City Health Information
Volume 33 (2014) New York City Department of Health and Mental Hygiene No. 1; 1-8



Diagnosing and Managing the Mental Health
Needs of Adults Exposed to Disaster
  • Educate patients about physical and emotional symptoms of normal stress reactions.
  • Ask patients about their exposure and reactions to disaster.
  • Identify patients who may have posttraumatic stress disorder, depression, generalized anxiety disorder, or a substance use disorder and use standard screening tools for further evaluation.
  • Encourage patients to take advantage of psychotherapy, pharmacotherapy, or both.



Anyone affected by a major disaster such as Hurricane Sandy can develop exposure-related mental health disorders, but certain factors place some individuals at higher risk. Ask patients about their exposure to the event and be alert to any risk factors for trauma-related mental health disorders (Box 1) (1,2,5-7).

Trauma-related Risk Factors

The strongest risk factor for trauma-related mental health conditions is severe exposure to the event such as witnessing people being killed or injured. People who experienced strong initial stress reactions are also at higher risk. Stress reactions can be psychological (eg, fear, anxiety, numbness, anger) or physical (eg, insomnia, headaches, reduced appetite, somatic complaints) (3).

Other risk factors include participation in rescue and recovery efforts; financial loss such as loss of a home or income; anxiety or stress due to evacuation or displacement to a shelter or temporary housing, especially for an extended period; and stress due to service disruptions such as power outages and lack of transportation or access to essential care and medication (1,2,5-7).

General Risk Factors

Some people are at higher risk for trauma-related mental health disorders because of factors unrelated to the event. People aged 40 through 60, females, people with a history of trauma exposure (including the World Trade Center disaster), people with psychiatric and medical disorders (including a substance use disorder), and people of low socioeconomic status are at higher risk for developing mental disorders after a disaster (1,2,5-7). Older adults are likely to have medical conditions that increase their risk. Children are also at higher risk due to their age and the effect that their caretakers' reactions can have on them (3) (Resources—City Health Information: World Trade Center Children).


Event-specific risk factors
  • Severe exposure, such as threat to life
  • Severe initial stress reaction
  • Injury and personal loss
  • Economic loss
  • Displacement
  • Major disruption in neighborhood or community
  • Role in rescue/recovery
General risk factors
  • Female gender
  • Young age (child or adolescent)
  • Middle age
  • Low socioeconomic status
  • Immigrant status
  • Previous trauma or disaster exposure
  • History of psychiatric or medical disorders

PDF version of Box 1



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