What percentage of persons exposed to mass casualties go on to develop psychiatric symptoms? Who is most at risk?

November 1, 2006
Volume 5, Issue 4

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.