title: Health problems presented in general practice by survivors before and after a fireworks disaster: associations with mental health care.
abstract: OBJECTIVE
  To study the health problems presented to general practitioners by disaster survivors who received specialized ambulatory mental health care.
  
  
  METHODS
  (Longitudinal) case-control study based on general practitioners' electronic medical records.
  
  
  METHODS
  General practice and a mental health institution (MHI) in Enschede, the Netherlands.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. d.denouden@nivel.nl
authors.forename: Dirk-Jan
authors.initials: DJ
authors.lastname: den Ouden
authors.forename: Anja J E
authors.initials: AJ
authors.lastname: Dirkzwager
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000150:complications / Q000523:psychology* / Q000628:therapy; D016022:Case-Control Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D004190:Disasters; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D009426:Netherlands / Q000453:epidemiology; D011602:Psychophysiologic Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy; D017741:Survivors / Q000523:psychology*