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Research examines importance of identifying need, providing delivery of mental health services following community disasters

A review of articles on disaster and emergency response interventions and services indicates that in postdisaster settings, a systematic framework of case identification, triage, and interventions should be integrated into emergency medicine and trauma care responses, according to a study in the August 7 issue of JAMA, a theme issue on violence/human rights.

“Mental and physical consequences of major disasters have garnered increasing attention to the need for an effective community response. It is estimated that much of the U.S. population will be exposed to a … natural disaster during their lives; adding technological events such as airplane crashes and intentional human acts such as terrorism to this estimate would yield even higher numbers. Mental health effects of disaster exposures are relevant to informing care for survivors of all forms of trauma, because 9 of 10 people are likely to experience trauma in their lifetimes,” according to background information in the article. “A systematic approach to the delivery of timely and appropriate disaster may facilitate their integration into the emergency medical response.”

Carol S. North, M.D., M.P.E., of the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and Betty Pfefferbaum, M.D., J.D., of the University of Oklahoma Health Sciences Center, Oklahoma City, reviewed and summarized evidence to provide a practical framework for delivering to individuals appropriate to their needs in the wake of a disaster. A search of the peer-reviewed English-language literature on disaster yielded 222 articles that met criteria for inclusion in the review.

The authors write that “unlike physical injuries, adverse mental health outcomes of disasters may not be apparent, and therefore a systematic approach to case identification and triage to appropriate interventions is required. Symptomatic individuals in postdisaster settings may experience new-onset disaster-related psychiatric disorders, exacerbations of preexisting psychopathology and/or psychological distress. Descriptive disaster mental health studies have found that many (11 percent-38 percent) distressed individuals presenting for evaluation at shelters and family assistance centers have stress-related and adjustment disorders; bereavement, major depression, and substance use disorders were also observed, and up to 40 percent of distressed individuals had preexisting disorders.”

The researchers also found that individuals with more intense reactions to disaster stress were more likely to accept referral to mental health services than those with less intense reactions.

Standard treatments for psychiatric disorders related to trauma in general and to disasters specifically are pharmacotherapy and psychotherapy. Usual clinical practice for management of trauma-related disorders and symptoms is generally appropriate.

“Evidence-based treatments are available for patients with active psychiatric disorders, but psychosocial interventions such as psychological first aid, psychological debriefing, crisis counseling, and psychoeducation for individuals with distress have not been sufficiently evaluated to establish their benefit or harm in disaster settings,” the authors write.

“The 3 components of case identification, triage, and intervention are consistent with established approaches to emergency and medical response to mass casualty incidents and may therefore facilitate integration of mental health services into the medical disaster response.”

“Compelling issues that must be addressed in improving disaster mental health response capacities focus on matching interventions and services to specified mental health outcomes (e.g., psychiatric illness vs. disaster-related distress) for exposed and unexposed groups, encouraging the use and integration of appropriate assessment and referral, and evaluating the effectiveness of the interventions and services offered.”


JAMA. 2013; DOI 310(5):507-518