Health Problems Presented to Family Practices in The Netherlands 1 Year Before and 1 Year After a Disaster

Abstract

Background: Disasters often have negative health consequences. Studies of health problems presented in family practice before and after a disaster are rare. The present study analyzed health problems before and after a disaster and predictors of increased morbidity after the disaster as presented in family practice.Methods: A matched cohort study design with measurements 1 year before the disaster and 1 year after the disaster. Victims (N ‫؍‬ 9183) and matched controls (N ‫؍‬ 7066) were surveyed in the electronic medical records of 30 family practices after the explosions of a fireworks depot in The Netherlands. All health problems were registered using the International Classification of Primary Care.Results: Victims showed significantly higher prevalence rates for psychological problems after the disaster than before the disaster (422 vs133 per 1000 person-years; P < .001) and for problems of the musculoskeletal system (450 vs 401 per 1000 person-years; P < .05).Relocation because of the disaster (odds ratio, 10.65; 95% confidence interval, 8.15-13.94) and, to a lesser degree, psychological morbidity before the disaster (odds ratio, 2.31; 95% confidence interval, 1.42-3.76) were the strongest predictors of psychological problems after the disaster.

Disasters and Population Health

“…Risk factors for MHSU after disaster include (a) level of exposure to disasterbeing trapped even if uninjured, residence in an affected area (Boscarino, Adams, Stuber, & Galea, 2005;Dorn et al, 2006;Smith, Christiansen, Vincent, & Hann, 1999;; (b) indirect consequences of disaster -loss of a child or relocation (Dorn et al, 2006;Soeteman et al, 2007;van der Velden, Yzermans, Kleber, & Gersons, 2007b); (c) residence in a geographically proximate area (Ford, Adams, & Dailey, 2006); (d) having a perievent panic attack (Boscarino, Adams, Stuber, et al, 2005); (e) access -having private insurance, a regular doctor (Boscarino, Adams, Stuber, et al, 2005;van der Velden et al, 2007b); (f) demographics -female gender, single, migrant status, white race (Boscarino, Adams, Stuber, et al, 2005;van der Velden et al, 2007b); (g) history of psychological problems (Soeteman et al, 2007;van der Velden et al, 2007b); (h) poor post-disaster mental health or mental health symptomatology (Ford et al, 2006;Jordan et al, 2004;van der Velden et al, , 2007b; and (i) receiving post-disaster mental health treatment (den Ouden et al, 2005;van der Velden et al, 2007b).…”

“…Risk factors for non-specific mental health problems include (a) direct exposure level to disaster -degree of exposure (de Mel, McKenzie, & Woodruff, 2008;Norris et al, 2002;Wang et al, 2000), witnessing injury, death, or destruction (Ghaffari-Nejad, Ahmadi-Mousavi, Gandomkar, & Reihani-Kermani, 2007;Thomas, 2006), and direct threat of disaster (Thomas, 2006); (b) participation in rescue and cleanup (Dirkzwager et al, 2004;Huizink et al, 2006;Slottje et al, 2007;Spinhoven & Verschuur, 2006); (c) media exposure (Ford, Adams, & Dailey, 2007;Thomas, 2006;Wayment, 2004); (d) characteristics of the disaster -mass violence/intentional man-made event rather than an accidental or a natural disaster (Norris et al, 2002;Thomas, 2006); (e) indirect consequences of disaster -having a child with a severe injury (Dorn, Yzermans, Spreeuwenberg, & van der Zee, 2007), having a close one affected by disaster (Slottje et al, 2007), relocation or residential problem (Dirkzwager et al, 2006;Foster, 2002;Ghaffari-Nejad et al, 2007;Soeteman et al, 2007;Thomas, 2006), or community destruction (Thomas, 2006); (f) proximityproximity to disaster (Foster, 2002;Thomas, 2006), being in the disaster-affected area/city at the time of disaster (Ghaffari-Nejad et al, 2007;Remennick, 2002;Smith et al, 1999;Soeteman et al, 2007), working near the disaster site (Trout et al, 2002); interestingly, some research has found signs of distress in geographically distant groups immediately after disaster, but with no change in ongoing moods (Whalen, Henker, King, Jamner, & Levine, 2004); (g) alcohol problems since disaster -alcohol depen...…”

“…Some authors have attempted to quantify the contribution of each of these risk factors to psychopathology. Soeteman et al (2007) found that pre-disaster psychological morbidity was the strongest predictor of psychological problems after the Enschede Fireworks Disaster, while Wang et al (2000) found that post-disaster variables were as important to psychosocial outcomes as pre-disaster vulnerability after an earthquake in China. The evidence appears mixed; clearly there is support for relationships between psychopathology and pre-disaster conditions, exposure level to disaster, and events occurring after disaster.…”

Gezondheidsproblemen en zorggebruik na drie rampen in Nederland: monitoring in de huisartspraktijk

“…In Volendam en in Enschede werd een tijdelijke verhoging gevonden van het voorkomen van lichamelijk onverklaarde klachten (vooral van het bewegingsapparaat en het spijsverteringskanaal) die na enige maanden terugkeerde naar het niveau van de referentiegroep en/of de periode voor de ramp (Soeteman et al, 2006). In de eerste maanden ging het hierbij vooral om slaapproblemen, stressreacties en een angstig, nerveus gevoel, terwijl na ongeveer drie jaren de nadruk lag op moeheid, malaise en een depressieve stoornis.…”

Globalization, the Underserved, and Poverty: An Interactive and Deadly Triad

“…We have 2 papers from The Netherlands, a country with a strong tradition of primary care research. Soeteman et al 7 consider the types of health problems that increase after a disaster, and the predictors thereof, as found in family medicine offices providing continuity of care before and after the disaster. This may have increased importance in an age of terrorism.…”