This study examines the role of coping in the onset of post-traumatic stress disorder (PTSD) in a nonpatient population following exposure to a natural disaster. In contrast to other studies, the use of all coping strategies was found to be associated with the presence of PTSD rather than the absence of symptoms. These data suggest that coping (in this sense) represents a psychological process used to contain the distress caused by symptoms as well as to manage environmental adversity.

Recent literature has been concerned with the relationship between life-events and psychological symptoms, and more particularly studies of communities subsequent to disasters have suggested the presence of intrusive cognitions to be a mediating variable. In this investigation new patients presenting to a general community psychiatric clinic over a four-month period completed a brief life-event scale, the Impact of Event Scale (IES) and the 28-item General Health Questionnaire (GHQ). Appropriate statistical methods were employed to model the intervening role of IES scores between numbers of life-events and subsequent psychiatric symptomatology. Data was collected on 48 subjects, for whom it was shown that IES score accounted for the reporting of psychiatric symptoms following adversity. It appeared to be the dimension of cognitive intrusion that mediated this effect, with cognitive avoidance occupying a subsidiary, reactive role. There was also evidence of specific relationships between intrusion and anxiety and somatic subscales of the GHQ, and between avoidance and depression. Despite small numbers and simple measures, the findings supported the post-disaster studies, and raises further questions about the emotional processing of adversity.

The rate of emergency referral is one indicator of the functioning of the service system as a whole. Improvements to the system should include better access to community mental health team services and a greater capacity of the primary care system to manage mental health crises. Services need to be developed that are acceptable to male patients who are experiencing social and behavioral problems.

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