2. Iran is one of the top ten countries most frequently stricken by natural disasters. More than 120 000 killed in such disasters during the last century in Iran, most commonly due to earthquakes.

3. ICEBERG OF TRAUMAS During past 8 years: 924 earthquakes 3 -7.3 R 17686 dead (17% world ) 53300 injured 275000 dwellings destroyed 2500 billion Rls damage

4. 5 Different Proposals Epidemiologic survey Direct needs assessment survey Rescuers’ educational needs assessment Objective losses Qualitative research

5. 1- Epidemiologic Study Historical cohort 2 earthquake ridden areas Ghaen - Birjand Ardabil 1 year after event Case : n=703 Control: n=684 Tools: GHQ-28,RUTTER,WATSON,YULE

6. Main Findings: GHQ-28: 34.1 VS 15.85 P<0.001 RUTTER: 13.08 VS 8.19 P<0.001 OR = 3.29 for adults OR = 2.05 for children

7. PTSD IN CHILDREN (cut off point under consideration)

8. PTSD IN ADULTS (cut off point under consideration)

9. Anniversary effect?

10. 2- DIRECT NEEDS ASSESSMENT 57 ITEM QUESTIONNAIRE EXPOSURES INFORMATION NEEDS NEED FOR EMOTIONAL SUPPORT NEED FOR EDUCATION

11. VISUAL EXPOSURES

12. NEED FOR INFORMATION

14. NEED FOR COUNSELLING

15. WHO PROVIDED PSYCHOLOGICAL SUPPORT?

16. RECEIVED “DON’T CRY” ADVICE YES = 63.7 % NO =36.3

17. HAVE YOU BEEN PLAYING SINCE THE EVENT? YES 43.7% NO 43.3% NO ANSWER 13.0%

19. WHOM DID YOU EXPECT ? PERCENT UNAWARE OF ROLES GOV. AUTHORITIES 64.7 3.6 CLERGIES 53.2 4 PSYCHIATRISTS 22.0 5 SOCIAL WORKERS 19.04 46 PSYCHOLOGISTS 14.70 53.2

20. 3- EDUCATIONAL NEEDS ASSESSMENT FOR RESCUERS NOT MUCH DIFFERENT

21. RISK COMMUNICATION MISINFORMING 20.5% GRADUAL BRIEFING 42.2% OUTRIGHT 6.5%

22. WHAT WOULD YOU DO ABOUT DRUG ABUSE TO COPE WITH THE STRESS? I WOULD IGNORE? 5.3% NOT A PROBLEM FOR A LIMITED PERIOD 11.5% I RECOMMEND THEM NOT TO DO? 83.2%

23. 4- OBJECTIVE LOSSES MORTALITY INJURIES NO OF DESTROYED HOUSES NO OF AFECTED FAMILIES NO OF KILLED CATTLE TIME LAG TO RESCUE

24. QUALITATIVE STUDY

25. SOME FINDINGS MOST TRAUMATIC EXPERIENCE OF LIFE WORRIES ABOUT CHILDREN DEPRESSION ACADEMIC DECLINE REEXPERIENCE CONTINUITY OF SYMPTOMS SHELTER LACK OF PRIVACY PRAYING AND RELIGIOUS BELIEFS PS NEEDS NOT ADDRESSED