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  • Print publication year: 2009
  • Online publication date: August 2011

7 - Disaster Mental and Behavioral Health



This chapter describes the range and timeline of typical reactions, approaches for screening, triage, and referral, preventing and managing psychological injuries, and integrated strategies to support disaster responders. Disasters and acts of terrorism produce a spectrum of common physiological, psychological, social, behavioral, emotional, cognitive, and spiritual reactions. An emerging incident management model for disaster mental and behavioral health is composed of three major components to enable a common operational picture for participating entities and jurisdictions. The components include community-based disaster systems of care, a common system for incident/event-specific rapid triage, and information technology for near-real-time data linkage. Psychological impact and resulting levels of psychiatric disorders may vary as a function of event characteristics, such as terrorism using weapons that can cause mass casualties and societal disruption. Using leadership, public messaging, and education greatly improves the mental and behavioral health of communities impacted by disasters and mass violence.

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Fullerton, CS, Ursano, RJ, Norwood, AE, Holloway, HH. Trauma, terrorism, and disaster. In: Ursano, RJ, Fullerton, CS, Norwood, AE, eds. Terrorism and Disaster: Individual and Community Mental Health Interventions. Cambridge: Cambridge University Press; 2003:1–20. [see p. 1]
Norris, FH, Elrod, CL. Psychosocial consequences of disaster: a review of past research. In: Norris, FH, Galea, S, Friedman, MJ, Watson, PJ, eds. Methods of Disaster Mental Health Research. New York: Guildford Press; 2006:20–42.
Engel, CC. Somatization and multiple idiopathic physical symptoms: relationship to traumatic events and posttraumatic stress disorder. In: Schnurr, PP, Green, BL, eds. Trauma and Health: Physical Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association; 2003:191–216.
Butler, AS, Panzer, AM, Goldfrank, LR; and Institute of Medicine Committee on Responding to the Psychological Consequences of Terrorism: Board of Neuroscience and Behavioral Health. Preparing for the Psychological Consequences of Terrorism: A Public Health Approach. Washington, DC: National Academies Press; 2003.
Schreiber, M. Learning from 9/11: Toward a national model for children and families in mass casualty terrorism. In: Danieli, Y, Dingman, R, eds. New York: Haworth Press; 2005;605–609.
Schuster, MA, Stein, BD, Jaycox, LH, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med. 2001;345(20):1507–1512.
Pfefferbaum, B, Seale, TW, Brandt, EN Jr, Pfefferbaum, RL, Doughty, , Rainwater, SM. Media exposure in children one hundred miles from a terrorist bombing. Ann Clin Psychiatry. 2003;15(1):1–8.
Pynoos, RS, Steinberg, AM, Wraith, R. A developmental model of child traumatic stress. In: Cicchetti, D, Cohen, DJ, eds. Manual of Developmental Psychopathology. New York: John Wiley and Sons;1995:72–83.
Gurwitch, RH, Kees, M, Becker, SM, Schreiber, M, Pfefferbaum, B, Diamond, D. When disaster strikes: responding to the needs of children. Prehosp Disaster Med. 2004;19(1):21–28. Review.
Carr, V, Lewin, T, Webster, R, Kenardy, J, Hazell, P, Carter, G. Psychosocial sequelae of the 1989 Newcastle earthquake: exposure and morbidity profiles during the first 2 years post-disaster. Psychol Med. 1997;27:167–178.
McFarlane, AC. Posttraumatic stress disorder: a model of the longitudinal course and the role of risk factors. J Clin Psychiatry. 2000;61(Suppl 5):15–20; discussion 21–23. Review.
Thompson, M, Norris, F, Hanacek, B. Age differences in the psychological consequences of Hurricane Hugo. Psychol Aging. 1993;8:606–616.
Dohrenwend, B. Psychological implications of nuclear accidents: The Three Mile Island. Bull NY Acad Med. 1983;59:1060–1076.
Smith, B. Coping as a predictor of outcomes following the 1993 Midwest flood. J Soc Behav Personality. 1996;11:225–239.
Baum, A, Gatchel, R, Schaeffer, M. Emotional, behavioral and physiological effects at Three Mile Island. J Consult Clin Psychol. 1983;51:565–572.
Ironson, G, Wynings, C, Schneiderman, N, et al. Posttraumatic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew. Psychosom Med. 1997;59(2):128–141.
Krakow, B, Haynes, PL, Warner, TD, et al. Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. J Trauma Stress. 2004;17(3):257–268.
Clayer, J, Bookless-Pratz, C, Harris, R. Some health consequences of a natural disaster. Med J Aust. 1985;43:182–184.
Murphy, S. Stress levels and health status of victims of a natural disaster. Res Nurs Health. 1984;7:205–215.
Grieger, TA, Fullerton, CS, Ursano, RJ. Posttraumatic stress disorder, depression, and perception of safety 13 months after September 11. Psychiatric Serv. 2004;55(9):1061–1063.
