The Impact of Disaster on Mental Health: Prospective and Retrospective Analyses

Scoping Review of PTSD Treatments for Natural Disaster Survivors

This scoping review explores the current research on PTSD interventions for Natural Disaster survivors. It includes fourteen randomized control trials (RCTs). The included interventions were, pharmaceuticals, nutraceuticals, herbal supplements, CBT, yoga, narrative exposure therapy, acupuncture stimulation, web-based interventions, and a multimodal art and meditation program. CBT is considered the standard of care for general PTSD treatment and was also found to be effective for the treatment of natural disaster-related PTSD symptoms. However, higher-level clinical evidence is needed. There are inconsistencies with the use of pharmaceuticals, nutraceuticals, and herbal supplements, while there is insufficient clinical evidence to effectively determine the efficacy of yoga, acupuncture, art, and narrative exposure therapies. Factors like the availability of resources, cultural sensitivity, and values and preferences impact the effectiveness of interventions used to treat PTSD in natural disaster survivors. Clinical studies in this field need to be further expanded regardless of the study type.

Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma

OBJECTIVE

To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma.

DATA SOURCES/STUDY SETTING

National Mental Health Services Surveys conducted in 2016 and 2020.

STUDY DESIGN

Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services).

DATA COLLECTION/EXTRACTION METHODS

The proportion and per 100,000 population rate of facilities offering crisis services were calculated.

PRINCIPAL FINDINGS

The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria.

CONCLUSIONS

There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.

Review of the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) Spanish version in a sample of Puerto Rican workers

Background

This study aimed to examine the internal structure and assess the psychometric properties of the Patient Health Questionnaire (PHQ-9) in a Puerto Rican sample of workers. This instrument is a nine-item questionnaire, which was conceptualized as a unidimensional structure; however, there are mixed results regarding this internal structure. This measure is used in the occupational health psychology context in organizations in Puerto Rico; nevertheless, there is little evidence of its psychometric properties with samples of workers.

Materials and methods

A total of 955 samples from two different study samples were used in this cross-sectional study design in which the PHQ-9 was used. We conducted confirmatory factor analysis, bifactor analysis, and random intercept item factor analysis to examine the internal structure of the PHQ-9. Moreover, a two-factor model was examined by randomly assigning items to the two factors. Measurement invariance across sex and the relationship with other constructs were examined.

Results

The best-fitted model was the bifactor model followed by the random intercept item factor. The five sets of two-factor models with items randomly assigned obtained acceptable and similar fit indices regardless of the items.

Conclusion

The results suggest that the PHQ-9 appears to be a reliable and valid instrument to measure depression. The more parsimonious interpretation of its scores, for now, is a unidimensional structure. Comparison across sex appears to be useful in occupational health psychology research settings since the results suggest that the PHQ-9 is invariant regarding this variable.

Ataque de nervios: The impact of sociodemographic, health history, and psychological dimensions on Puerto Rican adults

Introduction

Ataque de nervios (ADN) is a cultural syndrome prevalent in Puerto Ricans characterized as an episode of intense emotional upset due to overwhelming stress.

Methods

The Ataque de Nervios Questionnaire, developed at the Center for the Study and Treatment for Fear and Anxiety (CETMA), served as the diagnostic tool for this retrospective secondary data analysis. We evaluated three models regarding ADN's function as a marker of (1) sociodemographic vulnerability, (2) health history risk, and (3) psychological vulnerability. This last model was subdivided to assess the scores of screening tests regarding anxiety (Anxiety Sensitivity Inventory, Beck Anxiety Inventory, and State-Trait Anxiety Inventory), affect (Beck Depression Inventory, Emotional Dysregulation Scale, Positive and Negative Affective Schedule), personality (NEO Five-Factor Inventory), and trauma (considering the responses to the Childhood Trauma Questionnaire and the Life Event Checklist).

Results

Our study sample had a total of 121 Puerto Rican adult patients from CETMA out of which 75% had ADN. We differentiated subjects according to their ADN status with t-tests and Mann-Whitney U tests and evaluated our models using logistic regressions. People with ADN showed more anxiety, depressive symptoms, emotional dysregulation, and negative affect than those without ADN. They also revealed lower positive affect and agreeableness. Highly extraverted but minimally agreeable personalities related to ADN. Living with a partner and being employed were risk factors for ADN. Having higher educational levels showed the strongest effect size: it greatly reduced the odds of an ataque.

Discussion

These characteristics suggest a distinct profile of ADN seen in employed, educated, adult Puerto Ricans living on the Island experiencing anxiety. Our study provides clinical tools to comprehend our patients' ADN experience, enriching our practice as culturally competent health providers.

Trajectories of psychological distress among individuals exposed to the 9/11 World Trade Center disaster

BACKGROUND

Individuals present in lower Manhattan during the 9/11 World Trade Center (WTC) disaster suffered from significant physical and psychological trauma. Studies of longitudinal psychological distress among those exposed to trauma have been limited to relatively short durations of follow-up among smaller samples.

METHODS

The current study longitudinally assessed heterogeneity in trajectories of psychological distress among WTC Health Registry enrollees - a prospective cohort health study of responders, students, employees, passersby, and residents in the affected area (N = 30 839) - throughout a 15-year period following the WTC disaster. Rescue/recovery status and exposure to traumatic events of 9/11, as well as sociodemographic factors and health status, were assessed as risk factors for trajectories of psychological distress.

