Issues in Mental Health Nursing, 35:420436, 2014

Copyright 2014 Informa Healthcare USA, Inc.

ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.3109/01612840.2013.875085

The Psychosocial Impact of Natural Disasters among Adult

Survivors: An Integrative Review
Sri Warsini, M. Med, Caryn West, PhD, Grad Dip Ed (TT), Grad Cert Res Meth,
RN, and Jane Mills, RN. PhD, MN MEd, BN, GradCertEd, FACN
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James Cook University, School of Nursing, Midwifery and Health Nutrition, Cairns, Australia

Kim Usher, RN BA DipAppSc MNSt PhD

School of Health, University of New England, Armidale, NSW, Australia

The aim of this review was to identify the psychosocial impact

of natural disasters on adult (over the age of 18 years) survivors.
Databases searched included PsycInfo, CINAHL, Proquest, Ovid
SP, Scopus, and Science Direct. The search was limited to articles
written in English and published between 2002 and 2012. A total of
1,642 abstracts and articles were obtained during the first search;
39 articles were retained. The results indicate that PTSD is the
most-studied psychosocial impact after a disaster. Mental health
nurses have a significant role to play in supporting survivors and
can assist with the development of resilience in community members.

Disasters are traumatic events experienced almost every day,

somewhere in the world (Norris et al., 2002). Any type of disaster, whether natural or not, results in a multidimensional impact
on a large number of people. The aftermath of a disaster is a time
when survivors experience many psychosocial symptoms such
as stress, grief, depression, and anxiety (Cohen, 2002; Reyes
& Elhai, 2004). The psychosocial impact is exacerbated and
prolonged by personal and property losses, relocation, and disrupted social support networks and daily activities (Mitchell,
Witman, & Taffaro, 2008; Nikapota, 2006). In the months following a traumatic disaster, acute reactions are replaced by more
chronic psychological conditions that require ongoing management (Madrid & Grant, 2008; Rosser, 2008; Vijaykumar, Thata,
John, & Chellappa, 2006). The long-term psychosocial impact
of disasters can include serious problems, such as posttraumatic
stress disorder (PTSD), substance abuse, and major depression
(Leon, 2004).
The purpose of this article is to review the literature on
the psychosocial impact of natural disasters on adult survivors.
Funding was received from the School of Nursing, Midwifery and
Nutrition and the Graduate Research School at James Cook University,
Australia.
Address correspondence to Sri Warsini, James Cook University,
School of Nursing, Midwifery and Nutrition, P.O. Box 6811, Cairns,
4870 Australia. E-mail: sri.warsini@my.jcu.edu.au

While previous literature reviews on this subject have been conducted, the last review, conducted in 2002 (Norris et al., 2002),
explored empirical research on a variety of survivor groups including children, adults, and recovery workers, and other publications (Galea, Nandi, & Vlahov, 2005; Neria, Nandi, & Galea,
2008) were focused on specific issues, such as PTSD. Therefore, it was considered timely to undertake an update on the topic
area.
AIM
The aim of this integrative review was to identify the evidence
related to the psychosocial impact of natural disasters on adult
(over the age of 18 years) survivors.
The specific research questions were:
What is the psychosocial impact of a natural disaster on
survivors?
Does the psychosocial impact of natural disasters on survivors differ among types of disasters?
METHOD
This literature review was conducted using an integrative approach, a method that draws on a diverse range of studies and
methodologies to summarise the main points of past research
and to delineate what is known about a topic (Whittemore &
Knafl, 2005). A systematic search was conducted using the
keyword terms/phrases psychosocial impact and natural disaster, psychological impact and natural disaster. and mental health impact and natural disaster. The databases searched
included PsycInfo, CINAHL, Proquest, Ovid SP, Scopus, and
Science Direct. The search was limited to articles written in
English, reviewed and published in the period of 20022012.
This time frame was selected as appropriate as a previous review conducted by Norris et al. (2002) included articles up until
2001.
A total of 1642 abstracts and articles were obtained during
the first search. Preliminary screening identified articles that

420

THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

421

Inclusion Criteria

Exclusion Criteria

Published in English language

Published between 20022012
Primary research article
Related to adult direct survivors

Published in language other than English

Published prior to 2002 or after 2012
Dissertation, thesis, review, other documents
Focused on other than adult (i.e., children or teenagers) or if focused on specific populations,
such as female or male groups of survivors, pregnant mothers, health care workers,
students, nurses, or rescue workers
Man-made disaster, technological disaster

Natural disaster situation

Screening

Identification

focused on the psychological impact on adult victims. Another

nine articles were found by hand searching. Duplicates were
removed, resulting in a subset of 1615 articles. Articles were
screened based on inclusion criteria (see Table 1).
After the screening, 97 articles and abstracts were retained.
A PRISMA flow chart diagram was used to show the flow of the
literature selection process during the review. This flow chart,
adapted from Moher et al. (2009), records the number of articles

gathered, screened, excluded, and selected during the steps of a

systematic review (see Figure 1).
All articles were assessed for eligibility using the Critical
Appraisal Skills Programme (CASP) evaluation method. The
CASP is a common tool used to assess the quality of various
research articles (Burls, 2009). The final set of relevant articles
was narrowed down to 39 articles, which were synthesized and
included in the present review (see Table 2).

Records identified
through database
searching (n = 1633)

Hand search (n = 9)

Records after duplicates

removed (n = 1615)

Eligibility

Titles and abstract

screened (n = 1615)

Included

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TABLE 1
Inclusion and Exclusion Criteria

Full text articles assessed

for eligibility (n = 97)

Records excluded
(n = 1518)

Full text articles that did

not meet criteria (n = 58)

Studies included in review

of the literature (n = 39)

FIGURE 1 PRISMA Flow Chart (adapted from Moher, Liberati, Tetzlaff, Altman, & Group, 2009).

