Escalating Natural Disasters and Mental Health Crisis: A Viewpoint From Low- to Middle-Income Countries

Dear Editor,

As a consequence of increasing global warming, the frequency of natural catastrophes has escalated over time and is anticipated to further rise in the upcoming years. According to an estimate, 330 million individuals were affected due to disasters worldwide in 2010 when compared with 162 million in 2005. The impacts are more pronounced in resource-limited settings, particularly low- to middle-income countries (LMICs). ¹ According to a study, post-traumatic stress disorder (PTSD) prevalence stood at 30% to 40% among direct victims of disasters, and 10% to 20% among rescue workers, compared with 5% to 10% in the general population. According to a recent meta-analysis comprising 22 studies, the prevalence of mental disorders in post-disaster settings varied between 5.8% and 87.6%, with individual incidences ranging between 2.2% and 84%, 3.2% and 52.7%, and 2.6% and 52% for anxiety, depression, and PTSD, respectively. ²

The array of psychosocial disorders among the survivors is entirely dependent on the intensity of exposure to these disasters. Some people experience acute mental stress which is transient, but for others it transforms into chronic stress which gives rise to disorders such as PTSD and generalized anxiety disorder (GAD). Every age group in the affected population responds to psychological trauma differently like adolescents demonstrate symptoms of anger and aggression. The risk factors determining the psychiatric consequences include female gender, extremes of age, poor socioeconomic status, previous mental condition, low educational status, mental health resources availability, ethnicity, and loss of a loved one.^3,4

The world is a universal trade center for human resources, with more health care professionals shifting toward developed countries; there is an unfilled void left in terms of human resources concerning the medical field in the developing world. The already neglected mental health services, associated taboo, and daily life challenges significantly enhance psychiatric burden, even in the absence of the ruinous effects of disasters. In such settings, catastrophic disasters hold substantial potential to exacerbate psychological morbidity. Moreover, financial losses, infrastructure damage, law and order destruction, food poverty, physical morbidity, and disease outbreaks preoccupy the relevant authorities, often causing mental health to be overlooked following catastrophic events. ⁴

While global humanitarian aid enables the adequate provision of temporary shelters, packed food items, and medical supplies, often little attention is paid to psychological consequences. Early provision of psychological first aid (PFA) by rescue teams and community-based interventions encouragement, like debriefing, combined religious practices, cultural rituals, engaging children in educational, fun-based activities, and designating routine tasks among adults, can play a pivotal role in psychological healing and hence alleviate chronic morbidity. ⁵ Second, it is intrinsic to assess the extent of psychological morbidity and needs using locally validated questionnaires, with high-risk individuals offered culturally appropriate management. Telepsychiatry can be substantially beneficial in mitigating psychological morbidity by overcoming challenges such as psychologists’ and psychiatrists’ unavailability, particularly in villages and rural areas. Effective response in times of crisis beckons the call for pre-disaster preparatory measures by the governing institutions, ranging from actively integrating mental health interventions among rescue training to long-term reforms in public health policy. While the prioritization of physical health challenges is crucial, it is imperative to allocate sufficient resources toward psychiatric challenges as well, given the prevalence of stigmas and lack of mental health awareness found in LMICs.