RESULTS

Five psychological distress trajectory groups were found: none-stable, low-stable, moderate-increasing, moderate-decreasing, and high-stable. Of the study sample, 78.2% were classified as belonging to the none-stable or low-stable groups. Female sex, being younger at the time of 9/11, lower education and income were associated with a higher probability of being in a greater distress trajectory group relative to the none-stable group. Greater exposure to traumatic events of 9/11 was associated with a higher probability of a greater distress trajectory, and community members (passerby, residents, and employees) were more likely to be in greater distress trajectory groups - especially in the moderate-increasing [odds ratios (OR) 2.31 (1.97-2.72)] and high-stable groups [OR 2.37 (1.81-3.09)] - compared to the none-stable group.

CONCLUSIONS

The current study illustrated the heterogeneity in psychological distress trajectories following the 9/11 WTC disaster, and identified potential avenues for intervention in future disasters.

The Role of Social Determinants in Mental Health and Resilience After Disasters: Implications for Public Health Policy and Practice

In this general literature review, we will explore the impacts and contribution of social determinants to mental health and resiliency following both natural and man-made disasters. Natural disasters, such as wildfires, earthquakes, tsunamis, and hurricanes, as well as man-made disasters, such as civil wars, have been known to inflict significant damage to the mental health of the victims. In this paper, we mainly explore some most studied vulnerability and protective social determinant factors such as gender, age, ethnicity, socials support and socioeconomic status for the mental health and resiliency in survivors of such disasters. Several other possible factors such as previous trauma, childhood abuse, family psychiatric history, and subsequent life stress that were explored by some studies were also discussed. We conducted a literature search in major scientific databases, using keywords such as: mental health, social determinants, disasters, wildfires, earthquakes, terrorist attacks, and resilience. We discuss the implications for public health policy and practice.

Self-Rated Mental and Physical Health of U.S. Gulf Coast Residents

Repeated exposure to hurricanes and tropical storms likely impacts the mental and physical health of populations living along the U.S. Gulf Coast. In this study, the self-rated physical and mental health of residents in the U.S. Gulf Coast was estimated and factors associated with differences in self-rated health were identified. The 12-item Short Form Health Survey (SF-12) was administered online to a sample of 3030 residents of the U.S. Gulf Coast in December 2017. Responses were scored to calculate mental component summary scores and physical component summary scores. Multiple linear regression models were fitted to identify predictors of self-rated health among the residents. Residents of U.S. Gulf Coast States have poorer self-rated physical and mental health compared to the U.S. population. Women and respondents reporting higher perception of flood risk had worse self-rated mental health, while hurricane evacuees, adults of at least 25 years of age, those with self-reported hurricane damage, and respondents reporting higher perception of surge risk had worse self-rated physical health. Residents of U.S. Gulf Coast States have poorer self-rated health compared to national standards. These findings may have practical implications for hurricane-associated physical and mental health services planning and delivery.

Mediating role of post-traumatic growth in the relationship between inadequate disaster recovery and mental health outcomes: long-term evidence from the Wenchuan earthquake

Background: The mental health outcomes from disasters have aroused great concern worldwide, yet few studies incorporate a long-term disaster recovery perspective. Evidence has also emerged about the importance of the social determinants of mental health, but aspects of recovery including disruptions to livelihoods and social networks remain relatively understudied. Objective: This study utilizes cognitive adaptation theory to examine the long-term relationship between inadequate disaster recovery and mental health outcomes while considering domains of post-traumatic growth (PTG) as mediators. Methods: A cross-sectional study was conducted among 1369 adult survivors of the 2008 Wenchuan earthquake. Correlation analyses and multivariable regression analyses examined the association between inadequate disaster recovery and mental health outcomes, while parallel multiple mediator models and structural equation model explored the mediating role of PTG among these relationships. Results: 52.2% and 8.1% of the respondents reported inadequate recovery on livelihood and social ties, respectively. Inadequate disaster recovery was associated with higher levels of PTSD and depressive symptoms, and this association was partially mediated by PTG. Lower reported PTG on the interpersonal relationship and new possibilities domains mediated the association between inadequate livelihood recovery on PTSD and depressive symptom severity, and enhanced personal strength mediated the association between inadequate social ties recovery on these symptoms. Conclusion: Enhancing disaster recovery is essential for mental health protection, and PTG may be a valuable starting point in cognitive therapy to protect against stress responses after trauma.

Relationship between household composition and intergenerational post-disaster mental health in two-parent families: Evidence from Japan

BACKGROUND

Previous literature has neglected the effect of household composition on mental health, especially in the context of post-disaster recovery.

METHODS

Open access data from the 2015 Social Survey on Living and Disaster Recovery (SSLDR) in Japan are used. A total of 689 respondents (346 from Fukushima and 343 from Sendai) made up of people living in two-parent families are examined in the current study. Pearson's Chi-square Test and ANOVA are applied to assess the differences between four groups: Fukushima parent generation, Fukushima child generation, Sendai parent generation, and Sendai child generation. The method of multiple linear regression is used to explore the association factors of intergenerational mental health in two city sites, respectively.

RESULTS

Fukushima child generation tended to have the worst mental health status. In two city sites, the child generation tended to have a less degree of neighborhood connectedness than those in the parent generation. Variables of household composition, daily worries, and gender have significant associations with mental health in either two cities or one of them.

LIMITATIONS

The 2015 SSLDR datasets were collected by means of investigation through a series of questionnaires. Errors may exist if the respondents did not honestly or fully report their household composition. And there is some complexity in some attempted analysis models that is not fully included in the imputation model.

CONCLUSION

Household composition has significant association with intergenerational mental health in the context of post-disaster recovery. Our results highlight the need to look for appropriate and targeted supporting mechanisms.

