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While emergency response is not addressed as an overarching theme, this report focuses on the nuances of mental health within emergency response. A key, but often forgotten aspect of emergency response, the report seeks to better focus the treatment and study of mental health after an emergency. The report discusses how to better study mental illness in populations who have experienced trauma, which will further enable effective treatments. It also discusses a few interventions currently shown to help mitigate PTSD, MDD, and other disorders after a disaster event.

Emily Goldmann, PhD, MPH: assistant research professor of Global Public Health at NYU College of Global Public Health. Previous research includes work within several public health consulting firms and employment in the NYC Department of Health and Mental Hygiene in the Bureau of Adult Mental Health; this work included surveillance of psychological distress, metal illness, hospitalization, and rapid assessment of mental health conditions following hurricane Sandy. 

Sandro Galea MD, MPH, DrPH: a Canadian/American board-certified emergency medicine physician and epidemiologist, Dr. Galea is the current dean of the BU School of Public Health and former chair of Epidemiology at Mailman School of Public Health (Columbia University). His research primarily centers on social production of health within urban populations, including mental health disorders such as mood-anxiety and substance abuse; extensive publications exploring health inequalities, epidemiology, and health within vulnerable populations. Dr. Galea has served on numerous boards and committees analyzing the consequences of mass traumas, including 9/11, Hurricane Katrina, and numerous international conflicts. 

The report includes information gathered by both authors during the course of their own research, including citing several of their own publications within the report. Moreover, as a review article, the report includes work from other prominent epidemiologists, psychologists, and organizers of disaster relief; additionally, there appear to be several reports from various emergency response agencies providing data for prevalence of various mental disorders

1) "Interventions in the acute phase directly following the disaster are designed to promote survivors’ safety and stability and to help them cope with their experiences (12). One such intervention, psychological debriefing or critical incident stress debriefing, was developed in the 1980s for emergency responders and has been used with other victims of trauma (46)."

2) "Exposure to potentially traumatic events is disaster-specific and often measured differently between studies, making it difficult to compare experiences and mental health consequences or to generalize findings to all disaster-affected populations (22). Additionally, most instruments that assess symptoms of mental disorder have been developed and validated in the United States (23, 48) and may lack cultural relevance and validity in areas impacted by disasters worldwide"

3) "These studies can help us understand what factors are associated with different courses of mental illness, which can help us identify the most vulnerable populations and inform tailored interventions"

1) PFA: the article currently contends that most governmental agencies use this 3-pronged approach to mitigate effects after a disaster. I'd be interested in learning which agencies do not use this approach and what their alternative strategies may be.

2) Resilience: this is a term specifically described in the article, detailing the phenomena of how some individuals manage to survive horrific disasters but are devoid of psychological symptoms after. As a relatively new concept, not much is understood at this time. However, much of PTSD, MDD, and other post-traumatic mood disorders focus on traits predisposing an individual to develop the disorder-- I'd be intrigued to know what traits (if any) predisposed resilience.

3) Cocoanut Grove night club fire: a disaster event I had never heard of, was the deadliest nightclub fire in American history. Almost 500 perished, and hundreds more were injured. This, apparently, led to a huge tightening of fire and safety protocols throughout the US

The overarching goal of the report appears to be an overarching analysis of the current systems in place to address and research mental health outcomes in disaster events. The article firstly presents comorbidities known to predispose individuals to development of mental illness.This would be in the hands of the response team to recognize that a certain population may be more predisposed to developing PTSD from the event-- such as children or females, who have shown increased levels of PTSD and MDD. Recognizing that students from an all-girl's K-12 School who have just come from, say, a forest fire will be more likely to develop mental health complications after the disaster than a population of older, male welders will help streamline appropriate responses.

Secondly, by exploring and recognizing these factors (pre, peri, post), emergency responses can help prepare and minimize mental health effects. For example, by implementing PFA in all government agencies, this help mitigate the traumatic effects of experiencing a disaster; PFA includes three distinct goals in treating these patients, including limiting stress reactions and regaining feelings of control. 

Thirdly, while studying mental health in the wake of disasters is crucial to ensuring successful and adequate interventions, there are four major challenges, all discussed in the report (defining target population, obtaining representative sample, implementing an appropriate study design, and measuring key constructs). The authors contend that for future research, several key changes can be made to benefit overall research outcomes. These include widening the scope of psycho-pathological inquiry from to include other disorders such as GAD and panic disorder, the time ranges studied (with higher emphasis on pre/peri factors to help tailor interventions), other factors that create predisposition, and further intervention implementation.

As mentioned earlier, the bibliography provides several of the authors' own works as references/supporting works for the report. These include reports and specific studies. Additionally, there are several governmental and agency reports, giving credit to this report as an overarching review of the process and not being too narrowly scoped. It should be noted the bibliography also includes several psychological and psychiatric works, detailing nuances of mental illness and their respective prevalence. 

This article undertakes reviewing the current approaches to handling mental health in the wake of disasters. It particularly focuses of the current methodologies of research utilized, past methodologies/findings, and how these effect today's approaches to treatment of mental disorders during emergency response. The article begins by discussing the major psychopathology found in populations effected by disasters, including mood disorders such as PTSD and MDD. Other disorders, such as substance abuse and outside symptomologies, are also discussed-- but these first two seem to be the major players addressed here. The work then describes how current comorbidities exist, and how these manifest as pre-disaster risk factors (for example, female disaster survivors are generally more likely to have adverse psychological outcomes, such as PTSD or MDD). Other factors include age, socioeconomic status, and basal trait-level anxiety/depressive symptoms. The report also speaks to during disaster and post-disaster factors as well, as these both have been shown to indicate increased likelihood of developing mental health disorders from a disaster event. Finally, the report delves into current interventions utilized during all three of these time periods (pre, peri, and post), and how these may amplify or diminish the mental health effects of a disaster event. Unfortunately, the paper gives very general guidelines, such as discouraging building in vulnerable locations or testing responses in communities even before disasters occur. For post-disaster preventative measures, however, the report included several key notations-- including implementation of stress debriefings for disaster survivors, and usage of PFA (psychological first aid) to prevent adverse mental health outcomes. 

According to NCBI, this report has been cited 40 times by various other reports. This includes several longitudinal studies, a piece detailing climate change and public health, and several more review articles detailing overarching effects of disasters. Additionally, it has been cited in several shorter pieces focusing on specific disaster events and their subsequent effects on specific populations-- such as the effects of Deepwater Horizon oil spill on the physical health of adult women in So Louisiana. 

Emily Goldmann, PhD, MPH: current assistant research professor at NYU College of Global Public Health, Dr. Goldmann researches environmental and social determinants of mental health conditions. Formerly employed by NYC department of Health and mental Hygiene in the Bureau of mental Health, Dr. Goldmann focused on surveillance of psychological distress, serious mental illness, and psychiatric hospitalization of New Yorkers following Hurricane Sandy.

Sandro Galea, MD, MPH : a canadian/american board-certified emergency physician, Dr. Galea is currently the Dean of BU School of Public Health and former Chair of the Department of Epidemiology of Columbia University's Mailman School of Global Public Health. His particular research includes social production of health within urban populations, and especially notes psychological and mental health disorder prevalence within vulnerable populations, including mood-anxiety disorders and substance abuse. He also has participated in multiple committees and boards analyzing effects of mass trauma in the wake of international conflicts and disasters such as Hurricane Katrina, Iraq/Afghani wars, 9/11, and sub-Saharan Africa  conflicts.