Procedural Justice in Their Eyes: A Qualitative Interview Study Among Detainees

The literature on procedural justice has been mainly focused on examining whether a fair and respectful treatment affects justice-involved individuals' legitimacy evaluations and their behavior. It is, however, equally important to examine (a) the role that perceptions of procedural justice play for individuals in their encounters with criminal justice authorities and (b) what makes individuals feel treated procedurally (un-)just. In this qualitative study, semi-structured interviews were conducted with 35 detainees in a Dutch prison, asking questions about their encounters with police officers, prison staff, judges, and probation officers. The findings showed that the majority of detainees raised issues of procedural justice, indicating that procedural justice plays an important role for them. In addition, five elements primarily shaped detainees' perceptions of procedural justice: (1) trustworthy motives, (2) interpersonal treatment, (3) neutrality, (4) participation, and (5) agency and process information. These elements of procedural justice were mentioned after encounters with most authorities.

Detainees' Perceptions of Procedural Justice: An Examination Throughout the Criminal Justice System

Procedural justice literature proposes that when individuals perceive their treatment by criminal justice authorities as more procedurally just, they will be more likely to view those authorities as legitimate and, in turn, show more compliant behavior. Knowledge on potential determinants of procedural justice is, therefore, crucial. Research suggests that prior perceptions of procedural justice may influence later judgements of procedural justice. The current study used data from the Prison Project, including information on detainees' perceptions of their treatment by the police, the judge, the prison staff, the probation officer, and the lawyer. The findings show that detainees perceive the treatment by the lawyer as most procedurally just, while they evaluate the treatment by the police as least procedurally just. Further, how detainees experience the procedurally just treatment by the police is associated with how they feel treated by other authorities at a later stage in the criminal justice system.

PriSUD-Nordic-Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study

Background

A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research.

Objective

The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison.

Methods

PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release.

Results

PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages.

Conclusions

PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population.

International Registered Report Identifier (IRRID)

DERR1-10.2196/35182

Longitudinal trajectories of mental health problems and their association with reoffending in a Dutch pre-trial prison cohort

The burden of mental health problems in detained persons is high. At the same time, mental health problems are discussed as possible predictors of criminal recidivism. During detention, mental health tends to improve. The aims of the study were twofold: First, to identify group-based trajectories of mental health problems over the course of detention; second, to test the association between trajectories and criminal recidivism. A prospective cohort of 1,904 adult males detained in Dutch pre-trial detention facilities was assessed at three time points after imprisonment (week 3, month 3, and month 9). Mental health problems were measured using the Brief Symptom Inventory. Recidivism was defined as reconviction and re-incarceration up to 18 months post-release. We used group-based trajectory modeling and logistic regressions for the analyses. On average, self-reported mental health improved during incarceration. Two distinct groups of mental health trajectories were identified: The majority (81%) reported relatively low levels of mental health problems, remaining stable over time. A small group (19%) reported high distress after prison entry with improvements over time. Older age, pre-existing functional impairment due to alcohol or drug use, diagnosis of psychiatric disorders, debts, use of psychiatric care during detention, and a more severe experience of detention were associated with membership in the second group. Group membership did not predict reoffending. The study confirms prior findings illustrating a generally positive change in mental health symptoms during detention. The course of mental health was associated with pre-existing socio-demographic and psychological characteristics that seem worthy to be considered in correctional treatment plans. Changes in mental health did not result in better legal outcomes. An interesting avenue for future research would be to examine changes in specific mental health symptoms or disorders in relation to recidivism risk.

Mental and physical health problems before and after detention: A matched cohort study

Background

Individuals with poor health are largely overrepresented in prison populations. However, it remains unclear whether their poor health status already exists prior to their detention or reflects an effect of detention. We examined the health of detainees in the year before and after their detention and compared this with the health of matched non-detainees.

Methods

In this matched cohort study, we linked national data on all persons detained in the Netherlands in 2014/2015 to electronic health records (EHR's) of a representative sample of general practitioners in the Netherlands. Participants include 952 detained persons and 4760 matched non-detained persons (matched on age, sex and general practice). Prevalence rates of health problems in the year before and after detention and odds ratios with 95% confidence intervals were calculated. Rates for a variety of physical and mental health problems are presented.