Reissman, DB, Spencer, S, Tanielian, TL, Stein, BD. Integrating behavioral aspects into community preparedness and response systems. In: Danieli, Y, Brom, D, Sills, J, eds. The Trauma of Terrorism: Sharing Knowledge and Shared Care, an International Handbook. New York: Haworth Maltreatment and Trauma Press. 2005. Copublished simultaneously in J Aggress Maltreat Trauma. 2005;10(¾):707–720.
Galea, S, Ahern, J, Resnick, H, et al. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002;346(13):982–987.
North, CS, Nixon, SJ, Shariat, S, Et al. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999; 282(8):755–762.
Pfefferbaum, B, Doughty, . Increased alcohol use in a treatment sample of Oklahoma City bombing victims. Psychiatry. 2001;64(4):296–303.
Locke, SL, McDonald, M, Reissman, DB. The psychosocial dimensions of biodefense preparedness and response. Contract 200–2003-M-02317 Sponsored by the Centers of Disease Control and Prevention [cited 2007 March 15]. Available at: Accessed November 13, 2008.
Engel, CC, Locke, SL, Reissman, DB, et al. Terrorism, trauma, and mass casualty triage: how might we solve the latest mind-body problem? J Biosecur Bioterrorism. 2007;5(2):155–163.
Barbera, JA, McIntyre, AG. Hospital emergency preparedness and response. In: Jane's Mass Casualty Handbook. Surrey, UK: Jane's Information Group, Ltd; 2003.
Auf der Heide, E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47:34–49.
Glass, TA, Schoch-Spana, M. Bioterrorism and the people: how to vaccinate a city against panic. Clin Infect Dis. 2002;34(2):217–223. Review.
Kaji, A, Koenig, KL, Bey, T. Surge capacity for healthcare systems: A conceptual framework. Acad Emerg Med. 2006;13(11):1157–1159.
Reissman, DB, Watson, PJ, Klomp, RW, Tanielian, TL, Prior, SD. Pandemic influenza preparedness: adaptive responses to an evolving challenge. J Homeland Secur Emerg Manage. 2006 Jul [cited 2007 Mar 5];3(2): Article 13. Available at:
Wenger, , Dykes, JD, Sebok, TD, Neff, JL. It's a matter of myths: An empirical examination of individual insight into disaster response. Mass Emerg. 1975;1:33–46.
Mawson, AR. Understanding mass panic and other collective responses to threat and disaster. Psychiatry. 2005;68(2):95–113.
Covello, VT. Best practices in public health risk and crisis communication. J Health Commun. 2003;8(Suppl 1):5–8; discussion 148–151.
Bleich, A, Gelkopf, M, Soloman, Z. Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA. 2003;290(5): 612–620.
DiGiovanni, C, Reynolds, B, Harwell, R, Stonecipher, EB, Burkle, FM Community reaction to bioterrorism: prospective study of simulated outbreak. Emerg Infect Dis. 2003;9(6):708–712.
Lerner, JS, Gonzalez, RM, Small, DA, Fischhoff, B. Effects of fear and anger on perceived risks of terrorism: a national field experiment. Psychol Sci. 2003;14(2):144–150.
Germann, T, Kadau, K, Longini, I, Macken, C. Mitigation strategies for pandemic influenza in the United States. Proc Natl Acad Sci USA. 2006;11:5935–5940.
Hawryluck, L, Gold, WL, Robinson, S, Pogorski, S, Galea, S, Styra, R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–1212.
Redlener, I. Follow-Up 2005: Where the American Public Stands on Terrorism and Preparedness after Hurricanes Katrina & Rita. Mailman School of Public Health, Columbia University. Press Release 11/21/05 Crisis in Confidence in Government Widens. Available at: Accessed November 13, 2008.
Pynoos, R, Schreiber, M, Steinberg, A, Pfefferbaum, B. Children and terrorism. In: Saddock, B, Saddock, V, eds. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 8th ed. Vol 2. New York: Lippincott Williams and Wilkins; 2005;3551–3563.
Walker, EA, Katon, W, Russo, J, Ciechanowski, P, Newman, E, Wagner, AW. Health care costs associated with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry. 2003;60(4):369–74.
DeWolfe, DJ. Training Manual for Mental Health and Human Service Workers in Major Disasters. 2nd ed. DHHS Publication No. ADM 90–538. Substance Abuse and Mental Health Services Administration; 2000.
Kaniasty, K, Norris, FH. Social support in the aftermath of disasters, catastrophes, and acts of terrorism: altruistic, overwhelmed, uncertain, antagonistic, and patriotic communities. In: Ursano, RJ, Norwood, AE, Fullerton, CS, eds. Bioterrorism: Psychological and Public Health Interventions. New York: Cambridge University Press; 2004:200–231.