The Use of Public Health Indicators to Assess Individual Happiness in Post-Disaster Recovery

PURPOSE

Very few studies have examined the influential factors of survivors' feelings of happiness in the context of nuclear accidents. This paper aims to fill this gap with reference to the recovery process in Fukushima City following the 2011 Tohoku Earthquake Tsunami in Japan.

METHODS

Open access data were sourced from the 2015 Social Survey on Living and Disaster Recovery (SSLDR) (N = 1439) of Fukushima citizens. Pearson's Chi-square Test and the t-test were employed to examine gender differences with regard to happiness and exploratory variables. Following this, a multiple linear regression analysis was conducted to investigate the determinants of happiness.

RESULTS

The results showed that, compared to females, male respondents were unhappier and reported more property loss and less neighborhood connectedness. Individuals' mental and physical health and neighborhood connectedness were found to be significantly correlated with their happiness. However, the disaster-related variables of people's evaluation of recovery achievement, concerns around the health impacts of radiation, property loss in the disaster, and experiences of casualty, had no effects on happiness.

CONCLUSION

These findings indicate that policies and countermeasures dealing with disaster recovery over the long term should continuously focus on health issues and social relationships.

Post-disaster mental health and psychosocial support in the areas affected by the Great East Japan Earthquake: a qualitative study

BACKGROUND

Few studies exploring the actual practices implemented for long-term mental health and psychosocial support after a natural disaster have been published. This study aimed to reveal (1) the types of activities that were actually provided as mental health and psychosocial support (MHPSS) in the long-term phase after the Great East Japan Earthquake (GEJE) and (2) the problems that must be addressed to provide post-disaster MHPSS activities.

METHODS

An open-ended questionnaire was sent to organizations in the Iwate, Miyagi and Fukushima prefectures that were potentially involved in providing MHPSS to communities affected by the GEJE. The organizations were asked to describe their activities and the problems that needed to be addressed to provide these support activities. The collected statements were analysed using content analysis with NVivo11.

RESULTS

The support activities conducted to provide MHPSS in the long-term phase after the catastrophe were diverse and classified into 7 major categories, namely, (1) one-on-one support for individuals in need of assistance, (2) support for collective activities, (3) support around living conditions and income, (4) increasing public awareness about mental health, (5) human resource development to improve response capabilities for MHPSS, (6) support for MHPSS providers, and (7) facilitating collaborations among the MHPSS activities provided to affected communities. Problems with human resources and funding were the most frequently mentioned concerns among the organizations participating in the survey.

CONCLUSIONS

The establishment of systems to collect and share sufficient and relevant knowledge and to coordinate organizations for long-term post-disaster postventions would be desirable.

Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis

BACKGROUND

Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health.AimsOur aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters.

METHOD

This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics.

RESULTS

Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27-0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43-2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies.

CONCLUSIONS

Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects.Declaration of interestNone.

Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors

Background

With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that pre-existing psychopathology plays in developing PTSD after a disaster.

Methods

This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres ( N  = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD.

Results

The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65).

Conclusions

This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.

The Influence of Exposure to Natural Disasters on Depression and PTSD Symptoms among Firefighters

Introduction Firefighters represent an important population for understanding the consequences of exposure to potentially traumatic stressors. Hypothesis/Problem The researchers were interested in the effects of pre-employment disaster exposure on firefighter recruits' depression and posttraumatic stress disorder (PTSD) symptoms during the first three years of fire service and hypothesized that: (1) disaster-exposed firefighters would have greater depression and PTSD symptoms than non-exposed overall; and (2) depression and PTSD symptoms would worsen over years in fire service in exposed firefighters, but not in their unexposed counterparts.

METHODS

In a baseline interview, 35 male firefighter recruits from seven US cities reported lifetime exposure to natural disaster. These disaster-exposed male firefighter recruits were matched on age, city, and education with non-exposed recruits.

RESULTS

A generalized linear mixed model revealed a significant exposure×time interaction (e coef =1.04; P<.001), such that depression symptoms increased with time for those with pre-employment disaster exposure only. This pattern persisted after controlling for social support from colleagues (e coefficient=1.05; P<.001), social support from families (e coefficient=1.04; P=.001), and on-the-job trauma exposure (coefficient=0.06; e coefficient=1.11; P<.001). Posttraumatic stress disorder symptoms did not vary significantly between exposure groups at baseline (P=.61).

CONCLUSION

Depression symptoms increased with time for those with pre-employment disaster exposure only, even after controlling for social support. Posttraumatic stress disorder symptoms did not vary between exposure groups. Pennington ML , Carpenter TP , Synett SJ , Torres VA , Teague J , Morissette SB , Knight J , Kamholz BW , Keane TM , Zimering RT , Gulliver SB . The influence of exposure to natural disasters on depression and PTSD symptoms among firefighters. Prehosp Disaster Med. 2018;33(1):102-108.

The impact of the Canterbury earthquakes on successful school leaving for adolescents

OBJECTIVE

To examine the impact of the Canterbury earthquakes on the important adolescent transition period of school leaving.

METHOD

Local and national data on school leaving age, attainment of National Certificate of Educational Achievement (NCEA) standards, and school rolls (total registered students for schools) were examined to clarify long-term trends and delineate these from any impacts of the Canterbury earthquakes.  Results: Despite concerns about negative impacts, there was no evidence for increased school disengagement or poorer academic performance by students as a consequence of the earthquakes.

