Mental Health Service Use and Outcomes After the Enschede Fireworks Disaster: A Naturalistic Follow-Up Study

Abstract

This study documented the number of people seeking help for mental health problems after a fireworks disaster in Enschede, the Netherlands. It describes their diagnostic characteristics, interventions provided, and their results. Researchers coded data from intakes and medical charts of all patients who sought help (N=1,659) and entered treatment (N=663) at a disaster relief service between May 13, 2000 (day of the disaster), and June 1, 2004. Patients who received more than eight treatment sessions (N=394) and were in treatment one year after the disaster were interviewed with the Composite International Diagnostic Interview (CIDI) (N=228, response rate, 58%) and other questionnaires (N=271, response rate, 69%). In the population probably exposed, the cumulative referral-incidence for disaster-related mental health problems over four years was approximately 10%; in terms of referrals to the mental health facility over five years, the proportion of disaster-related referrals was 5.7%. Among adults, posttraumatic stress disorder (PTSD) was the most common clinical diagnosis (53%, chart sample). However, depression was the most common CIDI diagnosis (58%, CIDI interview sample). The recovery rate was about 50% on the basis of clinical judgment (chart sample), between 69% and 76% on the basis of "healthy" scores on symptoms, and between 39% and 60% in social and physical functioning (interview sample). Apart from persons seeking support during the first weeks postdisaster, the largest influx occurred after about one year and was limited in size. Clinicians in specialized services should be aware that conditions other than PTSD, such as depression, anxiety, substance abuse, and somatoform disorders, are also quite common after disasters.