A community mental health survey and relief program in Taiwan after the great earthquake-implementation, clinical observation and evaluation

No evidence-based consensus has been reached regarding effective interventions in the immediate and midterm post mass trauma phases. Through a community survey, the mental health of 14,013 evacuees was assessed to assist in the delivery of mental health programmes 2 months after a major earthquake. Three months later, 241 high-risk patients recruited in the second survey were actively served at mobile clinics, having been either identified through the first community survey or referred by mental health aides. The estimated psychiatric morbidity rate at the second month was 13.8 per cent. The sensitivity of the screening survey and the aide-referral method were 76.6 and 61.0 per cent, respectively. Post-traumatic stress disorder (PTSD), major depressive episode and dysthymia were the three most prevalent psychiatric diagnoses at the fifth month. Among those with diagnosis of PTSD, 57 per cent had psychiatric comorbidity, and approximately 50 per cent had other anxiety or depressive disorders before the earthquake. The psychiatrically morbid subjects rarely use health services. The rate of help seeking improved because of this programme. A high risk of mental disorder was found among middle-aged and nervous trait. According to our experience, in addition to development of a sensitive community screening tool, the implementation of programmes to mobilize local resources is critical.