CONCLUSION

Although there may have been negative effects for a minority, the possibility of post-disaster growth and resilience being the norm for the majority meant that negative effects on school leaving were not observed following the earthquakes. A range of post-disaster responses may have mitigated adverse effects on the adolescent population. Implications for Public Health: Overall long-term negative effects are unlikely for the affected adolescent population. The results also indicate that similar populations exposed to disasters in other settings are likely to do well in the presence of a comprehensive post-disaster response.

The Effects of an Acute Stressor on Depressive Symptoms among Older Adults

This study uses longitudinal data to examine the potential moderating effects of social support and age among older adults exposed to an acute stressor. Using a sample of 651 older persons, data were gathered in the spring of 1992 and in the fall of 1993, approximately 60 days after the peak impact of flooding in the Midwest. Results indicate a positive association between pre- and postflood depression and a negative association between social support and postflood depression. For the youngest of the two older age groups, there is also a positive association between flood exposure and post-flood depression, controlling for prior levels of depression. Age interactions reveal that social support moderates the effects of flood exposure on depression only for the younger age group.

A Quantitative Analysis of Ataque de Nervios in Puerto Rico

The authors present a quantitative analysis and assessment of the symptoms of ataque de nervios. A sample of 121 individuals living in Puerto Rico provided qualitative and structured data on ataques de nervios and psychiatric correlates. A total of 77 participants reported having an ataque de nervios during their lifetimes. Their reports of symptoms associated with the ataque-episode were analyzed using factor analysis. Two dimensions emerged from the analysis, representing respectively internalizing and externalizing experiences. Results sustained the heterogeneity of ataque de nervios with a marked anxiety component. The authors discuss results in the context of classification and understanding of ataques de nervios and a model for studying cultural variance among cultural syndromes.

Potentially Traumatic Events, Posttraumatic Stress Disorder, and Depression among Adults in Puerto Rico

The aims of the current study were to examine the prevalence of potentially traumatic events (PTEs), posttraumatic stress disorder (PTSD; data available in males only), and depressive symptoms in a Puerto Rican sample of 678 adult caretakers (50% female) of twins participating in the Puerto Rican Infant Twin Study. The World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was utilized to assess rates of PTEs, PTSD, and depression among male participants while an abbreviated version of the CIDI 3.0 and the Mood and Feelings Questionnaire were administered to females to assess PTEs and depressive symptoms. Significantly more males than females reported exposure to a PTE (76.6% vs. 44.2%, χ(2) = 64.44, p < 0.001). In males, endorsement of multiple PTEs was associated with increased level of PTSD symptomatology (β = 0.33, p < 0.001). With regard to depression, a similar dose-response relationship was found in both males and females, with depressive symptoms increasing as number of PTEs increased (βs = 0.15, 0.16, ps < 0.05). Exposure to an attack with a weapon was significantly associated with increased depression symptoms in both males and females (βs = 0.24, 0.20, ps < 0.01, respectively). These findings highlight the need for identification of putative risk and resilience factors among PTE-exposed individuals in Puerto Rico.

The impact of the Canterbury earthquakes on prescribing for mental health

OBJECTIVE

The aim of this study is to evaluate the impact of the Canterbury earthquakes on the mental health of the local population by examining prescribing patterns of psychotropic medication.

METHOD

Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics and sedatives/hypnotics are routinely recorded in a national database. The close relationship between prescribing and dispensing provides the opportunity to assess prescribing trends for Canterbury compared to national data and therefore examines the longitudinal impact of the earthquakes on prescribing patterns.

RESULTS

Short-term increases in the use of anxiolytics and sedatives/hypnotics were observed after the most devastating February 2011 earthquake, but this effect was not sustained. There were no observable effects of the earthquakes on antidepressant or antipsychotic dispensing.

CONCLUSION

Short-term increases in dispensing were only observed for the classes of anxiolytics and sedatives/hypnotics. No sustained changes in dispensing occurred. These findings suggest that long-term detrimental effects on the mental health of the Canterbury population were either not present or have not resulted in increased prescribing of psychotropic medication.

Psychiatric admissions fall following the Christchurch earthquakes: an audit of inpatient data

OBJECTIVE

Following the devastating earthquake in Christchurch, New Zealand, there was the widespread perception that the demand for inpatient mental health services would increase. However, our clinical observation was to the contrary, with substantial reductions in inpatient utilisation being noted. We therefore examined psychiatric bed occupancy and admission data to improve understanding of the impact of the disaster on mental health services.

METHOD

We audited acute psychiatric bed occupancy and admission rates prior to and following a major earthquake.

RESULTS

After the earthquake, total bed occupancy reduced from an average of 93% to 79%. Daily admissions also reduced by 20.2% for the 30 days following the earthquake. All diagnostic groups, with the exception of the 'Schizophrenia, schizotypal and delusional disorders' category, contributed to the reduction. No rebound to increased occupancy or admissions was seen over the study period.

CONCLUSION

The study confirmed our clinical observation that demand for acute inpatient psychiatric services were markedly reduced after the February 2011 earthquake.

Current research and recent breakthroughs on the mental health effects of disasters

A large existing academic disaster mental health literature provides a foundation to help guide disaster mental health response. Recent studies, however, have indicated that reconceptualization of certain mental health aspects of disasters may be indicated to guide further research to inform the planning and implementation of disaster mental health interventions. In particular, there is need to more carefully measure specific postdisaster disorders and syndromes using full diagnostic assessments, differentiate pre-existing from incident (new) postdisaster psychopathology, appropriately consider disaster trauma exposure groups in assessing psychopathology, and conduct prospective follow-up assessments over time from the acute postdisaster period to the long term. Further descriptive and longitudinal research is needed to better characterize the occurrence and course of fully-assessed psychiatric disorders after different disasters, clarify the role of disaster trauma exposures in the development of postdisaster psychopathology, and deconstruct confounding effects in determination of causalities in mental health consequences of disasters.

