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.