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Abstract #158855

Cynthia A. Claassen, PhD¹, Gregory L. Larkin, MD, MSPH, FACEP², T. Michael Kashner, PhD, JD¹, and Tetyana K. Kashner, MD³. (1) Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, 214-648-0164, cindy.claassen@utsouthwestern.edu, (2) Department of Surgery, Yale University, 464 Congress Ave, New Haven, CT 06510, (3) Department of Obstetrics and Gynecology, Pennsylvania State University, Milton S. Hershey Medical Center, P.O. Box 850, Mail Code H103, Hershey, PA 17033-0850

Introduction: This analysis characterized localized patterns of emergency mental-health-seeking behavior in the days following US-based mass casualty disasters.

Methods: Mass casualty events were selected for study using two criteria: a) media positioning as front-page headline local news for five or more consecutive days, and b) psychiatric emergency service (PES) impact as rated independently via q-sort by senior emergency psychiatrists. Four disasters met criteria: the Oklahoma City bombing (OKC--1995), Columbine (CHS--1999) and Wedgewood Baptist Church shootings (WBC--1999), and 9/11. Patient visits to Parkland Hospital's PES (Dallas) during the 30 days following each disaster were compared to the same 30 calendar days in years preceding and following each disaster, to control for maturation, historical, and seasonal effects. Study variables included demographics, manner of presentation (voluntary or police-accompanied), presenting symptoms (DSM-IV); and treatment (seclusion, admission).

Results: PES census during OKC, CHS, WBC and 9/11 disaster months were 705, 909, 784, and 835 patients, respectively, and did not differ significantly from control months. The overall disaster month profile included fewer police-initiated (48.5% vs. 44.8%; p=0.0009) and more psychotic (32.5% vs. 41.3%, p=<.0001) and adjustment disordered (4.1% vs. 2.6%, p=0.0002) presentations. After 9/11 there were more ethnic minority presentations (18.3% vs. 14.5%, p= 0.052), and police-initiated visits were significantly elevated after WBC (58.3% vs. 50.9%; p=0.0009).

Conclusions: Mental health presentations after high-impact mass casualty events follow similar patterns; however, the unique characteristics of a particular event (perpetrator profile, geographic proximity, etc) can influence post-disaster mental health help-seeking presentations.

Learning Objectives:

• List two ways to identify a high media impact mass casualty event
• Identify three common shifts in psychiatric emergency help-seeking after a mass casualty national disaster
• Describe one way in which a unique aspect of a recent mass casualty event impacted post-disaster mental health help-seeking in a unique way.

Keywords: Disasters, Mental Health Services

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.