First responders: mental health consequences of natural and human-made disasters for public health and public safety workers

COVID-19 Pandemic Surge: After-Action Report of a Coalition of Emergency Departments in New York City

The coronavirus disease (COVID-19) pandemic has stressed the US health care system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here, we present a structured after-action report of a coalition of 9 EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth. We report our experience in 6 key areas using a framework built around lessons learned. This report represents the most salient concepts related to our institutional after-action report, and those seemingly most relevant to our peer institutions dealing with similar circumstances.

What Helps Oiled Wildlife Responders Care for Animals While Minimizing Stress and Compassion Fatigue

Simple Summary

An oil spill can have severe environmental effects, as well as impacting the wellbeing of first responders. Oiled wildlife responders are a key professional group for the identification of wildlife at risk and to provide measures to rescue, rehabilitate and release wildlife back to their clean habitat. Currently, there is limited information documenting impacts to responders’ mental health during a spill response relating to stress, burnout and compassion fatigue; thus, there are limited interventions and strategies that can support responders and address these issues. A survey for oiled wildlife responders who participated in either the New Zealand MV Rena incident or the US Refugio pipeline oil spill was instigated to investigate and contribute to this knowledge gap. Results indicated that to support the health and wellbeing of oiled wildlife responders and sustain them to provide the best achievable care for oiled wildlife, ongoing professional training supported by organizations and professional networks in the areas of emergency preparedness, resilience, self-care and capacity building should be made available to enhance compassion satisfaction and role fulfilment.

Abstract

Oil spills are environmental disasters and their long-term impact is not just a concern for the environment and economy, but also for first responders’ health and wellbeing. Wildlife, such as aquatic birds and certain marine mammals, are highly susceptible to physiological effects of oiling, and oiled wildlife responders are crucial to provide measures for their survival. The purpose of this research was to explore the experiences of oiled wildlife responders and what factors and conditions have helped or inhibited the responders to care-affected wildlife. This study collected responses (n = 50) from a survey of responders who attended either the New Zealand MV Rena or US Refugio pipeline oil spills. Study participants were mostly older (>40), highly educated females. We found there were significant differences in compassion satisfaction, resilience, burnout and overall satisfaction based on age, gender and role. While most responders have only attended limited numbers of oil spill incidents, they reported positive experiences and found it rewarding. Findings from responders indicated that to lessen stress and compassion fatigue during an incident, provision of training and support from professional organizations equips responders with knowledge and skills that can support their personal resilience to respond to disaster events.

Nurses' core disaster-response competencies for combating COVID-19-A cross-sectional study

The core competencies in disaster nursing, nurses’ roles in disaster management and the potential barriers are assessed with a view to developing disaster nursing in Slovenia. Despite training and experience, many indicators show nurses are deficient in skills involving emergency and disaster-preparedness competencies. Nurses report little familiarity with disaster-planning skills, the implementation of disaster guidelines and assessment of patients subject to a disaster circumstance. A cross-sectional descriptive study was conducted based on data collected through an online survey. 118 registered nurses from different clinical settings in Slovenia participated in the study. Data were collected according to the Slovenian version of the Disaster Nursing Core Competencies Scale (Sl-DNCC-Scale). The scale was limited to a 7-point Likert response format (from 1 = strongly disagree to 7 = strongly agree). The results show the registered nurses perceive the core competencies of disaster nursing to be important to their preparedness for disaster situations (median = 161; range 74–189). Registered nurses who work in nursing homes and nurse managers are more aware of the importance of acquiring the listed competencies for unexpected events (p = 0.011 and 0.060 respectively) and the importance of their active role in disaster management (p = 0.027 and p = 0.004, respectively). To effectively deal with a disaster, nurses must be well prepared for unexpected events and more actively involved in disaster management. This study demonstrates that nurses regard the core disaster nursing competencies as important and greatly needed in various healthcare facilities. Future studies in this area should focus on ways to implement these competencies in nursing education.

Providing Effective Mental Health Support for Oncology Health-Care Workers in the COVID-19 Era: Responding Quickly but Carefully

Oncology health-care workers (HCWs) are facing substantial stressors during the current coronavirus disease 2019 pandemic, resulting in a wide range of acute stress responses. To appropriately meet the growing mental health needs of HCWs, it is imperative to differentiate expectable stress responses from posttraumatic stress disorder and mental illness, because traditional mental health interventions may pathologize healthy stress reactions and risk retraumatizing HCWs under acute duress. Further, HCWs are experiencing protracted forms of acute stress as the pandemic continues, including moral injury, and require mental health interventions that are flexible and can adapt as the acuity of stressors changes. Previously developed frameworks to support people experiencing acute stress, such as Psychological First Aid, are particularly relevant for HCWs in the ongoing pandemic. Acute stress interventions like Psychological First Aid are guided by the Stress Continuum Model, which conceptualizes stress reactions on a continuum, from a zone of normal readiness and expectable consequences to a zone of more persistent and extreme reactions such as posttraumatic stress disorder and major depression. Key principles of the Stress Continuum Model include the expectation that emotional reactivity does not lead to psychiatric problems, that interventions need to be appropriately targeted to symptoms along the stress continuum, and that people will return to normal recovery. Various core actions to reduce acute stress include delivering practical assistance, reducing arousal, mobilizing support, and providing targeted collaborative services. This nonpathologizing approach offers a valuable framework for delivering both individual and organizational-level interventions during the coronavirus disease 2019 pandemic.

Conceptualizing overdose trauma: The relationships between experiencing and witnessing overdoses with PTSD symptoms among street-recruited female sex workers in Baltimore, Maryland

BACKGROUND

The opioid crisis has rendered witnessing and experiencing overdoses a common occurrence, especially among marginalized and drug using populations, including female sex workers (FSW). Such exposures may confer psychological trauma that has gone unrecognized. We explored relationships between experiencing and witnessing overdoses and PTSD symptomology to understand the traumatic nature of these experiences.

METHODS

Data were from FSW (N = 380) in Baltimore City, Maryland, who reported whether they had witnessed/experienced any overdoses in the past 6 months ("overdose traumas") and PTSD symptoms (PCL-5). We tested for associations between overdose traumas and PTSD diagnoses/symptomology in bivariate logistic regression models and multivariate models, adjusting for sociodemographic, experiences of violence, and drug use characteristics.

RESULTS

In our sample, 35.3% witnessed a fatal overdose, 51.9% witnessed a non-fatal overdose, and 28.3% experienced an overdose in the past 6 months. More than half (52.4%) met criteria for PTSD. Most endorsed symptoms within each PTSD domain: 63.2% for intrusive, 58.4% for avoidance, 66.1% for cognition/mood, and 64.7% for arousal/reactivity symptoms. Experiencing an overdose was associated with meeting PTSD criteria and symptoms in all domains in bivariate models. Witnessing an overdose was associated with PTSD diagnoses and intrusive and arousal/reactivity symptoms in bivariate models. Adjusting for sociodemographic characteristics and drug use, experiencing an overdose was associated with intrusive and cognition/mood symptoms, while neither trauma remained associated with PTSD diagnoses.

