each disaster leaves an imprint on the affected population , a singular  signature .  a critical unmet need in the field of disaster mental / behavioral health is the capability to tailor mental health and psychosocial support ( mhpss ) to the unique constellation of psychological risk factors operating within each disaster event .
we have developed and introduced trauma signature ( tsig ) analysis to the fields of disaster mental / behavioral health and disaster public health in response to this identified need .
we define tsig analysis in the following manner : trauma signature ( tsig ) analysis is an evidence - based method that examines the interrelationship between population exposure to a disaster , extreme event , or complex emergency and the interrelated physical and psychological consequences for the purpose of providing timely , actionable guidance for effective mental health and psychosocial support ( mhpss)or disaster behavioral health ( dbh ) * 
 support  that is organically tailored and targeted to the defining features of the event . according to shultz et al .
2013 ( in press ) ,  tsig examines the extent to which disaster survivors were exposed to empirically - documented risk factors for psychological distress and mental health disorders . grounded on the disaster ecology model , tsig is premised on the assumption that each disaster exposes the affected population to a novel pattern of traumatizing hazards , loss , and change .
this singular  signature  of exposure risks is a predictor ( or series of predictors ) of the psychosocial and mental health consequences .
disaster - specific analysis is important because , as kessler and team have documented across a spectrum of international disasters ,  secondary stressors unique to a particular disaster situation have more impact than the disasters themselves  in determining the prevalence of post - disaster mental disorders .  too frequently , mhpss response to disasters is unguided , uncoordinated , and unscientific .
for example , in our tsig analysis of the 2010 haiti earthquake it was evident that mhpss was never prioritized .
the disaster behavioral health response that was cobbled together in haiti evidenced many serious deficits ( table 1 ) including : self - deployment and arrival on - scene of many uninvited personnel , lack of coordination among response teams , provision of non - evidence - informed services loosely labeled as  psychosocial ,  provision of services such as critical incident stress debriefing ( cisd ) that are known to be ineffective and potentially harmful for survivors , provision of services that were not culturally - adapted or language - appropriate for haiti , premature cessation of many services , and minimal or no program evaluation . from the perspective of responders , there was a lack of pre - deployment guidance about the specific stressors that would be encountered , and lack of on - scene psychological support , leading to high rates of traumatization among response personnel .
disaster - specific risk factors can be identified from disaster situation reports issued in the early aftermath allowing mhpss response to be tailored and timed to the defining features of the event .
it is time to infuse science into mhpss response ; we need evidence - based support and intervention .
optimal mhpss response that incorporates tsig analysis can be summarized as a sequence of six steps ( see also figure  1 ) : 1 ) initial tsig analysis to guide response based on the defining features of the disaster or potentially - traumatizing event ( pte ) , 2 ) tsig - guided preparation of responders for what to expect and deployment of appropriate response assets , 3 ) delivery and evaluation of evidence - informed early interventions , 4 ) implementation of onsite validated disaster behavioral health needs assessment , 5 ) identification and intervention with individuals at high risk for disaster - related psychological distress , impairment , or psychopathology , and 6 ) continuous monitoring of responder and survivor mental health throughout recovery with comprehensive (  end - to - end  ) evaluation of the mhpss response .
optimal mental health and psychosocial support ( mhpss ) : six sequential steps while the components that are uniquely contributed by tsig analysis are primarily incorporated into steps 1 and 2 , in order to achieve optimal mhpss response , significant quality improvement is needed and desirable for steps 36 . an electronic appendix , entitled  operationalizing tsig  ( www.landesbioscience.com/journals/disasterhealth/commart-sup.pdf ) provides details for each of the six steps in the categories of description , rationale , operationalization , unmet needs , research questions , and opportunities .
the initial tsig analysis is the first step of six that comprise an optimal evidence - based mhpss response ( summarized in figure  1 ) . as illustrated in figure  2 ,
initial tsig analysis consists of these elements : 1 ) characterization of the affected communities ( geographic scope , numbers affected , demographics ) ; 2 ) real - time collection and synthesis of information from disaster situation reports (  sitreps  ) issued regularly in the early days and weeks post - impact ; 3 ) identification and data collection from disaster monitoring and scientific resources specific to the disaster event ( e.g. , united states geological survey ( usgs ) earthquake data on the haiti earthquake , national hurricane center ( nhc ) data on superstorm sandy ) ; 4 ) consultation with disaster sciences subject matter experts ( e.g. , usgs geophysicists for haiti earthquake , nhc meteorologists for superstorm sandy ) ; 5 ) construction of a hazard profile based on open - source data developed in the preceding steps ; 6 ) review and integration of the scientific literature on evidence - based risk factors for psychological distress and psychopathology for persons exposed to the event - specific hazards ; 7 ) incorporation of information on disaster stressors identified anecdotally in media and social media accounts of the event ; 8) creation of an event - specific stressor / risk factor matrix that is cross - referenced with the evidence - based literature ( stressors are enumerated by disaster phase within the categories of exposure to hazard , loss , and change ) , ccounts , cross - referenced with the evidence - based literature ; and 9 ) generation of a tsig summary for the disaster based on the estimated psychological severity of exposures to hazards , loss , and change . figure  2 .