A person-centered analysis of posttraumatic stress disorder symptoms following a natural disaster: predictors of latent class membership

The present study applied latent class analysis to a sample of 810 participants residing in southern Mississippi at the time of Hurricane Katrina to determine if people would report distinct, meaningful PTSD symptom classes following a natural disaster. We found a four-class solution that distinguished persons on the basis of PTSD symptom severity/pervasiveness (Severe, Moderate, Mild, and Negligible Classes). Multinomial logistic regression models demonstrated that membership in the Severe and Moderate Classes was associated with potentially traumatic hurricane-specific experiences (e.g., being physically injured, seeing dead bodies), pre-hurricane traumatic events, co-occurring depression symptom severity and suicidal ideation, certain religious beliefs, and post-hurricane stressors (e.g., social support). Collectively, the findings suggest that more severe/pervasive typologies of natural disaster PTSD may be predicted by the frequency and severity of exposure to stressful/traumatic experiences (before, during, and after the disaster), co-occurring psychopathology, and specific internal beliefs.

Factors increasing vulnerability to health effects before, during and after floods

Identifying the risk factors for morbidity and mortality effects pre-, during and post-flood may aid the appropriate targeting of flood-related adverse health prevention strategies. We conducted a systematic PubMed search to identify studies examining risk factors for health effects of precipitation-related floods, among Organisation for Economic Co-Operation and Development (OECD) member countries. Research identifying flood-related morbidity and mortality risk factors is limited and primarily examines demographic characteristics such as age and gender. During floods, females, elderly and children appear to be at greater risk of psychological and physical health effects, while males between 10 to 29 years may be at greater risk of mortality. Post-flood, those over 65 years and males are at increased risk of physical health effects, while females appear at greater risk of psychological health effects. Other risk factors include previous flood experiences, greater flood depth or flood trauma, existing illnesses, medication interruption, and low education or socio-economic status. Tailoring messages to high-risk groups may increase their effectiveness. Target populations differ for morbidity and mortality effects, and differ pre-, during, and post-flood. Additional research is required to identify the risk factors associated with pre- and post-flood mortality and post-flood morbidity, preferably using prospective cohort studies.

Effects of the Higashi-Nihon earthquake: posttraumatic stress, psychological changes, and cortisol levels of survivors

On March 11, 2011, the Pacific side of Japan's northeast was devastated by an earthquake and tsunami. For years, many researchers have been working on ways of examining the psychological effects of earthquakes on survivors in disaster areas who have experienced aftershocks, catastrophic fires, and other damage caused by the earthquake. The goal of this study is to examine scores on psychological measures and salivary cortisol level in these individuals both before and three months after the earthquake. The participants had been measured for these variables before the earthquake. After the earthquake, we carried out PTSD screening using CAPS for participants for another experiment, and then again conducted the aforementioned tests. We collected saliva samples from all survivors. Our results show that social relationship scores on the WHO-QOL26, negative mood scores of the WHO-SUBI, total GHQ score, POMS confusion scores, and CMI emotional status score after the earthquake showed scores indicating significantly decreased compared to before the earthquake. On the other hand, salivary cortisol levels after the earthquake was significantly increased compared to before the earthquake. Moreover, the result of a multiple regression analysis found that negative mood score on the WHO-SUBI and social relationship score on the WHO-QOL26 were significantly related to salivary cortisol levels. Our results thus demonstrate that several psychological stress induced by the earthquake was associated with an increase in salivary cortisol levels. These results show similar findings to previous study. We anticipate that this study will provide a better understanding of posttraumatic responses in the early stages of adaptation to the trauma and expand effective prevention strategies and countermeasures for PTSD.

The importance of secondary trauma exposure for post-disaster mental disorder

BACKGROUND

Interventions to treat mental disorders after natural disasters are important both for humanitarian reasons and also for successful post-disaster physical reconstruction that depends on the psychological functioning of the affected population. A major difficulty in developing such interventions, however, is that large between-disaster variation exists in the prevalence of post-disaster mental disorders, making it difficult to estimate need for services in designing interventions without carrying out a post-disaster mental health needs assessment survey. One of the daunting methodological challenges in implementing such surveys is that secondary stressors unique to the disaster often need to be discovered to understand the magnitude, type, and population segments most affected by post-disaster mental disorders.

METHODS

This problem is examined in the current commentary by analyzing data from the WHO World Mental Health (WMH) Surveys. We analyze the extent to which people exposed to natural disasters throughout the world also experienced secondary stressors and the extent to which the mental disorders associated with disasters were more proximally due to these secondary stressors than to the disasters themselves. RESULTS. Lifetime exposure to natural disasters was found to be high across countries (4.4-7.5%). 10.7-11.4% of those exposed to natural disasters reported the occurrence of other related stressors (e.g. death of a loved one and destruction of property). A monotonic relationship was found between the number of additional stressors and the subsequent onset of mental disorders CONCLUSIONS. These results document the importance of secondary stressors in accounting for the effects of natural disasters on mental disorders. Implications for intervention planning are discussed.

