The involvement of adolescents already enrolled in a mental-health study in a fatal fire provides insight into important psychiatric outcomes for children who are exposed to a disaster, according to findings published in the August 30th issue of the Lancet. After a fire in a cafe over 2 years ago in which 14 teenagers died, Dutch study investigators showed that treating anxiety, depression, aggression, and alcohol abuse is a priority for mental-health interventions after disasters have occurred.

Although disasters significantly affect the mental health of children and adolescents, it is very difficult to evaluate such effects. A fire at a cafe frequented by adolescents on New Year’s Day 2001 provided an opportunity for Dutch researchers to explore post-disaster effects on psychiatric well-being.

Among the adolescents in the cafe at the time of the fire (which killed 14 adolescents and wounded 250) were 31 of 124 students aged 12 to 15 years who had already been enrolled and evaluated for a study on the effects of health-promotion programs in school on the outcomes of smoking, excessive use of alcohol, and use of psychoactive substances. In addition, researchers could compare those students with an additional 830 students from other schools who had been enrolled in the study but who had not been at the fire scene.

Data were obtained 5 months after the fire for roughly three quarters of the students enrolled in the original study. The adolescents who had been involved in the fire had a 75 percent increase in rates of clinical mental-health symptoms scores compared with the students from uninvolved schools. Scores for depression, anxiety, incoherent thought, and aggression were roughly 3 times greater than among students from the uninvolved schools; alcohol abuse was more than 4 times more likely. There were similar increases in alcohol abuse and mental-health scores for classmates not directly involved in the cafe fire. These increases were larger for girls than for boys.

Lead investigator Sijmen Reijneveld commented, "Postdisaster health care should be aimed at the physical and psychosocial consequences of disaster. Our results confirm the need for services to ameliorate the negative mental health effects of exposure to disaster, including anxiety, depression, incoherent thinking, aggression, and substance use, which commonly occur in combination with post-traumatic stress disorder...Our findings show that adolescents are inclined to react to severe stressful events with excessive use of alcohol. This might help policy-makers and researchers to incorporate prevention and treatment strategies to reduce excessive use of alcohol if a disaster involves adolescents, and to prevent alcohol dependence."