The chapter describes the ravages of the 1988 Spitak earthquake in northern Armenia and the geopolitical problems in the Caucasus region, leading to a war between Armenia and Azerbaijan. The widespread destruction, lack of essential materials due to blockade by the neighboring countries, the Soviet Union’s political turmoil and eventual collapse, and poor economy were significant factors that delayed recovery from the earthquake. The chapter also describes the existing mental health system in Soviet Armenia, the role of the clergy, and the inception of the Psychiatric Outreach Program (POP) by volunteer therapists from the diaspora shortly after the earthquake. The initial objective of POP was to provide care to the survivors for six months. Because of the pervasiveness of the psychological problems, the POP expanded its mission to include a teaching and training program for local professionals and paraprofessionals. These newly trained therapists worked alongside the consultants from the diaspora. Subsequently, two clinics were built in the earthquake zone, and the POP therapists serviced the population of Gumri, Spitak, and the adjacent villages for the next two decades. During those years, important trauma-related studies were conducted to determine the progression of stress reactions and the effectiveness of trauma-grief-focused psychotherapy.

Disasters have short and long-term negative effects on a large array of physical and mental health outcomes. Epidemiology offers a variety of tools and methodologies for conducting a needs assessment, surveillance, and longitudinal research aimed at identifying adverse outcomes and developing strategies for preventing disease and promoting health. The application of epidemiological methods has advanced our understanding of pervasive morbidity and mortality often experienced in the aftermath of disasters. Findings from epidemiological studies have implications for improving the allocation of resources and developing interventions targeting these adverse outcomes. In this chapter, we briefly highlight developments in the epidemiology of disasters. We present common study designs employed in disaster response and research and provide examples of applications of these methods in studying the consequences of the 1988 Spitak earthquake in Armenia. The chapter concludes with a brief discussion of recent developments in research methodology and their potential implications for disaster researchers and public health practitioners focusing on prevention and mitigation.

There is a paucity of long-term treatment outcome studies among children and adolescents after natural disasters. This chapter summarizes findings from three long-term studies among severely traumatized early adolescents after the 1988 Spitak earthquake in Armenia, including a twenty-five-year follow-up that represents the most extended prospective treatment outcome study to date after a disaster. School-based trauma-grief-focused psychotherapy was provided at 1.5 years post-earthquake. The intervention addressed trauma and loss experiences due to the earthquake; post-trauma distress reactions, including PTSD and grief; current problems and adversities; trauma and loss reminders, interpersonal conflicts, and developmental progression. The findings showed significant long-term benefits of treatment in reducing PTSD and depressive symptoms. We also present findings regarding differences in recovery trajectories among treated and not treated subjects and risk and protective factors associated with PTSD and depression. Despite the improvements, a sub-group of the students continued to experience earthquake-related chronic PTSD and depressive symptoms at twenty-five-year follow-up, indicating the need for ongoing surveillance of severely traumatized survivors. The findings underscore the benefit of post-disaster therapeutic intervention, social support by family members and friends, and the need for assistance by governmental and non-governmental agencies to mitigate post-disaster adversities that contributed significantly to the chronicity of symptoms.