Marchers unfold a giant banner as they arrive at City Hall to hold a rally for victims of Superstorm Sandy on Wednesday, July 31, 2013, in New York.
Marchers unfold a giant banner as they arrive at City Hall to hold a rally for victims of Superstorm Sandy on Wednesday, July 31, 2013, in New York. (Bebeto Matthews/AP/)

NEW YORK — "Hurricane Sandy is gone. For some the stress still lingers." A New York subway ad underscores a call by researchers for better mental health response in disasters.

In a study published Tuesday in the Journal of American Medical Association, researchers recommended that disaster teams provide mental health care for victims of emergencies sooner and more systematically to prevent illnesses from going unseen and untreated after a traumatic experience. They called for a system of early assessment, triage and referral be established and empirically tested for a mental health care emergency response.

"Mental injuries are prevalent and require a similar system for identifying and treating these individuals, just as you would those with physical injuries," said Carol North, a professor of psychiatry at the University of Texas Southwestern Medical Center and senior author of the study.

An increasing number of Americans experience a fire, flood, earthquake or other natural disaster during their lives, according to the study. About one third of people who experience these events, as well as airplane crashes and acts of terrorism, may develop post-traumatic stress disorder and about 1 in 4 may experience major depression, the researchers said.


While various treatments have been available in disaster settings, few previous studies emphasized the need for diagnosis that integrates psychiatric assessment early on, North said. Researchers reviewed 222 articles on emergency and medical disaster response to summarize evidence of the best ways to identify disaster victims in need of mental health services.

More than 26 percent of Americans ages 18 and older suffer from a diagnosable mental disorder in a year, according to the National Institute of Mental Health.

Distress almost universally affects victims of a disaster. Interventions can prevent a normal level of stress from escalating into post-traumatic stress disorder or major depression, the researchers said. Early intervention includes psychological first aid, psychological debriefing, and crisis counseling.

Providing mental health care without assessment creates the potential for failure to treat disorders as well as the potential for doing harm. People with serious psychiatric illness "might even get worse in debriefings, because they might have to encounter uncomfortable material that involves unpleasant reminders that they are not ready for," North said.

Post-traumatic stress disorder and major depression can take between two and four weeks to develop, so early diagnosis can "meaningfully address" issues, the report states.

After adequate assessment, the next major step is determining treatment and referral to appropriate care, researchers said.

People identified with previous disorders and those newly diagnosed with acute psychiatric crisis, such as suicidal thoughts, need formal mental health services. Among the sheltered evacuees from Hurricane Katrina in New Orleans in 2005 assessed in a mental health clinic, 40 percent were treated for pre-existing mental illness and 24 percent for a new post- disaster disorder.

Incorrect assessment of psychiatric illness can leave some without care while providing in-depth aid to those who are experiencing a normal level of distress. Failure to differentiate between distress and psychiatric illness "has the potential to overestimate need for psychiatric services and related costs by magnitudes as high as 10," the researchers said.