title: Posttraumatic stress disorder in rural primary care: improving care for mental health following bioterrorism.
abstract: BACKGROUND
  Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors.
  
  
  OBJECTIVE
  Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities.
  
  
  METHODS
  We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities.
  
  
  CONCLUSIONS
  Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.
authors.affiliation: Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. jtsao@mednet.ucla.edu
authors.forename: Jennie C I
authors.initials: JC
authors.lastname: Tsao
authors.forename: Aram
authors.initials: A
authors.lastname: Dobalian
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Wiens
authors.forename: Julius A
authors.initials: JA
authors.lastname: Gylys
authors.forename: Garret D
authors.initials: GD
authors.lastname: Evans
mesh_terms: D023482:Bioterrorism / Q000523:psychology*; D003156:Community Mental Health Services / Q000458:organization & administration*; D004189:Disaster Planning; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D014481:United States