Psychiatric emergency help-seeking following four high media impact mass casualty disasters in the US

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.