Trauma and victims: epidemiology of post-traumatic stress disorder

Scopo- Presentare una esaustivareviewdegli studi riguardanti l'epidemiologia del DPTS condotti nella popolazione generale, tra i soggetti a rischio, e, infine, tra gruppi clinicamente selezionati.Disegno- AttraversoExcepta Medica PsychiatryCD-ROM 1980-1993 (ottobre), utilizzando come parola chiave «Post-Traumatic Stress Disorder», sono stati identificati 1.057 articoli pubblicati nel periodo considerate Sono stati anche consultati altridata basedella letteratura medica (MEDLINE CD-ROM 1988-1993); è stata quindi operata una ricerca manuale su tutti i numeri delJournal of Traumatic Stress. Risultati- In totale, 135 lavori che hanno soddisfatto i criteri di inclusione prescelti sono stati inclusi nella review. I due terzi (n = 86, 64%) di queste ricerche sono state condotte negli USA. Solo 8 (6%) sono le indagini effettivamente realizzate nei paesi del Terzo Mondo. L'ampiezza del campione varia da un minimo di 11 soggetti, numero riscontrato in due studi, sino ad un massimo di 22.436, per un campione medio di 500 e mediano di 108. Per quanto attiene ai metodi di valutazione, in un terzo degli studi (n = 45, 33%), i ricercatori hanno impiegato un questionario (auto- o etero- somministrato). In un altro terzo delle ricerche elencate (n = 44, 33%) e stata somministrata un'intervista strutturata (la DIS, la SCID, o la SADS), mentre nei rimanenti studi la valutazione diagnostica si è basata o su una procedura clinica non strutturata, o sulla somministrazione di altri strumenti specifici dai quali è possibile inferire una diagnosi di DPTS (M-PTSD, IES, SCL-90-R,o pochi altri). In 77 studi (57%) i ricercatori hanno basato la loro valutazione sui criteri diagnostici propri del DSM-III, mentre in altri 55 (41%) su quelli del DSM-III-R. La prevalenza del DPTS e analizzata quindi separatamente per le diverse popolazioni studiate.Conclusioni- Nell'arco di soli 13 anni, a partire cioe dalla definizione di criteri diagnostici operazionali ben definiti per il DPTS, sono stati condotti numerosi studi volti ad indagare la prevalenza, i fattori di rischio, la storia naturale, il decorso e l' esito di questo disturbo tra campioni diversi di popolazioni a rischio; inoltre, anche il livello qualitativo di queste ricerche, per quanto attiene alia sofisticazione metodologica, si è accresciuto sensibilmente in un tempo tutto sommato breve. Molte aree, pero', restano tuttora inesplorate, ed inoltre appare imperativo avviare ricerche estensive tra le popolazioni dei paesi in via di sviluppo, maggiormente esposte a disastri naturali o provocati dall'uomo.

Trauma exposure and posttraumatic stress disorder among employees of New York City companies affected by the September 11, 2001 attacks on the World Trade Center

OBJECTIVE

Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD.

METHODS

Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision.

RESULTS

The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness.

CONCLUSIONS

Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

Prevalence and psychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan

BACKGROUND

On average in a year 939 earthquakes of a magnitude between 5 and 8 on the Richter scale occur around the world. In earthquakes developing countries are prone to large-scale destruction because of poor structural quality of buildings, and preparedness for earthquakes. On 8th October 2005, a major earthquake hit the remote and mountainous region of northern Pakistan and Kashmir. We wanted to find out the rate of PTSD in a randomly selected sample of participants living in earthquake area and the correlates of the PTSD.

METHOD

The study was conducted 18 months after the earthquake. We selected a sample of men and women living in the houses and tents for interviews. Using well established instruments for PTSD and general psychiatric morbidity we gathered information from over 1200 people in face to face interviews. We gathered information about trauma exposure and loss as well.

RESULTS

55.2% women and 33.4% men suffered from PTSD. Living in a joint family was protective against the symptoms of PTSD. Dose of exposure to trauma was associated with the symptoms of PTSD. Living in a tent was associated with general psychiatric morbidity but not with PTSD.

LIMITATIONS

We used questionnaire instead of interviews to detect the symptoms of psychiatric disorders.

CONCLUSIONS

The symptoms of PTSD are common 18 months after the earthquake and they are specifically associated with the dose of trauma exposure. This may have implications for rehabilitation of this population.

Psychosocial adjustment of directly exposed survivors 7 years after the Oklahoma City bombing

OBJECTIVE

The aim of this study was to prospectively examine the long-term course of psychiatric disorders, symptoms, and functioning among 113 directly exposed survivors of the Oklahoma City bombing systematically assessed at 6 months and again nearly 7 years postbombing.

METHODS

The Diagnostic Interview Schedule/Disaster Supplement was used to assess predisaster and postdisaster psychiatric disorders and symptoms and other variables of relevance to disaster exposure and outcomes.

RESULTS

Total prevalence of posttraumatic stress disorder (PTSD) was 41%. Seven years postbombing, 26% of the sample still had active PTSD. Delayed-onset PTSD and new postdisaster alcohol use disorders were not observed. PTSD nonremission was predicted by the occurrence of negative life events after the bombing. Posttraumatic symptoms among survivors without PTSD decayed more rapidly than for those with PTSD, and symptoms remained at 7 years even for many who did not develop PTSD. Those with PTSD reported more functioning problems at index than those without PTSD, but functioning improved dramatically over 7 years, regardless of PTSD or remission from PTSD. No survivors had long-term employment disability based on psychiatric problems alone.

CONCLUSIONS

These findings have potentially important implications for anticipation of long-term emotional and functional recovery from disaster trauma.