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S. WARSINI ET AL.

TABLE 2
Natural Disasters and Psychological Impact Review Articles

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type

Measurement Tool

Ali
Earthquake; 8
et al.
October
(2012)
2005
(Pakistan)

30 months
(2.5 years)
postdisaster

Earthquake
survivors from
Mansehra,
Hazara, and
Abbotabad
districts
(n = 300)

Cross
sectional

Aslam
Earthquake; 8
&
October
Tariq
2005
(2010)
(Pakistan)

1 year postdisaster

Comparative Impact of Event Scale

(IES), Depression
Anxiety and Stress
Scale (DASS)

Basoglu Marmara
et al.
Earth(2004)
quake;
August &
November
1999
(Turkey)

14 months
postdisaster

Survivors from
the most
affected
districts
(Mansehra,
Muzaffarabad,
and Bagh) and
unaffected
areas (Attock,
Hejlum, and
Mirpur)
(n = 600)
Participants form
Degirmendere
and Avcilar
(n = 650)

Cross
sectional

Davidson Trauma
Scale

Traumatic Stress
Symptoms
Checklist (TSSC)

Main Finding
Possible PTSD case:
41.3%. Predictor
factors: gender
(female), age
(elderly), marital
status (unmarried),
role in family (head of
family), occupational
status (jobless),
housing (impermanent
house). Protective
factors: higher social
economy status and
spirituality.
Predictor factors for
PTSD, depression, and
stress are geographic
proximity to disaster
site and marital status.
Gender became a
significant factor for
stress whereas, for
anxiety, geographic
proximity area was.

The prevalence of PTSD

and depression at the
worst damage area
was 1623%, 8%
higher than in the
other area. Fear
became the most
significant factor of
PTSD prevalence in
earthquake setting.
Gender, history of
mental illness and
trauma, property
destruction, family
loss, and have
contribution during
crisis period were
weak risk factors.
(Continued on next page)

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THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type

Measurement Tool

Main Finding

Cao
Yun Nan
et al.
Earth(2003)
quake;
1988
(China)

5 months
postdisaster

Participants from
affected area
(Shang Yun,
Lang Cang, and
Meng Lian) and
from unaffected
area (Lu Nan)
(n = 2202)

Case
control

Carroll
Carlisle
et al.
Flood;
(2009)
2005 (UK)

1013
months
postdisaster

Participants in
Carlisle city
(n = 40)

Chae
Flood;
et al.
August
(2005)
2002
(South
Korea)

3 months
pre-disaster
and 4
months
postdisaster

Survivors from
Gangneung city
and from
Gangwon
province
(n = 285)

Chan
Sichuan
et al.
Earth(2012)
quake; 12
May 2008
(China)

7.5 months
postdisaster

Respondents
from Guankou
town and
Jiannan town
(n = 1725)

Flood had become

traumatic event for
survivors. Some
emotional
terminologies have
been claimed by the
survivors such as,
horrifying,
terrified, petrified,
traumatic, panic
stricken, and never
been so frightened in
all my life.
Case
Korean Psychological Survivors from disaster
control
Wellbeing Index
affected area
(PWI SF), Zung
experienced PTSD,
Self-Rate
depression, anxiety,
Depression Scale
and health problems.
(ZRDS), The Stait
Among survivors in
Trate Anxiety
exposed area The PWI
Inventory (STAI)
SF score was
increased 7 points
after flood. The
incident of anxiety
cases was 21.3%
whereas PTSD cases
were 39.5%.
Comparative Impact of Event Scale 50.2% of survivors who
Revised (IESR),
lost their family had
Centre of
PTSD and 55.8% of
Epidemiological
them suffered from
Studies Depression
depression symptoms.
Scale (CES-D)
It was 18-23% higher
than the prevalence
among participants
who did not lose their
beloved one.
(Continued on next page)

General Health
Questionnaire
(GHQ), Life Event
Inventory,
Posttraumatic Stress
Disorder section of
Diagnostic
Interview Schedule,
Inventory of The
Impact of Disaster
Phenomeno- The key areas of
logy
questioning were
broadly based on
Tapsell et al.s
(2002) work

Possible psychological
morbidity and PTSD
case in the worst
damage area was 51%
and 1323%. The
average rate of PTSD
among common
population was only
8.9%

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S. WARSINI ET AL.

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Chan
Wenchuan or
et al.
Sichuan
(2011)
Earthquake; 12
May 2008
(China)

1 month post- Survivors from

disaster
Qinchuan
county
(n = 430)

Chen
Chi-Chi
et al.
Earth(2007)
quake; 21
September
1999
(Taiwan)

2 years postdisaster

Survivors from
Nantou county
(n = 6412)

Dorahy Christchurch
&
EarthKannis- quake; 4
Dymand September
(2012)
2010 (New
Zealand)

2 months
postdisaster

Survivors from
Christchurch
suburb of
Avonside and
Hornby North
(n = 124)

Emin
Marmara
et al.
Earth(2006)
quake; 17
August
1999
(Turkey)

3 years postdisaster

Respondents of
Kocaeli City
Centre
(n = 683)

Study Type
Cross
sectional

Measurement Tool
Posttraumatic Stress
Disorder
Self-Rating Scale
(PTSD-SS)