CONCLUSIONS

Traumas related to overdose, coined "overdose traumas" appear to be extremely psychologically traumatic, though the relationships vary by type and symptom. Programs should be cognizant of psychological trauma to address the full spectrum of overdose harms. Existing measures of PTSD do not accurately represent the effects of overdose traumas in populations like FSW due to the structural barriers to avoiding locations/situations where overdoses may occur and the overlap between symptoms, drug effects, and adaptive responses to homelessness.

Health-Promoting Leadership During an Infectious Disease Outbreak: A Cross-Sectional Study of US Soldiers Deployed to Liberia

ABSTRACT

Infectious disease outbreaks are uniquely stressful for essential employees. One way to support workers is for supervisors to engage in behaviors promoting employees' well-being and attitudes toward preventive medicine practices. We examined whether health-promoting leadership contributes to these outcomes in a population of active-duty soldiers (N = 173) deployed to provide nonmedical support in Liberia during the 2014 Ebola epidemic using data reported in Sipos, Kim, Thomas, and Adler (Mil Med 183[3-4]:e171-e178, 2018). Soldiers completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale, and attitudes and rated their leaders on health-promoting behaviors. Using mixed-effects logistic regression, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership focused on preventive medicine was associated with decreased odds of depression and anxiety, and increased odds of high morale, positive attitudes, and avoiding unnecessary risk. Findings suggest health-promoting leadership could be valuable for workers responding to epidemics.

Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review

INTRODUCTION

First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder's career.

METHODS

A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications.

RESULTS

A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder's career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being.

CONCLUSION

Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage "reaching in" rather than placing an onus on first responders to "reach out" when they are in crisis.

Prevalence of depression and its impact on quality of life in frontline otorhinolaryngology nurses during the COVID-19 pandemic in China

Objective

Exposure to the coronavirus disease 2019 (COVID-19) was associated with high risk of mental health problems among frontline nurses. This study examined the prevalence of depressive symptoms (depression hereafter) and its impact on quality of life (QOL) in otorhinolaryngology (ENT) nurses during the COVID-19 pandemic in China.

Methods

An online study was conducted between March 15 and March 20, 2020. Depression and QOL were assessed using standardized instruments.

Results

A total of 1,757 participants were recruited. The prevalence of depression was 33.75% (95% CI: 31.59%-35.97%). Results emerging from multiple logistic regression analysis showed that direct care of COVID-19 patients (OR: 1.441, 95% CI: 1.031–2.013, P = 0.032), and current smoking (OR: 2.880, 95% CI: 1.018–8.979, P = 0.048) were significantly associated with depression. After controlling for covariates, ENT nurses with depression had a lower overall QOL compared to those without depression (F_{(1, 1757)}= 536.80, P < 0.001).

Conclusions

Depression was common among ENT nurses during the COVID-19 pandemic in China. Considering the negative impact of depression on QOL and care quality, regular screening for depression should be conducted in ENT nurses and treatment should be provided.

The Impact of Intolerance of Uncertainty on Negative Emotions in COVID-19: Mediation by Pandemic-Focused Time and Moderation by Perceived Efficacy

The COVID-19 global pandemic has resulted in a large number of people suffering from emotional problems. However, the mechanisms by which intolerance of uncertainty (IU) affects negative emotions during the COVID-19 pandemic remain unclear. This study aimed to explore the mediating role of pandemic-focused time and the moderating role of perceived efficacy in the association between IU and negative emotions during the COVID-19 pandemic based on the uncertainty-time-efficacy-emotion model (UTEE). 1131 participants were recruited to complete measures of COVID-19 IU, pandemic-focused time, perceived efficacy, negative emotions and demographic variables during the COVID-19 pandemic. The results showed that COVID-19 IU was significantly and positively associated with negative emotions, and this link could be mediated by pandemic-focused time. Moreover, the direct effect of COVID-19 IU on negative emotions was moderated by perceived efficacy. Specifically, the direct effect of COVID-19 IU on negative emotions was much stronger for individuals with lower levels of perceived efficacy. The current study further extended the previous integrative uncertainty tolerance model. Furthermore, the study suggested that policy makers and mental health professionals should reduce the general public's negative emotions during the pandemic through effective interventions such as adjusting COVID-19 IU, shortening pandemic-focused time and enhancing perceived efficacy.

Prevalence of burnout syndrome among Italian volunteers of the Red Cross: a cross-sectional study

Burnout syndrome (BOS) is a work-related constellation of symptoms characterized by emotional exhaustion, depersonalization, and personal accomplishment. A cross-sectional survey was performed to study the prevalence of BOS among a randomly selected sample of 280 Italian Red Cross volunteers. A socio-demographic questionnaire and the Maslach Burnout Inventory (MBI)-HSS were used to collect data. 241 volunteers participated (response rate: 86.1%). A significant proportion of the workers had BOS subscale scores in the highest tertile: emotional exhaustion 8.0%, depersonalization 35.9% and perceived lack of accomplishment 23.5%, respectively. Volunteers in emergency care reported higher levels of emotional exhaustion (p=0.004) and depersonalization (p=0.001), and lower level of personal accomplishment (p=0.042) than volunteers engaged in non-healthcare social and administrative duties. These findings support the opportunity of a set of administrative, organizational and individual preventive interventions for emergency volunteers' mental health.

Longitudinal Study of Hurricane Preparedness Behaviors: Influence of Collective Efficacy

OBJECTIVE

Community characteristics, such as collective efficacy, a measure of community strength, can affect behavioral responses following disasters. We measured collective efficacy 1 month before multiple hurricanes in 2005, and assessed its association to preparedness 9 months following the hurricane season.

METHODS

Participants were 631 Florida Department of Health workers who responded to multiple hurricanes in 2004 and 2005. They completed questionnaires that were distributed electronically approximately 1 month before (6.2005-T1) and 9 months after (6.2006-T2) several storms over the 2005 hurricane season. Collective efficacy, preparedness behaviors, and socio-demographics were assessed at T1, and preparedness behaviors and hurricane-related characteristics (injury, community-related damage) were assessed at T2. Participant ages ranged from 21-72 (M(SD) = 48.50 (10.15)), and the majority were female (78%).

RESULTS

In linear regression models, univariate analyses indicated that being older (B = 0.01, SE = 0.003, P < 0.001), White (B = 0.22, SE = 0.08, P < 0.01), and married (B = 0.05, SE = 0.02, p < 0.001) was associated with preparedness following the 2005 hurricanes. Multivariate analyses, adjusting for socio-demographics, preparedness (T1), and hurricane-related characteristics (T2), found that higher collective efficacy (T1) was associated with preparedness after the hurricanes (B = 0.10, SE = 0.03, P < 0.01; and B = 0.47, SE = 0.04, P < 0.001 respectively).

CONCLUSION

Programs enhancing collective efficacy may be a significant part of prevention practices and promote preparedness efforts before disasters.