Conséquences des inondations de juillet 1996 sur la conception du chez-soi et la santé biopsychosociale des préretraités et retraités

In July 1996, major floods destroyed several houses occupied by pre-retirees (ages 50–59) and retirees (ages 60 and over). Faced with the task of relocating and rebuilding a new home, several of those older adults lived through difficult post-traumatic adaptation periods. The data collected during in-depth interviews with 31 aging people clearly show that the biopsychosocial health of pre-retirees and retirees, as well as their conception of home were greatly disturbed. The floods also had significant consequences on their behaviour, character and beliefs. A list of recommendations from the victims interviewed to individuals, workers and different government departments shows the need to take into account the emotional distress of victims in implementing emergency measures.

Symptoms of Posttraumatic Stress Disorder among Health Care Workers in Earthquake-Affected Areas in Southwest China

The symptoms of posttraumatic stress disorder and associated risk factors were investigated among health care workers in earthquake-affected areas in southwest China. 343 health care workers completed the Chinese version of the Impact of Event Scale–Revised 3 mo. after the Wenchuan Earthquake. The prevalence of probable PTSD was 19%. The significant risk factors identified for PTSD severity included being female, being bereaved, being injured, and higher intensity of initial fear. These findings suggest that PTSD is a common mental health problem among health care workers in earthquake-affected areas. The present information can be useful in directing, strengthening, and evaluating disaster-related mental health needs and interventions after an earthquake.

Symptoms of posttraumatic stress disorder among adult survivors three months after the Sichuan earthquake in China

The study investigated the symptoms of posttraumatic stress disorder (PTSD) and associated risk factors among adult survivors 3 months after the 2008 Sichuan earthquake in China. One thousand five hundred sixty-three earthquake survivors in two communities participated in the study. The prevalence of probable PTSD was 37.8% and 13.0%, respectively, in the two communities that were affected differently by the earthquake. The significant predictive factors for the severity of PTSD symptoms were female gender, subnationality, lower educational level, lower social support, and higher initial exposure level. The results indicate that PTSD is also a common mental health problem among earthquake survivors in China. Given inadequate knowledge and practices concerning the mental health of disaster victims in China, the information provided by this study is useful for directing, strengthening, and evaluating disaster-related mental health needs and interventions after the earthquake.

A spiritual-hypnosis assisted treatment of children with PTSD after the 2002 Bali terrorist attack

The aim of this study was to assess the effectiveness of a spiritual-hypnosis assisted therapy (SHAT) for treatment of posttraumatic stress disorder (PTSD) in children. All children, age 6-12 years (N=226; 52.7% females), who experienced the terrorist bomb blasts in Bali in 2002, and subsequently were diagnosed with PTSD were studied, through a longitudinal, quasi-experimental (pre-post test), single-blind, randomized control design. Of them, 48 received group SHAT (treatment group), and 178 did not receive any therapy (control group). Statistically significant results showed that SHAT produced a 77.1% improvement rate, at a two-year follow up, compared to 24% in the control group, while at the same time, the mean PTSD symptom score differences were significantly lower in the former group. We conclude that the method of spiritual-hypnosis is highly effective, economic, and easily implemented, and has a potential for therapy of PTSD in other cultures or other catastrophic life-threatening events.

Roadmap for the protection of disaster research participants: findings from the World Trade Center Evacuation Study

INTRODUCTION

This report addresses the development, implementation, and evaluation of a protocol designed to protect participants from inadvertent emotional harm or further emotional trauma due to their participation in the World Trade Center Evacuation (WTCE) Study research project. This project was designed to identify the individual, organizational, and structural (environmental) factors associated with evacuation from the World Trade Center Towers 1 and 2 on 11 September 2001.

METHODS

Following published recommended practices for protecting potentially vulnerable disaster research participants, protective strategies and quality assurance processes were implemented and evaluated, including an assessment of the impact of participation on study subjects enrolled in the qualitative phase of the WTCE Study.

RESULTS

The implementation of a protocol designed to protect disaster study participants from further emotional trauma was feasible and effective in minimizing risk and monitoring for psychological injury associated with study participation.

CONCLUSIONS

Details about this successful strategy provide a roadmap that can be applied in other post-disaster research investigations.

The traumatic impact of Hurricane Katrina on children in New Orleans

This article reviews the traumatic impact of Hurricane Katrina on the children of New Orleans. After describing the events comprising the trauma, it reviews the historical context of hurricanes in New Orleans and the social and political challenges that affected the area's response. It then considers the consequences of Hurricane Katrina in terms of disruption of services and governmental and nongovernmental responses to the psychologic needs created by the storm. The authors review preliminary studies about the affects of the hurricane on children and adolescents and conclude with a consideration of the lessons learned from both practice and policy perspectives.

Post-traumatic stress disorder following disasters: a systematic review

BACKGROUND

Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated.

RESULTS

We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13).

CONCLUSIONS

The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

Trends in mental illness and suicidality after Hurricane Katrina

A representative sample of 815 pre-hurricane residents of the areas affected by Hurricane Katrina was interviewed 5-8 months after the hurricane and again 1 year later as the Hurricane Katrina Community Advisory Group (CAG). The follow-up survey was carried out to study patterns-correlates of recovery from hurricane-related post-traumatic stress disorder (PTSD), broader anxiety-mood disorders and suicidality. The Trauma Screening Questionnaire screening scale of PTSD and the K6 screening scale of anxiety-mood disorders were used to generate DSM-IV prevalence estimates. Contrary to results in other disaster studies, where post-disaster mental disorder typically decreases with time, prevalence increased significantly in the CAG for PTSD (20.9 vs 14.9% at baseline), serious mental illness (SMI; 14.0 vs 10.9%), suicidal ideation (6.4 vs 2.8%) and suicide plans (2.5 vs 1.0%). The increases in PTSD-SMI were confined to respondents not from the New Orleans Metropolitan Area, while the increases in suicidal ideation-plans occurred both in the New Orleans sub-sample and in the remainder of the sample. Unresolved hurricane-related stresses accounted for large proportions of the inter-temporal increases in SMI (89.2%), PTSD (31.9%) and suicidality (61.6%). Differential hurricane-related stress did not explain the significantly higher increases among respondents from areas other than New Orleans, though, as this stress was both higher initially and decreased less among respondents from the New Orleans Metropolitan Area than from other areas affected by the hurricane. Outcomes were only weakly related to socio-demographic variables, meaning that high prevalence of hurricane-related mental illness remains widely distributed in the population nearly 2 years after the hurricane.

