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While conflict-induced forced migration is a global phenomenon, the situation in Colombia, South America, is distinctive. Colombia has ranked either first or second in the number of internally displaced persons for 10 years, a consequence of decades of armed conflict compounded by high prevalence of drug trafficking. The displacement trajectory for displaced persons in Colombia proceeds through a sequence of stages: (1) pre-expulsion threats and vulnerability, (2) expulsion, (3) migration, (4) initial adaptation to relocation, (5) protracted resettlement (the end point for most forced migrants), and, rarely, (6) return to the community of origin. Trauma signature analysis, an evidence-based method that elucidates the physical and psychological consequences associated with exposures to harm and loss during disasters and complex emergencies, was used to identify the psychological risk factors and potentially traumatic events experienced by conflict-displaced persons in Colombia, stratified across the phases of displacement. Trauma and loss are experienced differentially throughout the pathway of displacement.

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This study examined the mental health consequences of the January 2010 Haiti earthquake on Haitians living in Miami-Dade County, Florida, 2-3 years following the event. A random-sample household survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants (N = 421) were assessed for their earthquake exposure and its impact on family, friends, and household finances; and for symptoms of posttraumatic stress disorder (PTSD), anxiety, and major depression; using standardized screening measures and thresholds. Exposure was considered as "direct" if the interviewee was in Haiti during the earthquake. Exposure was classified as "indirect" if the interviewee was not in Haiti during the earthquake but (1) family members or close friends were victims of the earthquake, and/or (2) family members were hosted in the respondent's household, and/or (3) assets or jobs were lost because of the earthquake. Interviewees who did not qualify for either direct or indirect exposure were designated as "lower" exposure. Eight percent of respondents qualified for direct exposure, and 63% qualified for indirect exposure. Among those with direct exposure, 19% exceeded threshold for PTSD, 36% for anxiety, and 45% for depression. Corresponding percentages were 9%, 22% and 24% for respondents with indirect exposure, and 6%, 14%, and 10% for those with lower exposure. A majority of Miami Haitians were directly or indirectly exposed to the earthquake. Mental health distress among them remains considerable two to three years post-earthquake.

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Programs that provide services for internally displaced persons (IDPs) in Colombia, South America face challenges when attempting to engage and enroll the target population of forced migrants they intend to serve. Innovative multi-strategy outreach approaches must be used in order to effectively seek, recruit, provide services, monitor, and retain IDPs.

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INTRODUCTION: Few studies have focused on the mental health consequences of indirect exposure to disasters caused by naturally occurring hazards. The present study assessed indirect exposure to the 2010 earthquake in Haiti among Haitian-Americans now living in Miami; these subjects had no direct exposure to the earthquake, but retained their cultural identity, language, and connection to family and friends in Haiti. METHODS: Two months following the earthquake a sample of Haitian-Americans was surveyed inquiring about: (1) their psychological reactions to the quake; (2) types of exposures experienced by their family members and friends in Haiti; and (3) symptom levels of (a) major depression, (b) generalized anxiety disorder, (c) complicated grief, (d) mental health status, and (e) physical health status. RESULTS: Haitian-Americans living in Miami experienced a broad spectrum of indirect exposures to the 2010 earthquake in Haiti. These exposures were strongly associated with psychological distress, trauma-related mental health consequences, and diminished health status. Most notable was the multiplicity of indirect exposures to the on-scene experiences of multiple family members and friends in Haiti. CONCLUSIONS: Consideration should be given to the psychological impact and needs for support among indirectly-exposed populations with strong affiliation to directly-impacted victims.

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The 2010 Haiti earthquake was one of the most catastrophic episodes in history, leaving 5% of the nation's population killed or injured, and 19% internally displaced. The distinctive combination of earthquake hazards and vulnerabilities, extreme loss of life, and paralyzing damage to infrastructure, predicts population-wide psychological distress, debilitating psychopathology, and pervasive traumatic grief. However, mental health was not referenced in the national recovery plan. The limited MHPSS services provided in the first eight months generally lacked coordination and empirical basis.There is a need to customize and coordinate disaster mental health assessments, interventions, and prevention efforts around the novel stressors and consequences of each traumatic event. An analysis of the key features of the 2010 Haiti earthquake was conducted, defining its "Trauma Signature" based on a synthesis of early disaster situation reports to identify the unique assortment of risk factors for post-disaster mental health consequences. This assessment suggests that multiple psychological risk factors were prominent features of the earthquake in Haiti. For rapid-onset disasters, Trauma Signature (TSIG) analysis can be performed during the post-impact/pre-deployment phase to target the MHPSS response in a manner that is evidence-based and tailored to the event-specific exposures and experiences of disaster survivors. Formalization of tools to perform TSIG analysis is needed to enhance the timeliness and accuracy of these assessments and to extend this approach to human-generated disasters and humanitarian crises.

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