By Irina Haivas Iasi

Healthcare services after disasters should address anxiety, depression, aggression, and substance misuse of directly affected adolescents and their peer group, says new research in The Lancet (2003;362:691-6).

The researchers interviewed 950 young people who were directly and indirectly involved in a fire that killed 14 youngsters and wounded 250 in a cafe in Volendam, the Netherlands. The results showed an increase in mental health problems and substance misuse in adolescents after the disaster, with girls experiencing a larger increase than boys. Health problems in those affected included anxiety, depression, incoherent thinking, and aggression, as well as excessive drinking and taking marijuana, ecstasy, sedatives, and hypnotics.

The report also suggests, however, that the negative effects of a disaster were apparent among those who had not been exposed to the disaster directly. Experiences, such as losing classmates, friends, and siblings and the daily confrontation with people who survived but were injured, increased problems in this group.

The authors say that health care after disasters must include non-exposed adolescents as well and that "care should be aimed at the physical and psychosocial consequences of disaster."

Dr Reijneveld, president of the Netherlands Epidemiological Society and member of the National Scientific Committee investigating the fire at the Volendam Cafe, said, "Our advice is to pay attention to teens experiencing such events. Schools may be a very good medium for doing so, and they should keep in touch with parents too. This concerns general mental health problems, but also the prevention of alcohol dependence

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