A Brief Report of Surveillance of Traumatic Experiences and Exposures After the Earthquake-Tsunami in American Samoa, 2009

Abstract

Rapid mental health surveillance during the acute phase of a disaster response can inform the allocation of limited clinical resources and provide essential household-level risk estimates for recovery planning. To describe the use of the PsySTART Rapid Mental Health Triage and Incident Management System for individual-level clinical triage and traumatic exposure assessment in the aftermath of a large-scale disaster. We conducted a cross-sectional, comparative review of mental health triage data collected with the PsySTART system from survivors of the September 2009 earthquake-tsunami in American Samoa. Data were obtained from two sources--secondary triage of patients and a standardized community assessment survey-and analyzed descriptively. The main outcome measures were survivor-reported traumatic experiences and exposures--called triage factors--associated with risk for developing severe distress and new mental health disorders following disasters. The most common triage factors reported by survivors referred for mental health services were "felt extreme panic/fear" (93%) and "felt direct threat to life" (93%). The most common factor reported by persons in tsunami-affected communities was "felt extreme panic or fear" (75%). Proportions of severe triage factors reported by persons living in the community were consistently lower than those reported by patients referred for mental health services. The combination of evidence-based mental health triage and community assessment gave hospital-based providers, local public health officials, and federal response teams a strategy to match limited clinical resources with survivors at greatest risk. Also, it produced a common operating picture of acute and chronic mental health needs among disaster systems of care operating in American Samoa.