Occupational Stress and Anger: Mediating Effects of Resiliency in First Responders

First responders experience substantial stress due to the nature of their work (Carleton et al. 2017). Occupational stress (OS) results from a myriad of employment conditions (e.g., ambiguous work expectations, unreasonable workload; Osipow 1998). OS can lead to maladaptive anger, which negatively impacts personal well-being and work performance (Velichkovsky 2009). In contrast, resilience to demanding working conditions is associated with lower state and trait anger (Wilson et al. 2001); thus, resilience may serve a protective 'buffer' role against anger in the face of stress. Thus, we hypothesized that resiliency would mediate relations between dimensions of OS and anger. The current study included 201 first responders (male = 77.6%; M _age = 43.73 years (SD = 10.97); police officers = 64.2%) who completed measures of OS (OSI-R; Osipow 1998), Anger (DSM-5 CC Anger; APA 2013), and Resiliency (CD-RISC; Connor and Davidson 2003). Results indicated that resiliency mediated relations between five components of OS and anger: Role Overload (p < .001); Insufficiency (p < .001); Role Boundary (p < .001); Role Ambiguity (p < .001); and Role Responsibility (p < .001). Results support the importance of resiliency-enhancing interventions to offset the experience of anger when confronted with occupational stress in first responders.

Hardships in Italian Prisons During the COVID-19 Emergency: The Experience of Healthcare Personnel

Background: The recent COVID-19 pandemic has highlighted the deficiencies that characterize the functioning of the Italian national health system. Prisons have always mirrored the most radical expressions of these weaknesses. During the early stages of the pandemic, prison facilities across Italy underwent a series of changes dictated by the need to ensure the safety of the prisoners and staff. The adoption of these rules contributed to a total or partial redefinition of many central facets of life in prison, such as intake procedures for new arrivals and the ways prisoners were allowed to communicate with their families.

Objectives: The aim of this qualitative study was to analyze the testimony of penitentiary healthcare workers in prisons throughout Italy to determine the impact of COVID-19 on their professional and personal lives.

Participants: Thirty-eight participants were contacted and 20 decided to participate in the interview. The sample was made up of 10 women and 10 men. All the participants were members of the healthcare staff of a penitentiary facility (psychologists, psychiatrists, physicians, and nurses). All were recruited through an Italian association whose mission is the development, promotion, and implementation of social solidarity projects including prisoners' social and health care. This study was facilitated through representatives serving in nine different regions of Italy. The participants were divided according to their professional roles in prisons.

Method: In-depth interviews were conducted by telephone or online using telecommunication platforms (e.g., Zoom, WhatsApp, and Skype). The transcribed texts underwent thematic analysis using the Atlas.ti software to identify patterns of meaning across the dataset.

Results: Four main themes emerged from the analysis: Interpersonal difficulties, management and operational difficulties, the personal distress and bereavement of healthcare workers, and the distress of inmates. The importance of relationship management skills when interacting with prisoners emerged as a key topic in many interviews, and the participants highlighted the need for adequate training. The increase in prisoners' anxiety made communication more difficult.

Conclusions: The findings suggest that healthcare workers in jails need emergency-oriented training. Participants described their feeling of loneliness and quasi-abandonment when carrying out their duties during the pandemic. In particular, they underscored the need for psychological guidance to better manage altered reactions with prisoners and colleagues as a result of heightened death anxiety and isolation.

A Large Scale of Nurses Participated in Beating down COVID-19 in China: The Physical and Psychological Distress

The outbreak of coronavirus disease 2019 (COVID-19) posed an unprecedented threat to health care providers (HCPs) in Wuhan, China, especially for nurses who were frequently exposed to infected or suspected patients. Limited information was available about the working experience of nurses in fighting against the pandemic. To learn the physical and psychological responses of nurses during the pandemic and explore the potential determinants, we conducted a large-scale survey in Wuhan. This multicenter cross-sectional study enrolled 5521 nurses who worked in designated hospitals, mobile cabins, or shelters during the pandemic. A structured online questionnaire was distributed to assess the physical discomforts, emotional distress and cognitive reactions of nurses at work, and the log-binomial regression analysis was performed to explore potential determinants. A considerable proportion of nurses had symptoms of physical discomforts [3677 (66.6%)] and emotional distress [4721 (85.5%)]. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 2.35; 95% CI, 1.95-2.84), with irregular work schedules (RR, 2.36; 95% CI, 1.95-2.87), and working overtime (RR, 1.34; 95% CI, 1.08-1.65) were at a higher risk for physical discomforts. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 1.78; 95% CI, 1.40-2.29), with irregular work schedules (RR, 3.39; 95% CI, 2.43-4.73), and working overtime (RR, 1.51; 95% CI, 1.12-2.04) were at a higher risk for emotional distress. Therefore, formulating reasonable work schedules and improving workforce systems are necessary to alleviate the physical and emotional distress of nurses during the pandemic.

COVID-19 Pandemic and Mental Health of Vulnerable Two Groups: Developmental Trauma of the Child-Adolescents and Work Disaster of Health Care Workers

COVID-19 has spread worldwide. People are struggling to adjust to a new normal, but changes in their daily routines are also causing stress. A person may feel depressed, uneasy, or suicidal and may complain of symptoms such as panic attacks, post-traumatic stress disease (PTSD), psychosis, obsessive–compulsive disorder, or paranoia when personal resilience cannot effectively process the stress. Children, adolescents, and health care workers are especially psychologically vulnerable groups in the pandemic calamity situation; therefore, a long-term intervention plan is necessary for them. When intervening with children and adolescents, it should be considered that each individual has different ways of expressing stress according to the developmental level of cognition, language, and emotion, and taking into account these developmental levels, it is necessary to help them achieve developmental tasks appropriate for their age. Health care workers feel psychological pain from problems such as the risk of becoming infected, the risk of passing the virus to their families, overwork, isolation, and stigma. Therefore, it is necessary to help them recover themselves by supplying personal protective equipment and providing the most basic resources necessary for adequate rest, work-life balance, and childcare.

Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway

Background:

The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.

Aim:

Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.

Research design:

A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.

Ethical considerations:

Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421).

Findings:

Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.

Discussion:

By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.

Conclusion:

Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms.

Social Embeddedness of Firefighters, Paramedics, Specialized Nurses, Police Officers, and Military Personnel: Systematic Review in Relation to the Risk of Traumatization

Background: Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships. Methods: We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019. Results: A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor. Conclusions: Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.

Diversity, preventive work and education-matters of health and well-being in firefighter discourse

Purpose: The aim of this study is to analyse how recurrent health hindrance themes in the firefighter discourse, identified by firefighters themselves, relate to a set of policies about diversity, preventive work and education of firefighters. The intention is further to discuss the implications of these policy initiatives and the resistance against them in terms of firefighters' health and well-being at work. Method: Firefighters from three different rescue stations in Sweden, participated in either a focus group discussion or individual interviews. Different themes in firefighter discourse that were described as hindrances to the health and well-being of firefighters were identified. A strategic sample of policy documents that relate to the very same themes was also chosen for analysis and here we combined critical discourse analysis (CDA) with critical policy analysis. Results: The health hindrance themes regarding diversity, preventive work and education that firefighters identified have in common that they relate to changes in work culture and the firefighter profession. Conclusion: In conclusion, we argue that the most important challenge for the rescue service to tackle in the future, is how to transform firefighting to be more inclusive and yet maintaining the good health and well-being that exists among the vast majority of today's firefighters.

