Health problems presented in general practice by survivors before and after a fireworks disaster: associations with mental health care

Health problems among low-income parents in the aftermath of Hurricane Katrina

OBJECTIVE

Although the mental health consequences of disasters have been well documented, relatively less is known about their effects on survivors' physical health. Disaster studies have also generally lacked predisaster data, limiting researchers' ability to determine whether postdisaster physical health problems were influenced by disaster exposure, or whether they would have emerged even if the disaster had not occurred. The current study aimed to fill this gap.

METHOD

Participants were low-income, primarily non-Hispanic Black mothers (N = 334) who survived Hurricane Katrina and completed 4 survey assessments, 2 predisaster and 2 postdisaster. In each assessment, participants reported on whether they had experienced 3 common health problems (frequent headaches or migraines, back problems, and digestive problems) and completed 2 mental health measure (the K6 scale, the Perceived Stress Scale).

RESULTS

The descriptive results suggested that the hurricane led to at least short-term increases in the 3 health outcomes. Fixed effects modeling was conducted to explore how changes in various predictor variables related to changes in each health condition over the study. Bereavement and increases in psychological distress were significant predictors of increases in health problems.

CONCLUSIONS

Based on these results, further research that explores the processes through which disasters lead to both physical and mental health problems, postdisaster screenings for common health conditions and psychological distress, and interventions that boost survivors' stress management skills are suggested.

Physical symptoms 14 months after a natural disaster in individuals with or without injury are associated with different types of exposure

OBJECTIVE

To investigate whether different types of exposure to the 2004 tsunami were associated with physical symptoms 14 months after the disaster and to study correlations between survivors' physical and psychological symptoms.

METHODS

Using a cross-sectional design, 1505 survivors from the 2004 Indian Ocean Tsunami, tourists from Stockholm, who had been present in the disaster areas, responded to a postal questionnaire. Eight groups based on type of exposure were created. Physical symptoms occurring on a daily or weekly basis over the past year were investigated in four indices: musculoskeletal, cardiorespiratory, neurological, and gastrointestinal. Mental health symptoms (General Health Questionnaire-12) and posttraumatic stress symptoms (Impact of Event Scale-Revised) were also investigated. Multiple logistic regression analyses were conducted with controls for background variables and exposure, with physical symptoms as outcome variables. The association between physical and psychological symptoms was studied with the Spearman Rank Order Correlation.

RESULTS

Different types of exposure during the disaster were associated with physical symptoms 14 months later for survivors both with and without severe physical injury. The single exposure of life threat, also in combination with other exposures, was associated with a higher risk for reporting of physical symptoms. Physical symptoms showed modest yet significant correlation with psychological symptoms.

CONCLUSION

It is important to pay attention to both physical and psychological symptoms among disaster survivors whether they have been injured or not. A relatively simple questionnaire about physical symptoms may be a good complement to the scales used to assess psychological problems after disaster.

Minimizing the Impact of Complex Emergencies on Nutrition and Geriatric Health: Planning for Prevention is Key

Complex emergencies (CEs) can occur anywhere and are defined as crisis situations that greatly elevate the risk to nutrition and overall health (morbidity and mortality) of older individuals in the affected area.

In urban areas with high population densities and heavy reliance on power-driven devices for day-to-day survival, CEs can precipitate a rapid deterioration of basic services that threatens nutritionally and medically vulnerable older adults.

The major underlying threats to nutritional status for older adults during CEs are food insecurity, inadequate social support, and lack of access to health services.

The most effective strategy for coping with CEs is to have detailed, individualized pre-event preparations. When a CE occurs, the immediate relief efforts focus on establishing access to food, safe water, and essential medical services.

Psychological consequences of a firework factory disaster in a local community

OBJECTIVE

This study assessed the prevalence of post-traumatic stress disorder (PTSD) and other psychological consequences of an explosion disaster in a residential area in Kolding, Denmark, in November 2004.

METHOD

A community sample of 516 evacuated adults and a control group of 119 residents situated near the disaster area, but not affected by the explosion were assessed 3 months after the disaster by standardized instruments.

RESULTS

Of the evacuated sample, 13% met DSM-IV criteria for PTSD in contrast to 1% in the control group; 35% of the exposed sample and 7% of the control group were identified as 'probable cases' by the GHQ-30 (both p's < 0.0005).

CONCLUSION

The study provides evidence of the negative impact of a technological disaster on mental health and the need of preventive interventions.

Use of mental health services among disaster survivors: predisposing factors

Background

Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000).

Methods

Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2–3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0–18 months and 18–36 months post-disaster were examined using multiple logistic regression models.

Results

In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48–5.53), hostility (OR:2.04; CI:1.28–3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25–2.65), injuries as a result of the disaster (OR:1.80;CI:1.13–2.86), social functioning problems (OR:1.61;CI:1.05–2.44) and younger age (OR:0.98;CI:0.96–0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04–5.07) and hostility (OR:3.77;CI:1.51–9.40) predicted MHS utilization following 18 months post-disaster.

Conclusion

This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.