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Book Review   |    
Frederick J. Stoddard
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.7.815
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edited by Fran H. Norris, Sandro Galea, Matthew J. Friedman, and Patricia J. Watson; New York, Guilford Press, 2006, 326 pages, $43

Dr. Stoddard is affiliated with Harvard Medical School and Massachusetts General Hospital, Boston.

The book Methods for Disaster Mental Health Research is a unique contribution to the disaster mental health literature. It presents definitions and concepts and reviews research on the consequences of disaster. It describes the fundamentals of research methods and how to formulate questions and discusses ethical issues. The third section addresses sampling and data collection, with chapters on telephone-based methods, Web-based methods, child studies, and quantitative approaches. A fourth section on planning policy and service delivery explains surveillance and monitoring, the "precepts, pragmatics and politics" of such research, evidence-based treatments, and strategies for training clinicians after large-scale disasters. The book concludes with a special-topics section that addresses children, the uniformed services, minorities, international research, and challenges for the future. Two appendices describe disasters mentioned in the text and how to search the traumatic stress literature.

The authors explain that a disaster is not synonymous with trauma but rather is a category of trauma. Disasters have an acute onset and are time limited, thus differentiating them from wars, epidemics, and mass displacements. The consequences of disasters include acute stress disorder, posttraumatic stress disorder, dissociative responses, depression, and rather interestingly "death anxiety, phobias, and panic disorder" with useful mention that "panic attacks are highly predictive of subsequent consequences." The authors point out that in some samples there is an increased use of alcohol, drugs, or cigarettes, but not in all studies. They also point out that the mental health providers themselves are vulnerable to disaster-related stress (for example, post-Hurricane Katrina).

Research on disaster consequences has, according to the authors, "now sufficiently matured to require investigators to derive novel and theoretically sound questions, exercise good scholarship, choose the best methodologies, and collect data according to the highest ethical standards." The authors highlight three comparative approaches for estimating the effects of disasters. First, "severely exposed groups are sometimes compared with less severely or unexposed groups and differences between them are attributed to the disaster." A second comparative approach is to include predisaster mental health status in the study design, creating a one-group pretest-posttest design. A third way of estimating the effects of disasters is by employing both premeasures and comparison groups to strengthen the studies.

One chapter highlights "qualitative approaches to studying the effects of disasters," drawing from sociology and anthropology, which have used these methods to examine the behavior of individuals, groups, and organizations. Qualitative methods are used for identification, description, and explanation generation in contrast with quantitative methods, which are for explanation testing and control. A well-known method for collection of qualitative data is the use of ethnographic field work and focus groups.

The sections addressing children and families seem too limited given the extent and terrible consequences of disasters for children worldwide. The authors touch on design, reporting child abuse, consent for research (assent is also relevant here), and the principle that "future research be conducted from within a sound developmental, cultural, and ecological framework." The section on the uniformed services addresses issues such as gaining entry, confidentiality, participation of the spouse and family in research, and the importance of becoming familiar with this culture to gain trust. The issue of trust is again present in a chapter on conducting research in minority communities. The authors make strong cases for the inadequacy of existing research in these populations and how minority populations tend to be insulated and distrusting of researchers. This distrust is based on past studies that left participants from minority groups harmed or untreated by researchers. In the final chapter, Matthew Friedman discusses the implications of the book for the field. He favors moving the field toward a "more theoretical and longitudinal perspective." Friedman anticipates greater understanding of the mechanisms underlying psychological reactions as they emerge over time in the wake of disasters. It is hoped that understanding will better inform evidence-based interventions and improve outcomes.

Overall, this book should be read by mental health professionals who seek clearly written, timely, and authoritative presentations on disaster research methodology.




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