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Post-traumatic stress disorder following disasters: a systematic review

  • Y. Neria (a1) (a2), A. Nandi (a3) and S. Galea (a2) (a4) (a5)

Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters.


A systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated.


We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13).


The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

Corresponding author
*Address for correspondence: Dr Y. Neria, Columbia University, College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA. (Email:
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APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III). American Psychiatric Association: Washington, DC.
Abenhaim L, Dab W, Salmi LR (1992). Study of civilian victims of terrorist attacks (France 1982–1987). Journal of Clinical Epidemiology 45, 103109.
Adams RE, Boscarino JA (2005). Differences in mental health outcomes among Whites, African Americans, and Hispanics following a community disaster. Psychiatry 68, 250265.
Ahern J, Galea S, Resnick H, Kilpatrick D, Bucuvalas M, Gold J, Vlahov D (2002). Television images and psychological symptoms after the September 11 terrorist attacks. Psychiatry 65, 289300.
Alexander DA (1993). Stress among police body handlers. A long-term follow-up. The British Journal of Psychiatry 163, 806808.
Armagan E, Engindeniz Z, Devay AO, Erdur B, Ozcakir A (2006). Frequency of post-traumatic stress disorder among relief force workers after the tsunami in Asia: do rescuers become victims? Prehospital and Disaster Medicine 21, 168172.
Basoglu M, Kilic C, Salcioglu E, Livanou M (2004). Prevalence of posttraumatic stress disorder and comorbid depression in earthquake survivors in Turkey: an epidemiological study. Journal of Traumatic Stress 17, 133141.
Bradburn IS (1991). After the earth shook: children's stress symptoms 6–8 months after a disaster. Advances in Behaviour Research and Therapy 13, 173179.
Breslau N, Chase GA, Anthony JC (2002). The uniqueness of the DSM definition of post-traumatic stress disorder: implications for research. Psychological Medicine 32, 573576.
Breslau N, Davis GC, Andreski P, Peterson E (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48, 216222.
Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626632.
Brewin CR, Andrews B, Valentine JD (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748766.
Brunello N, Davidson JR, Deahl M, Kessler RC, Mendlewicz J, Racagni G, Shalev AY, Zohar J (2001). Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology 43, 150162.
Canino G, Bravo M, Rubio-Stipec M, Woodbury M (1990). The impact of disaster on mental health: prospective and retrospective analyses. International Journal of Mental Health 19, 5169.
Carlier IV, Gersons BP (1997). Stress reactions in disaster victims following the Bijlmermeer plane crash. Journal of Traumatic Stress 10, 329335.
Carr VJ, Lewin TJ, Kenardy JA, Webster RA, Hazell PL, Carter GL, Williamson M (1997 a). Psychosocial sequelae of the 1989 Newcastle earthquake: III. Role of vulnerability factors in post-disaster morbidity. Psychological Medicine 27, 179190.
Carr VJ, Lewin TJ, Webster RA, Hazell PL, Kenardy JA, Carter GL (1995). Psychosocial sequelae of the 1989 Newcastle earthquake: I. Community disaster experiences and psychological morbidity 6 months post-disaster. Psychological Medicine 25, 539555.
Carr VJ, Lewin TJ, Webster RA, Kenardy JA, Hazell PL, Carter GL (1997 b). Psychosocial sequelae of the 1989 Newcastle earthquake: II. Exposure and morbidity profiles during the first 2 years post-disaster. Psychological Medicine 27, 167178.
CDC (2004). Mental health status of World Trade Center rescue and recovery workers and volunteers – New York City, July 2002–August 2004. Morbidity and Mortality Weekly Reports 53, 812815.
CDC (2006). Health hazard evaluation of police officers and firefighters after Hurricane Katrina – New Orleans, Louisiana, October 17–28 and November 30–December 5, 2005. Morbidity and Mortality Weekly Reports 55, 456458.
Chang CM, Connor KM, Lai TJ, Lee LC, Davidson JR (2005). Predictors of posttraumatic outcomes following the 1999 Taiwan earthquake. Journal of Nervous and Mental Disease 193, 4046.
