Is psychiatric medical response necessary during disasters? J-SPEED data analysis by Disaster Psychiatric Assistance Teams

Is psychiatric medical response necessary during disasters? 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J-SPEED data analysis by Disaster Psychiatric Assistance Teams Yoshifumi Takagi, Sho Takahashi, Tatsuhiko Kubo, Yasuhisa Fukuo, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6056492/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The frequency and severity of natural disasters have increased globally, leading to mental health challenges. In response, the Mental Health and Psychosocial Support (MHPSS) framework emphasizes a multi-tiered approach, from basic care to specialized interventions. In Japan, Disaster Psychiatric Assistance Teams (DPAT) provide acute-phase psychiatric care, but limited evidence exists on whether this specialized medical response is more necessary than non-medical interventions. Methods This study analyzed 700 cases from the Japan Surveillance in Post Extreme Emergencies and Disasters (J-SPEED) database from June 28, 2018, to July 31, 2021. Disasters included heavy rains, earthquakes, and COVID-19–related missions. Interventions were classified as “psychiatric medical” (e.g., psychiatric care, medication) or “non-medical” (e.g., community support, counseling). We compared disaster type, timing, demographics, diagnosis, and outcome using chi-square tests and residual analyses. Results Overall, 34.7% of cases involved psychiatric medical responses and 65.3% non-medical responses. Heavy rain disasters showed a higher proportion of psychiatric interventions, whereas earthquake and COVID-19 missions had non-medical support. Psychiatric needs peaked between 3 and 14 days post-disaster. Individuals aged 65 or older more often required psychiatric care, commonly associated with stress-related (F4) and mood (F3) disorders. Ongoing support was more common among those receiving psychiatric medical interventions. Conclusion These findings highlight the importance of specialized psychiatric support during the acute phase of disasters, several days after onset when mental health needs become more apparent. DPAT’s approach—integrating Level 3 and Level 4 MHPSS interventions—may serve as a model for other regions. Further research should validate these results and refine acute-phase disaster mental health strategies. Psychiatric medical response natural disasters COVID-19 J-SPEED Disaster Psychiatric Assistance Team (DPAT) 1 Introduction In recent years, the frequency of natural disasters has increased worldwide, with serious consequences. The recent novel coronavirus disease 2019 (COVID-19) pan-demic, which is also considered an infectious disease disaster, has caused large-scale infections, deaths, and mental health issues worldwide [1, 2]. Disasters are known to cause post-traumatic stress disorder (PTSD), depression, and other mental disorders [3, 4]. Also, floods, tornadoes, and hurricanes, these events affect the mental health of a population, leading to the development of psychiatric conditions such as PTSD, as well as mood disorders like depression and anxiety [5]. A focused systematic review and meta-analysis of 27 studies from 1980 to 2017 on the prevalence of psychological dis-tress and mental illness after natural disasters found an increase in the prevalence of PTSD of 19.7% [4]. In addition, a survey study of survivors of 11 natural disasters found a prevalence of post-disaster depression ranging from 13–22% [1]. Furthermore, psychiatric symptoms such as anxiety, insomnia, and mood / emotional symptoms have been found to occur during the acute phase immediately following a disaster [6]. Therefore, it is important to address a wide range of mental health needs starting from the acute phase of a disaster. In 2007, the Inter-Agency Standing Committee (IASC) published the world's first Mental Health and Psychosocial Support Guidelines (MHPSS Guidelines) as a standard for addressing mental health and psychosocial needs during humanitarian crises such as disasters [7]. Since then, the World Health Organization (WHO) and the International Committee of the Red Cross (ICRC) have further developed the MHPSS Guidelines, and MHPSS is considered the global standard for a wide range of mental health responses in crisis situations. The MHPSS categorizes support as a pyramid with four levels: "basic support and safety" including food, clothing, and shelter (Level 1); "community and household support" (Level 2); " support for those in greater need than other victims " (Level 3); and "specialized support" including treatment by specialists (Level 4). In the context of mental health and psychosocial support during disasters, Psychological First Aid (PFA) has been standardized and positioned within the framework of MHPSS (Mental Health and Psychosocial Support). PFA is based on five fundamental principles: "1. Promote safety and a sense of security," "2. Promote calmness," "3. Promote connectedness," "4. Promote a sense of efficacy for individuals and communities," and "5. Promote hope" [8]. Additionally, cognitive behavioral therapy (CBT) is considered important for enhancing these basic principles of PFA and facilitating the process of recovery [8]. In Japan, the need for acute disaster medical care was recognized after the Great Hanshin-Awaji Earthquake in 1995. The Disaster Medical Assistance Team (DMAT) was established in 2005 and has remained active [9]. In addition, since the Great East Japan Earthquake of 2011, a Japanese version of the MHPSS system of mental health and psychosocial support in the event of a disaster response has been established. This system is officially implemented by the Disaster Psychiatric Assistance Team (DPAT), which was established in 2013 [6, 10]. The DPAT is a multidisciplinary psychiatric and emergency medical team consisting of a psychiatrist, nurses, and logistics personnel (social workers, psychologists, pharmacists, and administrative staff etc.). The DPAT system is configured for psychiatric care and begins responding to psychiatric needs in acute disaster areas within 48 hours of a disaster [11]. Since DPAT is primarily a response to acute stress reactions such as anxiety, insomnia, and depression during the acute stages of a disaster, psychiatrists will play a crucial role. It then transitions from psychiatric medical response to the need for psychosocial support. The decision to pro-vide psychiatric medical response to disaster victims is at the discretion of each DPAT team. The psychiatrist's medical judgment takes precedence, and the decision is made in consultation with the DPAT team's nurses, psychologists, and social workers. As described above, to enable rapid response in times of disaster, specialized training and education are obligatory. It is common to receive PFA to assist in recovery following traumatic events and personal crises. To date, DPAT has provided emergency assistance during numerous natural and infectious disease disasters including COVID-19 [12, 13]. Globally, however, there are no reports of organized psychiatric teams providing advanced mental health care during the acute phase of a disaster [10]. While there is growing evidence to support the effectiveness of post-disaster trauma interventions, it has been noted that more research on interventions geared towards the acute phase of disasters is needed [14]. Studies assessing the methodological quality of the MHPSS guidelines have found that people who have faced adversity are more at risk of experiencing both acute and long-term mental health issues, suggesting the difficulty of formulating appropriate responses to acute mental health problems [15]. In other words, medical responders such as DPATs, who are considered a small part of the aid described by the MHPSS but account for a large proportion of public mental health support in Japan, have never been examined to determine the extent of their actual necessity in a disaster or whether they can be replaced by non-medical professional responders. As a result, medical responses to mental health emergencies during the acute phase of a disaster have not been adequately studied. A record of DPATs assistance activities has been compiled into a database using Japan Surveillance in Post Extreme Emergencies and Disasters: J-SPEED [11]. J-SPEED records the DPATs disaster medical records rather than the electronic medical records for each victim during disaster relief [16]. It is a standard disaster medical record similar to the Emergency Medical Team Minimum Data Set (MDS), which has been adopted as an international WHO standard, and was developed and introduced in 2015 as a means to maintain disaster medical records [17]. Therefore, this study analyzed J-SPEED data from past disasters in which DPATs were deployed to determine whether a psychiatric medical response is truly necessary in the acute phase of a large-scale disaster and whether it differs from non-medical responses. 