Main Finding

62.6% of victims
diagnosed for PTSD. The
risk factors were marital
status (married), gender
(female), familys victim,
educational level (low),
and property loss.
Cross
Chinese Health
The prevalence rates of
sectional
Questionnaire-12
PTSD and mental health
(CHQ-12); Chinese
illness probability among
Startle,
survivors were 20.9%
Physiological
and 39.8%. The predictor
arousal, anger, and
factors for both problems
numbness (SPANwere gender (female),
C)
level of education (low),
and living place (shelter).
In addition, age (elderly)
became a specific risk
factor for psychiatric
morbidity whereas
property devastation was
risk in PTSD problems.
Comparative Acute Stress Disorder The prevalence rate of
Scale (ASDS);
anxiety and depression in
Patient Health
exposure community
Questionnaire 9
were higher than others,
depression module
but not the acute stress
(PHQ9);
disorder rate.
Generalized
Anxiety Disorder-7
(GAD7)
Cross
General Health
The rate of PTSD and
sectional
Questionnaire 12
Major Depressive
(GHQ-12);
Disorder (MDD) in
Composite
disaster site survivors
International
was 11.7% and 10.5%,
Diagnostic
and they became the
Interview (CIDI);
most common
Beck Depression
post-disaster problem.
Inventory (BDI);
Even though the rates
Traumatic Stress
were decreased over
Symptom Checklist
3 years, there were
(TSSC)
37.5% of victims who
suffered from PTSD and
fulfilled MDD criteria.
(Continued on next page)

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THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type
Cross
sectional

Gigantesco LAquila
et al.
Earth(2013)
quake; 6
April 2009
(Italy)

1419
months
postdisaster

Survivors in
LAquila city
(n = 957)

Goto et al.
(2006)

Volcano; 8
July 2000
(Japan)

10 months
postdisaster

Survivors in
Cross
Miyake Island
sectional
(n = 231)

Irmansyah
et al.
(2010)

Southeast
2 months
Asian
postEarthquake
disaster
and
Tsunami;
26
December
2004
(Indonesia)

Survivors from
IDP group
and non IDP
group who
live in Aceh
and North
Sumatra
(n = 783)

Cross
sectional

Measurement Tool
Mini International
Neuropsychiatric
Interview (MINI),
Patient Health
Questionnaire
(PHQ-8)

Main Finding

The rates of PTSD and

Major Depression (MD)
were 4.1% and 5.8%.
The PTSD predictor
factors were illness
history (chronic illness)
and loss of beloved one,
whereas for MD, they
were gender (female),
living in affected area,
and occupational status
(jobless). Financial
difficulties became a risk
factor in both problems.
Impact of Event Scale Volcano survivors who
Revised (IESR);
more frequently
Centre of
relocated had higher risk
Epidemiological
of PTSD symptoms
Studies-Depression
than the other group due
Scale (CESD)
to loss of belongings and
living in an uncertain
situation. The predictor
factors of PTSD
symptoms were age
(elderly), marital status
(widowed), educational
level (low), and length of
stay on the island
(longer). Meanwhile the
risk factors of depression
symptom were marital
status (widowed), length
of stay on the island
(shorter), and evacuation
history due to disaster.
Self-Reporting
81% of survivors who
Questionnaire
displaced from their
(SRQ); Connor
home were diagnosed
Davidson Resilience
with PTSD, whereas in
Scale (CDR)
control group only 63%
were, using Ehrenreich &
McQuaide cut off point.
However, using other cut
off points, the prevalence
rates for both groups
were 3538% lower.
(Continued on next page)

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TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type

Measurement Tool

Main Finding

Kumar
Southeast
et al.
Asian
(2007)
Earthquake
and
Tsunami;
26
December
2004
(India)
Kun
Wenchuan
et al.
Earth(2010)
quake; 12
May 2008
(China)

2 months
postdisaster

Survivors in
Tamil Nadu
(n = 314)

Cross
sectional

Harvard Trauma
Questionnaire
(HTQ)

12.7% of participants
were diagnosed with
PTSD. The risk
factors were gender
(female), injured, and
no revenue.

2,5 months
postdisaster

Respondents
from Beichuan
and Langzhong
in Sichuan
Province (n =
3862)

Cross
sectional

Short Form-12
(SF-12); Harvard
Trauma
Questionnaire
(HTQ)

Kun
Wenchuan
et al.
Earth(2009)
quake; 12
May 2008
(China)

2,5 months
postdisaster

Respondents
from Beichuan
and Langzhong
in Sichuan
Province (n =
450)

Cross
sectional

Harvard Trauma
Questionnaire
(HTQ)

Livanou Parnitha
et al.
Earth(2005)
quake; 7
September
1999
(Greece)

4 years postdisaster

Adult survivors
(n = 157)

Cross
sectional

Screening Instrument
for Traumatic Stress
in Earthquake
Survivors
(SITSES);
Traumatic Stress
Symptom Checklist
(TSSC)

The average score of

physical and mental
quality of life in both
locations showed
below 50. The
predictor factors of
victims quality of life
were gender (female),
housing (living in
shelter), household
income (higher),
family death, house
destruction,
and the past 2 weeks
history of illness.
The rate of PTSD
probability was 45.5%
among people who
lived in the most
severe destruction
area, five times higher
than those living in
another area. The
predictor factors were
income of family,
situation of
accommodation, loss
of beloved one, and
house destruction.
About 22% of survivors
experienced distress
symptoms,
subjectively, and 15%
of them reported
adjustment problem.

