Mental Health Response to Community Disasters: A Systematic Review

• Published in: JAMA : the journal of the American Medical Association 2013-08, Vol.310 (5), p.507-518
• Main Authors: North, Carol S, Pfefferbaum, Betty
• Format: Article
• Language: English
• Subjects: Adjustment; Biological and medical sciences; Counseling; Disasters; Emergency Medical Services - standards; General aspects; Humans; Medical sciences; Mental Health; Mental Health Services; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk; Stress; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - etiology; Systematic review; Triage
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2013.107799

IMPORTANCE Exposure to a disaster is common, and one-third or more of individuals severely exposed may develop posttraumatic stress disorder or other disorders. A systematic approach to the delivery of timely and appropriate disaster mental health services may facilitate their integration into the emergency medical response. OBJECTIVE To review and summarize the evidence for how best to identify individuals in need of disaster mental health services and triage them to appropriate care. EVIDENCE REVIEW Search of the peer-reviewed English-language literature on disaster mental health response in PsycINFO, PubMed, Cochrane Database of Systematic Reviews, Academic Search Complete, and Google Scholar (inception to September 2012) and PILOTS (inception to February 2013), using a combination of subject headings and text words (Disasters, Natural Disasters, Mental Health, Mental Health Programs, Public Health Services, Mental Disorders, Mental Health Services, Community Mental Health Services, Emergency Services Psychiatric, Emotional Trauma, Triage, and Response). FINDINGS 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%-38%) 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% of distressed individuals had preexisting disorders. Individuals with more intense reactions to disaster stress were more likely to accept referral to mental health services than those with less intense reactions. 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. CONCLUSION AND RELEVANCE In postdisaster settings, a systematic framework of case identification, triage, and mental health interventions should be integrated into