Chang CM, Lee LC, Connor KM, Davidson JR, Jeffries K, Lai TJ (2003). Posttraumatic distress and coping strategies among rescue workers after an earthquake. Journal of Nervous and Mental Disease 191, 391398.
Chung MC, Dennis I, Easthope Y, Farmer S, Werrett J (2005). Differentiating posttraumatic stress between elderly and younger residents. Psychiatry 68, 164713.
Cwikel JG, Abdelgani A, Rozovski U, Kordysh E, Goldsmith JR, Quastel MR (2000). Long-term stress reactions in new immigrants to Israel exposed to the Chernobyl accident. Anxiety Stress and Coping 13, 413439.
Durham TW, McCammon SL, Allison EJ Jr. (1985). The psychological impact of disaster on rescue personnel. Annals of Emergency Medicine 14, 664668.
Durkin ME (1993). Major depression and post-traumatic stress disorder following the Coalinga and Chile earthquakes: a cross-cultural comparison. Journal of Social and Behavior Personality 8, 405420.
Favaro A, Zaetta C, Colombo G, Santonastaso P (2004). Surviving the Vajont disaster: psychiatric consequences 36 years later. Journal of Nervous and Mental Disease 192, 227231.
Finnsdottir T, Elklit A (2002). Posttraumatic sequelae in a community hit by an avalanche. Journal of Traumatic Stress 15, 479485.
Franklin CL, Young D, Zimmerman M (2002). Psychiatric patients' vulnerability in the wake of the September 11th terrorist attacks. Journal of Nervous and Mental Disease 190, 833838.
Freed D, Bowler R, Fleming I (1998). Post-traumatic stress disorder as a consequence of a toxic spill in Northern California. Journal of Applied Social Psychology 28, 264281.
Fullerton CS, Ursano RJ, Reeves J, Shigemura J, Grieger T (2006). Perceived safety in disaster workers following 9/11. Journal of Nervous and Mental Disease 194, 6163.
Galea S, Ahern J, Resnick H, Kilpatrick D, Bucuvalas M, Gold J, Vlahov D (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine 346, 982987.
Galea S, Nandi A, Vlahov D (2005). The epidemiology of post-traumatic stress disorder after disasters. Epidemiologic Reviews 27, 7891.
Galea S, Resnick H (2005). Posttraumatic stress disorder in the general population after mass terrorist incidents: considerations about the nature of exposure. CNS Spectrums 10, 107115.
Galea S, Vlahov D, Resnick H, Ahern J, Susser E, Gold J, Bucuvalas M, Kilpatrick D (2003). Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology 158, 514524.
Galea S, Vlahov D, Tracy M, Hoover DR, Resnick H, Kilpatrick D (2004). Hispanic ethnicity and post-traumatic stress disorder after a disaster: evidence from a general population survey after September 11, 2001. Annals of Epidemiology 14, 520531.
Godeau E, Vignes C, Navarro F, Iachan R, Ross J, Pasquier C, Guinard A (2005). Effects of a large-scale industrial disaster on rates of symptoms consistent with posttraumatic stress disorders among schoolchildren in Toulouse. Archives of Pediatrics and Adolescent Medicine 159, 579584.
Goenjian AK, Pynoos RS, Steinberg AM, Najarian LM, Asarnow JR, Karayan I, Ghurabi M, Fairbanks LA (1995). Psychiatric comorbidity in children after the 1988 earthquake in Armenia. Journal of the American Academy of Child and Adolescent Psychiatry 34, 11741184.
Goenjian AK, Steinberg AM, Najarian LM, Fairbanks LA, Tashjian M, Pynoos RS (2000). Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. American Journal of Psychiatry 157, 911916.
Green BL, Grace MC, Vary MG, Kramer TL, Gleser GC, Leonard AC (1994). Children of disaster in the second decade: a 17-year follow-up of Buffalo Creek survivors. Journal of the American Academy of Child and Adolescent Psychiatry 33, 7179.
Green BL, Lindy JD, Grace MC, Gleser GC, Leonard AC, Korol M, Winget C (1990). Buffalo Creek survivors in the second decade: stability of stress symptoms. American Journal of Orthopsychiatry 60, 4354.