The roles of emergency managers and emergency social services directors to support disaster risk reduction in Canada

Emergency managers (EMs) and Emergency Social Services Directors (ESSDs) are essential service providers who fulfill critical roles in disaster risk reduction. Despite being positioned throughout all levels of government, and in the private sector, EMs and ESSDs fulfill roles which occur largely behind the scenes. The purpose of this phenomenological study was to explore the roles of EMs and ESSDs from different regions across Canada. Specifically, we wanted to understand their perceptions of barriers, vulnerabilities and capabilities within the context of their roles. EMs (n = 15) and ESSDs (n = 6) from six Canadian provinces participated in semi-structured telephone interviews. Through content analysis, five themes and one model were generated from the data: 1) Emergency management is not synonymous with first response, 2) Unrealistic expectations for a "side-of-desk" role, 3) Minding the gap between academia and practice with a 'whole-society' approach, 4) Personal preparedness tends to be weak, 5) Behind the scenes roles can have mental health implications. We present a model, based on these themes, which makes explicit the occupational risks that EMs and ESSDs may encounter in carrying out the skills, tasks, and roles of their jobs. Identification of occupational risks is a first step towards reducing vulnerabilities and supporting capability. This is particularly relevant in our current society as increased demands placed on these professionals coincides with the increasing frequency and severity of natural disasters due to climate change and the emergence of the world wide COVID-19 pandemic.

Psychological Impact of COVID-19 Duties During Lockdown on Police Personnel and Their Perception About the Behavior of the People: an Exploratory Study from India

To evaluate the psychosocial issues among the police personnel during the COVID-19 pandemic. In a web-based cross-sectional survey, 623 police personnel were evaluated on Patient Health Questionnaire-4 (PHQ-4) and Perceived stress scale (PSS), and a self-designed questionnaire. 10.6% of the police personnel had significant anxiety and 18% have significant depressive symptoms with overall psychological morbidity of 22.2%. Higher age was significantly associated with higher depressive symptoms, total PHQ-4 score, and higher perceived stress. The present survey suggests that a substantial proportion of the police personnel on COVID-19 duty during the lockdown period have significant anxiety, depressive symptoms, and perceive significant stress. There is an urgent need to evaluate the mental health issues and provide psychological support to the police personnel who are considered as faceless warriors of the COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-020-00408-8.

Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review

BACKGROUND

Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symptoms of mental health problems commonly include depression, anxiety, stress, and additional cognitive and social problems; these can impact on function in the workplace. The mental health and resilience (ability to cope with the negative effects of stress) of frontline health and social care professionals ('frontline workers' in this review) could be supported during disease epidemics by workplace interventions, interventions to support basic daily needs, psychological support interventions, pharmacological interventions, or a combination of any or all of these.

OBJECTIVES

Objective 1: to assess the effects of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Objective 2: to identify barriers and facilitators that may impact on the implementation of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic.

SEARCH METHODS

On 28 May 2020 we searched the Cochrane Database of Systematic Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global Index Medicus databases and WHO Institutional Repository for Information Sharing. We also searched ongoing trials registers and Google Scholar. We ran all searches from the year 2002 onwards, with no language restrictions.

SELECTION CRITERIA

We included studies in which participants were health and social care professionals working at the front line during infectious disease outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For objective 1 we included quantitative evidence from randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies, which investigated the effect of any intervention to support mental health or resilience, compared to no intervention, standard care, placebo or attention control intervention, or other active interventions. For objective 2 we included qualitative evidence from studies that described barriers and facilitators to the implementation of interventions. Outcomes critical to this review were general mental health and resilience. Additional outcomes included psychological symptoms of anxiety, depression or stress; burnout; other mental health disorders; workplace staffing; and adverse events arising from interventions.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently applied selection criteria to abstracts and full papers, with disagreements resolved through discussion. One review author systematically extracted data, cross-checked by a second review author. For objective 1, we assessed risk of bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For objective 2, we assessed methodological limitations using either the CASP (Critical Appraisal Skills Programme) qualitative study tool, for qualitative studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for descriptive studies. We planned meta-analyses of pairwise comparisons for outcomes if direct evidence were available. Two review authors extracted evidence relating to barriers and facilitators to implementation, organised these around the domains of the Consolidated Framework of Implementation Research, and used the GRADE-CERQual approach to assess confidence in each finding. We planned to produce an overarching synthesis, bringing quantitative and qualitative findings together.

MAIN RESULTS

We included 16 studies that reported implementation of an intervention aimed at supporting the resilience or mental health of frontline workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID-19: 4). Interventions studied included workplace interventions, such as training, structure and communication (6 studies); psychological support interventions, such as counselling and psychology services (8 studies); and multifaceted interventions (2 studies). Objective 1: a mixed-methods study that incorporated a cluster-randomised trial, investigating the effect of a work-based intervention, provided very low-certainty evidence about the effect of training frontline healthcare workers to deliver psychological first aid on a measure of burnout. Objective 2: we included all 16 studies in our qualitative evidence synthesis; we classified seven as qualitative and nine as descriptive studies. We identified 17 key findings from multiple barriers and facilitators reported in studies. We did not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings. We are moderately confident that the following two factors were barriers to intervention implementation: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. We are moderately confident that the following three factors were facilitators of intervention implementation: interventions that could be adapted for local needs; having effective communication, both formally and socially; and having positive, safe and supportive learning environments for frontline workers. We are moderately confident that the knowledge or beliefs, or both, that people have about an intervention can act as either barriers or facilitators to implementation of the intervention.

AUTHORS' CONCLUSIONS

There is a lack of both quantitative and qualitative evidence from studies carried out during or after disease epidemics and pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline workers. Alternative sources of evidence (e.g. from other healthcare crises, and general evidence about interventions that support mental well-being) could therefore be used to inform decision making. When selecting interventions aimed at supporting frontline workers' mental health, organisational, social, personal, and psychological factors may all be important. Research to determine the effectiveness of interventions is a high priority. The COVID-19 pandemic provides unique opportunities for robust evaluation of interventions. Future studies must be developed with appropriately rigorous planning, including development, peer review and transparent reporting of research protocols, following guidance and standards for best practice, and with appropriate length of follow-up. Factors that may act as barriers and facilitators to implementation of interventions should be considered during the planning of future research and when selecting interventions to deliver within local settings.

Personal Accomplishment and Hardiness in Reducing Emergency Stress and Burnout among COVID-19 Emergency Workers

During the severe phase of the pandemic, COVID-19 emergency workers were engaged in long and numerous shifts of duty, resulting in exposure to various stress factors. A high stress level is associated with risk of burnout. Resilience and personal accomplishment can effectively help mitigate and reduce emergency stress levels and emotional exhaustion. The main aim of this study was to analyze the relationship of emergency stress and hardiness with burnout among emergency workers. The participants included 494 emergency volunteers from the Red Cross Committee in Veneto, Italy, engaged in various health, emergency, and social activities aimed at COVID-19 patients and people at risk of contracting the virus. Questionnaires used to measure emergency stress, hardiness and burnout were administered on an online platform. We analyzed the influence of age, sex, weekly hours of service, stress risk factors, and use of personal protective equipment. To verify the predictive effects of risk and protective factors on burnout, correlational and multivariate analyses, and regressions were conducted. Hardiness showed an effect in reducing emergency stress levels, emotional exhaustion, and depersonalization and simultaneously increased personal accomplishment.

