Mental Health Study: Factors that Influence Coping, Psychological Distress, and Risk for Subsequent Injuries Following a Mass Casualty Event

Purpose:

• To assess the relationship between specific coping strategies and the psychosocial and behavioral sequela of trauma.
• To assess individual, family, and community factors associated with the use of specific coping strategies following a mass casualty event.
• To provide data that would inform others preparing for, and responding to, mass casualty events.

Research questions:

• What type of coping behaviors (e.g., seeking social support, volunteering in relief efforts, increased religious activities, social withdrawal, increased substance abuse) do people engage in following mass casualty events?
• Which coping strategies are most effective at reducing the risk for psychological problems such as depression, anxiety, and Post-Traumatic Stress Disorder (PTSD, and behavioral problems such as reckless, aggressive, or suicidal behavior that could contribute to subsequent injuries?
• What factors (individual, family, community) are associated with using the most effective coping strategies? How do these factors vary among key groups–the general population, the population directly affected by the event, health care providers, emergency response teams, and other vulnerable groups such as children and those with prior trauma experiences?

Setting:

Population in defined area surrounding the mass casualty event, including those who do and do not seek counseling.

Study design:

Case-control, cross-sectional, or longitudinal study of individuals with various levels of exposure, including those most affected (i.e., because of injury outcomes, proximity to the event, or close relationship with direct victims).

Data sources:

Random, digit-dial telephone screening for various levels of exposure followed by personal interviews. Registries of victims and their families, first responders, and volunteer relief workers might also be used to identify those most affected.

Sample variables:

• General: Current and prior exposure to trauma, confidence in public services (esp. health and law enforcement), prior history of substance abuse and mental health problems, and perceptions of vulnerability and control.
• Coping: Behavioral strategies such as helping others, seeking social support, participating in spiritual activities, avoiding reminders of the trauma, substance abuse, and self-sheltering; and cognitive strategies such as denial, confronting, acceptance, and planning.
• Outcomes: Mental health consequences such as anxiety, depression, PTSD, hopelessness, and suicidal ideation; and injury related consequences such as suicidal behavior, family violence, and impaired driving.
• Support: Perceived availability of support by source (friends, family, neighbors, etc.), actual information and support received, barriers and facilitating factors, community mental health resources, formal risk communications, etc.

Time frame:

• Subacute: 4-12 wks following event
• Chronic: 6 months, 12 months, 24 months after event

Potential partners:

CDC, NCIPC; NIMH; SAMSHA; local mental health service agencies