The review assessed effects of post-disaster relocation on physical and mental health. The author concluded that relocated individuals were more likely to experience psychological morbidity post-disaster, but no firm conclusions could be drawn for other outcomes. A lack of detail on study quality, and methodological limitations in the review process, mean that conclusions may not be reliable.

To assess the effects of post-disaster relocation on physical and mental health.

PubMed, CINAHL, EMBASE, Web of Science, PsycINFO and Google were searched from inception to 2006. Search terms were reported. Reference lists of relevant publications were screened. Only English-language articles were considered.

Studies that evaluated the physical or mental health impacts of residential relocation following a man-made or natural disaster were eligible for inclusion. Studies of a single displaced population and those comparing displaced and non-displaced populations, with a quantitative data analysis, were included. Studies of populations in temporary evacuation shelters were excluded, as were those completing needs assessments less than two weeks post-disaster. Studies focusing on complex humanitarian emergencies or war were excluded. The review outcomes included mental health categories (e.g. psychological morbidity/distress, post-traumatic stress disorder syndrome and/or symptoms, depression, and psychosomatic symptoms) and physical health categories (e.g. self-reported health, medical complaints/service use, mortality, injuries, diseases/infections, nutritional status and heart disease risk factors).

The majority of included studies focused on natural disasters (earthquakes, hurricanes, tsunamis and explosions). Included studies had considerable variations in the severity of the disasters; almost half of studies evaluated the impacts of disasters with one to 100 fatalities, whilst one third of studies assessed those disasters with over 5,000 fatalities. All the disasters with over 5,000 fatalities occurred in developing countries. The majority of included studies focused on disaster events in developed countries.

One reviewer assessed studies for inclusion.

The author did not state that validity assessment was performed.

Data were extracted on the outcomes of interest. Where possible, proportions of participants experiencing an event were extracted.

One reviewer performed the data extraction.

The studies were combined in a narrative synthesis, supported by accompanying data tables.

Twenty-four studies were included in the review. The total number of participants in the review was not reported. The follow-up duration of included studies ranged from one week to four years. Eleven studies used the post-event cross-sectional design, whilst ten studies used the post-event longitudinal design. Fifteen studies involved two comparison groups (relocated versus non-relocated).

Mental health outcomes

Psychological distress/morbidity (ten studies): Eight studies reported a significant association between relocation and psychological morbidity.

Post-traumatic stress disorder syndrome and/or symptoms (eleven studies): Six studies showed a significant association between relocation and post-traumatic stress disorder syndrome and/or symptoms.

Depression (ten studies): Five studies reported a significant association between relocation and depression.

Physical health outcomes

Self-reported health (five studies): One study reported a significant association between relocation status and disaster-related health decline.

Medical complaints/utilisation (three studies): Three studies showed that relocated individuals were more likely to use medical services, particularly for psychological problems.

Mortality (two studies): Two studies showed that death rates were not subsequently elevated in relocated individuals.

Post-event injury (two studies): One study showed an association between relocation and post-event injuries, but one study did not.

Outcomes assessing vulnerable groups prone to suffer from adverse consequences as a result of relocation were also reported.

Relocated individuals were more likely to experience psychological morbidity post-disaster, but no firm conclusions could be drawn for other outcomes.

The review addressed a clear research question. Inclusion criteria were broad for the study design. A number of relevant databases were searched for published and unpublished studies, reducing the potential of publication bias. The restriction to English-language studies meant that language bias could not be ruled out. The reliance on some self-reported outcome measures was also a potential source of bias. In the absence of two reviewers, insufficient attempts were made to minimise bias and error in the review process at study selection and data extraction phases. A formal validity assessment was not carried out. A narrative synthesis was appropriate given the diversity of included studies. The author's conclusions reflected the evidence presented, but a lack of details on study quality and methodological limitations in the review process mean that they may not be reliable.

Practice: The author did not state any implications for practice.

Research: The author stated that further high-quality studies, with consistent variable definitions and comparable disaster types, are required to evaluate the physical health implications of post-disaster relocation. Also, the meaning of psychological morbidity requires further specification in future research. Future studies should specifically evaluate the condition of historically vulnerable populations. Further research guided by theory is required to inform emergency preparedness and recovery policy.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.