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    • Photos from Gyumri, Armenia, which was devastated by the 1988 Spitak earthquake. Photography by Kariné Armen.

Rebuilding After Tragedy

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THE 6.9-MAGNITUDE EARTHQUAKE that struck northern Armenia on December 7, 1988, almost entirely destroyed the town of Spitak, closest to the epicenter, and caused damage to nearly one-third of the country. More than 25,000 people died, an estimated 100,000 were injured and half a million people lost their homes.

Photos from Gyumri, Armenia, which was devastated by the 1988 Spitak earthquake. Photography for this article by Kariné Armen.
Photos from Gyumri, Armenia, which was devastated by the 1988 Spitak earthquake. Photography for this article by Kariné Armen.

In the initial years after the tragedy, as many as half of the earthquake survivors suffered from symptoms of post-traumatic stress disorder (PTSD) ranging from palpitations, sweating and anxiety to flashbacks and recurring nightmares about the event. More than two decades later, many of the survivors had put the psychological distress behind them and were leading productive and fulfilling lives, but a substantial portion – as many as 20-25 percent – continued to experience PTSD and other mental health after-effects that severely impaired their quality of life.

These and other findings about the long-term mental health impact of living through a disaster, as well as the potential for public health to successfully intervene, come from follow-up surveys of thousands of Spitak earthquake survivors in the first several years after the tragedy, and then again starting in 2012. “Many of these psychological effects that were initially identified continued to persist in this population some 23 years later, affecting not only their mental health and quality of life, but in many cases their physical health as well,” says Dr. Haroutune K. Armenian, professor of epidemiology at the Fielding School, who has headed the studies.

“But by following up with the same population all these years later, we are able to look at factors that make a difference in helping people overcome such a traumatic experience. And we have found that well-targeted public health efforts following a disaster can make a tremendous difference in improving the long-term quality of life of survivors.”

Armenian notes that although other studies have shown the effects of disaster-related experiences on mental and physical health, little is known about the long-term quality of life of disaster survivors, or the factors associated with positive and negative outcomes – knowledge that could go a long way toward informing public health strategies in a disaster’s aftermath.

In 1990, Armenian began one of the first and largest population-based assessments of earthquake survivors’ mental and physical health, collecting data in 1990, 1992 and 1994 on more than 32,000 Spitak earthquake survivors to learn how their lives unfolded in the disaster’s aftermath. Then in 2011, while Armenian was teaching at the American University of Armenia, one of his MPH students, Vahe Khachadourian, approached him about re-contacting participants from those early phases of the study to see how they were doing 23 years after the quake. Today, Khachadourian is a Fielding School doctoral student continuing to work with Armenian on follow-up studies of more than 1,700 individuals from the original cohort. Funding for the initial 23-year follow-up research, as well as for the first year of Khachadourian’s doctoral studies, came from The Turpanjian Family Educational Foundation of Los Angeles.

The impact of the lingering PTSD on the survivors is profound, Khachadourian says. Beyond the PTSD-related symptoms, the FSPH researchers have found the condition to be associated with other mental health problems such as depression, anxiety, and alcohol and substance abuse. “The PTSD has a major impact on quality of life,” Khachadourian explains. “People will avoid places, other individuals, discussions, and events that remind them of the trauma.”

By following up with the survivors over such a long period of time, Armenian and Khachadourian are beginning to identify factors associated with being able to move beyond the psychological difficulties and rebuild their lives – in some cases even reporting better quality than they had before the earthquake. Among their findings: Survivors with high scores on measures of dignity have fared much better in the post-earthquake years. In addition, for those who experienced the most severe losses from the quake, immediate support in the form of food, shelter, and financial resources was critical to the long-term psychological recovery. The findings have also pointed to the importance of social support.

“People who experienced the earthquake with someone else have shown better resilience than those who experienced the trauma alone,” Armenian explains. The researchers are now preparing to embark on a much larger follow-up study with the same population.

Khachadourian is a physician who, after a year as a general practitioner in Armenia, decided to move into public health – and particularly research that explores the factors associated with positive and negative mental health outcomes. Presented with the opportunity to work with Armenian on a follow-up of the Spitak earthquake survivor cohort, he didn’t hesitate to move to the United States, apply and later enroll in the Fielding School’s PhD program in the Department of Epidemiology.

Born in Iran, Khachadourian moved to Armenia in 2003, when he was 17. Although it had been 15 years since the earthquake, he could see the enduring impact. “It was always interesting to hear stories of what people went through and how it affected their lives,” he says. “I have known some people who overcame the adversity and are now successful, while others continue to suffer. By learning more about what is most helpful to the recovery, public health can develop programs and policies that will make a difference following future disasters.”