Findings

Detainees and matched controls differed statistically significant in their pre-detention health status. Compared with controls, male detainees were more likely to report psychological (odds ratio [OR] 3·64 [95% CI 3·11–4·26]), social (1·96 [1·46–2·64]), neurological (1·34 [1·02–1·76]), digestive (1·23 [1·02–1·49]), genital system-related (1·36 [1·07–1·72]), and unspecified health problems (1·32 [1·10–1·59]) in the year before their detention. For example, 43·7% of detainees and 17·6% of controls reported psychological problems in this pre-detention year. To some extent these pre-detention health differences were related to socioeconomic differences. Nevertheless, after taking these characteristics into account, a number of pre-detention health differences between detainees and controls remained statistically significant. No statistically significant changes in prevalence rates from pre- to post-detention and no differences in the levels of change across detainees and controls were observed. For female detainees a similar pattern was found.

Interpretation

People who experience detention have high and complex health needs both pre- and post-detention. While this study did not show a health deteriorating effect of detention, it also did not show a health improving effect. This latter finding may indicate a missed opportunity for health care services to address detainees’ health, especially since persons entering detention have elevated health problems. Knowledge on detainees’ specific health problems may help health care providers in prisons and in the community to adequately address the health care needs of this vulnerable group.

Funding

None.

The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis

INTRODUCTION

More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance.

OBJECTIVES

To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison.

METHODS

We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology.

RESULTS

The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up.

CONCLUSIONS

The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population.

KEY WORDS

Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

The longitudinal course of prisoners’ mental health problems during and after imprisonment

Mental health problems are common in prison populations. Correctional institutions offer an important opportunity to improve prisoners’ health, which also benefit the wider public health agenda. At present, little is known about the longitudinal course of prisoners’ mental health problems during and after imprisonment. The aims of this presentation are: (a) to examine the longitudinal development of mental health problems in prison and after release; and (b) to identify individual and institutional factors associated with prisoners’ mental health problems.

Data are used from the Prison Project, a nationwide and longitudinal study examining 1.904 male prisoners in the Netherlands. Participants were surveyed at various intervals during detention, and 6 and 24 months after their release. Data include detailed longitudinal information on prisoners’ self-reported mental health problems, healthcare use, prison experiences (e.g. sentence length, victimisation, receiving visits, and exercise), and background characteristics (e.g. sociodemographic characteristics, financial situation, social support, and personality traits).

Prisoners reported more mental health problems in and after prison than men in the general population. Initial results demonstrate that prisoners who entered detention with pre-existing mental health problems and problematic alcohol and drug use, showed mental health improvements during detention.

The high levels of prisoners’ mental problems highlight the importance of addressing mental issues in prison and ensuring the continuity of care to support prisoners with their transition into the community.

[Mental health symptoms among prisoners: psychometric properties of the Brief Symptom Inventory (BSI)]

Mental health problems are common in prison populations. Imprisonment may provide important opportunities to improve prisoners' mental health. To do so, it is important to systematically identify prisoners with mental health problems as soon as possible.<br/> AIM: To examine the psychometric properties of the Brief Symptom Inventory (BSI) among male prisoners.<br/> METHOD: A total of 1,624 male prisoners filled out the BSI. The following psychometric properties of the BSI scales were examined: distribution, internal consistency, inter-item correlations, and the factor structure. To examine the (criterion) validity, the BSI scores of different groups were compared.<br/> RESULTS: Cronbach's α's of the BSI scales ranged from 0.97 to 0.76. In general, the observed factor structure resembled the intended nine BSI scales. Prisoners reported significantly higher scores on the BSI than men from the general population, but had lower scores than male psychiatric patients. Prisoners who had been treated for mental disorders prior to their detention, scored significantly higher than prisoners who had not.<br/> CONCLUSION: The BSI showed reliable scales among prisoners and is well able to distinguish between different groups. KEY WORDS Brief Symptom Inventory, prisoners, psychiatry, psychometric properties.

Mental health symptoms during imprisonment: a longitudinal study

OBJECTIVE

Mental health problems are common in prison populations. Less is known about how mental health problems develop during imprisonment. The objective was to examine the longitudinal course of mental health symptoms during imprisonment and individual factors associated with the development of these symptoms.