Koenig, KL. Homeland Security and Public Health: role of the Department of Veterans Affairs, the U.S. Department of Homeland Security, and implications for the public health community. Prehosp Disast Med. 2003;19 (4):327–333.
Asarnow, J, Glynn, S, Pynoos, RS, et al. When the earth stops shaking: earthquake sequelae among children diagnosed for pre-earthquake psychopathology. J Am Acad Child Adolesc Psychiatry. 1999;38(8):1016–23.
Fairbrother, G, Stuber, J, Galea, S, Pfefferbaum, B, Flieschman, AR. Unmet need for counseling services by children in New York City after the September 11th attacks on the World Trade Center: implications for pediatricians. Pediatrics. 2004;113(5):1267–74.
Foa, EB, Meadows, EA. Psychosocial treatments for posttraumatic stress disorder: a critical review. Ann Rev Psychol. 1997;48:935–938.
Shalev, AY. (2006) Resilience after disaster is the default: how not to miss it. Valhalla NY: New York Medical College, 2006. Webcast presentation “Early psychological intervention following mass trauma: The present and future directions.” Available at: Accessed November 13, 2008.
Thienkrua, W, Cardozo, BL, Chakkraband, ML, et al. Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. JAMA. 2006;296(5):549–559.
Pynoos, R, Schreiber, M. The impact of Laguna Beach wildfire on children and parents. Presentation at the 42nd Annual Meeting of the American Academy of Child and Adolescent Psychiatry, New Orleans, LA. 1995.
Goenjian, AK, Pynoos, RS, Steinberg, AM, et al. Psychiatric co-morbidity in children after the 1988 earthquake in Armenia. J Am Acad Child Adolesc Psychiatry. 1995;34:1174–1184.
Brackbill, RM, Thorpe, , DiGrande, L, et al. Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings. MMWR. 2006;55(No. SS-2): 1–11.
Hoven, CW, Duarte, CS, Lucas, CP, et al. Psychopathology among New York City public school children 6 months after September 11. Arch Gen Psychiatry. 2005; 62(5):545–552.
Gerrity, ET, Flynn, BW. Mental health consequences of disasters. In: Noji, EK, ed. The Public Health Consequences of Disasters. New York: Oxford University Press; 1997:101–121.
,National Institute of Mental Health. Mental health and mass violence: evidence-based early psychological intervention for victims/survivors of mass violence; A workshop to reach consensus on best practices (NIH Publication No. 02–5138). Rockville, MD: National Institute of Mental Health, 2002.
Orner, RJ, Kent, AT, Pfefferbaum, BJ, Raphael, B, Watson, PJ. The context of providing immediate postevent intervention. In: Ritchie, EC, Watson, PJ, Friedman, MJ, eds. Interventions Following Mass Violence and Disasters. New York: Guilford Press; 2006:121–133.
Watson, PJ, Friedman, MJ, Gibson, , Ruzek, JI, Norris, FH, Ritchie, EC. Early intervention for trauma-related problems. In: Ursano, RJ, Norwood, JE, eds. Trauma and Disaster Responses and Management. Washington, DC: American Psychiatric Publishing; 2003:118–129.
Hobfoll, SE, Watson, PJ, Ruzek, JI, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry (in press, 2007).
,National Center for PTSD, National Center for Child Traumatic Stress. Psychological First Aid: Operations Guide. 2nd ed. Los Angeles: National Center for Child Traumatic Stress; 2006.
Schreiber, M, Gurwitch, RH. Listen, protect, and connect model. Sponsored by the U.S. Department of Homeland Security. Available at: Accessed November 13, 2008.
Schreiber, M, Gurwitch, RH, Wong, M. Psychological first aid for children in schools: The “listen, protect, connect, and teach model.” Unpublished manuscript. University of California Los Angeles, Center for Public Health and Disasters. 2007.
Masten, A. Ordinary magic: resilience processes in development. Am. Psychologist. 2001;56:1–12.
Reissman, DB, Klomp, RW, Kent, AT, Pfefferbaum, B. Exploring psychological resilience in the face of terrorism. Psychiatr Ann. 2004;34(8):627–632. Review.
Ursano, RJ. Workplace Preparedness for Terrorism. Sponsored by The Alfred P. Sloan Foundation, 2005. Available at: Accessed November 13, 2008.
Reissman, DB. Workforce and community resilience: health protection strategies for emerging public health threats. Valhalla NY: New York Medical College, 2006. Webcast presentation “Early psychological intervention following mass trauma: The present and future directions.” Available at: Accessed November 13, 2008.
Caruso, CC, Bushnell, T, Eggerth, D, et al. Long working hours, safety, and health: toward a national research agenda. Am J Ind Med. 2006;49(11):9300–9342.
Shultz, JM, Espinel, Z, Galea, S, Shaw, JA, Miller, GT. Surge, sort, support: disaster behavioral health for health care professionals. University of Miami Center for Disaster and Extreme Event Preparedness: Disaster Life Support Publishing; 2006.