2 Methods 2.1 Study Subjects The cases in this study were victims of natural disasters that occurred between June 28, 2018, and July 31, 2021, including the Hokkaido Eastern Iburi Earthquake in 2018, Northern Kyushu Heavy Rains in 2019, Typhoon HAGIBIS in 2019, the July 2020 Heavy Rains, Mt. Izu Landslide Disaster in 2021, West Japan Heavy Rains in 2021, as well as air returnees from Wuhan, China during COVID-19 on February, 2020, who received DPAT support and were registered in J-SPEED. Case data were collected from an anonymized database created using the J-SPEED " Mental Health version." 2.2 Statistical Analysis First, the J-SPEED " Mental Health version " data active between June 28, 2018, and July 31, 2021, were extracted from the J-SPEED database to create an individual dataset. Natural disasters were categorized as heavy rains and earthquakes. The quarantined cruise ship Diamond Princess for COVID-19-related responses and hospital support by cluster infections were analyzed separately for other special missions. The survey items analyzed were: "demographics” (age, sex), "duration of response," "place of response” (shelter, home), "diagnosis (F0: organic mental disorders, F1: substance use disorders, F2: schizophrenia, F3: mood disorders, F4: neurotic and stress-related disorders, F5: behavioural syndromes, F6: personality disorders, F7: mental retardation, F8: developmental disorders, F9: childhood behavioural disorders, F99: unspecified mental disorder, and G40: episodic disorders)," "type of support” (psychiatric care, physical care, medication, admission / health and welfare services, response in community, workplace, and home, case management, counseling), and "outcome of support” (single instance or ongoing). The duration of response was based on 1 to 2 weeks [hyperacute phase], 1 month [acute phase], and more than 1 month [medium to long term] [10] after the disaster, and this timing breakdown was further classified into 4 groups: "within 48 hours," "within 3 to 14 days," and "within 15 to 28 days" for the hyperacute and acute phases, and "more than 1 month" for the mid- to long-term phase. The J-SPEED " Mental Health version " form and data collection have been reported previously [12]. Next, among the support types, psychiatric care, physical care, medication, and admission were classified as "Psychiatric Medical Response," while health and welfare services, community response, workplace response, home response, case management, and counseling were classified as "Non-Medical Response (Table 1 )," and among the survey items "disaster type," (heavy rain, earthquake, covid-19), "duration of response," "age group” (under 65, 65 and older), "sex," "place of response," "diagnosis," and "outcome" were compared. When comparisons were made, cross-tabulations were performed, significant differences were examined with chi-squared tests, and residuals were analyzed if significant bias was found. The absolute value of the adjusted residuals was greater than 1.96. When the expected value of the cross-tabulation was less than 5, a Fisher's exact probability test was performed. In addition, this study also performed a cross-tabulation analysis of effect size "Φ" and "Cramer’s V" (0.5, and above: strongly related; 0.3–0.49: related; 0.1–0.29: weakly related; below 0.1: unrelated) [18] was used as the criterion for measurement. Regression analysis and correction for multiple testing were not conducted because the number of cases for certain clinical characteristics was insufficient. SPSS software (ver. 28.0; IBM Corp., Armonk, NY, USA) was used for statistical analysis, with a statistical significance level of 5%. The Hiroshima Universi-ty Ethics Committee examined and approved the ethical procedure used in this study (approval number: E − 2059). 3 Results 3.1 Basic characteristics, timing, mental health statuses outcome of subjects compared between psychiatric medical and non-medical responses Table 2 presents the type of disasters, duration of response, age, sex, mental health statuses, and outcome of the subjects compared between psychiatric medical response and non-medical responses. Data was collected from 700 medical examinations. Of these, 365 occurred during heavy rains, 66 during earthquakes, and 269 were related to COVID-19. The overall psychiatric medical response was 243 people (34.7%), and the non-medical response was 457 people (65.3%). By type of disaster, for heavy rain, psychiatric medical response was 173 people (47.4%), and non-medical response was 192 people (52.6%). For earthquake, psychiatric medical response was 14 people (21.2%), and non-medical response was 52 people (78.8%). For COVID-19-related disasters, psychiatric medical response was 56 people (20.8%), and non-medical response was 213 people (79.2%). In terms of heavy rain, the results of the residual analysis showed that significantly more people received psychiatric medical response than non-medical response during natural disasters. In contrast, non-medical response was significantly more common than psychiatric medical response when they were earthquakes and COVID-19 related (χ2 = 54.137; p < 0.0001, Cramer’s V = 0.28). In terms of the duration of response, psychiatric medical response was provided within 3–14 days, and non-medical response was provided within 48 hours more frequently than at other periods (χ2 = 98.472; p < 0.0001, Cramer's V = 0.38). Regarding age distribution, there was significantly more psychiatric medical response for people in 65 years and older and non-medical response for people in younger than 65 (χ2 = 18.935; p < 0.0001, φ = 0.16). There were no significant differences by sex (χ2 = 0.052; p < 0.819, φ = 0.01). No significant differences were found between shelters and homes in terms of response location (χ2 = 1.530; p < 0.216, φ = 0.06). In terms of diagnosis, psychiatric medical response was provided more frequently than non-medical response when the people had F0(χ2 = 11.311; p < 0.0001, φ = 0.13), F1༈χ2 = 13.298; p < 0.0001, φ = 0.14༉, F2༈χ2 = 12.674; p < 0.0001, φ = 0.14༉, F3༈χ2 = 20.292; p < 0.0001, φ = 0.17༉, F4༈χ2 = 107.453; p < 0.0001, φ = 0.39༉, F5༈χ2 = 7.566; p < 0.014, φ = 0.10༉, G40༈χ2 = 7.566; p < 0.014, φ = 0.10༉. However, non-medical intervention was more frequent than psychiatric medical intervention in cases diagnosed with F99༈χ2 = 4.049; p < 0.044, φ = 0.08༉. It was moderately associated with F4. In addition, psychiatric medical response was provided significantly more often than non-medical response when ongoing support was needed, and non-medical response was provided significantly more often than psychiatric medical response when support was discontinued after a