METHOD

In a prospective cohort study, 1.664 Dutch male prisoners were questioned 3 weeks after their arrival in detention. Those still in custody were questioned again after 3, 9, and 18 months. Multilevel analyses were conducted to identify predictors of the course of mental health symptoms.

RESULTS

Prisoners reported continued elevated symptom levels compared to the general population. Inmates who entered detention with pre-existing mental health problems and problematic alcohol/drugs use showed mental health improvements during detention.

CONCLUSION

The high levels of prisoners' mental health problems highlight the importance of addressing mental health issues in prison. Imprisonment does not have an overall negative effect on mental health.

Short-Term Effects of Imprisonment Length on Recidivism in the Netherlands

This article assesses the relationship between imprisonment length and recidivism. The data come from a unique longitudinal and nationwide study of Dutch prisoners, serving an average of 4.1 months of confinement (N = 1,467). A propensity score methodology is used to examine the dose-response relationship for three types of registered recidivism (i.e., reoffending, reconviction, and reincarceration) within a 6-month follow-up period. Findings indicate that length of imprisonment exerts an overall null effect on future rates of recidivism and that this conclusion holds across the various types of recidivism. These findings contribute to continuing scholarly debates over the social and economic costs of imprisonment.

Treatment Readiness as a Determinant of Treatment Participation in a Prison-Based Rehabilitation Program: An Exploratory Study

The current study had three aims. First, it measured treatment readiness among offenders who entered the Prevention of Recidivism program. This is a prison-based rehabilitation program in the Netherlands that aims to lower re-offending rates among offenders with a prison sentence of at least for months and that is carried out during the final months of incarceration. Second, the study evaluated whether treatment readiness was associated with treatment participation. Third, the study examined whether treatment readiness measured with a validated instrument predicted treatment participation above and beyond a clinical assessment of treatment readiness, currently used as a criterion to include offenders in rehabilitation programs. To address these aims, data were used from the fourth wave of a research project studying the effects of imprisonment on the life of detainees in the Netherlands. Results indicated that treatment readiness as measured with a validated instrument was a significant predictor of treatment participation. Also, the current study showed that treatment readiness measured with a validated instrument improved the prediction of treatment participation above and beyond a clinical assessment of treatment readiness. Outcomes were discussed in light of study limitations and implications.

A longitudinal study of mental health symptoms in young prisoners: exploring the influence of personal factors and the correctional climate

BACKGROUND

Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms.

METHODS

Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data.

RESULTS

Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables.

CONCLUSIONS

The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

Doing your own time: Peer integration, aggression and mental health in Dutch male detainment facilities

BACKGROUND

Prior research demonstrates a strong positive association between social integration (e.g., strong social ties) and individual health. However, researchers also emphasize that this correlation may vary by context and potentially reverse direction under certain conditions. In this study, we draw on competing criminological theories of peer relations to examine if social integration, measured by trust in peers, is positively or negatively associated with violence and mental health of men detained in pre-trial confinement facilities.

METHODS

We test our hypotheses with peer network and health data from 467 Dutch male pre-trial detainees.

RESULTS

Results suggest that peer trust has no direct association with reported rates of peer aggression while detained and low peer trust is generally protective for mental health.

CONCLUSIONS

Our study adds to a small body of literature finding that social integration within certain correctional settings may not operate in the same way that it does in the general population and may actually contribute to adverse mental health outcomes.

Procedural justice in prison: the importance of staff characteristics

A humane and fair treatment of prisoners is of intrinsic value in itself, and is generally acclaimed to reduce prisoners' psychological distress and misconduct in prison, and their criminal behavior after release from prison. To create a more just prison climate, scholars have emphasized the importance of correctional staff. However, there is a lack of empirical research on the relationship between correctional officers' characteristics and prisoners' perceptions of a just treatment in prison. Our study fills this gap in knowledge. Data were used from (a) the Prison Project, a large-scale study in which prisoners held in all Dutch remand centers were surveyed (n = 1,610) and (b) the Dutch Correctional Staff Survey 2011 (n = 690). Multilevel analyses showed that prisoners perceived their treatment in prison as more procedurally just in units where there are more female officers, where officers held more positive attitudes toward rehabilitation, and where there is a higher officer-to-inmate ratio.