(Continued on next page)

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THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type

Measurement Tool

Mason Flood (UK)

et al.
(2010)

6 months
postdisaster

Flood survivors
(n = 444)

Cross
sectional

Harvard Trauma
Questionnaire
Revised (HTQ-R);
Hopkins Symptom
Checklist (HSC);
Coping Styles
Strategies (CSQ)

Musa
Southeast
et al.
Asian
(2013)
Earthquake
and
Tsunami;
26
December
2004 and
West
Sumatra
Earthquake;
September
2009
(Indonesia)
Naeem Kashmir
et al.
Earth(2011)
quake; 8
October
2005
(Pakistan)

4 years postdisaster

Respondents
from Aceh and
West Sumatra
(n = 200)

Cross
sectional

Depression, Anxiety,
and Stress Scale
(DASS)

18 months
postdisaster

Survivors from
Cross
Muzaffarabad
sectional
city (n = 1298)

Norris
Mexicans
et al.
Flood;
(2004)
1999
(Mexico)

6, 12, 18, and Participants from

Villahermosa
24 months
Tezuitlan,
postdisaster
Puebla, and
Tobasco (n =
561)

Main Finding
The prevalence rates of
anxiety, PTSD, and
depression were 24.5%,
27.9%, and 35.1%,
respectively. The predictor
factor of those
psychological problems
was gender (female).
The prevalence rate of
depression, stress, and
anxiety were 19%, 22%,
and 51%, respectively.
The predictor factors for
these three psychological
problems were gender
(female), age (younger),
occupational status
(jobless), and marital
status (being single).

Screening Instrument 46.6% respondents had

for Traumatic Stress
PTSD problems. The risk
in Earthquake
factor is gender (female),
Survivors
whereas living together in
(SITSES);
family was protective
Traumatic Stress
factor.
Symptom Checklist
(TSSC);
Self-Reporting
questionnaire
(SRQ); Brief
Disability
Questionnaire
(BDQ)
Longitudinal Composite
The PTSD rate and other
International
potentially traumatic
Diagnostic
events of people who lived
Interview (CIDI)
in Tezuitlan were higher
modules K & E
than those in the other city.
The frequencies of MDD
relatively declined from 6
months to 2 years after
flood, from 9.1% to 5.9%.
(Continued on next page)

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TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type

North
Great
et al.
Midwestern
(2004)
Flood;
1993
(USA)

4 and 5
months
postdisaster

Participants from
St Charles and
St Louis
Counties (n =
162)

Paranjothy Flood; Juneet al.

July
(2011)
2007(UK)

3 and 6
months
postdisaster

People from
South
Yorkshire and
Worcestershire
(n = 2265)

Parslow Bushfire;
et al.
January
(2006)
2003
(Australia)

4 years
before
disaster
and 318
months
postdisaster

First wave (n =
2404) and
second wave (n
= 2085)

Priebe
Earthquake; 4
et al.
September
1997 (Italy)
(2011)

8 years postdisaster

Participants from
Camerino city
(n = 200)

Cross
sectional

Soldatos Earthquake; 7
et al.
September
(2006)
1999
(Greece)

3 weeks postdisaster

Subjects of
Athens
Metropolitan
Area (n = 102)

Cross
sectional

Measurement Tool

Longitudinal DSM-III-R
Diagnostic
Interview
Schedule/Disaster
Supplement (DIS
III-R)
Comparative General Health
Questionnaire -12
(GHQ 12);
Generalized
Anxiety Disorder
(GAD7); Patient
Health
Questionnaire
(PHQ9); PTSD
Checklist
Comparative Goldberg Depression
and Anxiety Scores;
Eysenck Personality
QuestionnaireRevised (EPQ-R);
Trauma Screening
Questionnaire
(TSQ)

Mini International
Neuropsychiatric
Interview (MINI),
Brief Symptom
Inventory (BSI),
Impact of Event
Scale Revised
(IESR),
Manchester Short
Assessment of
Quality of Live
(MANSA)
International
Statistical
Classification of
Diseases (ICD 10)

Main Finding
Four months post-flood,
22% participants had
PTSD and a month
later it declined to
16%.
People who were
exposed to flood
disaster (South
Yorkshire city) were
diagnosed to have
psychological distress,
anxiety, depression,
and PTSD two to five
times higher than
unexposed people.
Only 5% of participants
diagnosed with PTSD
symptoms. The risk
factors of PTSD were
gender (female),
educational level
(low), mental health
condition (poor), and
higher levels of
neuroticism.
Based on MINI results,
7.5% respondents
diagnosed with a
mental disorder.
However, the victims
symptoms levels were
not high and their
quality of live was
positive.

Approximately 85% of
respondents were
diagnosed to have
Acute Stress Disorder,
and 43% of the
victims met the PTSD
criteria.
(Continued on next page)

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THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Stratta LAquila
et al.
Earth(2012) quake; 6
April 2009
(Italy)

Time Frames
(pre- and/or
post-disaster)
1 year postdisaster

Tang
Southeast
6 months
(2006) Asian
postEarthquake
disaster
and
Tsunami;
26
December
2004
(Thailand)
Tang
Southeast
2 weeks & 6
(2007) Asian
months
Earthquake
postand
disaster
Tsunami;
26
December
2004
(Thailand)

Chi-Chi
Tsai
Earthet al.
(2007) quake; 21
September
1999
(Taiwan)
Tuason Hurricane
et al.
Katrina;
(2012) August
2005.
(USA)

6 months &
3 years
postdisaster

More than
4 years
postdisaster

Sample Size

Study Type

Measurement Tool

Main Finding

People from
LAquila
district
(affected) and
unaffected
district
(n = 984)

Case control Trauma and Loss

About 22 victims from
Spectrum-Self
affected area and 8 victims
Report (TALS-SR);
from unaffected areas were
Brief
diagnosed to have suicidal
Multidimensional
ideation. Female victims had
Measure of
higher risk for Suicidal
ReligiousScreen Positive (SSP).
ness/Spirituality
(BMMRS); Impact
of Event Scale (IES)
Participants from Cross
General Health
A half-year post-disaster, 40%
Phuket area
sectional
Questionnaire
of survivors showed negative
(n = 267)
(GHQ); Post
adjustment while 34% of
traumatic Growth
survivors adjusted positively.
Inventory (PGI);
The predictor factors for
Brief Coping
poor adjustment were lack of
Strategies
support-seeking behavior
Inventory(BCSI)
and greater PTSD symptoms.
Survivors from
Phuket area
(n = 265)

