The behavioral fallout from the current Ebola crisis has created a historic and consequential dilemma for the global mental health and public health communities. Computational models to track the Ebola crisis provide forecasts of death tolls by scenario, but human behavior cannot be adjusted for given the misinformation, hysteria, and superstition brooding over communities in West Africa and around the world. The nature of crises—war, disease, famine—is dire, but in the advent of modern technologies and evidence-based programs, survivorship has seemingly increased. Physical damage is in most cases obvious, whereas mental harm is less apparent.
There is some certainty of how the world will respond as death and disease nears areas where comfort and distance were previously enjoyed. The psychological toll of outbreaks and other crises are peripheral issues—given the acute physical effects of global public health issues of the day—in the immediate term, but Kathryn Magruder, MPH, PhD foresees a long period of rebuilding, reform and changes to the overall global mental and public health system.
“When there is good infrastructure and programs to reduce exposure to psychological distress, we can deal with random global issues,” explained Magruder. “Over the long term we need to invest in public health infrastructure in these countries.”
Magruder has been an ambassador of psychiatric epidemiology as a Professor and Director of the Office of Research Integrity at the Medical University of South Carolina (MUSC), while serving on a number of international mental health boards and committees. She studies behavioral conditions, specifically post-traumatic stress disorder, using epidemiologic methods. Her research interests led her to apply and become selected as a Fulbright Scholar in Ankara, Turkey. Magruder explained that working with a people who have developed resilience to hardships over time continue to respond promisingly to traumatic stimuli.
“The people we were looking at grew up through a host of traumatic experiences, including bombings, kidnappings and murdered relatives,” said Magruder. “We asked things like: did they have experiences with PTSD symptoms? Many had resiliency because of close family ties, but many also had significant PTSD symptoms.”
As new crises emerge around the globe, first responders will have to be equipped with the latest, evidence-based tools to reduce crisis-induced stress. This includes preparatory and debriefing programs for victims, and workers who provide treatment in crisis areas. The global community has done a better job in recent years communicating the need for psychological first aid and other available treatment techniques, notably through the World Health Organization’s (WHO) ongoing education campaigns.
“It’s huge that mental health has increasingly received attention globally,” said Magruder. “We still need to pay more attention to world mental health issues. Reducing stigma, better availability of services, education and outreach, and appropriate interventions play a large role in addressing these issues.”
Resiliency, according to Magruder, is due in large part to the matriarchs in families, whether they are daughters, mothers, aunts or cousins. Women are the frontline of the familial and public health guard (nurses, case workers). They enlist themselves to care for the ailing although they are at risk of experiencing physical and mental trauma—more so than men.
According to Magruder, even though women have lower rates of trauma exposure, they have higher rates of PTSD. “It’s the interpersonal trauma, which is more prevalent among women, that takes a worse toll psychologically, so women really bear the brunt of it,” she said.
In the current Ebola outbreak, women account for 55 to 60 percent of the dead in the three countries affected, Liberia, Guinea and Sierra Leone based on reporting from the Washington Post and UNICEF. Given the role women play in nurturing and caring for friends, relatives and victims of the Ebola outbreak and other crises (Yazidi captives, sexual assault in South Sudan, famine in Somalia), the psychological damage survivors experience could be substantial.
“Women are by nature more vulnerable,” Magruder said. “Men do, however, experience more traumatic events than women.”
Though crises are inevitable, there are ways to minimize the impact they have on societies, public health systems, and economies. Proactive investments in programs to potentially thwart threats to the developing and developed world —taken together with increasing global connectedness—have been seen as largely beneficial but only after major catastrophes are manifest. Magruder believes that by preempting global public health concerns with proper training, education, interventions and most importantly, funding, the impact of crises can be mitigated.
“We need to raise the health of everyone,” remarked Magruder. “One of the things I’ve been trying to do as a member of the International Society for Trauma and Stress Studies is to develop a global public health approach to trauma that benefits all communities. I feel like if I can get people to understand that preventing trauma is a major priority, then I will have made a contribution.”