Procedural justice and prisoners' mental health problems: a longitudinal study

BACKGROUND

Given the high prevalence of mental health problems among prisoners, knowledge on its determinants is important. Prior cross-sectional studies suggest that procedurally just treatment within prison is a significant predictor; however, longitudinal research is lacking.

AIM

The aims of this study were to examine (1) the longitudinal relationship between prisoners' perceptions of procedural justice--including fairness, respect, humanity and relationships with officers--and their mental health and (2) the moderating role of coping style in this relationship.

METHODS

Data were obtained from the Prison Project, a longitudinal study of adult male prisoners in the Netherlands, interviewed both 3 weeks and 3 months after their reception into pre-trial detention (N = 824). A cross-lagged structural equation model was employed to investigate associations.

RESULTS

Prisoners who reported experiencing a higher level of procedural justice 3 weeks after their arrival in custody reported fewer mental health problems after 3 months. No evidence was found that coping style moderated this relationship.

CONCLUSIONS

These findings suggest a causal relationship between procedural justice and psychological well-being. Fair and respectful treatment of prisoners is a predictor not only of prison order and prisoners' compliance but also of prisoners' psychological well-being.

Disaster-related posttraumatic stress disorder and physical health

OBJECTIVE

To examine the relationship between posttraumatic stress disorder (PTSD) and self-reported as well as physician-recorded physical health in a sample of survivors (n = 896) of a man-made disaster, using a longitudinal design that included predisaster health data. Most studies on the relationship between PTSD and physical health are cross-sectional and use self-reported physical health outcomes.

METHODS

A surveillance using the electronic medical records of survivors' family practitioners (FPs), 1 year predisaster until 4 years postdisaster, was combined with a survey, 3 weeks and 18 months postdisaster. Self-reported PTSD and self-reported physical health were assessed at 18 months postdisaster. FP-recorded physical health problems in the subsequent 2 years were classified according to the International Classification of Primary Care. Multiple regression analyses were used to describe the relationships between PTSD and physical health.

RESULTS

After adjusting for demographics, smoking behavior, and predisaster physical health, PTSD was significantly associated with FP-recorded vascular, musculoskeletal, and dermatological problems, and with all self-reported physical health aspects. Prospectively, PTSD signaled an increased risk of new vascular problems (odds ratio = 1.92; 1.04-3.55).

CONCLUSIONS

This study suggests an effect of PTSD in the development of vascular problems. The results imply that clinicians should be alert that disaster survivors with PTSD can suffer from comorbid medical problems as well.

The influence of a disaster on the health of rescue workers: a longitudinal study

BACKGROUND

Rescue workers strive, after disasters, to help victims and restrict damage, often in dangerous circumstances. We examined the effect of a disaster on the physical and psychological health of rescue workers (firefighters, police officers and medical emergency services personnel) who provided assistance after the explosion of a fireworks depot in the Netherlands in May 2000.

METHODS

We carried out a 4-year longitudinal study of 1403 rescue workers employed in or near the affected neighbourhood (the study group) and a control group of 1650 uninvolved rescue workers (from another city of similar size and urbanization). Health outcomes were measured as prevalence, incidence (both measured as the percent of workers who took sick leave), frequency of the absences and number of sick days (both per 100 workers), and duration (mean length of sickness absences, in days).

RESULTS

Sick leave among the study workers increased substantially during the 18 months after the explosion. For example, the prevalence of absences attributed to psychological problems increased from 2.5% of workers during the 6 months before the disaster to 4.6% during the first 6-month period after the explosion and 5.1% during the second. That for respiratory problems rose from 5.4% predisaster to 14.9% 6-12 months afterward. In comparison with controls, immediate increases occurred in musculoskeletal, psychological, respiratory and nonspecific ill health (e.g., malaise, fatigue) during the first year postdisaster. Rates of sick leave for musculoskeletal and respiratory reasons remained elevated until 3 years postdisaster, whereas leave for psychological problems and other ill health had returned to predisaster levels by then. Neurological problems increased after a 1-year delay. No significant increase in gastrointestinal problems was observed among the study workers, in comparison with controls.