Cross
sectional

9 participants

Consensual
qualitative

DSM-IV (ASD &

PTSD); General
Health
Questionnaire
(GHQ)

The prevalence rate of Acute

Stress Disorder (ASD)
(according DSM-IV) of
tsunami victims was 22%; 6
months later, 30% of victims
developed PTSD symptoms.
70% of the survivors had
positive adjustment and
became resilient, whereas
the rest became chronic with
a delayed stress response.
First survey (n = Longitudinal Short Form 36 (SF
6 months after earthquake,
4223) and
36); Posttraumatic
23.8% participants had
follow-up
Stress Scale (PTSS)
PTSD; after 3 years, only
survey (n =
4.4% still experienced it.
1756)
Multiple losses felt by
survivors after hurricane
disaster were loss of family,
house, property, and
livelihood, loss of protection,
and loss of neighborhood.
Displacement experiences
may bring some problems
for survivors, such as a lack
of trust of the government,
poor health care, and loss of
support systems.
(Continued on next page)

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S. WARSINI ET AL.

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Time Frames
(pre- and/or
post-disaster)

Sample Size

Study Type

Measurement Tool

van
Southeast
2 months & 9 Displaced and
Grivensen Asian
months
non-displaced
et al.
Earthquake
postparticipants
(2006)
and
disaster
from Phang
Tsunami;
Nga and
26
non-displaced
December
persons from
2004
Krabi and
(Thailand)
Phuket (n =
1038).

Comparative Short Form 36 (SF

36); Harvard
Trauma
Questionnaire
(HTQ); Hopkins
Checklist:
(HSCL-25)

Wang
Wenchuan or
et al.
Sichuan
(2009)
Earthquake; 12
May 2008
(China)

3 months
postdisaster

Survivors from
Yongan Town
and Leigu
Town (n =
1563)

Cross
sectional

Weems Hurricane
et al.
Katrina;
(2007)
August
2005.
(USA)

2 months
postdisaster

Participants from
New Orleans,
Greater New
Orleans, and
the Mississippi
Gulf Coast
(n = 386)

Cross
sectional

Xu &
Wenchuan or
Liao
Sichuan
(2011)
Earthquake; 12
May 2008
(China)

1 year postdisaster

Adult survivors
from 19
counties in
Sichuan
province (n =
2080)

Cross
sectional

Main Finding

The prevalence rates of

PTSD, depression, and
anxiety of relocated
victims were 12%, 30%,
and 37%, respectively.
Nine months later they
were 7%, 16.7%, and
24.8%. The strongest
factor of these three
psychological problems
was loss of livelihood.
Los Angeles
The rates of probable
Symptom Checklist
PTSD in both cities were
(LASC) for PTSD;
37.8% and 13%. The risk
Perceived Social
factors were gender
Support Scale
(female), ethnic type,
(PSSS)
education level (low),
social support (low), and
exposure (higher).
Survey Exposure to
The prevalence of PTSD
Hurricanes and their
and psychological
Aftermath (SEHA);
symptoms among 3
Brief Symptom
communities were
Inventory (BSI);
significantly different,
PTSD checklist;
however Mississippi
Family Support
survivors have the
Scale
highest among them.
PTSD and BSI
symptoms were
significantly correlated
with the survivors
number of traumatic
events.
Posttraumatic Growth Rates for posttraumatic
(PTG); Impact of
growth and PTSD of
Events Scale (IESR)
survivors, one year
post-earthquake were
similar (around 50%).
The factors that
correlated with
posttraumatic growth
were gender (female),
age (younger), level of
education (high),
exposure (high), and
element of PTSD signs.
(Continued on next page)

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THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

TABLE 2
Natural Disasters and Psychological Impact Review Articles (Continued)

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Authors

Event

Yang
Chi-Chi
et al.
Earth(2003) quake; 21
September
1999
(Taiwan)

Time Frames
(pre- and/or
post-disaster)
3 months
postdisaster

Sample Size

Study Type

Survivors from
Pu Li town (n
= 663)

Cross
sectional

Zhang Wenchuan or 1 year postet al.

Sichuan
disaster
(2011) Earthquake; 12
May 2008
(China)

Survivors from
earthquake (n
= 1181)

Cross
sectional

Zhang Yushu Earthet al.

quake; 14
(2012) April 2010
(China)

Residents in
Yushu county
(n = 505)

Cross
sectional

3-4 months
postdisaster

RESULTS
The articles reviewed address the psychosocial impact from a
number of different types of natural disasters. The psychosocial
impacts included in this review were posttraumatic stress disorder (PTSD), depression, anxiety, acute stress disorder, and suicide ideation. Quality of life also was measured in some studies.
The articles considered the psychosocial impact of seven types
of natural disasters: earthquake, flood, tsunami, hurricane, landslide, volcano, and bushfire.
Earthquakes
The most-studied type of natural disaster identified in this
review is the earthquake. Among the 23 articles analysed in

Measurement Tool

Main Finding

Chinese Health
Questionnaire 12
(CHQ-12);
Posttraumatic
symptom checklist
according to
DSM-IV; Simple
Personality
Inventory (SPI)