Rapid ethnographic assessment of the COVID-19 pandemic April 2020 'surge' and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center

OBJECTIVES

Assess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands.

DESIGN

Rapid clinical ethnography of patient-provider encounters during an initial pandemic 'surge' conducted by a team of clinician-researchers using a structured protocol for qualitative data collection and analysis.

SETTING

Level 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020.

PARTICIPANTS

Frontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients.

RESULTS

We identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale.

CONCLUSIONS

Although limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.

Chronic and Traumatic Stress Among Emergency Medical Services Personnel

Abstract. Background: Emergency medical services (EMS) personnel are frequently confronted with multiple stressful and potentially traumatic events as well as adverse working conditions. Objective: This narrative review provides an overview of the impact of adverse mission experiences and working conditions on the mental and physical health of EMS personnel. Methods: We summarize the empirical findings on prevalence rates as well as individual vulnerability factors and resilience. Results: EMS personnel show the highest prevalence rates of stress-related health problems among first responders. The article outlines prevention and intervention approaches that contribute to maintaining and improving the mental and physical health of EMS personnel. Conclusion: In the future, further evidence-based intervention measures should be developed to adequately support this professional group.

Reliability and validity of a post-traumatic checklist-5 (PCL-5) among fire and rescue officers in Selangor, Malaysia

Purpose

This study is to establish the validity and reliability of Malay version of Post-traumatic Check List-5 (MPCL-5) among the fire and rescue officers in the state of Selangor, Malaysia.

Design/methodology/approach

A cross-sectional study was conducted, which involved 100 firefighters from the state of Selangor, Malaysia. Construct validity, internal consistency, and concurrent validity were performed and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Concurrent validity was tested with validated Malay version of Trauma Screen Questionnaire (TSQ-M).

Findings

Overall internal consistency reliability was a 0.960 and individual construct Cronbach's alpha ranged from 0.827 to 0.926. The model, which consists of four constructs with 20 items, demonstrated the presence of acceptable loading factors. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) are 0.81, 0.65, 0.31 and 0.95 respectively at an optimum cut-off score of 35.

Research limitations/implications

The Post Traumatic Check List 5 (PCL-5) is the latest tool based on DSM-5 developed recently and still having limited studies on the psychometric properties of the tool in local population and the findings produced are comparable with the results from validation from previous studies. The study limitations are population samples used are considering the minimum numbers of sample for each item for factor analysis and the concurrent validation was tested with the TSQ-M instead of the Clinician Administered PTSD Scale for DSM-5 (CAPS-5).

Practical implications

The study suggested that MPCL-5 is acceptable to be used to measure post-traumatic stress disorder in local populations.

Originality/value

There are limited known validation studies for PCL-5 in local populations and this is the first study done among fire and rescue officers in Malaysia. The results are comparable with findings from previous studies and therefore MPCL-5 are valid and reliable for PTSD screening.

The mental health of emergency services personnel in the UK Biobank: a comparison with the working population

Background: There is evidence that mental disorders are more frequently reported among emergency services personnel due to the stressful nature of the job in combination with a high exposure to traumatic events. However, most of this research is based on occupational surveys that may lead to a contextual bias in the prevalence estimates or lack an adequate comparison group. Objectives: To investigate mental health outcomes and associations with individual, job and trauma related characteristics among emergency services personnel compared to other workers. Method: Participants were identified from the UK Biobank, a large study that collected a variety of genetic, physical and health data on individuals from across the UK. UK Biobank participants were aged between 40-69 years at recruitment. Those employed in the emergency services were identified based on job titles. A comparison sample of other workers was selected and matched to the gender composition of emergency services personnel. Results: 5052 participants were included, and 842 were currently working in the emergency services. The majority were male (77.4%) and the mean age at Biobank enrolment was 52.5 years. Alcohol misuse was reported in 32.8% of emergency services personnel compared to 29.2% in non-emergency services personnel, followed by PTSD (9.2% vs 6.0%), depression (6.8% vs 5.1%) and anxiety (3.9% vs 3.6%). An increased risk of PTSD was found among emergency services personnel compared to other workers (odds ratio 1.58, 95% confidence interval 1.21-2.06), but this association was no longer significant after adjustment for exposure to traumatic events and job characteristics. Conclusions: The substantial levels of alcohol misuse and increased risk of PTSD, possibly as a result of traumatic exposures in the line of duty in combination with job stressors such as shift work, call for continued monitoring of the health and wellbeing of emergency services personnel.

Warr;or21: A 21-Day Program to Enhance First Responder Resilience and Mental Health

First responders face multiple stressors on a daily basis. They have experienced higher rates of anxiety disorders, depression, burnout, post-traumatic stress disorder (PTSD), suicide (Asmundson and Stapleton, 2008), alcohol and substance abuse (Ballenger et al., 2010), and deficient sleep hygiene (Pearsall, 2012) compared to the general population. Existing resilience research can be utilized and adapted to help first responders cope in a positive manner as a form of prevention and also as part of their recovery. New resiliency programs continue to emerge and this paper details one – warr;or21. The warr;or21 program is explained and based on an evaluation of the program’s preliminary data, the results are promising with how the program can assist first responders (and the general public) increase their resiliency and mental health.

Assessment of Factors Associated With Long-term Posttraumatic Stress Symptoms Among 56 388 First Responders After the 2011 Great East Japan Earthquake

IMPORTANCE

First responders are at risk for developing symptoms of posttraumatic stress disorder (PTSD). Little is known about the risk factors for developing PTSD during a years-long period after complex mass disasters.

OBJECTIVE

To explore the long-term course of PTSD symptoms and to identify risk factors and their relative association with PTSD among first responders dispatched to the 2011 Japanese earthquake, tsunami, and nuclear disaster.

DESIGN, SETTING, AND PARTICIPANTS

This 6-year, large, prospective cohort study was part of a continuous longitudinal study of Japan Ground Self-Defense Force first responders. The data were collected at 1, 6, 12, 24, 36, 48, 60, and 72 months after mission completion from 2011 to 2017. Of approximately 70 000 eligible participants, 56 388 were enrolled in this study. Data were analyzed from 2017 to 2020.

EXPOSURES

Stress exposures owing to personal or professional disaster experience (eg, duties with body recovery or radiation exposure risk) and working conditions (eg, deployment length, postdeployment overtime work).

MAIN OUTCOMES AND MEASURES

The Impact of Event Scale-Revised score assessed PTSD symptoms; scores of at least 25 were defined as probable PTSD. Cox proportional hazards regression models assessed the risk factors for incidence of probable PTSD.

RESULTS

Among the 56 388 participants, 97.1% were men, and the median age at enrollment was 34 (range, 18-63) years. A probable PTSD rate was 2.7% at 1 month and showed a downward trend in the first year and a subsequent plateau. The cumulative incidence of probable PTSD was 6.75%. The severity of PTSD symptoms demonstrated a high degree of rank-order stability over time. Rather than professional disaster experience, sociodemographic factors and working conditions were independently associated with the incidence of probable PTSD: personal experience of the disaster (hazard ratio [HR], 1.96; 95% CI, 1.72-2.24), deployment length of at least 3 months (HR vs <1 month, 1.75; 95% CI, 1.52-2.02), increased age (HR for ≥46 vs ≤25 years, 2.28; 95% CI, 1.79-2.92), and postdeployment overtime work of at least 3 months (HR vs little to none, 1.61; 95% CI, 1.39-1.87).

