Mental health aspects of disasters.

Disaster preparations and responses are incomplete without addressing the mental health aspects of disasters. Unpleasant mental states can be a natural and even adaptive human response following a disaster; however, disasters also can contribute to the development of mental illnesses and substance use disorders or exacerbate existing disorders for disaster survivors, response personnel, and even families and close contacts of survivors and responders. Disaster-related psychopathology can mimic or negatively affect other disaster-related illnesses and can impair health professionals and others who must respond to catastrophic events; however, disasters also can encourage tremendous human coping, perseverance, and resilience and can even enhance personal and collective feelings of purpose, connection, and meaning. Integrating mental health promotion and care into disaster planning and response has the potential to mitigate psychiatric and medical consequences of a disaster and may preserve the mission readiness of disaster response personnel and promote healing among communities traumatized by disaster.

Attachment styles of Oregonians who request physician-assisted death.

OBJECTIVE: Qualitative analyses suggest that requests for physician-assisted death (PAD) may often be the culmination of a person's lifelong pattern of concern with issues such as control, autonomy, self-sufficiency, distrust of others, and avoidance of intimacy. Such characteristics may be measured by attachment style. We compared family members' reports of attachment style in Oregonians who did and did not request PAD. METHOD: Eighty-four family members of terminally ill patients who requested PAD before death and 63 members of a comparison group that included family members of terminally ill Oregonians who died without requesting PAD rated their loved ones' attachment style in a one-time survey. RESULTS: Individuals who requested PAD were most often described as having dismissive personality styles (56%) compared to 41% of comparison individuals, and on continuous measures of relational style, the highest mean score among PAD requesters was for dismissive style. There were marginally significant differences in the proportions of each attachment style when comparing the two groups (p = 0.08). SIGNIFICANCE OF RESULTS: Patients' attachment styles may be an important factor in requests for PAD. Recognition of a patient's attachment style may improve the ability of the physician to maintain a constructive relationship with the patient throughout the dying process.