Hanson RF, Kilpatrick DG, Freedy JR, Saunders BE (1995). Los Angeles County after the 1992 civil disturbances: degree of exposure and impact on mental health. Journal of Consulting and Clinical Psychology 63, 987996.
Havenaar JM, Rumyantzeva GM, van den Brink W, Poelijoe NW, van den Bout J, van Engeland H, Koeter MW (1997). Long-term mental health effects of the Chernobyl disaster: an epidemiologic survey in two former Soviet regions. American Journal of Psychiatry 154, 16051607.
Hoven CW, Duarte CS, Lucas CP, Wu P, Mandell DJ, Goodwin RD, Cohen M, Balaban V, Woodruff BA, Bin F, Musa GJ, Mei L, Cantor PA, Aber JL, Cohen P, Susser E (2005). Psychopathology among New York city public school children 6 months after September 11. Archives of General Psychiatry 62, 545552.
Hull AM, Alexander DA, Klein S (2002). Survivors of the Piper Alpha oil platform disaster: long-term follow-up study. British Journal of Psychiatry 181, 433438.
Jordan NN, Hoge CW, Tobler SK, Wells J, Dydek GJ, Egerton WE (2004). Mental health impact of 9/11 Pentagon attack: validation of a rapid assessment tool. American Journal of Preventive Medicine 26, 284293.
Joseph S, Yule W, Williams R, Hodgkinson P (1994). Correlates of post-traumatic stress at 30 months: the Herald of Free Enterprise disaster. Behaviour Research and Therapy 32, 521524.
Kessler RC (2000). Posttraumatic stress disorder: the burden to the individual and to society. Journal of Clinical Psychiatry 61 (Suppl. 5), 412; discussion 1314.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.
Koplewicz HS, Vogel JM, Solanto MV, Morrissey RF, Alonso CM, Abikoff H, Gallagher R, Novick RM (2002). Child and parent response to the 1993 World Trade Center bombing. Journal of Traumatic Stress 15, 7785.
Lee I, Ha YS, Kim YA, Kwon YH (2004). PTSD symptoms in elementary school children after Typhoon Rusa. Taehan Kanho Hakhoe Chi 34, 636645.
Liu A, Tan H, Zhou J, Li S, Yang T, Wang J, Liu J, Tang X, Sun Z, Wen SW (2006). An epidemiologic study of posttraumatic stress disorder in flood victims in Hunan China. Canadian Journal of Psychiatry 51, 350354.
Livanou M, Basoglu M, Salcioglu E, Kalendar D (2002). Traumatic stress responses in treatment-seeking earthquake survivors in Turkey. Journal of Nervous and Mental Disease 190, 816823.
Madakasira S, O'Brien KF (1987). Acute posttraumatic stress disorder in victims of a natural disaster. Journal of Nervous and Mental Disease 175, 286290.
McFarlane AC (1988). The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors. Journal of Nervous and Mental Disease 176, 3039.
McFarlane AC, Papay P (1992). Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. Journal of Nervous and Mental Disease 180, 498504.
Miguel-Tobal JJ, Cano-Vindel A, Gonzalez-Ordi H, Iruarrizaga I, Rudenstine S, Vlahov D, Galea S (2006). PTSD and depression after the Madrid March 11 train bombings. Journal of Traumatic Stress 19, 6980.
Mileti D (1999). Disasters by Design. Joseph Henry Press: Washington, DC.
Mirzamani M, Bolton D (2002). PTSD symptoms of mothers following occurrence of a disaster affecting their children. Psychol Rep 90, 431438.
Murphy RT, Wismar K, Freeman K (2003). Stress symptoms among African-American college students after the September 11, 2001 terrorist attacks. Journal of Nervous and Mental Disease 191, 108114.
Najarian LM, Goenjian AK, Pelcovitz D, Mandel F, Najarian B (2001). The effect of relocation after a natural disaster. Journal of Traumatic Stress 14, 511526.
Nandi A, Galea S, Ahern J, Vlahov D (2005). Probable cigarette dependence, PTSD, and depression after an urban disaster: results from a population survey of New York City residents 4 months after September 11, 2001. Psychiatry 68, 299310.
