Disasters, characterized by their unpredictability and capacity for causing death, trauma, and property destruction (1), affect millions globally each year. The frequency and impact of these events are escalating due to climate change and population density growth (2), defining disasters by three key characteristics of large-scale traumatic events: significant harm or fatalities among a large group of people, societal disruption, and ensuing mental and physical health consequences (1, 3, 4).

The aftermath of disasters encompasses cognitive, emotional, and physiological responses, leading to predictable psychiatric morbidity (5, 6). Beyond post-traumatic stress disorder, common mental health effects include distress, grief, anxiety disorders, and depression (5–7), for examples, from the exposure to natural (8) or deliberately caused (9) disasters. Individuals often resort to self-medication, primarily with alcohol, risking harm and substance use disorders while delaying the recognition of mood and anxiety disorders (10).

The demands on psychiatrists differ significantly from routine clinical practice (10). Psychiatrists in hospitals must be informed about disaster plans and engage in planning processes, ensuring patients have crisis plans covering mental health management and accessing post-disaster treatment and medication (11, 12). Rapidly mobilized mental health teams, equipped with specialized disaster mental health skills, play a pivotal role in disaster intervention (13). Psychiatrists, as responders, can lead multidisciplinary teams to organize post-disaster psychiatric care, providing crucial assessments and interventions (14). Hence, acquiring fundamental competency in disaster psychiatry is vital for every psychiatrist.

Post-graduate medical education emphasizes clinical training for healthcare professionals, which focused on the standardized training and, under senior physicians’ guidance, develop independent healthcare skills for medical graduates (15, 16). In Taiwan, psychiatric training also following the principles of post-graduate medical education as aforementioned (17, 18), yet there’s a shortage of training competencies incorporating perspectives from both high- and low-income countries (19). In addition, the training for psychiatric trainee might also influence the psychiatrists’ preparedness (20).

Given the heightened risk for natural disasters in several Asian countries, notably by earthquakes, volcanic eruptions, typhoon, and cyclones (21), scant attention has been directed toward assessing psychiatrists’ readiness in managing disaster-related mental health crises (13). This study aims to examine the readiness of Taiwanese psychiatrists in responding to disaster-related mental health crises. We hypothesize discrepancies among psychiatrists based on training in the post-graduate medical education duration and prior clinical experiences.

A total of 103 psychiatrists participated in this study, with male participants, board-certified professionals, and those working in regional hospitals or medical centers comprising the majority ( Table 1 ). Notably, 82.5% of these psychiatrists expressed varying degrees of intent to treat, follow up, and even be deployed for the management of DRPD within the scope of this investigation.

Among these psychiatrists, a significant majority—ranging from 74% to 85%—reported previous experience in treating various forms of DRPD, including PTSD, depressive disorders, anxiety disorders, sleep disorders, and other conditions such as conversion disorders, dissociative disorders, and adjustment disorders. However, only 24% had prior experience in external deployment for DRPD management, while 40% had experience with internal hospital deployment ( Table 2 ).

Table 3 outlines the subjective confidence levels of psychiatrists regarding their competence in managing DRPD through psychotherapy. Across various conditions such as PTSD, depressive disorders, anxiety disorders, sleep disorders, and other related disorders, all participating psychiatrists involved conveyed a moderate level of confidence, in a 5-level rating scale, in their ability to conduct both individual and group therapies.

Regarding the choice of psychotropic medications for DRPD treatment, the majority of psychiatrists in this study leaned toward Selective Serotonin Reuptake Inhibitors (SSRIs) and benzodiazepines (for anxiolysis or sleep) ( Table 4 ). Specifically, when addressing disaster-related PTSD, most preferred sertraline, escitalopram, and fluoxetine as their antidepressant choices ( Table 4 ).

Table 5 presents data indicating that SSRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), and Z-drugs/benzodiazepines were the most frequently selected psychotropic medications for addressing disaster-related depressive disorders, anxiety disorders, sleep disorders, and other associated conditions.

Table 6 illustrates that psychiatrists with longer years of service (10 years or more) and holding board-certified status are associated with greater experience in managing DRPD and demonstrate a preference for specific mobilization locations, whether out of hospital or within hospital settings, for interventions, by the multiple linear regression analysis. Psychiatrists aged 40 or older exhibit more experience in managing DRPD, with statistically significant associations found for DRPD in general, particularly anxiety disorders, and both out-of-hospital and in-hospital intervention mobilizations. There is no discernible association between gender and hospital levels with regard to experience in managing DRPD.

