This chapter describes the evolution of a disaster ecological framework for portraying the impact of disasters on human populations. It begins with a detailed look at exposure to hazards-categorized by type, intensity, time, and place factors. Globally, the cumulative impact of disasters can be estimated using multiple measures. Directly relevant to the field of disaster psychiatry, the degree of psychosocial impact varies by disaster type and generally increases with increasing magnitude and frequency of disaster occurrence. The public health consequences of disasters can be assessed in terms of mortality, morbidity and disruption of health care infrastructure. Disaster impact on citizens and whole populations varies by individual and family characteristics such as age, gender, race/ethnicity, education, occupation, employment status and income. The scope and magnitude of disasters are associated with the extent of disruption of health and social services.

This chapter focuses on the psychosocial impact of a family suicide on children and adolescents, and discusses intervention strategies at the individual, family, and community level. Bereavement early in life increases children's susceptibility to depression, anxiety, and social adjustment problems such as school dysfunction and delinquency. Like bereaved spouses, parents of adolescent suicides were at higher risk for depression than controls, and, at follow-up three years later, mothers of suicide victims were still at an increased risk for recurrent depression. Bereavement is generally associated with increased likelihood of mood disorders in children and adolescents but distinguishing between the symptoms of bereavement and major depressive disorder is often difficult. A significant number of children today have experienced a suicidal death of a relative. The reactions and responses to a suicidal death are complex and include an increased risk of depression and posttraumatic stress disorder (PTSD).