The prevalence of PTSD was

11.3% (full criteria) and
32% (partial), whereas the
mental health sickness rate
was 24.5%. The risk factors
of both psychological
problems were gender
(female), age (elderly), loss
due to disaster (financial),
and personality type.
PTSD
The rate of survivors
Checklist-Civilian
possibility of PTSD was
Version (PCL-C);
26.3%, whereas anxiety and
Hopkins Symptoms
depression rates were about
Checklist-25
49%. The risk factors of
(HSCL 25);
psychological distress were
Perceived Social
age (middle-aged and
Support Scale
elderly), injured, and
(PSSS)
become jobless because of
disaster and fear. Gender
factor has correlation with
PTSD and depression but
not to anxiety.
PTSD
The proportion of survivors
Checklist-Civilian
who suffered from PTSD,
Version (PCL-C);
depression, and anxiety was
Hopkins Symptoms
33.7%, 38.6%, and 43.8%,
Checklist-25
respectively. The risk
(HSCL 25);
factors of survivors
Perceived Social
psychiatric morbidity were
Support Scale
gender (female), fear, and
(PSSS)
social support (low).

this review, nine papers were from China (studying three earthquake events), three were from Italy (studying two events), three
each were from Taiwan (focusing on the Chi-chi earthquake in
September 1999) and Pakistan (focusing on the Kashmir earthquake in October 2005), two were from Greece (focusing on
the Parnitha earthquake in September 1999) and Turkey (Marmara earthquake in August 1999), and one article was from New
Zealand (focusing on the Christchurch earthquake in September
2010).
In total, 17 papers discussed the incidence of PTSD in
earthquake survivors. PTSD, however, was measured at different intervals and using different measuring scales. Seven
articles discussed PTSD experienced by survivors in the aftermath (less than six months) after the disaster. Of these

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S. WARSINI ET AL.

articles, five indicated that PTSD manifested in earthquake survivors at a rate above 30% (33.762.6%) (Chan et al., 2011; Kun
et al., 2009; Soldatos, Paparrigopoulos, Pappa, & Christodoulou,
2006; Wang, Zhang, Shi, & Wang, 2009; Z. Zhang, Wang, Shi,
Wang, & Zhang, 2012). Two papers, by Yang et al. (2003) and
Cao et al. (2003), contradicted these findings as they found less
than 23% of survivors experienced PTSD. However, the partial
prevalence of PTSD in the research of Yang et al. (2003) is quite
high at 32%. Research conducted by Soldatos et al. (2006) assessed the incidence of PTSD soonest after the disaster hitthat
is, three weeks after the earthquakeand the research indicated
survivors were experiencing PTSD at a rate of 43%.
The prevalence of PTSD declines as time passes after a disaster. This assertion is reflected in longitudinal research by Tsai
et al. (2007) in Taiwan, which found that six months after the
Chi Chi earthquake survivors were experiencing PTSD at a rate
of 23.8% and three years after the event, the PTSD rate had
fallen to 4.4%.
In the longer term, the prevalence of post-earthquake PTSD
varies between 56.8% and 4.1%. These rates also are influenced
by the survivors losses. In Chan et al.s (2012) study, survivors
who lost family members suffered PTSD at a rate of 50.2%
and those who had not lost family members reported suffering
PTSD at the much lower rate of 27.1%.
Interestingly, researchers studying the psychological effects
felt by earthquake survivors reported very different results, even
if they were conducting research with survivors of the same
earthquakes. Some of these differences can be explained easily.
Studies were undertaken within varying time frames pre- and
post-disaster and used a range of measuring instruments. Not all
discrepancies are easily explained, however. For example, two
researchers working with survivors of the Wenchuan earthquake
measured PTSD rates one year after the earthquake and came
up with very different figures. The prevalence of PTSD in Y.
Zhang and Hos (2011) research subjects was 26.3%, while in
Xu and Liaos (2011) study the figure was twice that amount at
56.8%. Similarly, great differences in the measured PTSD rates
were noted in research conducted after the Chi Chi earthquake.
Tsai et al. (2007) reported 4.4% prevalence of PTSD three years
after the earthquake while Chen et al. (2007) reported a 20.9%
rate two years after the earthquake.
More consistency can be seen in research studies conducted
in Pakistan, Turkey, and Greece. In Pakistan, the prevalence
of PTSD between 1.5 and 2.5 years after the earthquake was
41.3% (Ali, Farooq, Bhatti, & Kuroiwa, 2012) and 46.6%
(Naeem et al., 2011), while in Turkey the prevalence of PTSD
was 19.2% after three years (Basoglu, Kilic, Salcioglu, &
Livanou, 2004) and 12% after four years (Emin, Tural, Aker,
Cengiz, & Erdogan, 2006).
A difference in results also was obvious in studies on
earthquake-related depression. The prevalence of depression in
survivors 7.5 months after the Wenchuan earthquake was 55.8%
(Chan et al., 2012), but according to Y. Zhang and Ho (2011),
depression was experienced by 49.6% of survivors one year after

