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Oregon Psychiatric Association (OPA) leaders responded to the high school shooting last May in Springfield, Ore., that claimed the lives of two students and injured 22 others by helping to organize a conference on community recovery and medical responses to disasters.
The idea for the conference originated with OPA President Thomas Foster Jr., M.D. He told Psychiatric News, "The purpose was to make psychiatrists with national and international expertise in disaster recovery available to local medical professionals and school personnel. The central message was this traumatic event will have longer-term consequences."
The July conference was arranged with the help of Victor Holm, M.D., chair of the OPA committee on disasters, and Robert Ursano, M.D., chair of APA's Committee on Psychiatric Dimensions of Disasters. Two local hospitals and the local medical society sponsored the one-day conference held at Sacred Heart Medical Center in Eugene, Ore.
Ursano, who was also a panelist, said certain groups are at risk for developing post-trauma-related symptoms, including community leaders who must make rapid decisions and "first responders," such as emergency medical technicians and search-and-rescue teams. Those who are considered to be heroes are also at high risk because they "become a monument representing the hopes of their community for recovery."
Because these groups are highly visible and were closest to the situation, they often are not given time to digest the event or the opportunity to talk about how it affected them, said Ursano.
"The more severe the trauma, the more we see psychiatric problems," he said. The most common illnesses are acute stress disorder, PTSD, major depression, substance abuse, generalized anxiety disorder, and adjustment disorder.
Ursano reassured the audience that most people do recover from a disaster but added that teachers and students returning in the fall to Thurston High School, where the shooting occurred, will be reminded of the incident, which is a normal part of the grieving process.
Jon Shaw, M.D., a professor of psychiatry at the University of Miami School of Medicine, stated that trauma victims "oscillate between two contradictory states: that of reliving and reenacting the trauma and that of avoiding any reminder of the traumatic situation."
He noted that experiencing a life-threatening trauma challenges a person's assumptions about safety, protection, and long life. Adults who can accept the fragility of life and even find meaning in the experience generally find it easier to move on.
"Adults who believe in chance are less likely to blame the traumatic event on themselves or others in contrast to children, who think in terms of causality and their own culpability," Shaw observed.
Children are also more likely to have cognitive distortions, a fear of recurrence, and emotional and behavioral problems, he said.
Factors that can increase PTSD symptoms are proximity to the event, having family members who were killed or injured in the incident, threat to life or body, personal injury, gender, and response of family members.
To facilitate a community's response to a disaster, Shaw suggested the following strategies:
Robert Pynoos, M.D., a professor of psychiatry at the University of California, Los Angeles, School of Medicine, recommended gathering public health data to document the need for continuing resources and determine strategies for training, support, and intervention.
He also suggested schoolwide screening of students and school personnel and on-site counseling services including support groups and remedial interventions.
Further information can be found at the Web site of the American Academy of Child and Adolescent Psychiatry at www. aacap.org under Facts for Families. For more information on APA's Committee on Psychiatric Dimensions of Disasters, see APA's Web site under Practice of Psychiatry/Special Programs.