Exposure to the tsunami disaster, PTSD symptoms and increased substance use - an Internet based survey of male and female residents of Switzerland

BACKGROUND

After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with mental health services. Although primarily designed for surviving Swiss tourists as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms.

METHODS

One section of the screening covered addiction related behavior. We analyzed the relationship between increased substance use, the level of PTSD symptoms and trauma exposure using multivariable logistic regression with substance use as the dependent variable. Included in the study were only subjects who reported being residents of Switzerland and the analyses were stratified by gender in order to control for possible socio-cultural or gender differences in the use of psychotropic substances.

RESULTS

In women PTSD symptoms and degree of exposure enlarged the odds of increased alcohol, pharmaceuticals and cannabis use significantly. In men the relationship was more specific: PTSD symptoms and degree of exposure only enlarged the odds of increased pharmaceutical consumption significantly. Increases in alcohol, cannabis and tobacco use were only significantly associated with the degree of PTSD symptoms.

CONCLUSION

The tsunami was associated with increased substance use. This study not only replicates earlier findings but also suggests for a gender specificity of post-traumatic substance use increase.

Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina

On August 29, 2005, Hurricane Katrina made landfall resulting in catastrophic damage and flooding to New Orleans, LA, and the Gulf Coast, which may have had significant mental health effects on the population. To determine rates and predictors of symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) in New Orleans residents following Hurricane Katrina, we conducted a web-based survey 6 months after Hurricane Katrina made landfall. Participants included 1,542 employees from the largest employer in New Orleans. The prevalence of PTSD symptoms was 19.2%. Predictors of PTSD symptoms in a multivariate-adjusted regression model included female sex, non-black race, knowing someone who died in the storm, not having property insurance, having had a longer evacuation, a much longer work commute compared to before Hurricane Katrina, and currently living in a newly purchased or rented house or in a temporary trailer. Despite universal health coverage and the benefits of an employee assistance program for all employees, only 28.5% of those with PTSD symptoms had talked to a health professional about the events of Hurricane Katrina or issues encountered since the storm. A significant burden of PTSD symptoms was present 6 months following Hurricane Katrina among a large group of adults who had returned to work in New Orleans. Given their key role in the economic redevelopment of the region, there is a tremendous need to identify those in the workforce with symptoms consistent with PTSD and to enhance treatment options. The strong relationship between displacement from one's pre-Katrina residence and symptoms of PTSD suggests a need to focus resource utilization and interventions on individuals living in temporary housing.

Risk factors for psychological and physical health problems after a man-made disaster. Prospective study

BACKGROUND

There are few prospective studies on risk factors for health problems after disasters in which actual pre-disaster health data are available.

AIMS

To examine whether survivors' personal characteristics, and pre-disaster psychological problems, and disaster-related variables, are related to their post-disaster health.

METHOD

Two studies were combined: a longitudinal survey using the electronic medical records of survivors' general practitioners (GPs), from 1 year before to 1 year after the disaster, and a survey in which questionnaires were filled in by survivors, 3 weeks and 18 months after the disaster. Data from both surveys and the electronic medical records were available for 994 survivors.

RESULTS

After adjustment for demographic and disaster-related variables, pre-existing psychological problems were significantly associated with post-disaster self-reported health problems and post-disaster problems presented presented to the to the GP. This association was found for both psychological and physical post-disaster problems.

CONCLUSIONS

In trying to prevent long-term health consequences after disaster, early attention to survivors with pre-existing psychological problems, and to those survivors who are forced to relocate or are exposed to many stressors during the disaster, appears appropriate.

The impact of flooding on the mental health of affected people in South Korea

In this study we hypothesized that the residents in the disaster-exposed group would experience higher levels of stress, anxiety, depression and post-traumatic stress disorder compared to those in the non-disaster group. Furthermore, this would result in an increased need for health-related welfare in the disaster-exposed group. Our data supports both hypotheses, and these research findings are consistent with a growing body of research that supports such a conclusion.

Psychological aftermath of the Lviv air show disaster: a prospective controlled study

OBJECTIVE

To investigate the psychological aftermath of an air show disaster using prospectively obtained epidemiologic data.

METHOD

Participants in a recently completed epidemiologic mental health survey in Lviv (disaster site) and controls from western Ukraine were interviewed shortly before and 6 months after a gruesome air show disaster.

RESULTS

The Lviv group reported more psychopathology and post-traumatic stress symptom severity, but less anomie than controls. Somatization symptoms were similar in the two groups. Predisaster mental health and postdisaster threat were the strongest risk factors while demographic characteristics, emotional support, and repeated television viewing of the event were only weakly associated with postdisaster mental health.

CONCLUSION

This is the first prospective study to find a significantly higher rate of disorder as well as post-traumatic stress disorder symptomatology after a disaster. The risk factor findings suggest avenues for targeting postdisaster interventions.