single visit (χ2 = 24.019; p < 0.001, φ = 0.20). Table 1 Classification and distribution of type of supports Type of response Item N* Psychiatric Medical Response Psychiatric care 206 Physical care 35 Medication 69 Admission 6 Non-Medical response Health and welfare services 130 Response in community, workplace, and home 238 Case management 78 Counseling 609 *Note: multiple answer items Table 2 Basic Characteristics, Timing, Mental Health Status, Outcome of Subjects Compared Between Psychiatric Medical and Non-Medical Responses Psychiatric Medical Response Non-Medical response x 2 Φ Cramer’s V p n % n % Type of disaster heavy rain 173* 47.4 192 52.6 54.137 0.28 < 0.0001 earthquake 14 21.2 52* 78.8 COVID-19 56 20.8 213* 79.2 Duration of response within 48 hours 28 11.2 223* 88.8 98.472 0.38 < 0.0001 within 3–14 days 173* 49.9 174 50.1 within 15–28 days 32 41.6 45 58.4 more than 1 month 10 40.0 15 60.0 Age under 65 155 30.0 361* 70.0 18.935 0.16 < 0.0001 65 and older 88* 47.8 96 52.2 Sex male 135 34.4 258 65.6 0.052 0.01 0.819 female 108 35.2 199 64.8 Place of response shelter 135 43.8 173 56.2 1.530 0.06 0.216 home 32 52.5 29 47.5 Diagnosis (ICD-10) F0 14* 70.0 6 30.0 11.311 0.13 < 0.0001 F1 7* 100 0 0.0 13.298 a 0.14 < 0.0001 F2 17* 68.0 8 32.0 12.674 0.14 < 0.0001 F3 24* 70.6 10 29.4 20.292 0.17 < 0.0001 F4 120* 66.3 61 33.7 107.453 0.39 < 0.0001 F5 4* 100.0 0 0.0 7.566 a 0.10 0.014 F6 1 33.3 2 66.7 0.003 a 0.002 1.000 F7 7 41.2 10 58.8 0.321 0.02 0.571 F8 10 55.6 8 44.4 3.541 0.07 0.060 F9 4 80.0 1 20.0 4.557 a 0.08 0.052 F99 2 11.8 15* 88.2 4.049 0.08 0.044 G40 4* 100.0 0 0.0 7.566 a 0.10 0.014 Outcome single instance 113 30.5 257* 69.5 24.019 0.20 0.001 ongoing 114* 50.7 111 49.3 Note: χ2 test. *Residual Z > 1.96; a Fisher's exact test; p 0.5 (strong); 0.3–0.49 (moderate); 0.1–0.29 (weak); <0.1 (no association). 4 Discussion This study used data from DPAT activities for natural disasters and COVID-19 in Japan to examine whether a psychiatric medical response to mental health needs is necessary during the acute phase of disasters. As far as we could find, to date there are few reports comparing disaster psychiatric medical response and non-medical response during the disasters, as examined in this study. In particular, DPAT falls under Level 4 of the MHPSS. The focus on this point in this study reveals that Level 4 and Level 3 activities are, in fact, occurring simultaneously. 4.1 Importance of psychiatric response during the acute phase of disasters The results of this study indicate that the need for psychiatric medical response increases in the immediate aftermath of natural disasters such as heavy rain accompanying typhoons, and earthquakes. In previous studies on the acute phase of disasters, we have found identified the need to reduce anxiety and prevent sleep disturbances, as well as observed the impact on mood / emotion [6]. Although not a natural disaster, it has been reported that even in disasters like the 9/11 terrorist at-tacks, there is a necessity for psychiatrists to assess the need for psychiatric treatment and medication therapy, and to conduct triage for continuous care [19]. The results of this study confirm the importance of a medical response to mental health symptoms following disasters. On the other hand, responses to the spread of COVID-19 appeared to be more non-medical than medical, as they were a prophylactic care for mental health deterioration caused by isolation measures: Of the assistance provided by the DPAT to passengers on the Diamond Princess, about 90% was PFA, and it is believed that brief communication, not necessarily medical, led to relief of anxiety [12]. 4.2 Factors requiring psychiatric response during the acute phase of a disaster For the hyperacute phases (48 hours or less, 3 to 14 days), the acute phase (15 to 28 days), and the medium to long-term phase (1 month or more), we examined the differences in psychiatric medical response and non-medical response. Non-medical support was needed more often than psychiatric medical response within 48 hours or less. However, it was found that psychiatric medical needs were increasing more rapidly than non-medical needs within 3 to 14 days of the start of activities. In the immediate aftermath of a disaster, DPATs role is to set up a command center and establish a system of instructions in cooperation with local health facilities and DMATs [11]. In other words, within 48 hours of the start of the hyper-acute phase, the DPAT focused on non-medical response, such as patient transport, rather than direct individual psychiatric medical response. On the other hand, the results suggest that after 3 days, the need for medical support would become apparent as the DPAT support system was established and support of evacuation centers was initiated. Depending on the disaster situation, medical resources and services in the affected area may not have ceased even immediately after the disaster. In this case, it was considered that the main response would be by MHPSS Level 3, not by medical specialty care response. In the immediate aftermath of a disaster, victims are less likely to seek psychiatry care and psychological support on their own. Therefore, it needs to be modified to meet changing local medical needs over time. Early intervention plays a critical role in disaster situations. Preventing anxiety and sleep disorders and managing their influence on mood and emotions should be a top priority. This requires prompt collaboration with relevant support teams as soon as the acute phase of the disaster begins. Therefore, in the context of a disaster or humanitarian emergency, specialized teams should be equipped to provide both Level 3 and Level 4 services to address a comprehensive spectrum of needs. By examining the various aspects discussed above, the importance of psychiatric medical responses during the acute phase of a disaster has become clear. The need for practical guidelines to reduce disaster-related mental health risks is suggested [15]. Based on the results of this study, we propose that it would also be desirable for other countries to consider establishing organizations such as DPAT to provide psychiatric response during the acute phase of disasters. 4.3 Limitations This study has several limitations. First, due to the timing of the survey, the COVID-19 data was limited to returnees from Wuhan, which may lead to selection bi-as. Also, the sample sizes for the various groups in this survey were different due to the multiple heavy rain disasters. In addition, the characteristics of the affected areas and victims are different, which also limits the generalizability of the result. In addition, since the J-SPEED mental health version has been in use since the “West Japan Rainstorm of 2008,” which is the subject of this study, it is necessary to consider the accuracy of some of the data input. Despite these limitations, we believe that this study has a unique strength in that it provides mental health data from the acute phase of disasters, which was not previously available. Further research is needed to validate the findings of this study and to expand the data collection to include other mental health support for the acute phase of disasters. 5 Conclusion This study examined natural disasters (heavy rains, and earthquakes) and COVID-19-related disasters data where DPATs were active. The study found a strong need for psychiatric medical response during natural disasters from the acute phase following the disaster. This study supports the importance of psychiatric medical response during the acute phase of a disaster, the duration of response (from 48 hours to 1 month), and ongoing assistance for support outcomes were found to significantly increase psychiatric medical response. It is hoped that DPAT will serve as a model for other countries to implement psychiatric response during disasters. Declarations Ethics approval and consent to participate Approval was obtained from the Hiroshima University Ethics Committee (number: E−2059). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Informed Consent Statement In this study, all data are anonymized, no-patient identifiable data were recorded at any time, and informed consent of patients was not required. The need for informed consent was waived by Hiroshima University ethics committee/IRB. Data Availability Statement The authors do not have permission to share data. Competing interests The authors declare no competing interests. Author Contributions Conceptualization, Y.T., S.T. and H.T.; Methodology, Y.T., S.T. and H.T.; Formal analysis, Y.T. and H.T.; Data curation, Y.T. and H.T.; Writing—original draft preparation, Y.T. and H.T.; visualization, Y.T. and H.T.; Supervision, T.K. and H.T.; Writing—review and editing, Y.T., S.T., T.K., Y.F., S.G., C.Y., T.A., and H.T.; Project administration, H.T.; Funding acquisition, Y.F. and H.T. All authors have read and agreed to the published version of the manuscript. Funding This work was supported by Ministry of Health, Labour and Welfare Comprehensive Research on Disability Health and Welfare Program Grant Number 23IA1004. Clinical trial number Not applicable. Acknowledgments We would like to express our sincerest sympathy to those struck by disaster, and once again to express our gratitude to all the staff of the DPATs, DMATs, and other EMTs conducting difficult support activities in this case. References North CS, Surís AM, Pollio DE. 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Health Data Collection Before, During and After Emergencies and Disasters—The Result of the Kobe Expert Meeting. Int J Environ Res Public Health. 2019;16(5). https://doi.org/10.3390/ijerph16050893 Mizumoto A, Takeuchi O. Basics and Considerations for Reporting Effect Sizes in Research Papers. Engl Educ Stud. 2008;31. Pandya A, Katz CL, Smith R, Ng AT, Tafoya M, Holmes A, et al. Services provided by volunteer psychiatrists after 9/11 at the New York city family assistance center: September 12–November 20, 2001. J Psychiatr Pract. 2010;16(3). https://doi.org/10.1097/01.pra.0000375717.77831.83 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6056492","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":435546566,"identity":"29b6b035-2485-4844-a555-5feee8948cfa","order_by":0,"name":"Yoshifumi Takagi","email":"","orcid":"","institution":"Iwate Prefectural University","correspondingAuthor":false,"prefix":"","firstName":"Yoshifumi","middleName":"","lastName":"Takagi","suffix":""},{"id":435546569,"identity":"5c5b9d2e-698c-42d3-a9ff-fe669e35ed1c","order_by":1,"name":"Sho Takahashi","email":"","orcid":"","institution":"University of Tsukuba","correspondingAuthor":false,"prefix":"","firstName":"Sho","middleName":"","lastName":"Takahashi","suffix":""},{"id":435546571,"identity":"82babfa4-c577-45d1-8ce7-22a7218c67e6","order_by":2,"name":"Tatsuhiko Kubo","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Tatsuhiko","middleName":"","lastName":"Kubo","suffix":""},{"id":435546574,"identity":"c29e0307-e9d7-484b-8d69-f4d7b734ab5e","order_by":3,"name":"Yasuhisa Fukuo","email":"","orcid":"","institution":"DPAT Secretariat","correspondingAuthor":false,"prefix":"","firstName":"Yasuhisa","middleName":"","lastName":"Fukuo","suffix":""},{"id":435546577,"identity":"a4e7471e-49b5-4b6b-a8a1-f88cd96f78d3","order_by":4,"name":"Sayaka Gomei","email":"","orcid":"","institution":"DPAT Secretariat","correspondingAuthor":false,"prefix":"","firstName":"Sayaka","middleName":"","lastName":"Gomei","suffix":""},{"id":435546580,"identity":"b84d121d-7b6b-429a-a98f-6995ce7ef455","order_by":5,"name":"Chie Yaguchi","email":"","orcid":"","institution":"University of Tsukuba","correspondingAuthor":false,"prefix":"","firstName":"Chie","middleName":"","lastName":"Yaguchi","suffix":""},{"id":435546583,"identity":"e4026386-e73a-4c74-8c1f-4102a6f30de3","order_by":6,"name":"Tetsuaki Arai","email":"","orcid":"","institution":"University of Tsukuba","correspondingAuthor":false,"prefix":"","firstName":"Tetsuaki","middleName":"","lastName":"Arai","suffix":""},{"id":435546585,"identity":"969be8e0-862d-4abb-9cb7-86c0e7f18de6","order_by":7,"name":"Hirokazu Tachikawa","email":"data:image/png;base64,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","orcid":"","institution":"University of Tsukuba","correspondingAuthor":true,"prefix":"","firstName":"Hirokazu","middleName":"","lastName":"Tachikawa","suffix":""}],"badges":[],"createdAt":"2025-02-18 13:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6056492/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6056492/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85398943,"identity":"aa005a76-946b-46f9-a6e1-6e591286e2ad","added_by":"auto","created_at":"2025-06-25 11:38:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6056492/v1/00439d17-d454-476a-af47-27677a106c66.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Is psychiatric medical response necessary during disasters? J-SPEED data analysis by Disaster Psychiatric Assistance Teams","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIn recent years, the frequency of natural disasters has increased worldwide, with serious consequences. The recent novel coronavirus disease 2019 (COVID-19) pan-demic, which is also considered an infectious disease disaster, has caused large-scale infections, deaths, and mental health issues worldwide [1, 2]. Disasters are known to cause post-traumatic stress disorder (PTSD), depression, and other mental disorders [3, 4]. Also, floods, tornadoes, and hurricanes, these events affect the mental health of a population, leading to the development of psychiatric conditions such as PTSD, as well as mood disorders like depression and anxiety [5]. A focused systematic review and meta-analysis of 27 studies from 1980 to 2017 on the prevalence of psychological dis-tress and mental illness after natural disasters found an increase in the prevalence of PTSD of 19.7% [4]. In addition, a survey study of survivors of 11 natural disasters found a prevalence of post-disaster depression ranging from 13\u0026ndash;22% [1]. Furthermore, psychiatric symptoms such as anxiety, insomnia, and mood / emotional symptoms have been found to occur during the acute phase immediately following a disaster [6]. Therefore, it is important to address a wide range of mental health needs starting from the acute phase of a disaster.\u003c/p\u003e \u003cp\u003eIn 2007, the Inter-Agency Standing Committee (IASC) published the world's first Mental Health and Psychosocial Support Guidelines (MHPSS Guidelines) as a standard for addressing mental health and psychosocial needs during humanitarian crises such as disasters [7]. Since then, the World Health Organization (WHO) and the International Committee of the Red Cross (ICRC) have further developed the MHPSS Guidelines, and MHPSS is considered the global standard for a wide range of mental health responses in crisis situations. The MHPSS categorizes support as a pyramid with four levels: \"basic support and safety\" including food, clothing, and shelter (Level 1); \"community and household support\" (Level 2); \" support for those in greater need than other victims \" (Level 3); and \"specialized support\" including treatment by specialists (Level 4).\u003c/p\u003e \u003cp\u003eIn the context of mental health and psychosocial support during disasters, Psychological First Aid (PFA) has been standardized and positioned within the framework of MHPSS (Mental Health and Psychosocial Support). PFA is based on five fundamental principles: \"1. Promote safety and a sense of security,\" \"2. Promote calmness,\" \"3. Promote connectedness,\" \"4. Promote a sense of efficacy for individuals and communities,\" and \"5. Promote hope\" [8].