Psychological Intervention in Primary Care After Earthquakes in Lorca, Spain

After the earthquakes that occurred in Lorca, Spain, on May 11, 2011, the regional mental health management employed 2 clinical psychologists for 6 months to provide care to people referred by primary care physicians. The objective was to address the expected increased demand for treatment of mental disorders, notably posttraumatic stress disorder (PTSD) and adjustment disorders.

Referred individuals were evaluated and treated according to a clinical protocol designed ad hoc from June 12, 2011, to November 30, 2011. The protocol provided a stepped intervention guided by clinical and psychometric assessment using "normalization" for those with no psychiatric diagnosis, brief group treatment for mild to moderate PTSD or adjustment disorders, individual treatment for more severe PTSD, and referral to the local mental health center for other mental health disorders. Standard adult and child scales to assess posttraumatic, depression, and anxiety symptoms and resilience were used at initial assessment to guide treatment allocation and repeated to assess outcome status. Psychologists also provided a clinical assessment of symptom resolution at the end of the study.

Rates of symptom resolution and improvements on all scales (PTSD, depression, anxiety, and resilience) demonstrated clinically and statistically significant improvement in all treatment groups (P = .000). Dropout was low. Medications were prescribed frequently to adults; no child received medication as a result of the earthquakes. No case of mental disorder related to the earthquakes was referred to the local mental health center during the 6 months of psychologist intervention.

The structured intervention resulted in a high resolution of cases and low dropout, allowing treatment of a larger number of people with optimal frequency (weekly), devoting more time to the most severe cases and less to those moderately or mildly affected.