Protracted displacement and health correlates among survivors of typhoon Haiyan in the Philippines

Abstract

Displacement is a common experience among survivors of mass disasters. The impact of various dimensions of displacement can lead to adverse health outcomes among survivors. Aside from decreased subjective well-being, poor mental health outcomes and sleep disturbances have been documented among those survivors relocated from their previous communities. Protracted displacement would be expected to adversely impact the recovery of disaster-affected communities, especially in low-resource settings where there are weak healthcare systems or inadequate health service delivery provisions to meet these emergent public health needs. The lack of effective and sustainable models for public health intervention in post-disaster settings, especially among displaced communities in these settings need to be addressed. This thesis project examined the long-term impact of disaster exposure and displacement experience on the health outcomes among the 2013 Typhoon Haiyan survivors in the Philippines several years after the event and tested a model for public health intervention. First, the thesis examined the differential impact of displacement experience or forced relocation among Typhoon Haiyan survivors to subjective health, sleep problems, posttraumatic stress, depression, anxiety, and stress symptoms. Second, it sought to examine psychological adjustments among survivors after traumatic exposure to the disaster by looking at sleep disturbances, posttraumatic stress, and psychological distress. Third, it examined the longitudinal relationship between insomnia and mental health outcomes, specifically posttraumatic stress, depression, anxiety, and stress symptoms. Lastly, it tested a lifestyle modification intervention that integrated sleep, diet, physical activity, and other health behaviors to address these health problems among displaced survivors. Study 1 provided evidence that displacement or forced relocation is associated with poorer health outcomes. The results of Study 2 corroborated the presence of elevated levels of sleep problems and posttraumatic stress and psychological distress among survivors, with longitudinal data from Study 3 supporting the importance of addressing sleep problems to manage co-morbid mental disorders. Study 4 provided evidence that promoting a lifestyle medicine-based psychoeducation intervention have the potential to address some of these mental health problems among displaced survivors. In conclusion, the results of the four studies showed the importance of addressing persistent health problems among displaced survivors and the potential use of a lifestyle medicine-based approach to address these health problems that can be sustainable, culturally-grounded, and empowers local communities to take responsibility for their own health.