the same earthquake. Consistent results were obtained from two

research studies in Turkey that indicated the prevalence of depression at 14 months after the earthquake was 16.8% (Basoglu
et al., 2004) and at three years was 18.7% (Emin et al., 2006).
Meanwhile the lowest rate was noted in Italian survivors who, at
1419 months after the LAquila earthquake, were experiencing
depression at a rate of 5.8% (Gigantesco et al., 2013).
Anxiety problems were discussed in only two articles. The research by Z. Zhang et al. (2012) found the prevalence of anxiety
three months after the Yushu earthquake was 43.8%. Y. Zhang
and Ho (2011) also studied survivors of the Wenchuan earthquake one year later and found the anxiety rate to be 49.8%. Both
researchers employed the same instrument to measure anxiety,
namely the Hopkins Symptom Checklist-25 (HSCL-25).
Acute stress disorder in an earthquake setting also is studied
in several articles. The reviewed articles reported on earthquakes
in Greece and New Zealand. Soldatos et al. (2006) found a high
number of research participantssome 85.3%were experiencing acute stress disorder three weeks after the earthquake,
while Dorahy and Kannis-Dymand (2012) found 37.7% of survivors experienced acute stress disorder two months after the
Christchurch earthquake in New Zealand.
Earthquake survivors may be susceptible to psychological
problems, which decrease their quality of life. Four articles
discussed probable psychological morbidity on earthquake survivors. Research on survivors of the Yun Nan earthquake indicated probable psychiatric morbidity of 51% five months after
the earthquake (Cao et al., 2003), while psychiatric morbidity
was reported in Chi Chi earthquake survivors at 39.8% two
years after the earthquake (Chen et al., 2007). The studies employed different instruments to measure psychological morbidity; Chen et al. (2007) utilized the Chinese Health Questionnaire
12 whereas Cao et al. (2003) used the General Health Questionnaire (GHQ).
Suicide risk is another mental health concern. This issue is
addressed in relation to the LAquila earthquake. The research
of Stratta et al. (2012) conducted one year after the earthquake
found 5% of the respondents reported suicidal ideation.
Flood
The psychological aftermath of flood has been studied in
four countries (UK, US, Mexico, and South Korea). PTSD is
the most-studied problem in flood victims; five out of six articles
discussed PTSD. Three to six months after the 1993 Great Midwestern flood (North, Kawasaki, Spitznagel, & Hong, 2004), the
prevalence of PTSD varied between 15.6% and 21.6%, while
flood survivors in South Korea had a prevalence of 39.5% (Chae,
Kim, Rhee, & Henderson, 2005), and flood survivors in the UK
had between a 2227.9% prevalence rate of PTSD (Mason, Andrews, & Upton, 2010; Paranjothy et al., 2011).
The depression rate three to six months after the UK flood was
35.143% (Mason et al., 2010; Paranjothy et al., 2011), while
Norris et al.s (2004) research found a depression rate of 9.1%
in flood victims; that rate decreased to 5.4% after two years.

THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

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Anxiety rates also were found to be high after floods. Three

to six months after the major flood, anxiety was calculated by researchers at rates between 21.348% (Chae et al., 2005; Mason
et al., 2010; Paranjothy et al., 2011).
Tsunami
Six articles discussed the psychological impacts of the Southeast Asian Tsunami in three different locations, namely Indonesia, Thailand, and India. The psychological problems discussed
in those articles include PTSD, anxiety, depression, and stress.
Post-tsunami stress is studied by Tang (2007) and Musa et al.
(2013). The prevalence of acute and chronic stress in tsunami
survivors in Thailand and Indonesia is 22%. Tang (2007) studied
acute stress disorder in survivors from Phuket two weeks after
the tsunami, while Musa studied stress experienced by tsunami
survivors in Aceh four years after the disaster. The researchers,
however, employed different measuring instruments.
The rate of posttraumatic stress disorder varies in tsunami
survivors. Two months after the tsunami the prevalence rate
of PTSD in Indonesia was 81% for displaced people and 63%
for non-displaced people (Irmansyah, Dharmono, Maramis, &
Minas, 2010), while in Thailand (Van Griensven et al., 2006)
and India (Kumar et al., 2007) the PTSD rate was 12% for
displaced people and 7% for non-displaced people. The result of
follow-up research conducted by Van Grievensen et al. (2006)
indicates that the prevalence of PTSD nine months after the
disaster decreased by 7% for displaced people and by 23% for
non-displaced people.
Two researchers discuss depression and anxiety problems:
Van Grievensen et al. (2006), conducting research in Thailand,
and Musa et al. (2013), working in Indonesia. The results indicate that the rate of depression and anxiety in tsunami survivors
in Aceh (Indonesia) was still high four years after the disaster.
Van Grievensen et al. (2006) showed the depression rate two
months after the tsunami was 30% and seven months later was
16.7%, while the anxiety rate was 37% after two months and
24.8% after seven months. Four years after the tsunami in Aceh,
Musa et al. (2013) found that the depression rate was 19% and
the anxiety rate was 51%.
Hurricanes and Other Natural Disasters
Two articles about the effects of hurricanes are discussed in
this review. Both articles discuss Hurricane Katrina in the US.
Weemss (2007) study indicated hurricane survivors suffered
from PTSD and other psychological symptoms as measured
by the Brief Symptom Inventory (BSI) two months after the
event while Tuasons study (2012) found that Hurricane Katrina
survivors experienced multiple losses.
Two articles discussed the psychological impacts of other natural disasters (volcanoes and bushfires). The research of Goto
et al. (2006) on volcano survivors in Miyake Island, Japan, found
that material loss and uncertainty greatly influenced PTSD.
Meanwhile, the research of Parslow et al. (2006) on the bush-

433

fire disaster in Australia in January 2003 found that 5% of the

survivors experienced PTSD.
RISK FACTORS OF PSYCHOSOCIAL PROBLEMS
POST-DISASTER SITUATION
Certain factors may predict psychosocial problems likely to
occur in survivors after a disaster. Posttraumatic stress disorder
has been more widely studied in disaster settings than any other
psychosocial disorders and is, thus, addressed in the greatest
detail in this review. Few articles discuss the risk factors for
anxiety and stress. None of the articles analysed consider the
risk factors of acute stress disorder.
The review of 19 PTSD research articles indicates that certain
groups are more likely to develop PTSD. These at-risk groups
include females, the elderly, and middle-aged people. The likelihood of developing PTSD also is influenced by economic status,
extent of house and property damage, loss of beloved people,
injury, anxiety levels during the disaster, and whether survivors
are living in a shelter after the disaster. Factors such as low
education level, loss of occupation, personality type, and history of mental health problems, also are mentioned by some
researchers.
Six articles discuss the factors that may predict depression.
Most of the articles mention gender (female) and loss of occupation as the strongest factors influencing the likelihood of developing depression. There is little agreement among researchers
about other factors influencing disaster-related depression.
Y. Zhang and Ho (2011) found that middle-aged and old-age
earthquake survivors were more likely to suffer from depression, while Musa et al. (2013) found that younger survivors
of tsunamis had a greater propensity to experience depression.
There is disagreement between researchers about whether depression is more commonly felt after a disaster by married or
single survivors. Aslam and Tariq (2010) state that married survivors tend to experience depression in greater numbers, while
Musa et al. (2013) indicate that depression is more commonly
noted in unmarried survivors.
The factor predictors of psychiatric morbidity are discussed
in two articles. All articles mention that women and people who
are living at a shelter are more prone to psychiatric problems.
Old age, house and property damage, low level of education, and
a history of mental illness are strong influencing factors that may
explain why a survivor experiences psychosocial problems after
a disaster.
DISCUSSION
The aim of this integrative review was to identify the evidence related to the psychosocial impact of natural disasters
on adult (over the age of 18 years) survivors. The results of
the review indicate that PTSD is the most-studied psychosocial problem after a disaster. Short-and long-term studies also
have considered the prevalence of depression, anxiety, and
stress. Fewer research studies have looked at the impacts of a

