A complicated disaster

By MainGate Staff
Fall 2020/Winter 2021

When the explosion occurred at the Beirut port, a family driving through the winding streets near Gemayze was tossed around inside its vehicle. The father and his two sons, six-year-old Ahmad* and eight-year-old Zein,* suffered contusions, sprains, and bruises. Weeks passed and while these minor injuries healed, Zein’s interior life darkened. “He would cling to his father, he wouldn’t get in the car,” says Psychiatry Department Chair Fadi Maalouf. Meanwhile, his brother Ahmad appeared calm and content. Thus, the conundrum: What was it about Zein that made him more vulnerable to trauma than his brother?

Since his return to Lebanon from the University of Pittsburgh in 2009, Maalouf has been trying to answer this question. He and his team of researchers have conducted prevalence and screening studies of adolescent populations in Beirut and other parts of Lebanon, generating a set of baseline mental health statistics for the country that otherwise would not exist, and which international public health organizations like the World Health Organization can draw from to make regional public health policy recommendations.

In 2012, Maalouf and Assistant Professor of Epidemiology and Applied Biostatistics Lillian Ghandour ran a small-scale study in Beirut to assess the prevalence of psychiatric disorders in adolescents living in Beirut. The data collection team fanned out across the city, knocking on doors at random, so long as they could access them (high-security buildings were left out of the study). “Reactions varied. Some people viewed the opportunity to talk to a researcher as an opportunity to vent. Others flatly refused. Either they were busy, or they felt it was too intrusive,” says Maalouf.

The study found the incidence of psychiatric disorders among the Beirut adolescent population to be around 25 percent, higher than in the politically stable Gulf, but lower than in those areas that have experienced intense ongoing conflict, like Gaza; refugee communities have much higher rates of mental illness than individuals residing in their home countries. “It’s anywhere between 30 and 50 percent for Syrian refugees,” says Maalouf.

Yet the most the troubling statistic for Maalouf was that a mere six percent of those suffering from a mental health issue were actively seeking treatment. “As a follow-up to the study, we focused on access to care and making care available to children. We looked at integrating mental health services into the school system and arrived at an intervention, in collaboration with Harvard Medical School, that focuses on building resilience in children and adolescents.” That intervention was found to reduce feelings of depression and anxiety.

In 2018, Maalouf and Ghandour ran a countrywide screening study, interviewing more than 1,500 families and finding 30 percent to be at risk of developing mental illness, with over 90 percent of those at risk never having sought treatment. Now, in the wake of the blast, this sampling of families whose pre-blast risk profiles have been determined is poised to be reassessed by Maalouf and Ghandour. “We are in the process of calling these families post-blast to determine who developed PTSD or depression,” says Maalouf. They can then determine the correlation between risk profile and the manifestation of symptoms.

Like the chaotic nature of the blast itself, the damage done to the psyches of Lebanese has been random and unexpected. And many are facing their traumas alone. “A very significant stressor is the exodus of families who’ve left the country. Kids grieving the loss of their friends, their relatives. Collective loss is a common theme. It makes it more challenging to overcome because to overcome a collective loss requires a collective effort,” says Maalouf.

*Names have been changed to protect individuals’ privacy.

We are in the process of calling these families post-blast to determine who developed PTSD or depression.