Neria Y, Gross R, Litz B, Maguen S, Insel B, Seirmarco G, Rosenfeld H, Suh EJ, Kishon R, Cook JM, Marshall RD (2007). Prevalence and psychological correlates of complicated grief among bereaved adults. Journal of Traumatic Stress 20, 251262.
Neria Y, Gross R, Marshall R (eds) (2006 a). 9/11: Mental Health in the Wake of Terrorist Attacks. Cambridge University Press: New York.
Neria Y, Gross R, Marshall R (2006 b). Mental health in the wake of terrorism: making sense of mass casualty trauma. In 9/11: Mental Health in the Wake of Terrorist Attacks (ed. Neria Y., Gross R. and Marshall R.). Cambridge University Press: New York.
Neria Y, Gross R, Olfson M, Gameroff MJ, Wickramaratne P, Das A, Pilowsky D, Feder A, Blanco C, Marshall RD, Lantigua R, Shea S, Weissman MM (2006 c). Posttraumatic stress disorder in primary care one year after the 9/11 attacks. General Hospital Psychiatry 28, 213222.
Neuner F, Schauer E, Catani C, Ruf M, Elbert T (2006). Post-tsunami stress: a study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress 19, 339347.
Norris FH (1992). Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology 60, 409418.
Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65, 207239.
Norris FH, Murphy AD, Baker CK, Perilla JL (2004). Postdisaster PTSD over four waves of a panel study of Mexico's 1999 flood. Journal of Traumatic Stress 17, 283292.
Norris FH, Perilla JL, Riad JK, Kaniasty K, Lavizzo EA (1999). Stability and change in stress, resources, and psychological distress following natural disaster: findings from Hurricane Andrew. Anxiety Stress Coping 12, 363396.
North CS, Pfefferbaum B, Narayanan P, Thielman S, McCoy G, Dumont C, Kawasaki A, Ryosho N, Kim YS, Spitznagel EL (2005). Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. British Journal of Psychiatry 186, 487493.
North CS, Smith EM, Spitznagel EL (1994). Posttraumatic stress disorder in survivors of a mass shooting. American Journal of Psychiatry 151, 8288.
North CS, Smith EM, Spitznagel EL (1997). One-year follow-up of survivors of a mass shooting. American Journal of Psychiatry 154, 16961702.
Onder E, Tural U, Aker T, Kilic C, Erdogan S (2006). Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES). Social Psychiatry and Psychiatric Epidemiology 41, 868874.
Ozen S, Sir A (2004). Frequency of PTSD in a group of search and rescue workers two months after 2003 Bingol (Turkey) earthquake. Journal of Nervous and Mental Disease 192, 573575.
Palinkas LA, Petterson JS, Russell J, Downs MA (1993). Community patterns of psychiatric disorders after the Exxon Valdez oil spill. American Journal of Psychiatry 150, 15171523.
Parslow RA, Jorm AF, Christensen H (2006). Associations of pre-trauma attributes and trauma exposure with screening positive for PTSD: analysis of a community-based study of 2,085 young adults. Psychological Medicine 36, 387395.
Pfefferbaum B, Nixon SJ, Krug RS, Tivis RD, Moore VL, Brown JM, Pynoos RS, Foy D, Gurwitch RH (1999). Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing. American Journal of Psychiatry 156, 10691074.
Pynoos RS, Frederick C, Nader K, Arroyo W, Steinberg A, Eth S, Nunez F, Fairbanks L (1987). Life threat and posttraumatic stress in school-age children. Archives of General Psychiatry 44, 10571063.
Quarantelli EL (1995). What is a disaster? Six views of the problem. International Journal of Emergency Mental Health 13, 221229.
Quarantelli EL (ed.) (1998). What is a Disaster: Perspectives on the Question. Routledge: London, New York.
Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology 61, 984991.
Russoniello CV, Skalko TK, O'Brien K, McGhee SA, Bingham-Alexander D, Beatley J (2002). Childhood posttraumatic stress disorder and efforts to cope after Hurricane Floyd. Behavioral Medicine 28, 6171.
Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, Thalji L, Dennis JM, Fairbank JA, Kulka RA (2002). Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. Journal of the American Medical Asssociation 288, 581588.
Scott RB, Brooks N, McKinlay W (1995). Post-traumatic morbidity in a civilian community of litigants: a follow-up at 3 years. Journal of Traumatic Stress 8, 403417.
Shannon MP, Lonigan CJ, Finch AJ Jr., Taylor CM (1994). Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles. Journal of the American Academy of Child and Adolescent Psychiatry 33, 8093.
Silver RC, Holman EA, McIntosh DN, Poulin M, Gil-Rivas V (2002). Nationwide longitudinal study of psychological responses to September 11. Jama 288, 12351244.
Sims A, Sims D (1998). The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma. Psychopathology 31, 96112.
Sloan P (1988). Post-traumatic stress in survivors of an airplane crash-landing: a clinical and explanatory research intervention. Journal of Traumatic Stress 1, 211229.
Smith EM, North CS, Spitznagel EL (1993). Post-traumatic stress in survivors of three disasters. Journal of Social Behavior and Personality 8, 353368.
Soldatos CR, Paparrigopoulos TJ, Pappa DA, Christodoulou GN (2006). Early post-traumatic stress disorder in relation to acute stress reaction: an ICD-10 study among help seekers following an earthquake. Psychiatry Research 143, 245253.
Spurrell MT, McFarlane AC (1993). Post-traumatic stress disorder and coping after a natural disaster. Social Psychiatry and Psychiatric Epidemiology 28, 194200.
Stuber J, Resnick H, Galea S (2006). Gender disparities in posttraumatic stress disorder after mass trauma. Gender Medicine 3, 5467.
Sungur M, Kaya B (2001). The onset and longitudinal course of a man-made post-traumatic morbidity: survivors of the Sivas disaster. International Journal of Psychiatry in Clinical Practice 5, 195202.
Thompson MP, Norris FH, Hanacek B (1993). Age differences in the psychological consequences of Hurricane Hugo. Psychology and Aging 8, 606616.
Tierny K, Lindell M, Perry R (2001). Facing the Unexpected Disaster: Preparedness and Response in the United States. Joseph Henry Press: Washington, DC.
Tucker P, Pfefferbaum B, Nixon SJ, Dickson W (2000). Predictors of post-traumatic stress symptoms in Oklahoma City: exposure, social support, peri-traumatic responses. Journal of Behavioral Health Services and Research 27, 406416.
Tyano S, Iancu I, Solomon Z, Sever J, Goldstein I, Touviana Y, Bleich A (1996). Seven-year follow-up of child survivors of a bus-train collision. Journal of the American Academy of Child and Adolescent Psychiatry 35, 365373.
Ursano RJ, Fullerton CS, Kao TC, Bhartiya VR (1995). Longitudinal assessment of posttraumatic stress disorder and depression after exposure to traumatic death. Journal of Nervous and Mental Disease 183, 3642.
van Griensven F, Chakkraband ML, Thienkrua W, Pengjuntr W, Lopes Cardozo B, Tantipiwatanaskul P, Mock PA, Ekassawin S, Varangrat A, Gotway C, Sabin M, Tappero JW (2006). Mental health problems among adults in tsunami-affected areas in southern Thailand. Journal of the American Medical Association 296, 537548.
Verger P, Dab W, Lamping DL, Loze JY, Deschaseaux-Voinet C, Abenhaim L, Rouillon F (2004). The psychological impact of terrorism: an epidemiologic study of posttraumatic stress disorder and associated factors in victims of the 1995–1996 bombings in France. American Journal of Psychiatry 161, 13841389.
Vernberg EM, Silverman WK, La Greca AM, Prinstein MJ (1996). Prediction of posttraumatic stress symptoms in children after hurricane Andrew. Journal of Abnormal Psychology 105, 237248.
Wang X, Gao L, Shinfuku N, Zhang H, Zhao C, Shen Y (2000). Longitudinal study of earthquake-related PTSD in a randomly selected community sample in north China. American Journal of Psychiatry 157, 12601266.
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