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Psychiatric epidemiology and disaster exposure in Australia

Published online by Cambridge University Press:  27 September 2017

L. Reifels
Affiliation:
Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia Disaster Research Unit, Department of Political and Social Sciences, Free University of Berlin, Berlin, Germany
K. Mills
Affiliation:
NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
M. L. A. Dückers
Affiliation:
Impact – National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Diemen, The Netherlands NIVEL – The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
M. L. O'Donnell
Affiliation:
Phoenix Australia – Centre for Posttraumatic Mental Health, Melbourne, Australia
Corresponding
E-mail address:

Abstract

Aims.

To examine the lifetime prevalence and risk of psychiatric disorders associated with natural and man-made disaster exposure in Australia.

Methods.

We utilised data from a nationally representative population survey (N = 8841) which were analysed through univariate and multivariate logistic regression in order to examine the full spectrum of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) affective, anxiety and substance use disorders associated with exposure to natural and man-made disaster.

Results.

Man-made disaster exposure was primarily associated with an increased lifetime risk (odds ratio (95% CI)) of alcohol abuse disorder 2.29 (1.56–3.37), post-traumatic stress disorder (PTSD) 2.27 (1.36–3.79), obsessive–compulsive disorder (OCD) 1.95 (1.08–3.51) and major depressive disorder 1.69 (1.01–2.85). Multiple natural disaster exposure was associated with an increased lifetime risk of panic disorder 2.26 (1.11–4.61). Among the broader disorder spectrum examined, alcohol abuse disorder accounted for the single greatest increase in lifetime disorder prevalence associated with man-made disaster exposure, and the greatest number of natural or man-made disaster exposed individuals who had developed a lifetime psychiatric disorder. Despite the relatively greater disorder risk associated with man-made disaster, natural disaster exposure was associated with more cases of psychiatric disorder, likely due to the frequency with which these events occur in Australia.

Conclusions.

Notwithstanding the inability to draw causal inferences from cross-sectional survey data, population-based analyses provide a comprehensive and consistent method to ascertain the population imprint of psychiatric disorder and disaster exposure. Mental health policy and services should be targeting a range of psychiatric disorders in disaster contexts in addition to the usual focus on PTSD and depression, including alcohol abuse, panic disorder and OCD. Despite the relatively greater disorder risk associated with man-made disaster exposure, the national burden of psychiatric disorder in natural disaster contexts is particularly high.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2017 

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