Psychiatric morbidity and posttraumatic symptoms among earthquake victims in primary care clinics Yen Kuang Yang, M.D. a , Tzung Lieh Yeh, M.D. a, *, Chwen Cheng Chen, M.D., Ph.D., M.R.C. Psych a,e , Chih Kuei Lee, M.D., M.P.H. b , I Hui Lee, M.D. a , Li-Ching Lee, Ph.D. c , Keith J. Jeffries, M.H.S. d a Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University and University Hospital, Tainan, Taiwan b Department of Family Medicine, Pu-li Christian Hospital, Nantou, Taiwan c Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA d National Institutes of Health, Bethesda, MD USA e Pharmacia Taiwan Inc., Taipei, Taiwan Abstract Three months after the devastating Chi-Chi earthquake (magnitude of 7.3 on the Richter scale) struck the central area of Taiwan, 663 victims were screened for psychiatric morbidity at a local general hospital in a community mental health program. The rate of psychiatric morbidity as defined by the 12-item Chinese Health Questionnaire as greater than 4, was 24.5%. Posttraumatic symptoms were still prevalent. The rate of posttraumatic stress disorder was 11.3%, and the rate of partial PTSD was 32.0%. Variables associated with the presence of psychiatric morbidity and posttraumatic symptoms included female gender, old age, financial loss, obsessive trait, and nervous trait. A disproportionate use of mental health services (18%) was found, suggesting an urgent need to deliver mental health care to disaster victims at local medical settings. In addition, health care professionals who work with the earthquake victims need to be promptly and efficiently trained in mental health crisis intervention. © 2003 Elsevier Science Inc. All rights reserved. Keywords: Psychiatric morbidity; Posttraumatic stress disorder; Earthquakes; Medical setting 1. Introduction At 1:47 AM on September 21, 1999, an earthquake reg- istering 7.3 on the Richter scale struck the central area of the island of Taiwan, causing about 2,500 deaths and 17,048 damaged or destroyed homes and buildings [1]. As a result, many victims were forced to relocate elsewhere. Although Taiwan is often subject to natural disasters, such as ty- phoons, massive mudslides, and earthquakes, this repre- sented the most devastating disaster in the last 100 years. Prior studies have shown that the impact of disasters on the psychiatric and psychosocial status of victims is serious [2– 4]. This event posed a significant public mental health care challenge since there had been few prior experiences in caring for a large number of victims after catastrophic earthquakes in Taiwan [5,6]. The risk of posttraumatic stress disorder (PTSD) follow- ing exposure to trauma is 9.2% [7]. The prevalence is 3 times higher in Vietnam veterans who were not wounded than in the general population and 20 times higher in those who were wounded [8]. Motor vehicle crashes present the most adverse combination of frequency and impact, and tragic deaths occur most often [9]. Resnick, et al. [10] reported that the lifetime prevalence of PTSD in civilians after traumatic events is 12.3%, with the rate significantly higher among crime versus noncrime victims. Data from a recent epidemiological survey indicated that approximately 80% of individuals with PTSD also met the criteria for at least 1 other psychiatric diagnosis [3,11]. Patients, however, may unconsciously neglect traumatic history and simultaneously ignore their mental problems, such as PTSD or depression. Clinicians may also confuse PTSD and other mental disorders with other medical diag- noses, unaware of the possibility of co-morbidity [12,13]. The consequences of being traumatized by an earthquake or other traumatic events are enormously costly, not only to the * Corresponding author. Tel.: +886-6-2766188; fax: +886-6- 2759259. E-mail address: yehtl@mail.ncku.edu.tw (T.L. Yeh). General Hospital Psychiatry 25 (2003) 253–261 0163-8343/03/$ – see front matter © 2003 Elsevier Science Inc. All rights reserved. doi:10.1016/S0163-8343(03)00022-7