title: The course of post-disaster health problems of victims with pre-disaster psychological problems as presented in general practice.
abstract: BACKGROUND
  Survivors of disaster with pre-disaster psychological problems are believed to be at risk for presenting post-disaster psychological and physical morbidity. Up till now this statement is based on cross-sectional studies with self-reported data and without pre-disaster measurement.
  
  
  OBJECTIVE
  To monitor post-disaster health care utilization and morbidity presented in general practice after a man-made disaster by victims and controls with and without pre-disaster psychological problems.
  
  
  METHODS
  A controlled cohort study with pre-disaster (1 year) and post-disaster (two-and-a-half years) data. Victims (N = 2518) of an exploding fireworks depot in a residential area and matched controls (N = 2512), representing patients in 30 general practices, were included. Main outcome measures were utilization measured by GP attendances, and psychological and physical problems registered by the GP using the International Classification of Primary Care.
  
  
  RESULTS
  Only victims without pre-disaster psychological problems demonstrated a significant increase in utilization in the first half year post-disaster. Victims with pre-disaster psychological problems did not. Being a victim (OR = 6.13; 95% CI = 4.84-7.77) had a greater effect than pre-disaster psychological problems (OR = 4.96; 95% CI = 3.96-6.21) on presenting post-disaster psychological problems. Pre-disaster psychological problems had more effect (OR = 1.93; 95% CI = 1.79-2.08) than the effect of being a victim (OR = 1.25; 95% CI = 1.18-1.32) on the development of post-disaster physical symptoms.
  
  
  CONCLUSIONS
  Post-disaster increases in utilization and psychological morbidity were observed. Post-disaster psychological problems were more influenced by the disaster, while post-disaster physical symptoms were more influenced by pre-disaster psychological problems. GPs should concentrate on the pre-disaster health history of victims of man-made disasters in their practices.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht. jh.soeteman@nivel.nl
authors.forename: Rik J H
authors.initials: RJ
authors.lastname: Soeteman
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Kerssens
authors.forename: Anja J E
authors.initials: AJ
authors.lastname: Dirkzwager
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Wil J H M
authors.initials: WJ
authors.lastname: van den Bosch
authors.forename: Jouke
authors.initials: J
authors.lastname: van der Zee
mesh_terms: D000059:Accidents; D000328:Adult; D001753:Blast Injuries / Q000523:psychology* / Q000628:therapy*; D015331:Cohort Studies; D004190:Disasters; D005194:Family Practice; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D009426:Netherlands; D017741:Survivors / Q000523:psychology*; D013997:Time Factors