It Is Important to Identify Mental Distress Quickly After Trauma

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In the aftermath of disaster, emergency mental health responses should focus on identification of individuals in need, triage, and appropriate interventions, according to a systematic literature review published in the Aug. 7 issue of Journal of the American Medical Association.

The review examined 222 articles discussing mental health concerns after large-scale disasters such as the Boston Bombing, the World Trade Center attack on Sept. 11, 2001, and the bombing of the London Underground on July 7, 2005. The team was lead by Carol S. North, MD, of the University of Texas Southwestern Medical Center in Dallas, and Betty Pfefferbaum, MD, JD, of the University of Oklahoma in Oklahoma City.

Alexander Isakov, MD, of Emory University in Atlanta, wasn’t involved in the study but he helped explain the findings to Medpage Today. He said, “the authors were proposing that there be a means to assess the cases, that they get triaged to the appropriate intervention, and that the appropriate intervention then be executed.”

The biggest and most important issue in the initial stages of responding to disaster is differentiating actual psychopathology from normal distressed responses to the event. This can be difficult as the initial identification of emotional problems following a major trauma “conceptually differs from its counterpart in disaster emergency and medical response, because unlike physical injuries incurred in mass-casualty incidents, psychological wounds are often not apparent and therefore require concerted efforts and different procedures for identification and assessment,” North and Pffeferbaum explained in the published report.

Another difficulty of identifying those in need of emotional and mental health intervention and care is that many of the actual disorders aren’t readily apparent until weeks after the disaster occurs. Specifically, major depression or post-traumatic stress disorder (PTSD) tend to arise roughly 2 to 4 weeks after the event.

However, initial assessment such as what is normally carried out in evacuation centers “can identify psychosocial issues, symptoms, level of functioning, attitudes and beliefs, and current status of pre-existing psychiatric disorders,” as the researchers noted.

Following the initial assessment, the focus of care needs to shift to triage, where individuals found to have new or recurrent psychiatric illnesses are referred for formal care and intervention. Interventions in this early stage “are indicated for the majority of survivors to reduce distress, provide emotional support, educate and normalize emotional responses, even before new psychiatric disorders have time to develop and be diagnosable.”

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