\u003c/p\u003e \u003cp\u003eAdditionally, cognitive behavioral therapy (CBT) is considered important for enhancing these basic principles of PFA and facilitating the process of recovery [8].\u003c/p\u003e \u003cp\u003eIn Japan, the need for acute disaster medical care was recognized after the Great Hanshin-Awaji Earthquake in 1995. The Disaster Medical Assistance Team (DMAT) was established in 2005 and has remained active [9]. In addition, since the Great East Japan Earthquake of 2011, a Japanese version of the MHPSS system of mental health and psychosocial support in the event of a disaster response has been established. This system is officially implemented by the Disaster Psychiatric Assistance Team (DPAT), which was established in 2013 [6, 10]. The DPAT is a multidisciplinary psychiatric and emergency medical team consisting of a psychiatrist, nurses, and logistics personnel (social workers, psychologists, pharmacists, and administrative staff etc.). The DPAT system is configured for psychiatric care and begins responding to psychiatric needs in acute disaster areas within 48 hours of a disaster [11]. Since DPAT is primarily a response to acute stress reactions such as anxiety, insomnia, and depression during the acute stages of a disaster, psychiatrists will play a crucial role. It then transitions from psychiatric medical response to the need for psychosocial support. The decision to pro-vide psychiatric medical response to disaster victims is at the discretion of each DPAT team. The psychiatrist's medical judgment takes precedence, and the decision is made in consultation with the DPAT team's nurses, psychologists, and social workers. As described above, to enable rapid response in times of disaster, specialized training and education are obligatory. It is common to receive PFA to assist in recovery following traumatic events and personal crises. To date, DPAT has provided emergency assistance during numerous natural and infectious disease disasters including COVID-19 [12, 13].\u003c/p\u003e \u003cp\u003eGlobally, however, there are no reports of organized psychiatric teams providing advanced mental health care during the acute phase of a disaster [10]. While there is growing evidence to support the effectiveness of post-disaster trauma interventions, it has been noted that more research on interventions geared towards the acute phase of disasters is needed [14]. Studies assessing the methodological quality of the MHPSS guidelines have found that people who have faced adversity are more at risk of experiencing both acute and long-term mental health issues, suggesting the difficulty of formulating appropriate responses to acute mental health problems [15]. In other words, medical responders such as DPATs, who are considered a small part of the aid described by the MHPSS but account for a large proportion of public mental health support in Japan, have never been examined to determine the extent of their actual necessity in a disaster or whether they can be replaced by non-medical professional responders. As a result, medical responses to mental health emergencies during the acute phase of a disaster have not been adequately studied.\u003c/p\u003e \u003cp\u003eA record of DPATs assistance activities has been compiled into a database using Japan Surveillance in Post Extreme Emergencies and Disasters: J-SPEED [11]. J-SPEED records the DPATs disaster medical records rather than the electronic medical records for each victim during disaster relief [16]. It is a standard disaster medical record similar to the Emergency Medical Team Minimum Data Set (MDS), which has been adopted as an international WHO standard, and was developed and introduced in 2015 as a means to maintain disaster medical records [17].\u003c/p\u003e \u003cp\u003eTherefore, this study analyzed J-SPEED data from past disasters in which DPATs were deployed to determine whether a psychiatric medical response is truly necessary in the acute phase of a large-scale disaster and whether it differs from non-medical responses.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Subjects\u003c/h2\u003e \u003cp\u003eThe cases in this study were victims of natural disasters that occurred between June 28, 2018, and July 31, 2021, including the Hokkaido Eastern Iburi Earthquake in 2018, Northern Kyushu Heavy Rains in 2019, Typhoon HAGIBIS in 2019, the July 2020 Heavy Rains, Mt. Izu Landslide Disaster in 2021, West Japan Heavy Rains in 2021, as well as air returnees from Wuhan, China during COVID-19 on February, 2020, who received DPAT support and were registered in J-SPEED. Case data were collected from an anonymized database created using the J-SPEED \" Mental Health version.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Statistical Analysis\u003c/h2\u003e \u003cp\u003eFirst, the J-SPEED \" Mental Health version \" data active between June 28, 2018, and July 31, 2021, were extracted from the J-SPEED database to create an individual dataset. Natural disasters were categorized as heavy rains and earthquakes. The quarantined cruise ship Diamond Princess for COVID-19-related responses and hospital support by cluster infections were analyzed separately for other special missions. The survey items analyzed were: \"demographics\u0026rdquo; (age, sex), \"duration of response,\" \"place of response\u0026rdquo; (shelter, home), \"diagnosis (F0: organic mental disorders, F1: substance use disorders, F2: schizophrenia, F3: mood disorders, F4: neurotic and stress-related disorders, F5: behavioural syndromes, F6: personality disorders, F7: mental retardation, F8: developmental disorders, F9: childhood behavioural disorders, F99: unspecified mental disorder, and G40: episodic disorders),\" \"type of support\u0026rdquo; (psychiatric care, physical care, medication, admission / health and welfare services, response in community, workplace, and home, case management, counseling), and \"outcome of support\u0026rdquo; (single instance or ongoing). The duration of response was based on 1 to 2 weeks [hyperacute phase], 1 month [acute phase], and more than 1 month [medium to long term] [10] after the disaster, and this timing breakdown was further classified into 4 groups: \"within 48 hours,\" \"within 3 to 14 days,\" and \"within 15 to 28 days\" for the hyperacute and acute phases, and \"more than 1 month\" for the mid- to long-term phase. The J-SPEED \" Mental Health version \" form and data collection have been reported previously [12].\u003c/p\u003e \u003cp\u003eNext, among the support types, psychiatric care, physical care, medication, and admission were classified as \"Psychiatric Medical Response,\" while health and welfare services, community response, workplace response, home response, case management, and counseling were classified as \"Non-Medical Response (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e),\" and among the survey items \"disaster type,\" (heavy rain, earthquake, covid-19), \"duration of response,\" \"age group\u0026rdquo; (under 65, 65 and older), \"sex,\" \"place of response,\" \"diagnosis,\" and \"outcome\" were compared. When comparisons were made, cross-tabulations were performed, significant differences were examined with chi-squared tests, and residuals were analyzed if significant bias was found. The absolute value of the adjusted residuals was greater than 1.96. When the expected value of the cross-tabulation was less than 5, a Fisher's exact probability test was performed. In addition, this study also performed a cross-tabulation analysis of effect size \"Φ\" and \"Cramer\u0026rsquo;s V\" (0.5, and above: strongly related; 0.3\u0026ndash;0.49: related; 0.1\u0026ndash;0.29: weakly related; below 0.1: unrelated) [18] was used as the criterion for measurement. Regression analysis and correction for multiple testing were not conducted because the number of cases for certain clinical characteristics was insufficient. SPSS software (ver. 28.0; IBM Corp., Armonk, NY, USA) was used for statistical analysis, with a statistical significance level of 5%. The Hiroshima Universi-ty Ethics Committee examined and approved the ethical procedure used in this study (approval number: E\u0026thinsp;\u0026minus;\u0026thinsp;2059).