Mental health, natural and human-made disasters: lessons learnt and future needs.

In the medical literature, the interest in what happens before, during and after natural or human-made disasters is growing. Disasters and large-scale crises continue to increase in frequency. During the last quarter century, more than 3.4 million lives have been lost due to disasters and tens of billions of dollars spent on repairing damage and reconstructing lives (Hogan & Burstein, 2007). Natural disasters like earthquakes, landslides, volcanic eruptions, floods and cyclones kill thousands of people and destroy billions of dollars of habitats and properties each year. The rapid growth of the world’s population and its increased concentration, often in hazardous environments, has escalated both the frequency and the severity of natural disasters. Although it may not be possible to control the nature and to stop the development of natural phenomena, efforts could be made to avoid disasters and alleviate their effects on human lives, infrastructures and properties. On the other side, human-made disasters are those disasters resulting from human-made hazards. We can distinguish sociological hazards like wars, terrorism, civil disorders, arsons from technological and/or industrial hazards like mining accidents, structural collapses, environmental and contamination hazards (e.g., nuclear hazards). If we look specifically at mental health, we see that a wide literature exists on the psychological effects of natural and human-made disasters (e.g., PostTraumatic Stress Disorders (PTSD), anxiety disorders, etc.), while very little has been studied about the effects of disasters on functioning and organization of mental health services and on the long-term effects on the prevalence of mental disorders. A wide review of disaster-specific literature published from 1977 to 2009 (Smith et al. 2009) showed that following 25 individual disasters or overwhelming crises, a total of 2098 peer-reviewed, event-specific publications were published in 789 journals (652 publications following disasters/events caused by natural hazards, 966 following human-made/technological disasters/events and 480 following conflict/complex humanitarian events). The event with the greatest number of peer-reviewed, event-specific publications was the 11 September 2001 terrorist attacks (686 publications). Human-made/technological events tend to result in a greater number of psychosocial studies and peer-reviewed publications (with an emphasis on post-traumatic stress disorder and mental health), whereas disasters due to natural hazards and conflict events predominantly result in publications on medical/health-related response to the event. Most studies that provide information on mental health services use the following disasters that have been limited to examining the rates of services utilization in victims, but not in those patients with previous contacts with mental health services. Services utilization studies can be then divided into either those that examine mental health services use among the direct victims or those that examine mental health services use in the affected community (Rodriguez & Kohn, 2008). In a survey (Wang et al. 2007) of 1043 survivors of Hurricane Katrina, 16% had sought mental health services: 4% sought a mental health specialist and 11% a general medical provider. Only 18% of those with a new-onset disorder sought treatment. Psychopharmacological treatments were used by 12% of the sample, 19% with a mild to moderate mental illness and 37% with a severe mental illness. The most commonly prescribed psychopharmacological agents were antidepressants, followed by benzodiazepines; psychotherapy was utilized by 16%. Of those who did receive psychotherapy following the disaster, 60% had dropped out of treatment. Fourteen percent of the respondents who did not seek treatment reported that they were in need of treatment. In a subsequent study conducted among people with preexisting mental disorders who reported using mental health services in the year before the hurricane, over one-fifth experienced reduction in or termination of treatment after Hurricane Katrina (Wang et al. 2008). Jones et al. (2009), for example, showed that people with severe mental disorders are a neglected and vulnerable group in complex emergencies and they stated that protection and care of people with severe mental disorders in complex emergencies is a humanitarian responsibility. * Address for correspondence: Professor Francesco Amaddeo, Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico ‘G.B. Rossi’, Piazzale L.A. Scuro 10, 37134 Verona, Italy. (E-mail: francesco.amaddeo@univr) Epidemiology and Psychiatric Sciences (2012), 21, 1–5. © Cambridge University Press 2012 doi:10.1017/S2045796011000813 PRESENTATION OF THE EDITORIALS, MARCH 2012