INTERPRETATION

Many health problems arise immediately after a disaster and may persist for years. Health care workers should realize, however, that some disaster-related effects may not emerge until a year or more after the event.

The correspondence between persistent self-reported post-traumatic problems and general practitioners' reports after a major disaster

BACKGROUND

Little is known about the correspondence between persistent self-reported disaster-related psychological problems and these problems reported by general practitioners (GPs). The aim of this study is to analyse this correspondence and to identify the factors associated with GPs' detection of persistent psychological problems.

METHOD

This study was conducted in a sample of 879 adult disaster-affected victims, taken from two longitudinal sources: the Enschede Firework Disaster Study and the GP-Monitor Study. Participants filled out a questionnaire 2-3 weeks and 18 months post-disaster and these data were combined with data from a GP-monitor collected up to 18 months post-disaster. The correspondence between persistent self-reported and GP-reported psychological problems was analysed with cross-tabulations. Logistic regression analyses were performed to identify variables which predicted GPs' detection of psychological problems.

RESULTS

The correspondence rate among victims who visited their GP 18 months post-disaster was 60.4% for persistent intrusions and avoidance reactions, 72.6% for persistent general psychological distress and less than 20% for persistent depression and anxiety symptoms or sleep disturbances. Characteristics that predict GPs' identification of post-traumatic reactions or psychological distress were the level of self-reported post-traumatic symptoms/mental health, the number of contacts the victims had with their GP and the level of the victims' disaster-related experiences.

CONCLUSIONS

In general, there is a considerable correspondence between GP-reported and persistent self-reported incidences of post-traumatic stress and general psychological distress in disaster-affected victims. However, the correspondence declines in the case of more specific psychological symptoms.

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 course of post-disaster health problems of victims with pre-disaster psychological problems as presented in general practice

BACKGROUND

Survivors of disaster with pre-disaster psychological problems are believed to be at risk for presenting post-disaster psychological and physical morbidity. Up till now this statement is based on cross-sectional studies with self-reported data and without pre-disaster measurement.

OBJECTIVE

To monitor post-disaster health care utilization and morbidity presented in general practice after a man-made disaster by victims and controls with and without pre-disaster psychological problems.

METHODS

A controlled cohort study with pre-disaster (1 year) and post-disaster (two-and-a-half years) data. Victims (N = 2518) of an exploding fireworks depot in a residential area and matched controls (N = 2512), representing patients in 30 general practices, were included. Main outcome measures were utilization measured by GP attendances, and psychological and physical problems registered by the GP using the International Classification of Primary Care.

RESULTS

Only victims without pre-disaster psychological problems demonstrated a significant increase in utilization in the first half year post-disaster. Victims with pre-disaster psychological problems did not. Being a victim (OR = 6.13; 95% CI = 4.84-7.77) had a greater effect than pre-disaster psychological problems (OR = 4.96; 95% CI = 3.96-6.21) on presenting post-disaster psychological problems. Pre-disaster psychological problems had more effect (OR = 1.93; 95% CI = 1.79-2.08) than the effect of being a victim (OR = 1.25; 95% CI = 1.18-1.32) on the development of post-disaster physical symptoms.

CONCLUSION

Post-disaster increases in utilization and psychological morbidity were observed. Post-disaster psychological problems were more influenced by the disaster, while post-disaster physical symptoms were more influenced by pre-disaster psychological problems. GPs should concentrate on the pre-disaster health history of victims of man-made disasters in their practices.

Health problems in children and adolescents before and after a man-made disaster

OBJECTIVE

The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems.

METHOD

Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N=1,628) and controls (N=2,856) was possible. Health problems were classified according to the International Classification of Primary Care.

RESULTS

Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status.

CONCLUSIONS

Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems.

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

OBJECTIVE

To study the health problems presented to general practitioners by disaster survivors who received specialized ambulatory mental health care.

DESIGN

(Longitudinal) case-control study based on general practitioners' electronic medical records.

SETTING

General practice and a mental health institution (MHI) in Enschede, the Netherlands.

SUBJECTS

A total of 728 adult disaster survivors who were registered in 30 study practices and had attended a specialized mental health institution (MHI group), and 728 practice-matched controls.