initial post - impact trauma signature analysis several key points in this process require more explanation . initial tsig analysis is triggered when a disaster alert or warning is issued , or when disaster strikes without warning .
local disaster response is activated immediately and higher - level response ( regional , national , international ) is brought into play as needed depending upon the scale of the event . for major events ,
publicly - accessible disaster situation reports ( sitreps ) are generated and hosted on websites such as the global disaster alert and coordination system ( gdacs ) , united nations office for the coordination of humanitarian assistance , and reliefweb within the early hours or days , hazard profile . to create the hazard profile that provides a scientifically - sound description of the event
, tsig begins with review of disaster data including sitreps from governmental and ngo agencies and available data from disaster monitoring and scientific resources .
subject matter experts ( smes ) may be contacted to assure that the event is correctly described from a disaster sciences perspective .
this step describes the physical forces of harm that impact the human population in harm s way in order to characterize  exposure to hazard .
 disaster epidemiologic data are also collected on numbers of deaths , injuries , displaced , affected .
the next step involves matching the scientific event description to the ever - expanding literature on psychological risk factors ( for distress , disorder , and psychiatric diagnosis ) .
this is summarized in a  stressor matrix  : risk factors are arrayed by disaster phase for categories of exposure to hazard , loss , and change . news media and social media feeds
may also be incorporated at this stage to enrich the list of stressors . trauma signature summary .
the final step in the initial tsig analysis involves the construction of a summary table of salient psychological risk factors , grouped into categories of exposure to hazard , loss , and change with an estimate of the  exposure severity  for each risk factor .
to demonstrate the feasibility of conducting tsig analysis , we developed a series of disaster case studies , beginning with post hoc analyses of historical disasters and progressing to real - time analyses of unfolding events .
our first tsig case study was performed on data from the 2010 haiti earthquake which we described as  a potent example of the rare catastrophic event where all major risk factors for psychological distress and impairment are prominent and compounding . 
our tsig case studies have been wide - ranging , including examples of natural , human - generated , and hybrid disasters , and complex emergencies .
in addition to tsig analyses for the 2010 haiti earthquake , we performed analyses on other natural disaster events including the 2011 us , super tornado outbreak , 2009 and 2011 river floods in the upper midwest , and 2012 superstorm sandy . in the realm of hybrid ( interacting natural and human - generated components ) , we carefully analyzed the 2011 great east japan disaster .
the 2010 deepwater horizon oil spill provided an application of tsig for an anthropogenic ( human - generated ) event . in the realm of complex emergencies / humanitarian crises , we have examined patterns of internal displacement in colombia and the russia - georgia conflict in south ossetia . with each case study , the research literature database of evidence - based research studies is expanded .
the case studies have provided an open invitation for colleagues with interest in a particular disaster event to join with us both in authorship and in advancing the tsig methodology .
tsig developers and co - authors have presented a series of invited papers , workshops , and institutes to introduce the methodology and actively seek feedback .
currently , an international cadre of co - authors and co - developers spans five continents .
however , at present we are soliciting additional disaster case studies , consulting with subject matter experts , creating the structure for the literature database , and launching an internet - based delphi process in 2013 to develop expert consensus regarding the methodology .
we will then seek opportunities to partner with lead response agencies in real - world , real - time applications of the tsig process .
once refined , our intention is to develop a practical system that can help infuse evidence - based science into the decision - making process for matching mhpss response to the defining features of the disaster event .
tsig is designed to contribute to the creation of mhpss response that increasingly approaches the attributes of optimal response outlined in table 2 .
 trauma signature ( tsig ) analysis is an evidence - based method that examines the interrelationship between population exposure to a disaster , extreme event , or complex emergency , and the inter - related physical and psychological consequences for the purpose of providing timely , actionable guidance for effective mental health and psychosocial support that is organically tailored and targeted to the defining features of the event . 

 
 a series of tsig case studies has been published since 2011 and tsig analyses of recent disasters are in process . 
 disaster health intends to expedite and feature novel tsig research focusing on late - breaking disaster events . 
 at the current stage of development , 
 expert consensus is sought for refining the tsig methodology using a delphi process . 
 the overarching goal is to create a fully operational system to provide timely guidance for adapting disaster behavioral health support to the salient psychological risk factors in each disaster . 
Introduction and Rationale for Trauma Signature (TSIG) Analysis
TSIG Analysis in the Context of Evidence-Based MHPSS Disaster Response
Framework for the Initial TSIG Analysis
TSIG Case Studies
Ongoing Development and Refinement of the TSIG Model
Supplementary Material
Disclosure of Potential Conflicts of Interest