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disaster on other psychosocial disorders, such as sleep disorder

and suicidal ideation.
The results indicate that post-disaster research is more commonly conducted six months after a disaster or after an even
longer time frame has elapsed. This may be attributed to the
difficulties of conducting research during or immediately after
a disaster. For example, feasibility issues and ethical considerations may make it difficult for researchers to work in a chaotic
post-disaster environment. The researcher also may feel reluctant to speak to survivors in what are often miserable and difficult
circumstances.
It is, however, necessary to identify responses of survivors
at an early phase to identify the necessary actions to be taken
by mental health workers and emergency relief personnel. It
is therefore important to develop a method of research that
explores responses of survivors in the immediate aftermath of a
disaster, which gives proper consideration to the ethical issues
associated with working in such an environment.
This review can only describe the various trends and observations reported in disaster studies. It is difficult to make
meaningful comparisons of the data because researchers have
employed a variety of tools, methodologies, data collection techniques, and time frames to analyse the after-effects of different
disasters. Further complicating the data is the use of different
cut-off points when deciding who had a mental illness and how
much of the psychological turmoil could be attributed to the
disaster.
One means of addressing this for future disaster research
would be the identification or development of a single tool that
accurately captures and measures the psychological after-effects
of a disaster. To achieve this, a study of specific, disaster-related,
psychosocial problems, assessed using several different instruments, with a large study cohort, would need to be performed.
The results could help explain the sensitivity and specificity of
instruments so future researchers could determine which instruments were most reliable and accurate in assessing post-disaster
psychological problems.
Clear guidelines also need to be established to determine
the point at which a person is considered to be well and no
longer experiencing a psychosocial illness. The results show
differing opinions about whether a person was experiencing a
diagnosable mental illness or was actually experiencing a transient psychosocial reaction to the disaster. It is possible that
study results were influenced by determination of the cut-off
point for the various tools used to measure the components of
psychosocial distress and differences in results can be explained
largely by the way the researcher defines mental illness. Employing clear guidelines and a uniform approach would benefit
researchers, policy-makers, and mental health workers. Further
data could be compared in a more meaningful way, and time,
money, and resources could be allocated more effectively.
The results clearly highlight posttraumatic stress disorder as
the most studied post-disaster psychosocial problem and several
risk factors were identified. Post-disaster depression also was

explored in a number of studies, yet very few studies looked

at the broader range of mental health problems, such as acute
stress disorder, anxiety, sleep disorders, and suicide risk. An
opportunity exists for these areas to be explored and for risk
factors and triggers to be identified.
Mental health nurses play an important role in the management and support of disaster survivors and are pivotal in longerterm recovery and rebuilding efforts. It is important that mental
health nurses be aware of the psychosocial responses likely to
be experienced by survivors of natural disasters to enable them
to provide effective and timely care. Given that the numbers of
natural disasters are on the rise, mental health nurses have an
important role in assessment of psychosocial problems after an
event as well as supporting those with psychosocial problems
during the recovery phase. The provision of support in a timely
manner is thought to foster resilience in survivors (Jacobowitz,
2013). Mental health nurses can assist individuals and communities to become more resilient after disasters by offering
appropriate treatment and support.
Limitations
Despite extensive searching, it is possible a study focusing
on psychological or psychosocial impacts of disasters may have
been missed. Disaster research is a multidisciplinary field and
studies are published in a variety of journals. Studies in languages other than English, gray literature, or anecdotal evidence
were not accessed for this review.
CONCLUSION
This integrative review of the literature uncovered a number of valuable findings. With the frequency of natural disasters
increasing, many individuals, families, and communities are
experiencing the psychosocial impact of these events. Mental
health nurses have a significant role to play supporting survivors in the aftermath of natural disasters and assisting with
the development of resilience in community members. While
the depth of the findings vary, this review provides evidence
that further research is needed, especially relating to clear definitions and cut-off points for defining psychosocial distress
and post-disaster impacts. A number of recommendations have
been made highlighting the narrow scope of the current literature, which predominantly addresses posttraumatic stress disorder, and the inadequacies of some approaches, particularly
around definitions of mental illness and transient post-disaster
psychosocial impact.
Needless to say, this is an area of growing interest and the
available literature highlights important data for policymakers,
health care systems, and individuals involved in disaster response. Critically, future research needs to build on the work
currently available, including exploring other psychosocial and
psychological impacts post-disaster. This will not only enhance
understanding, but also provide evidence-based support for future policy and planning.

THE PSYCHOSOCIAL IMPACT OF NATURAL DISASTERS

Declaration of Interest: The authors report no conflicts of

interest. The authors alone are responsible for the content and
writing of the paper.

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