MAIN OUTCOME MEASURES

Attendance rates in general practice before and after the disaster; health problems presented to the GP, classified according to the International Classification of Primary Care.

RESULTS

Disaster survivors in the MHI group reported higher GP attendance rates pre- and post-disaster and more health problems than controls. In the year post-disaster, the MHI group reported an increase in psychological, medically unexplained physical symptoms (MUPS), gastrointestinal and musculoskeletal problems, compared with the year pre-disaster. Controls, survivors themselves, showed also an increase in psychological problems in the year post-disaster compared with the year pre-disaster.

CONCLUSION

General practitioners should be aware of an increase in consultations and health problems among patients who also receive mental health care following a disaster. The services of GP and mental health care professionals should be integrated when supporting disaster victims. Information on severity of exposure to disasters should be included in disaster databases.

Secondary traumatization in partners and parents of Dutch peacekeeping soldiers

This study examines secondary traumatization among 708 partners and 332 parents of Dutch peacekeepers (i.e., personnel who participated in military actions implemented by international organizations such as the United Nations). Partners or parents of peacekeepers with 4 levels of posttraumatic stress symptoms were compared on posttraumatic stress, health problems, the quality of the marital relationship, and social support. In comparison with partners of peacekeepers without posttraumatic stress disorder (PTSD) symptoms, partners of peacekeepers with PTSD symptoms reported more sleeping and somatic problems, reported more negative social support, and judged the marital relationship as less favorable. No significant differences were found for parents. Thus, peacekeepers' stress reactions were related to various problems of their partners. A systemic approach to the treatment of persons with PTSD appears appropriate.

Health problems of victims before and after disaster: a longitudinal study in general practice

BACKGROUND

We aimed to quantify the health problems and to assess the possible risk factors for developing health problems in persons affected by the explosion of a firework depot at Enschede, The Netherlands, on May 13, 2000. The explosion considerably damaged buildings in the local neighbourhood and caused 22 immediate deaths and injuries in over 1000 people.

METHODS

A longitudinal study of (89% of all) victims (n = 9329) and controls (n = 7392) with pre-disaster baseline morbidity for 16 months and post-disaster data for 2.5 years was conducted using the electronic medical records of general practitioners. Symptoms and diagnoses were recorded using the International Classification of Primary Care (ICPC). Prevalence rates for clusters of symptoms were compared between victim and control groups pre- and post-disaster. Risk factors for developing health problems were examined in hierarchical linear models.

RESULTS

Two and a half years post-disaster, the prevalence of psychological problems in victims who had to relocate was about double and in the non-relocated victims one-third more than controls. Victims with pre-disaster psychological problems were at a greater risk for post-disaster psychological problems. Relocated victims showed an excess of medically unexplained physical symptoms (MUPS) especially in a period of increased media attention. Both groups of victims showed some increase of gastrointestinal (GI) morbidity 2.5 years post-disaster compared with their pre-disaster rate, and compared with the control group.

CONCLUSIONS

Two and a half years post-disaster an excess of psychological problems, MUPS, and gastrointestinal morbidity was observed. Pre-disaster psychological problems and inevitable relocation were predictors of more post-disaster psychological problems.

Psychological, musculoskeletal, and respiratory problems and sickness absence before and after involvement in a disaster: a longitudinal study among rescue workers

BACKGROUND

On 13 May 2000 a firework depot situated in a residential area in the Netherlands exploded. Many rescue workers were involved in the aftermath of this explosion.

AIMS

To examine the longitudinal course of psychological, musculoskeletal, and respiratory problems and sickness absence among rescue workers involved.

METHODS

The study population was composed of 1036 rescue workers. Data on health and sickness absence both before and after the disaster were collected from the electronic database of the rescue workers' occupational physicians. Health problems were coded according to an adapted version of the ICD-10.

RESULTS

After the disaster a long term increase was found in psychological, musculoskeletal, and respiratory problems. Compared to six months before the disaster, the average length of sickness absence in the first half year after the disaster increased from 6.6 to 11.6 days, and decreased slowly in the following six month periods.

CONCLUSIONS

Rescue workers involved in a disaster may experience subsequent impairment in occupational functioning.