\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003e \u003cb\u003e3.1 Basic characteristics, timing, mental health statuses outcome of subjects compared between psychiatric medical and non-medical responses\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the type of disasters, duration of response, age, sex, mental health statuses, and outcome of the subjects compared between psychiatric medical response and non-medical responses. Data was collected from 700 medical examinations. Of these, 365 occurred during heavy rains, 66 during earthquakes, and 269 were related to COVID-19. The overall psychiatric medical response was 243 people (34.7%), and the non-medical response was 457 people (65.3%). By type of disaster, for heavy rain, psychiatric medical response was 173 people (47.4%), and non-medical response was 192 people (52.6%). For earthquake, psychiatric medical response was 14 people (21.2%), and non-medical response was 52 people (78.8%). For COVID-19-related disasters, psychiatric medical response was 56 people (20.8%), and non-medical response was 213 people (79.2%). In terms of heavy rain, the results of the residual analysis showed that significantly more people received psychiatric medical response than non-medical response during natural disasters. In contrast, non-medical response was significantly more common than psychiatric medical response when they were earthquakes and COVID-19 related (χ2\u0026thinsp;=\u0026thinsp;54.137; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, Cramer\u0026rsquo;s V\u0026thinsp;=\u0026thinsp;0.28). In terms of the duration of response, psychiatric medical response was provided within 3\u0026ndash;14 days, and non-medical response was provided within 48 hours more frequently than at other periods (χ2\u0026thinsp;=\u0026thinsp;98.472; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, Cramer's V\u0026thinsp;=\u0026thinsp;0.38). Regarding age distribution, there was significantly more psychiatric medical response for people in 65 years and older and non-medical response for people in younger than 65 (χ2\u0026thinsp;=\u0026thinsp;18.935; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, φ\u0026thinsp;=\u0026thinsp;0.16). There were no significant differences by sex (χ2\u0026thinsp;=\u0026thinsp;0.052; p\u0026thinsp;\u0026lt;\u0026thinsp;0.819, φ\u0026thinsp;=\u0026thinsp;0.01). No significant differences were found between shelters and homes in terms of response location (χ2\u0026thinsp;=\u0026thinsp;1.530; p\u0026thinsp;\u0026lt;\u0026thinsp;0.216, φ\u0026thinsp;=\u0026thinsp;0.06). In terms of diagnosis, psychiatric medical response was provided more frequently than non-medical response when the people had F0(χ2\u0026thinsp;=\u0026thinsp;11.311; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, φ\u0026thinsp;=\u0026thinsp;0.13), F1༈χ2\u0026thinsp;=\u0026thinsp;13.298; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, φ\u0026thinsp;=\u0026thinsp;0.14༉, F2༈χ2\u0026thinsp;=\u0026thinsp;12.674; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, φ\u0026thinsp;=\u0026thinsp;0.14༉, F3༈χ2\u0026thinsp;=\u0026thinsp;20.292; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, φ\u0026thinsp;=\u0026thinsp;0.17༉, F4༈χ2\u0026thinsp;=\u0026thinsp;107.453; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, φ\u0026thinsp;=\u0026thinsp;0.39༉, F5༈χ2\u0026thinsp;=\u0026thinsp;7.566; p\u0026thinsp;\u0026lt;\u0026thinsp;0.014, φ\u0026thinsp;=\u0026thinsp;0.10༉, G40༈χ2\u0026thinsp;=\u0026thinsp;7.566; p\u0026thinsp;\u0026lt;\u0026thinsp;0.014, φ\u0026thinsp;=\u0026thinsp;0.10༉. However, non-medical intervention was more frequent than psychiatric medical intervention in cases diagnosed with F99༈χ2\u0026thinsp;=\u0026thinsp;4.049; p\u0026thinsp;\u0026lt;\u0026thinsp;0.044, φ\u0026thinsp;=\u0026thinsp;0.08༉. It was moderately associated with F4. In addition, psychiatric medical response was provided significantly more often than non-medical response when ongoing support was needed, and non-medical response was provided significantly more often than psychiatric medical response when support was discontinued after a single visit (χ2\u0026thinsp;=\u0026thinsp;24.019; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, φ\u0026thinsp;=\u0026thinsp;0.20).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification and distribution of type of supports\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatric Medical Response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatric care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Medical response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth and welfare services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse in community, workplace, and home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCounseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Note: multiple answer items\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic Characteristics, Timing, Mental Health Status, Outcome of Subjects Compared Between Psychiatric Medical and Non-Medical Responses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePsychiatric Medical Response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNon-Medical response\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ex\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eΦ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCramer\u0026rsquo;s V\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of disaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eheavy rain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eearthquake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e213*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewithin 48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e223*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewithin 3\u0026ndash;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewithin 15\u0026ndash;28 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunder 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e361*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 and older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eshelter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis (ICD-10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.298\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e107.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.566\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.557\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.566\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle instance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e257*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eongoing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eNote: χ2 test. *Residual Z\u0026thinsp;\u0026gt;\u0026thinsp;1.96; \u003csup\u003ea\u003c/sup\u003eFisher's exact test; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Effect size: \u0026gt;0.5 (strong); 0.3\u0026ndash;0.49 (moderate); 0.1\u0026ndash;0.29 (weak); \u0026lt;0.1 (no association).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study used data from DPAT activities for natural disasters and COVID-19 in Japan to examine whether a psychiatric medical response to mental health needs is necessary during the acute phase of disasters. As far as we could find, to date there are few reports comparing disaster psychiatric medical response and non-medical response during the disasters, as examined in this study. In particular, DPAT falls under Level 4 of the MHPSS. The focus on this point in this study reveals that Level 4 and Level 3 activities are, in fact, occurring simultaneously.