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On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, interagency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.
A substantial amount of research pertinent to understanding the effects of disasters has been published over the past 20 years. Part I of this review described results for 160 distinct samples composed of over 60,000 individuals who experienced 102 different events (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty this volume). These samples' experiences and outcomes were studied using a variety of designs, time frames, assessment strategies, and sampling methods. Although American adults were overrepresented in the data, the samples were impressively diverse, including children, adolescents, college students, and older adults as well as middleaged adults, from 29 countries or territories and five continents. Living in a variety of resource contexts, these survivors experienced almost every imaginable type of disaster, including floods, hurricanes, earthquakes, wildfires, nuclear and industrial accidents, an array of transportation accidents on the ground, in the air, and at sea, terrifying sniper attacks, and bombings that caused unthinkable destruction and death. Individuals' experiences ranged from little more than inconvenience to lifethreatening danger, severe injuries, multiple bereavements, and the total destruction of their communities. Accordingly, it is not surprising that psychological outcomes varied across samples from a predominance of transient stress reactions to prevalent and persistent psychopathology. In this companion article, we aim to summarize and interpret the empirical results and to draw implications from them for practice...