Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Medical planning and response for a nuclear detonation: a practical guide.

This article summarizes major points from a newly released guide published online by the Office of the Assistant Secretary for Preparedness and Response (ASPR). The article reviews basic principles about radiation and its measurement, short-term and long-term effects of radiation, and medical countermeasures as well as essential information about how to prepare for and respond to a nuclear detonation. A link is provided to the manual itself, which in turn is heavily referenced for readers who wish to have more detail.

The integration of mental and behavioral health into disaster preparedness, response, and recovery.

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises.

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

Social, psychological, and behavioral responses to a nuclear detonation in a US city: implications for health care planning and delivery.

A nuclear detonation in a US city would have profound psychological, social, and behavioral effects. This article reviews the scientific literature on human responses to radiation incidents and disasters in general, and examines potential behavioral health care provider (BHCP) contributions in the hours and days after a nuclear detonation. In the area directly affected by the blast, the immediate overarching goal of BHCP interventions is the support of lifesaving activities and the prevention of additional casualties from fallout. These interventions include 6 broad categories: promoting appropriate protective actions, discouraging dangerous behaviors, managing patient/survivor flow to facilitate the best use of scarce resources, supporting first responders, assisting with triage, and delivering palliative care when appropriate. At more distant sites, BHCP should work with medical providers to support hospitalized survivors of the detonation. Recommendations are also made on BHCP interventions later in the response phase and during recovery.

Deployment and the probability of spousal aggression by U.S. Army soldiers.

OBJECTIVE: To determine the relationship between length of soldier deployment and self-reports of moderate and severe spousal violence. METHODS: The Conflict Tactics Scale was used to measure self-reports of behaviors exhibited in marital conflict. Surveys were administered to a 15% random sample of 26,835 deployed and nondeployed married active duty U.S. Army men and women in the 50 United States during the period 1990 to 1994. Multinomial logistic regression and ordered probit analysis were used to estimate the probabilities of moderate and severe violence by length of deployment. RESULTS: After controlling for demographic variables, the probability of severe aggression was significantly greater for soldiers who had deployed in the past year compared with soldiers who had not deployed. CONCLUSIONS: Deployment contributes a significant but small increase to the probability of self-reported spousal aggression during a 1-year period. Although deployment is a military operation, similar effects may be observed in certain civilian occupations.

Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Postdeployment domestic violence by U.S. Army soldiers.

The objective of this study was to determine whether a military deployment of 6 months predicted domestic violence against the wives of deployed and nondeployed soldiers during the postdeployment period. The method involved the completion of an anonymous questionnaire by a sample of the spouses of soldiers deployed from a large U.S. Army post. The Conflict Tactics Scale identified incidents of domestic violence by the soldier husbands, and a logistic regression model predicted domestic violence during the postdeployment period. The results indicate that deployment was not a significant predictor of domestic violence during the first 10 months of the postdeployment period. Younger wives and those who were victims of predeployment domestic violence were more likely to report postdeployment domestic violence. The conclusion was that interventions for domestic violence in the U.S. Army should address risks among younger couples and those with a previous incident of domestic violence.

Belief in exposure to terrorist agents: reported exposure to nerve or mustard gas by Gulf War veterans.

September 11 brought increased awareness that even the threat of chemical and biological terrorism can overwhelm this country's health care system. Belief in exposure to toxic agents, even when none is documented, is not uncommon in crisis and merits vigilant health care evaluation and services. This study examined risk factors (demographics, physical symptoms, clinical diagnosis, exposures, and health status) for belief in exposure to potential terrorist agents (nerve or mustard gas) using a large sample of Gulf War veterans who reported belief in exposure to nerve or mustard gas. We found that females, nonwhites, and those who were older (age 32 to 61 years) were more likely to report exposure. When adjusting for demographics and military service, these veterans reported more exposures (nonnerve or mustard gas) to potentially toxic agents and traumatic events (odds ratio [OR], 6.80; p<.001), reported more physical symptoms during the Gulf War (OR, 2.38; p<.001), were more likely to be diagnosed with a mental disorder (OR, 1.72; p<.001), and reported poorer current health status (OR, 3.47 to 1.22; p<.001). Not unlike previously reported studies of disasters, traumatic exposures, or risk exposures, belief in exposure to toxic agents suggests that certain people are at a greater health care risk. This knowledge will aid in better responding to rapid demands that may be placed on our health care delivery systems in times of potential terrorist activity.

Spousal aggression by U.S. Army female soldiers toward employed and unemployed civilian husbands.

Aggression by a random sample of female soldiers (N = 1,185) toward their employed (n = 840) and unemployed (n = 345) civilian husbands was measured by the Conflict Tactics Scale. When age, race, rank, years married, and the number of previous marriages were held constant, severe aggression toward unemployed male spouses was significantly greater than toward employed spouses.

Domestic violence and deployment in US Army soldiers.

Although military deployment has been suggested as a possible cause of increases in domestic violence, little is known about it. The purpose of this study was to determine if deployment of 6 months to Bosnia predicted early postdeployment domestic violence. Active duty recently deployed (N = 313) and nondeployed (N = 712) male soldiers volunteered to take an anonymous questionnaire. Deployment was not a significant predictor of postdeployment domestic violence. However, younger soldiers, those with predeployment domestic violence, nonwhite race, and off-post residence also were more likely to report postdeployment domestic violence. The predicted probability of postdeployment domestic violence for a deployed 20-year-old, nonwhite soldier with a history of predeployment domestic violence and who lives on-post was.20. For the soldier without a history of predeployment domestic violence, it was.05. Prevention and intervention programs for postdeployment domestic violence shortly after return should target age and persons with a domestic violence history rather than deployment per se.

Preparing for bioterrorism at the state level: report of an informal survey.

Members of 18 states' departments of mental health were interviewed about their plans for managing the psychosocial impacts of a bioterrorism event. Questions were developed from recommendations of an international conference on planning for bioterrorism ("Planning for bioterrorism," 2000). Information derived from the survey highlights the need for, and the importance of, mental health consultation to the state's planning process. Familiarity with the unique psychological and behavioral consequences of a bioterrorism event in contrast to natural disasters is essential. Realistic training scenarios that incorporate likely psychosocial impacts and appropriate mental health response must be developed.