CONCLUSIONS AND RELEVANCE

Given these findings, in the future, first responders' PTSD symptoms might be mitigated by shortening deployment length, avoiding postdeployment overtime work, and paying special attention to the needs of personnel with personal experience of the disaster or older age. Efforts to alleviate responders' initial symptoms will be required.

Trajectories for Post-traumatic Stress Disorder Symptoms Among Local Disaster Recovery Workers Following the Great East Japan Earthquake: Group-based Trajectory Modeling

BACKGROUND

As many local municipality and medical workers were involved in disaster recovery duties following the Great East Japan Earthquake (GEJE) on March 11, 2011, the aim of this work was to elucidate the distinct trajectories for post-traumatic stress disorder (PTSD) symptoms and associated factors among these personnel. They confronted a diverse range of stressors both as survivors and as relief workers; however, little is known about their longitudinal PTSD symptoms.

METHODS

The participants were 745 local municipality and hospital medical workers [average age: 43.6 ± 9.5 years, range: 20 - 66 years; 306 (59%) women] involved in disaster recovery duties following the GEJE. PTSD symptoms were measured using the Japanese version of the PTSD Checklist Specific Version (PCL-S) at four time points: 14, 30, 43, and 54 months after the GEJE. Using group-based trajectory modeling, distinct trajectories were elucidated.

RESULTS

We identified five distinct PTSD symptoms profiles: resistance (n = 467, 62.7%), subsyndromal (n = 181, 24.3%), recovery (n = 47, 6.3%), fluctuating (n = 26, 3.5%), and chronic (n = 24, 3.2%). The trajectories differed according to the post-disaster working conditions and personal disaster experiences.

LIMITATIONS

Potential selection bias resulting from the limited number of participants who completed all waves. The survey was conducted in one region of the disaster area.

CONCLUSIONS

The majority of participants remained stable, with a relatively small group classified as chronic and fluctuating. Our results highlight the importance of improved working conditions and sustained monitoring of workers responding to natural disasters.

Social support as a mediator of occupational stressors and mental health outcomes in first responders

This cross-sectional study aimed to address whether occupational stressors are associated with adverse mental health outcomes in first responders via lower social support. A total of 895 first responders including emergency medical technicians, paramedics, and firefighters from 50 US States and the Virgin Islands (mean = 37.32, standard deviation = 12.09, 59.2% male, and 91.3% White) completed an online survey. Bivariate analyses indicated that occupational stressors were positively correlated with posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) symptoms, and negatively correlated with social support, whereas social support was negatively correlated with PTSD, MD, and GAD symptoms. Mediation analyses revealed significant indirect effects of occupational stressors on PTSD, MD, and GAD symptoms via social support, after controlling for covariates. Although longitudinal research is needed for a more robust examination of this pathway, the results highlight the importance of social support in first responders. Efforts to augment the support systems of first responders are recommended.

Canadian emergency physician psychological distress and burnout during the first 10 weeks of COVID-19: A mixed-methods study

Objectives

The aim of this study was to report burnout time trends and describe the psychological effects of working as a Canadian emergency physician during the first weeks of the coronavirus disease 2019 (COVID‐19) pandemic.

Methods

This was a mixed‐methods study. Emergency physicians completed a weekly online survey. The primary outcome was physician burnout as measured by the emotional exhaustion and depersonalization items, from the Maslach Burnout Inventory. We captured data on work patterns, aerosolizing procedures, testing and diagnosis of COVID‐19. Each week participants entered free text explaining their experiences and well‐being.

Results

There were 468 participants who worked in 143 Canadian hospitals. Burnout levels did not significantly change over time (emotional exhaustion P = 0.632, depersonalization P = 0.155). Three participants were diagnosed with COVID‐19. Being tested for COVID‐19 (odds ratio [OR] 11.5, 95% confidence interval [CI] 3.1–42.5) and the number of shifts worked (OR 1.3, 95% CI 1.1–1.5 per additional shift) were associated with high emotional exhaustion. Having been tested for COVID‐19 (OR 4.3, 95% CI 1.1–17.8) was also associated with high depersonalization. Personal safety, academic and educational work, personal protective equipment, the workforce, patient volumes, work patterns, and work environment had an impact on physician well‐being. A new financial reality and contrasting negative and positive experiences affected participants’ psychological health.

Conclusion

Emergency physician burnout levels remained stable during the initial 10 weeks of this pandemic. The impact of COVID‐19 on the work environment and personal perceptions and fears about the impact on lifestyle have affected physician well‐being.

Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic

The number of health workers infected with COVID-19 in Spain is one of the highest in the world. The aim of this study is to analyse posttraumatic stress, anxiety and depression during the COVID-19 pandemic. Associations between burnout, resilience, demographic, work and COVID-19 variables are analysed. Cross-sectional data on 1422 health workers were analysed. A total of 56.6% of health workers present symptoms of posttraumatic stress disorder, 58.6% anxiety disorder, 46% depressive disorder and 41.1% feel emotionally drained. The profile of a health worker with greater posttraumatic stress symptoms would be a person who works in the Autonomous Community of Madrid, in a hospital, is a woman, is concerned that a person he/she lives with may be infected, and thinks that he/she is very likely to be infected. The risk variables for anxiety and depression would be a person that is a woman, working 12- or 24-h shifts, and being worried that a family member could be infected. High scores on emotional exhaustion and depersonalization are risk factors for mental health, with resilience and personal fulfilment being protective variables. Data are provided to improve preventive measures for occupational health workers.

Free Your Mind: Emotional Expressive Flexibility Moderates the Effect of Stress on Post-Traumatic Stress Disorder Symptoms

Servicemen are exposed to high levels of stress as part of their daily routine, however, studies which tested the relationship between stress and clinical symptoms reached inconsistent results. The present study examines the role of expressive flexibility, which was determined according to the ability to enhance or suppress either negative or positive emotional expression in conflictual situations, as a possible moderator between stress and Post-Traumatic Stress Disorder (PTSD) symptoms. A total of 82 active-duty firefighters (all men, age range = 25–66, M = 33.59, SD = 9.56, range of years in duty service = 2–41, M = 14.37, SD = 11.79), with different duty-related repeated traumatic exposure, participated in the study. We predicted and found that firefighters with low, but not high, expressive flexibility showed a significant positive correlation between duty-related traumatic exposure and PTSD symptomology (t(81) = 3.85, p < 0.001). Hence, the greater the exposure the higher level of symptoms they exhibited. In addition, we found a difference between the moderating roles of suppressing positive and negative emotional expression, as high but not low, ability to suppress the expression of negative emotions (t(81) = 1.76, p > 0.05), as low but not high, ability to suppress the expression of positive emotions (t(81) = 1.6, p > 0.05), served as a protective factor in buffering the deleterious effect of repeated traumatic exposure. The results provide a pivotal support for the growing body of evidence that a flexible emotional profile is an adaptive one, in dealing with negative life events. However, while there is a need to update behavior, the direction of the adaptive update may differ as a function of valance.

Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic

The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the shortterm, and place individuals at risk for persistent stressexposure syndromes, subclinical mental health symptoms, and professional burnout in the longterm. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peersupport model (Battle Buddies) developed by the United States Army. This intervention—the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center—also incorporates evidence-informed “stress inoculation” methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) apeersupport Battle Buddy; and (2) adesignated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention’s effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.

Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses

The COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research-examining how it affects mental health and recovery; (b) practice-implementing evidence-based stigma reduction initiatives; and (c) policy-coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Communication Skills in the Age of COVID-19

COVID-19 has placed enormous stress on hospitals and health care providers worldwide. Limitations in hospital capacity may result in difficult decisions in how life-sustaining technologies are allocated among patients. The authors of this essay provide guidance on how to communicate with patients who are seriously ill from COVID-19 infection.

The disaster worker resiliency training program: a randomized clinical trial

Objectives

Disaster workers are at elevated risk for mental health problems as a result of trauma exposures during response efforts. One possible way to prevent mental health problems is to build-up coping resources that promote resilience to the effects of disaster work. The primary aim of this study was to evaluate the efficacy of a resilience building workshop, the Disaster Worker Resiliency Training Program (DWRT), in disaster workers previously exposed to Hurricane Sandy.

Methods

Disaster workers (N = 167) were randomly assigned to the DWRT workshop (n = 78) or a waitlist (n = 89). Workers completed self-report measures on healthy lifestyle behaviors, perceived stress, depression, and Posttraumatic Stress Disorder (PTSD) symptoms at baseline and 3-month follow-up. They also completed a measure assessing subsequent trauma-exposure between the baseline and 3-month post-intervention.

Results

Participants in the workshop condition, as compared to those in a waitlist control, reported significantly greater improvements from pre-intervention (T1) to 3-month follow-up (T2) in healthy lifestyle behaviors (η² = .03; p = .03), stress management (η² = .03, p = .04), and spiritual growth (η² = .03, p = .02). Among participants reporting subsequent trauma exposures between T1 and T2  (n = 101), participants in the waitlist condition, were more likely to report significant increases in perceived stress (η² = .07, p < .01), PTSD (η² = .05, p = .03), and depression (η² = .07, p < .01) symptoms.

Conclusions

Participation in the resilience workshop promoted engagement in positive health behaviors and reduced the incidence of mental health symptoms, especially when administered prior to a repeat trauma exposure. Further research is needed to evaluate the long-term health effects of participation in the program.

Risk Factors for Duty-Related Posttraumatic Stress Disorder among Police Officers in the Mt. Ontake Eruption Disaster-Support Task Force

Mount Ontake in Nagano Prefecture, Japan erupted on 27 September 2014. Many police officers were called in for duty as a disaster-support task force. We investigated the association between the peritraumatic situation and posttraumatic stress disorder (PTSD) symptoms in these police officers. In January 2015, a health survey (OHS) on disaster stress related to the Mt. Ontake eruption disaster support work was distributed to all of the police officers and staff involved in the disaster support. We analyzed the 213 participants who had PTSD symptoms following the eruption and no missing OHS data. Logistic regression analyses were conducted to clarify the relationship between the participants' symptom severity and their peritraumatic situation (i.e., stressors and daily support prior to the eruption, disaster-support work duties, and postdisaster stress relief). The symptom severity was associated with 'more than seven cumulative days at work' (odds ratio [OR] = 2.47, 1.21-5.06), 'selecting drinking and/or smoking as stress relief after disaster-support work' (OR = 2.35, 1.09-5.04), and 'female' (OR = 3.58, 1.19-10.77). As disaster-support work, 'supporting the victims' families' (OR = 1.99, 0.95-4.21) tended to be associated with symptom severity. The number of days of disaster-support work, stress-relief behavior, and gender were associated with the severity of PTSD symptoms.

The Impact of Intolerance of Uncertainty and Anxiety Sensitivity on Mental Health Among Public Safety Personnel: When the Uncertain is Unavoidable

BACKGROUND

Public safety personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, public safety communications officials) are regularly exposed to potentially traumatic events and considerable uncertainty as part of their employment. Canadian PSP screen positively for mental disorders at much higher rates than the general population. Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are empirically-supported vulnerability factors associated with the development and maintenance of mental disorders.

METHODS

The present study was designed to assess IU and AS across PSP-a population regularly encountering uncertainty-with and without mental disorders (n = 4304; 33.3% women), and across normative clinical, community, and undergraduate samples. Further, the study examined the relationship between IU and AS and mental disorders among PSP.

RESULTS

There were significant differences across groups on IU and AS scores (ps < .001). All PSP, with and without a positive screen for a mental disorder, reported lower IU and AS than clinical samples; however, PSP without mental disorders reported lower IU and AS than all other groups (ps < .001).

CONCLUSION

Increased resilience or the development of coping skills to manage regular exposures to uncertain threat may help explain why PSP reported low levels of IU and AS despite higher prevalence of mental disorders. Implications for PSP training and treatment are discussed.

Development and validation of the humanitarian aid workers resilience scale (HAWRS)

Background: Humanitarian aid workers experience various challenges in disasters, which affects their wellbeing. Being resilience can help volunteers to adapt to them. This study was conducted to develop and validate a resiliency questionnaire to evaluate the resilience of humanitarian aid workers in disasters. Methods: This study was conducted in 2 phases between Dec 2017 and Oct 2018. In the first phase for item generation, we used qualitative content analysis. Face-to-face semi-structured interviews with 18 humanitarian aid workers were used for data collection. In the second phase, by conducting a quantitative study, the psychometric properties of the scale including face, content and construct validities as well as internal and external reliabilities, were determined. Data analysis was performed using SPSS 19 and the significance level was set at less than 0.05. Results: Six main subjects were extracted from the first-stage data using content analysis. The final questionnaire included six factors and 31 items after validity and reliability criteria analysis. These six factors including organizational supports, individual factors, organizational planning, social support, teamwork and challenges of disaster scene included 52.19% of the variance. The internal consistency was confirmed as well (Cronbach's alpha = 0.814). Conclusion: This specific self-assessment questionnaire can be used for scoring the resilience of humanitarian aid workers in disasters. In the case of low resilience score of volunteers, managers should avoid sending them on missions and try to improve their resilience through educational programs.

A Literature Review on Psychosocial Support for Disaster Responders: Qualitative Synthesis with Recommended Actions for Protecting and Promoting the Mental Health of Responders

Little scientific evidence exists on ways to decrease the psychological stress experienced by disaster responders, or how to maintain and improve their mental health. In an effort to grasp the current state of research, we examined research papers, agency reports, the manuals of aid organisations, and educational materials, in both English and Japanese. Using MEDLINE, Ichushi-Web (Japanese search engine), Google Scholar, websites of the United Nations agencies, and the database of the Grants System for Japan’s Ministry of Health, Labour, and Welfare, 71 pertinent materials were identified, 49 of which were analysed. As a result, 55 actions were extracted that could potentially protect and improve the mental health of disaster responders, leading to specific recommendations. These include (1) during the pre-activity phase, enabling responders to anticipate stressful situations at a disaster site and preparing them to monitor their stress level; (2) during the activity phase, engaging in preventive measures against on-site stress; (3) using external professional support when the level of stress is excessive; and (4) after the disaster response, getting back to routines, sharing of experiences, and long-term follow-up. Our results highlighted the need to offer psychological support to disaster responders throughout the various phases of their duties.

