Health problems presented in general practice by survivors before and after a fireworks disaster: Associations with mental health care

Objective. To study the health problems presented to general practitioners by disaster survivors who received specialized ambulatory mental health care. Design. (Longitudinal) case-control study based on general practitioners' electronic medical records. Setting. General practice and a mental health institution (MHI) in Enschede, the Netherlands. Subjects. A total of 728 adult disaster survivors who were registered in 30 study practices and had attended a specialized mental health institution (MHI group), and 728 practice-matched controls. Main outcome measures. Attendance rates in general practice before and after the disaster; health problems presented to the GP, classified according to the International Classification of Primary Care. Results. Disaster survivors in the MHI group reported higher GP attendance rates pre- and post-disaster and more health problems than controls. In the year post-disaster, the MHI group reported an increase in psychological, medically unexplained physical symptoms (MUPS), gastrointestinal and musculoskeletal problems, compared with the year pre-disaster. Controls, survivors themselves, showed also an increase in psychological problems in the year post-disaster compared with the year pre-disaster. Conclusion. General practitioners should be aware of an increase in consultations and health problems among patients who also receive mental health care following a disaster. The services of GP and mental health care professionals should be integrated when supporting disaster victims. Information on severity of exposure to disasters should be included in disaster databases.