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Article
Psychiatric Issues in Emergency Care Settings
What percentage of persons exposed to mass casualties go on to develop psychiatric symptoms? Who is most at risk?
The 2 most common types of mass casualty events are natural disasters (eg, hurricanes) and mass interpersonal violence (eg, terrorist attacks).1 The psychological effects of such traumas vary in type and extent. More severe responses occur in the context of greater event severity; closer proximity to the epicenter of the event; physical injury; witnessing injury or death of others (especially family or loved ones); higher levels of peritraumatic terror, panic, horror, or helplessness; major property loss; and circumstances in which the survivor is unable to access social support and post-disaster resources.2,3 Certain survivor-related variables also can be contributory, including a history of previous trauma exposures, previous or current psychiatric disorder, female gender (probably based on the greater number of prior traumas already experienced by women by the time they encounter the event), older age, and lower socioeconomic status.1,2
Psychiatrist
Jackson, Miss
The 2 most common types of mass casualty events are natural disasters (eg, hurricanes) and mass interpersonal violence (eg, terrorist attacks).1 The psychological effects of such traumas vary in type and extent. More severe responses occur in the context of greater event severity; closer proximity to the epicenter of the event; physical injury; witnessing injury or death of others (especially family or loved ones); higher levels of peritraumatic terror, panic, horror, or helplessness; major property loss; and circumstances in which the survivor is unable to access social support and post-disaster resources.2,3 Certain survivor-related variables also can be contributory, including a history of previous trauma exposures, previous or current psychiatric disorder, female gender (probably based on the greater number of prior traumas already experienced by women by the time they encounter the event), older age, and lower socioeconomic status.1,2
The most common psychiatric disorders after a mass casualty event are depression, acute stress disorder, posttraumatic stress disorder (PTSD), and other anxiety disorders.1,3 Increased rates of substance abuse among survivors of a mass casualty event have been found in some studies but not in others. Although statistics vary from study to study, the prevalence of PTSD following a mass casualty event generally ranges from 6% to 35%,1,2 depending on the severity of the event, the risk factors described above, and when the follow-up study was conducted.
John Briere, PhD
Associate Professor of Psychiatry and Psychology
Keck School of Medicine, University of Southern California
Director, Psychological Trauma Program
LAC+USC Medical Center
Co-director, MCAVIC-USC Child and Adolescent Trauma Program, National Child Traumatic Stress Network
Los Angeles
Catherine Scott, MD
Assistant Professor of Clinical Psychiatry
Keck School of Medicine, University of Southern California
Medical Director, Psychological Trauma Program
Attending Psychiatrist, Psychiatric Emergency Services
LAC+USC Medical Center
Los Angeles
References:
REFERENCES
1. Briere J.
Psychological Assessment of Adult Posttraumatic States: Phenomenology, Diagnosis, and Measurement.
2nd ed. Washington, DC: American Psychological Association; 2004.2. Lee A, Isaac MK, Janca A. Post-traumatic stress disorder and terrorism.
Curr Opin Psychiatry.
2002;15:633-637.3. Ritchie EC, Watson PJ, Friedman MJ.
Interventions Following Mass Violence and Disasters.
New York: Guilford; 2006.
