We present in this review the current state of disaster mental health research. In particular, we provide an overview of research on the presentation, burden, correlates, and treatment of mental disorders following disasters. We also describe challenges to studying the mental health consequences of disasters and discuss the limitations in current methodologies. Finally, we offer directions for future disaster mental health research.

The biologic underpinnings of posttraumatic stress disorder (PTSD) have not been fully elucidated. Previous work suggests that alterations in the immune system are characteristic of the disorder. Identifying the biologic mechanisms by which such alterations occur could provide fundamental insights into the etiology and treatment of PTSD. Here we identify specific epigenetic profiles underlying immune system changes associated with PTSD. Using blood samples (n = 100) obtained from an ongoing, prospective epidemiologic study in Detroit, the Detroit Neighborhood Health Study, we applied methylation microarrays to assay CpG sites from more than 14,000 genes among 23 PTSD-affected and 77 PTSD-unaffected individuals. We show that immune system functions are significantly overrepresented among the annotations associated with genes uniquely unmethylated among those with PTSD. We further demonstrate that genes whose methylation levels are significantly and negatively correlated with traumatic burden show a similar strong signal of immune function among the PTSD affected. The observed epigenetic variability in immune function by PTSD is corroborated using an independent biologic marker of immune response to infection, CMV-a typically latent herpesvirus whose activity was significantly higher among those with PTSD. This report of peripheral epigenomic and CMV profiles associated with mental illness suggests a biologic model of PTSD etiology in which an externally experienced traumatic event induces downstream alterations in immune function by reducing methylation levels of immune-related genes.epidemiology | methylation | cytomegalovirus | cumulative trauma | psychiatry

Many families around the world make sizable out-of-pocket payments for health care. We calculated the frequency of borrowing money or selling assets to buy health services in forty low-and middle-income countries and estimated how various factors are associated with these coping strategies. The data represented a combined population of 3.66 billion, or 58 percent of the world's population. On average, 25.9 percent of households borrowed money or sold items to pay for health care. The risk was higher among the poorest households and in countries with less health insurance. Health systems in developing countries are failing to protect families from the financial risks of seeking health care.

The COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research—examining how it affects mental health and recovery; (b) practice—implementing evidence-based stigma reduction initiatives; and (c) policy—coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts.

Exposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least one traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.Studies frequently demonstrate a large burden of exposure to traumatic events among African Americans, particularly in poor urban areas (Alim, Charney, & Mellman, 2006). Findings from the National Crime Victimization Survey (NCVS) show that urban African Americans are more likely than Whites and suburban or rural African Americans to be victims of violent crime such as assault (Federal Bureau of Investigation [FBI], 2008). Additionally, a study of the Detroit metropolitan area reported that non-Whites (who were predominantly African American) had significantly higher odds of experiencing assaultive violence than Whites, controlling for other sociodemographic factors (Breslau, et al., 1998). (Alim, Graves, et al., 2006). We aimed to fill this gap in the literature by examining lifetime exposure to traumatic events and burden of PTSD in an urban African American population, using data from a population-based sample of Detroit residents. We anticipated that the lifetime prevalence of PTSD would be relatively high given that Detroit has one of the highest rates of violent crime of all large U.S. cities (FBI, 2009) and has been for many years experiencing severe economic decline. HHS Public Access Method Participants and MeasuresThis study focused on the 1,306 adult (aged 18 years or older) African American participants of the Detroit Neighborhood Health Study (86.9% of the total study population), a telephone survey that was conducted from September 2008-May 2009. Participants were drawn from a probability sample of households within the city limits of Detroit, and one adult from each household was randomly selected. The overall response rate among eligible persons was 53.0%.We asked participants about lifetime experience with traumatic events using a list of 20 traumatic events, which can be divided into four groups based on type: assaultive violence, other injury or shocking experience, learning about trauma to a loved one, and sudden unexpected death of a loved one (Breslau, et al., 1998). We used the PTSD Checklist (PCL-C), a 17-item self-report measure of Diagnostic and Statistical Manual of Mental Disorders (DSM-I...