Disasters and public health crises pose multifaceted challenges, emphasizing the pivotal role psychiatrists play in addressing post-disaster psychiatric needs (11, 13, 27). This study represents the first exploration of disaster preparedness among Taiwanese psychiatrists and presents several notable findings. Primarily, a significant majority of these professionals exhibit substantial experience, willingness, and capability in managing DRPD. However, while many have treated DRPD, fewer have been involved in hospital deployments for DRPD management, signaling potential areas for improvement.

In Taiwan’s psychiatric resident training, the clinical training program must contain the Suicide Prevention and Disaster Psychiatry Program (17). However, in the results of this study, the average of the participants’ subjective feelings of competence in the 5-level rating scales are between 1.91–2.97 in the psychotherapeutic methods for DRPD. Among these psychotherapeutic techniques, the lowest feelings of competence are group and individual psychotherapies. In addition, the 3^rd rank of medications chosen by psychiatrists for PTSD are benzodiazepine. However, benzodiazepines are better avoided the pharmacotherapy for PTSD (28–30).

In the disaster psychiatric response, the interdisciplinary team is needed (31–34). The post-graduate education about the disaster responses for nurses (35), psychologists/counselors (36, 37), and social workers (38) for disaster-related general and mental health services are also important. Therefore, the core competence in the training psychiatric residents is needed, in the post-graduate medical education.

The study notes a perceived lack of competence in utilizing psychotherapeutic approaches for DRPD. Core competence training in the postgraduate psychiatric education programs might enhance the subjective and objective competence in individual and group psychotherapies (39), even for the DRPD (40).

In this study, the deployment experiences of participants are associated with age, the length of practice, and board-ship in psychiatry. Incorporating real-world deployment experiences into postgraduate training might enhance psychiatrists’ readiness and confidence in disaster response (41, 42).

The variance in reported DRPD prevalence (ranging from 1.5% to 74%) in prior Taiwan-based studies may stem from methodological disparities, differing study populations, diagnostic criteria, and case definitions. This variance could also be attributed to Taiwan experiencing fewer wars and natural disasters compared to other regions. As a result, the populace might initially seek primary care providers over psychiatrists during disasters, highlighting potential gaps in popularizing disaster psychiatry in Taiwan (43).

Recent clinical guidelines underscore the efficacy of SSRIs and SNRIs in managing post-traumatic stress, recommending these medications for eligible patients (44). Complementary studies have also highlighted the benefits of benzodiazepines or nonbenzodiazepine agents for disaster-related anxiety and sleep disorders (45, 46). Correspondingly, the preference of Taiwanese psychiatrists for SSRIs, SNRIs, and Z-drugs/benzodiazepines aligns with international guidelines, indicating their substantial knowledge in managing DRPD through pharmacotherapy.

Psychotherapy’s significance in post-disaster mental health recovery cannot be overstated, especially in providing continuous psychological support (47–50). Despite evidence favoring psychotherapy’s efficacy over medications (51, 52), our study revealed psychiatrists’ perceived lack of competence in utilizing psychotherapeutic approaches for DRPD. This underscores the need for bolstering psychotherapy training among Taiwanese psychiatrists.

The study revealed that over 90% of participants exhibited intent to treat, follow-up, or be involved in the management of DRPD, while nearly 80% possessed prior experience in treating these disorders. Findings suggest that within post-graduate medical education, Taiwanese psychiatrists demonstrate significant experience, willingness, and capacity to effectively manage DRPD. However, there is a need to integrate comprehensive training on disaster psychiatry into post-graduate psychiatric education programs to further enhance preparedness and optimize outcomes in managing these challenging conditions.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

This study received approval from the Institutional Review Board at Tri-Service General Hospital, and written informed consent was obtained from all participants (TSGH IRB: 2-104-05-136). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

P-CL: Data curation, Formal analysis, Funding acquisition, Investigation, Writing – original draft. Y-CC: Data curation, Investigation, Writing – original draft, Methodology, Validation. L-CK: Data curation, Investigation, Methodology, Writing – original draft, Conceptualization, Formal analysis, Resources. F-JW: Conceptualization, Data curation, Investigation, Methodology, Resources, Writing – original draft. N-ST: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Writing – original draft, Funding acquisition, Project administration, Supervision, Validation, Writing – review & editing.