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Importance of psychiatric response during the acute phase of disasters\u003c/h2\u003e \u003cp\u003eThe results of this study indicate that the need for psychiatric medical response increases in the immediate aftermath of natural disasters such as heavy rain accompanying typhoons, and earthquakes. In previous studies on the acute phase of disasters, we have found identified the need to reduce anxiety and prevent sleep disturbances, as well as observed the impact on mood / emotion [6]. Although not a natural disaster, it has been reported that even in disasters like the 9/11 terrorist at-tacks, there is a necessity for psychiatrists to assess the need for psychiatric treatment and medication therapy, and to conduct triage for continuous care [19]. The results of this study confirm the importance of a medical response to mental health symptoms following disasters. On the other hand, responses to the spread of COVID-19 appeared to be more non-medical than medical, as they were a prophylactic care for mental health deterioration caused by isolation measures: Of the assistance provided by the DPAT to passengers on the Diamond Princess, about 90% was PFA, and it is believed that brief communication, not necessarily medical, led to relief of anxiety [12].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Factors requiring psychiatric response during the acute phase of a disaster\u003c/h2\u003e \u003cp\u003eFor the hyperacute phases (48 hours or less, 3 to 14 days), the acute phase (15 to 28 days), and the medium to long-term phase (1 month or more), we examined the differences in psychiatric medical response and non-medical response. Non-medical support was needed more often than psychiatric medical response within 48 hours or less. However, it was found that psychiatric medical needs were increasing more rapidly than non-medical needs within 3 to 14 days of the start of activities. In the immediate aftermath of a disaster, DPATs role is to set up a command center and establish a system of instructions in cooperation with local health facilities and DMATs [11]. In other words, within 48 hours of the start of the hyper-acute phase, the DPAT focused on non-medical response, such as patient transport, rather than direct individual psychiatric medical response. On the other hand, the results suggest that after 3 days, the need for medical support would become apparent as the DPAT support system was established and support of evacuation centers was initiated. Depending on the disaster situation, medical resources and services in the affected area may not have ceased even immediately after the disaster. In this case, it was considered that the main response would be by MHPSS Level 3, not by medical specialty care response. In the immediate aftermath of a disaster, victims are less likely to seek psychiatry care and psychological support on their own. Therefore, it needs to be modified to meet changing local medical needs over time. Early intervention plays a critical role in disaster situations. Preventing anxiety and sleep disorders and managing their influence on mood and emotions should be a top priority. This requires prompt collaboration with relevant support teams as soon as the acute phase of the disaster begins. Therefore, in the context of a disaster or humanitarian emergency, specialized teams should be equipped to provide both Level 3 and Level 4 services to address a comprehensive spectrum of needs.\u003c/p\u003e \u003cp\u003eBy examining the various aspects discussed above, the importance of psychiatric medical responses during the acute phase of a disaster has become clear. The need for practical guidelines to reduce disaster-related mental health risks is suggested [15]. Based on the results of this study, we propose that it would also be desirable for other countries to consider establishing organizations such as DPAT to provide psychiatric response during the acute phase of disasters.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, due to the timing of the survey, the COVID-19 data was limited to returnees from Wuhan, which may lead to selection bi-as. Also, the sample sizes for the various groups in this survey were different due to the multiple heavy rain disasters. In addition, the characteristics of the affected areas and victims are different, which also limits the generalizability of the result. In addition, since the J-SPEED mental health version has been in use since the \u0026ldquo;West Japan Rainstorm of 2008,\u0026rdquo; which is the subject of this study, it is necessary to consider the accuracy of some of the data input. Despite these limitations, we believe that this study has a unique strength in that it provides mental health data from the acute phase of disasters, which was not previously available. Further research is needed to validate the findings of this study and to expand the data collection to include other mental health support for the acute phase of disasters.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThis study examined natural disasters (heavy rains, and earthquakes) and COVID-19-related disasters data where DPATs were active.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe study found a strong need for psychiatric medical response during natural disasters from the acute phase following the disaster.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThis study supports the importance of psychiatric medical response during the acute phase of a disaster, the duration of response (from 48 hours to 1 month), and ongoing assistance for support outcomes were found to significantly increase psychiatric medical response.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIt is hoped that DPAT will serve as a model for other countries to implement psychiatric response during disasters.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e Approval was obtained from the Hiroshima University Ethics Committee (number: E\u0026minus;2059). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e In this study, all data are anonymized, no-patient identifiable data were recorded at any time, and informed consent of patients was not required. The need for informed consent was waived by Hiroshima University ethics committee/IRB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e The authors do not have permission to share data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e Conceptualization, Y.T., S.T. and H.T.; Methodology, Y.T., S.T. and H.T.; Formal analysis, Y.T. and H.T.; Data curation, Y.T. and H.T.; Writing\u0026mdash;original draft preparation, Y.T. and H.T.; visualization, Y.T. and H.T.; Supervision, T.K. and H.T.; Writing\u0026mdash;review and editing, Y.T., S.T., T.K., Y.F., S.G., C.Y., T.A., and H.T.; Project administration, H.T.; Funding acquisition, Y.F. and H.T. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This work was supported by Ministry of Health, Labour and Welfare Comprehensive Research on Disability Health and Welfare Program Grant Number 23IA1004.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e We would like to express our sincerest sympathy to those struck by disaster, and once again to express our gratitude to all the staff of the DPATs, DMATs, and other EMTs conducting difficult support activities in this case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNorth CS, Sur\u0026iacute;s AM, Pollio DE. A Nosological Exploration of PTSD and Trauma in Disaster Mental Health and Implications for the COVID-19 Pandemic. Behav Sci. 2021;11(7). https://doi.org/10.3390/bs11010007\u003c/li\u003e\n\u003cli\u003eShigemura J, Kurosawa M. Mental health impact of the COVID-19 pandemic in Japan. Psychol Trauma. 