Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective.

BACKGROUND: Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. METHOD: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. RESULTS: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (beta-coefficient 0.257, P = 0.000), a house destroyed (beta-coefficient 0.148, P = 0.001), female sex (beta-coefficient 0.139, P = 0.001), previous mental health problems (beta-coefficient 0.109, P = 0.009) and illiteracy (beta-coefficient 0.110, P = 0.009). Those with previous mental health problems (OR = 4.84; 95% CI = 3.04-7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR = 0.38; 95% CI = 0.21-0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI = 1.12-4.37) and those with previous mental health problems (OR 2.84; 95% CI = 1.12-4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. CONCLUSION: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention.

Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden.

This study examined cross-cultural variability in personality and defenses among Nicaraguan and Swedish healthy individuals, patients with borderline personality disorder and schizophrenic disorders by means of the projective perceptual Defense Mechanism Test. The over-all aim was to test the hypothesis proposed by Anthony Marsella of 'severity related cross-cultural variability' suggesting that differences in symptom profile or personality patterns between cultures are most pronounced among healthy individuals and less so among individuals with severe mental disorders as they are perceived as more universal and less culturally determined. The over-all results showed that cross-cultural differences were in accordance with the proposed hypothesis. In addition, there were significant intracultural differences between the different diagnostic groups in both countries. The conclusion is that the Defense Mechanism Test and Partial Least Squares analysis seem to be powerful methods for personality assessment and potentially for cross-cultural research, and culture-specific norms in the Defense Mechanism Test must be employed.

Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua.

Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.

[Central American seminars for young psychiatrists of the region and training of leaders in community mental health. Sweden/PAHO-WHO collaboration program]. / Seminarios centroamericanos para psiquiatras jóvenes de la región y formación de cuadros líderes en salud mental en la comunidad. Programa de colaboración Suecia/OPS-OMS.

The Swedish Psychiatric Association, in collaboration with the Department of Psychiatry, University of Umeå, Sweden, and the Pan American Health Organization/WHO, has obtained economic support from the Swedish Agency for International Development (ASDI), to organize training seminars for young psychiatrists from Central America. The program will continue until 1995 with an option to pursue further studies leading to a master or other post-graduate degrees. The overall purpose is to strengthen the knowledge in epidemiology and community mental health, along the lines set by the "Caracas Declaration" of a cadre of young leaders in the field of psychiatry in Central America.

[Mental disorders in Nicaragua: family perspective]. / Trastornos mentales en Nicaragua: perspectiva familiar.

In recent years the family perspective in Psychiatry has become more important a factor. Therefore this paper is aimed at examining the family structure of mentally disordered people in León, Nicaragua, as well as presenting the use of a Genogram in epidemiological research. 201 families were randomly selected, whose members were interviewed in two steps: a screening, and a diagnostic stage. The family map or Genogram for each family was analyzed with respect to adult and child cases, generations within the family, and other background variables.

[Prevalence of mental disorders in adults in Subtiava, León, Nicaragua]. / Prevalencia de trastornos mentales en adultos de Subtiava, León, Nicaragua.

The objective of this study was to estimate the prevalence of mental disorders in the Subtiava district of León, Nicaragua. Two-stage cluster sampling was used to select 219 families (n = 584 persons). The study was carried out in two phases. In the first, probable mental disorder cases were screened using the Self-Reporting Questionnaire. In the second, the diagnoses were confirmed through the Present State Examination questionnaire. The validity and reliability of the questionnaires had been confirmed in a pilot study. The present study was conducted in October and November 1987, when Nicaragua was still immersed in armed conflict. Construction of a family map made it possible to analyze, through the multiple imputation method, the characteristics of persons who were absent at the time of the interviews or who did not respond. The estimated prevalence percentages and their respective 95% confidence intervals were as follows: neurosis, 7.5% (5.2%-9.8%); depression, 6.2% (2.6%-8.1%); reactive crisis, 3.3% (2.6-6.5%); alcoholism, 5.8% (3.9%-8.9%); organic brain syndrome, 3.9% (1.7%-5.2%); psychosis, 0.5% (0.2%-1.6%); and other disorders, 0.7% (0.2%-1.6%). The estimated overall prevalence of mental disorders in the study population was 27.9%. Disorders were more prevalent among men (30.8%) than women (26.3%). It is concluded that these high estimated prevalences are associated with stress caused by the war.

[Changes in psychiatric care. Reform or revolution? The experience of the Swedish model]. / Cambios en la asistencia psiquiátrica. Reforma o revolución? La experiencia del modelo sueco.

Reforms to psychiatric practice in Sweden are discussed, expecting that the Scandinavian experience be of assistance as regards changes that are being implemented for a re-structuration of psychiatric care in Latin America. The following points are enhanced: (a) epidemiological studies as an important basis for planning and action in mental health; (b) a progressive closing of mental hospitals while, at the same time, more institutionalization capacities are being created at general health services, and (c) organizing non-hospital care by sectors with community mental health teams being in charge of. As far as negative aspects are concerned, a tendency towards a "psychologization" so to speak of social issues, and a certain lack of attention of patients with severer disorders are pointed out.

Mental disorders among primary health care patients in Nicaragua.

The objective of this study was to validate the Self Report Questionnaire (SRQ-20) as a screening instrument to identify probable psychiatric cases in the general population in Nicaragua and to study the prevalence and identification of mental disorders in primary health care. In the general population 576 people were screened using SRQ-20. A subsample was further interviewed using the Present State Examination (PSE). In primary health care centers 781 patients were screened according to SRQ-20 and staff indicated whether a mental disorder was identified or not. In the general population study, 9/10 turned out an adequate cut-off for SRQ-20, identifying 23% as probable cases. Using the same cut-off, 47% of the primary health care patients were identified as probable cases. Among male probable cases only 7% were identified as cases by health care staff, and among female probable cases health care staff identified 13% as cases. When the results are compared with previous studies, it becomes evident that the general level of psycho-emotional complaints and accordingly the cut-off for caseness differ in different parts of the world. SRQ must be calibrated for each cultural setting. Among primary health care patients, mental disorders were overrepresented and frequently overlooked by the physicians. Educational programs with training in psychiatry should be implemented for primary health care staff.

Experiences of a psychiatric outpatient team in Nicaragua. Mental health problems seen in a primary care setting.

The paper presents experiences from one of the first psychiatric out-patients teams in Nicaragua which was started in 1982. 198 patients consecutively attending the unit were studied thoroughly as regards clinical diagnosis and areas of conflict presented as reason for attendance. Depressive neurosis and anxiety neurosis were the predominant diagnoses, followed by epilepsy and schizophrenic disorders. Almost half of the patients stated that they had family problems.

Community attitudes and awareness of mental disorders. A key informant study in two Nicaraguan towns.

Attitudes towards mentally ill people were studied in two Nicaraguan towns through interviews with key informants. They were presented 8 case histories originally developed in a World Health Organization collaborative study. Alcoholism and depressive neurosis were considered the most common disorders, while the schizophrenic case was generally judged as the most severe. The methodology was found useful and valid.