Application of Eco-Friendly Waterborne Polyurethane Composite Coating Incorporated with Nano Cellulose Crystalline and Silver Nano Particles on Wood Antibacterial Board

To endow wood plate with antimicrobial properties, waterborne polyurethane (WPU) coatings incorporated with nano cellulose crystalline (NCC) and silver nanoparticles (AgNPs) were prepared. AgNPs were obtained by the chemical reactions of silver nitrate solution and sodium borohydride solution. The scribe testing results showed that the adhesion of the NCC-WPU composites was improved with the addition of NCC. The adhesion reached its peak when the amount of NCC added was 1%. Scanning electron microscopy (SEM) observation displayed that the NCC dispersed into the WPU without aggregation. NCC was well able to bind WPU and wood cell walls tightly together. Atomic force microscopy (AFM) and ultraviolet-visible (UV-vis) results revealed that WPU/NCC/AgNPs composites were homogeneous. This compatibility was also confirmed by transmission electron microscopy (TEM) analysis. The antibacterial property was improved too. When the adding amount of NCC was 0.5%, and the proportion of silver elements added was 5%, the antibacterial effect was at its best. As a comparison, the antibacterial effect of hybrid colloid without the addition of NCC was far less than that of including NCC. The WPU/NCC/AgNPs composite could be applied as an antibacterial coating in wood materials.

Ecological Disasters and Mental Health: Causes, Consequences, and Interventions

Ecological disasters highlight the importance of understanding natural disasters as they relate to a changing global climate. Such disasters often have a predictable pattern of evolving over time and anticipated psychological and behavioral problems and community disruptions. Various factors enhance transmission of these adverse effects beyond the geographic location of the ecological disaster, with certain populations being particularly vulnerable to these effects. Understanding the range and pattern of these effects can aid in optimizing interventions. The use of evidence-informed interventions can reduce distress, enhance well-being, and improve functioning for affected individuals and communities. Effective preparedness involves an understanding of these factors, incorporation of them at all stages of disaster management, and continuous education and training for disaster planners and responders.

Deconstructing Traumatic Mission Experiences: Identifying Critical Incidents and Their Relevance for the Mental and Physical Health Among Emergency Medical Service Personnel

Emergency medical service (EMS) personnel frequently encounter emotionally stressful or even traumatic incidents in their line of duty. In this study, a checklist of emotionally stressful events for the German EMS was introduced. A mixed-method approach was used to identify mission events that were critical for the development of mental and physical stress symptoms. Data were collected in a cross-sectional sample of 102 EMS employees. A quantitative content analysis of the participants' worst experiences on duty indicated, traumatic missions to be a concatenation of two to five emotionally stressful events. Rescue missions were experienced as traumatic if (i) EMS personnel became victims of attacks or threats; (ii) certain circumstances caused them to give up their professional detachment from patients; (iii) EMS personnel perceived the overall mission as exceptionally tragic. In subsequent correlation analyses, the corresponding checklist items showed consistent positive associations with the post-traumatic, depressive and physical stress symptoms among the study cohort. Within the exploratory regressions, the sum score of critical on-duty exposures contributed incrementally to the prediction of mental and physical stress symptoms when non-work-related trauma exposure and perceived social support were also considered. Findings point toward the importance of considering the cumulative burden of critical incidents for the long-term health of EMS personnel. Future research is needed to investigate, how on-duty trauma affects the social support EMS personnel received from their work and personal relationships.

Differential effect of Hurricane Sandy exposure on PTSD symptom severity: comparison of community members and responders

OBJECTIVES

To evaluate whether the association between Hurricane Sandy exposures and post-traumatic stress disorder (PTSD) symptom severity was greater for exposed community members compared with responders.

METHODS

Data were analysed from three existing studies with similar methodologies (N=1648): two community studies, Leaders in Gathering Hope Together (n=531) and Project Restoration (n=763); and the Sandy/World Trade Center Responders Study (n=354). Sandy-related PTSD symptoms were measured using the PTSD checklist-specific traumatic event and dichotomised as elevated (>30) versus low/no (<30) PTSD symptoms. Sandy exposures were measured with a summed checklist. Multivariable logistic regression was performed to evaluate the differential effect of exposures on PTSD by responder status, adjusting for demographics and time elapsed since Sandy.

RESULTS

Responders were somewhat older (50.5 years (SD=8.3) vs 45.8 years (SD=20.0)), more likely to identify as white (92.4% vs 48.1%) and were male (90.7% vs 38.4%). Responders were less likely to have elevated PTSD symptoms than community members (8.6% vs 31.1%; adjusted OR=0.28, 95% CI 0.17 to 0.46). While exposure was significantly related to elevated PTSD status, the effects were similar for responders and community members.

CONCLUSIONS

Responders appear to be more resilient to PTSD symptoms post-Sandy than community members. Understanding the mechanisms that foster such resilience can inform interventions aimed at populations that are more vulnerable to experiencing PTSD after natural disasters.

Mechanisms of resiliency against depression following the Deepwater Horizon Oil Spill

Prior studies of oil spills have reported adverse impacts on mental health, but have not examined some potentially important moderators. In this cross-sectional analysis of n=38,361 responses to the 2010-2011 Gulf States Population Survey, we assessed the association of direct oil contact with depression severity following the Deepwater Horizon oil spill, and modification by self-mastery, emotional support, and cleanup participation using Tobit regression models accounting for the complex survey design. Oil contact was associated with increased depression severity. Among respondents with oil contact, depression was more severe for those reporting lower self-mastery. However, respondents with oil contact had lower depression severity if they participated in cleanup efforts, compared to exposed individuals who did not participate. This potential protective effect was larger for respondents with lower self-mastery. Our results are consistent with the notion that participation in recovery efforts may reduce depressive symptoms following oil spills among impacted individuals.

Association Between Earthquake Exposures and Mental Health Outcomes in Phulpingdanda Village After the 2015 Nepal Earthquakes

In 2015, two strong earthquakes, as well as continuous, high magnitude aftershocks, struck Nepal. Phulpingdanda village was greatly impacted due to its lack of infrastructure and environmental remoteness. Adults from sampled households were surveyed 1-year later to examine the association between earthquake exposures and indicators of depression, post-traumatic stress disorder (PTSD), and resilience. Results showed 33% of surveyed residents screened positive for depression, 9% screened positive for severe PTSD, and 46% displayed moderate to high resilience. Additionally, participants experienced resource loss (100%), damaged home and goods (99%), and exposure to the grotesque (82%). Traumatic earthquake experiences related to personal harm were associated with symptoms of depression and PTSD and resource loss was associated with depressive symptoms. Earthquake experiences associated with less damage to home and goods, but greater exposure to the grotesque were associated with increased resilience. This research adds to our knowledge of the relationship between traumatic exposures and indicators of psychological distress and resilience following a disaster.