2020;12(5).\u003cbr\u003e https://doi.org/10.1037/tra0000803\u003c/li\u003e\n\u003cli\u003eNeria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2007;38.\u003cbr\u003e https://doi.org/10.1017/S0033291707001353\u003c/li\u003e\n\u003cli\u003eBeaglehole B, Mulder RT, Frampton CM, Boden JM, Howes GN, Bell CJ. Psychological distress and psychiatric disorder after natural disasters systematic review and meta-analysis. Br J Psychiatry. 2018;213(6).\u003cbr\u003e https://doi.org/10.1192/bjp.2018.210\u003c/li\u003e\n\u003cli\u003eCianconi P, Betr\u0026ograve; S, Janiri L. The Impact of Climate Change on Mental Health: A Systematic Descriptive Review. Front Psychiatry. 2020;11.\u003cbr\u003e https://doi.org/10.3389/fpsyt.2020.00074\u003c/li\u003e\n\u003cli\u003eTakagi Y, Takahashi S, Fukuo Y, Arai T, Tachikawa H. Acute-Stage Mental Health Symptoms by Natural Disaster Type: Consultations of Disaster Psychiatric Assistance Teams (DPATs) in Japan. Int J Environ Res Public Health. 2021;18(23).\u003cbr\u003e https://doi.org/10.3390/ijerph182312409\u003c/li\u003e\n\u003cli\u003eInter-Agency Standing Committee (IASC). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.\u003cbr\u003e https://interagencystandingcommittee.org/iasc-task-force-mental-health-and-psychosocial-support-emergency-settings/iasc-guidelines-mental-health-and-psychosocial-support-emergency-settings-2007 Accessed 2 Feb 2025\u003c/li\u003e\n\u003cli\u003eHobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, et al. Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry. 2007;70(4).\u003cbr\u003e https://doi.org/10.1521/psyc.2007.70.4.283\u003c/li\u003e\n\u003cli\u003eHomma M. Development of the Japanese National Disaster Medical System and Experiences during the Great East Japan Earthquake. Yonago Acta Med. 2015;58(2).\u003c/li\u003e\n\u003cli\u003eTakahashi S, Takagi Y, Fukuo Y, Arai T, Watari M, Tachikawa H. Acute Mental Health Needs Duration during Major Disasters: A Phenomenological Experience of Disaster Psychiatric Assistance Teams (DPATs) in Japan. Int J Environ Res Public Health. 2020;17(5).\u003cbr\u003e https://doi.org/10.3390/ijerph17051530\u003c/li\u003e\n\u003cli\u003eDisaster Psychiatric Assistance Team (DPAT). An MHLW-Commissioned Project: Disaster Mental Health Information System: Operational Manual.\u003cbr\u003e https://www.dpat.jp/images/dpat_documents/3_220415.pdf Accessed 2 Feb 2025\u003c/li\u003e\n\u003cli\u003eTachikawa H, Kubo T, Gomei S, Takahashi S, Kawashima Y, Manaka K, et al. Mental health needs associated with COVID-19 on the diamond princess cruise ship: A case series recorded by the disaster psychiatric assistance team. Int J Disaster Risk Reduct. 2022;15(81).\u003cbr\u003e https://doi.org/10.1016/j.ijdrr.2022.103250\u003c/li\u003e\n\u003cli\u003eAsaoka H, Koido Y, Kawashima Y, Ikeda M, Miyamoto Y, Nishi D. Association Between Attitudes Toward Trauma Informed Care and Psychological First-Aid Training Experience Among Health Care Professionals in Japan. Disaster Med Public Health Prep. 2023;3(17).\u003cbr\u003e https://doi.org/10.1017/dmp.2023.103\u003c/li\u003e\n\u003cli\u003eGrolnick WS, Schonfeld DJ, Schreiber M, Cohen J, Cole V, LJ, Lochman J, Pfefferbaum B, Ruggiero K, Wells K, Wong M, Zatzick D. Improving adjustment and resilience in children following a disaster: Addressing research challenges. Am Psychol. 2018;73(3).\u003cbr\u003e https://doi.org/10.1037/amp0000181\u003c/li\u003e\n\u003cli\u003eD\u0026uuml;ckers M, van Hoof W, Willems A, Brake HT. Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines\u0026mdash;PART II: A Content Analysis with Implications for Disaster Risk Reduction. Int J Environ Res Public Health. 2022;19(13).\u003cbr\u003e https://doi.org/10.3390/ijerph19137798\u003c/li\u003e\n\u003cli\u003eJ-SPEED+ System Simplified Operational Manual.\u003cbr\u003e https://www.dpat.jp/images/j-speed/manual.pdf Accessed 2 Feb 2025\u003c/li\u003e\n\u003cli\u003eKubo T, Yanasan A, Herbosa T, Buddh N, Fernando F, Kayano R. Health Data Collection Before, During and After Emergencies and Disasters\u0026mdash;The Result of the Kobe Expert Meeting. Int J Environ Res Public Health. 2019;16(5).\u003cbr\u003e https://doi.org/10.3390/ijerph16050893\u003c/li\u003e\n\u003cli\u003eMizumoto A, Takeuchi O. Basics and Considerations for Reporting Effect Sizes in Research Papers. Engl Educ Stud. 2008;31.\u003c/li\u003e\n\u003cli\u003ePandya A, Katz CL, Smith R, Ng AT, Tafoya M, Holmes A, et al. Services provided by volunteer psychiatrists after 9/11 at the New York city family assistance center: September 12\u0026ndash;November 20, 2001. J Psychiatr Pract. 2010;16(3).\u003cbr\u003e https://doi.org/10.1097/01.pra.0000375717.77831.83\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Psychiatric medical response, natural disasters, COVID-19, J-SPEED, Disaster Psychiatric Assistance Team (DPAT)","lastPublishedDoi":"10.21203/rs.3.rs-6056492/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6056492/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe frequency and severity of natural disasters have increased globally, leading to mental health challenges. In response, the Mental Health and Psychosocial Support (MHPSS) framework emphasizes a multi-tiered approach, from basic care to specialized interventions. In Japan, Disaster Psychiatric Assistance Teams (DPAT) provide acute-phase psychiatric care, but limited evidence exists on whether this specialized medical response is more necessary than non-medical interventions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study analyzed 700 cases from the Japan Surveillance in Post Extreme Emergencies and Disasters (J-SPEED) database from June 28, 2018, to July 31, 2021. Disasters included heavy rains, earthquakes, and COVID-19\u0026ndash;related missions. Interventions were classified as \u0026ldquo;psychiatric medical\u0026rdquo; (e.g., psychiatric care, medication) or \u0026ldquo;non-medical\u0026rdquo; (e.g., community support, counseling). We compared disaster type, timing, demographics, diagnosis, and outcome using chi-square tests and residual analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, 34.7% of cases involved psychiatric medical responses and 65.3% non-medical responses. Heavy rain disasters showed a higher proportion of psychiatric interventions, whereas earthquake and COVID-19 missions had non-medical support. Psychiatric needs peaked between 3 and 14 days post-disaster. Individuals aged 65 or older more often required psychiatric care, commonly associated with stress-related (F4) and mood (F3) disorders. Ongoing support was more common among those receiving psychiatric medical interventions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings highlight the importance of specialized psychiatric support during the acute phase of disasters, several days after onset when mental health needs become more apparent. DPAT\u0026rsquo;s approach\u0026mdash;integrating Level 3 and Level 4 MHPSS interventions\u0026mdash;may serve as a model for other regions. Further research should validate these results and refine acute-phase disaster mental health strategies.\u003c/p\u003e","manuscriptTitle":"Is psychiatric medical response necessary during disasters? J-SPEED data analysis by Disaster Psychiatric Assistance Teams","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 08:39:31","doi":"10.21203/rs.3.rs-6056492/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff44cf8b-cc5b-4f27-a58e-9c36f401cef9","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-25T11:38:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 08:39:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6056492","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6056492","identity":"rs-6056492","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}