in the UCLA Department of Psychiatry and Biobehavioral Sciences, and a co-researcher in the study. "Also, post-disaster hardships and adversities tend to be more severe and prolonged."

Six months after the hurricane, UCLA researchers surveyed 158 adolescents in three Nicaraguan cities affected in different ways. The survey examined both objective and subjective features of exposure to the hurricane in measuring the impact on each adolescent's mental health.

In Posoltega, the hardest hit of the three cities, an estimated 90 percent of the adolescents surveyed met criteria for PTSD, 81 percent depressive disorder and 79 percent both. In Chinandega, an estimated 54 percent suffered from PTSD, 51 percent depressive disorder, and 38 percent both. In Leon, the least severely affected of the three cities, 13 percent suffered PTSD, 29 percent depressive disorder and 8 percent both.

Among other findings:

� The severity of post-traumatic stress reaction in Posoltega and Chinandega far exceed levels found in U.S. communities severely affected by Hurricanes Hugo (1989) and Andrew (1992). Both were Category 4 storms.
� A total of 54 percent of adolescents surveyed in hard-hit Posoltega reported vengeful thoughts toward the government for failing to provide advance warning before the storm or help after the hurricane. Vengeful thoughts as a consequence of human perpetrated trauma are well documented, but this finding indicates that vengeful thoughts may be prevalent in natural disasters as well.
� Adolescents in Posoltega and Chinandega demonstrated high levels of depression six months after Hurricane Mitch. Similar high levels of depression were found among children and adolescents years after the devastating 1988 earthquake in Armenia, which killed thousands. The comparisons suggest that adolescents in Posoltega and Chinandega may be at risk of worsening depression.

The Trauma Psychiatry Program at UCLA is directed by Dr. Robert S. Pynoos, and housed in the Department of Psychiatry and Biobehavioral Sciences. The Program is one of the foremost research, training and clinical centers dedicated to enhancing the standards of mental health care provided to children and families exposed to community violence, war, disaster, catastrophic injury and life-threatening medical illness.

In addition to Goenjian, Steinberg and Pynoos, other researchers involved in the study are Dr. Lynn A. Fairbanks of UCLA, and Drs. Luis Molina and Maria Alvarez of Managua, Nicaragua.

The research was supported in part by the Bing Fund, which aids children and families around the world.