Risk and resilience in canine search and rescue handlers after 9/11

An experimental examination of the perceptual paradox surrounding police canine units

Objectives

To experimentally examine public perceptions of police canine units.

Methods

As part of the between-subjects paradigm, participants were randomly assigned to view and rate an image of a police officer either with a police dog (i.e., as a police canine unit) or alone on eight dimensions: aggression, approachability, fairness, friendliness, intimidation, professionalism, respectfulness, and trustworthiness.

Results

The analyses reveal that the officer was perceived more negatively when presented with a police dog than when presented alone.

Conclusions

Police dogs play a multifaceted role in policing, including in crime control and public relations. In addition to their many functions, police canine units can also elicit many perceptual effects.

Microfluidics-Based Point-of-Care Testing (POCT) Devices in Dealing with Waves of COVID-19 Pandemic: The Emerging Solution

Recent advances in microfluidics-based point-of-care testing (POCT) technology such as paper, array, and beads have shown promising results for diagnosing various infectious diseases. The fast and timely detection of viral infection has proven to be a critical step for deciding the therapeutic outcome in the current COVID-19 pandemic, which in turn not only enhances the patient survival rate but also reduces the disease-associated comorbidities. In the present scenario, rapid, noninvasive detection of the virus using low cost and high throughput microfluidics-based POCT devices embraces the advantages over existing diagnostic technologies, for which a centralized lab facility, expensive instruments, sample pretreatment, and skilled personnel are required. Microfluidic-based multiplexed POCT devices can be a boon for clinical diagnosis in developing countries that lacks a centralized health care system and resources. The microfluidic devices can be used for disease diagnosis and exploited for the development and testing of drug efficacy for disease treatment in model systems. The havoc created by the second wave of COVID-19 led several countries' governments to the back front. The lack of diagnostic kits, medical devices, and human resources created a huge demand for a technology that can be remotely operated with single touch and data that can be analyzed on a phone. Recent advancements in information technology and the use of smartphones led to a paradigm shift in the development of diagnostic devices, which can be explored to deal with the current pandemic situation. This review sheds light on various approaches for the development of cost-effective microfluidics POCT devices. The successfully used microfluidic devices for COVID-19 detection under clinical settings along with their pros and cons have been discussed here. Further, the integration of microfluidic devices with smartphones and wireless network systems using the Internet-of-things will enable readers for manufacturing advanced POCT devices for remote disease management in low resource settings.

Economic expectations and anxiety during the COVID-19 pandemic: a one-year longitudinal evaluation on Italian university students

The COVID-19 pandemic has produced an extensive aggravation of people's anxiety level. Different policies aimed at fighting the spread of the virus could affect anxiety in various ways. We built an ad hoc web-based survey, administered to the student population of three Italian universities at the beginning of the pandemic and at one year's distance, to collect information on retrospective and current anxiety levels and the underlining reasons. The survey also included questions concerning sociodemographic, economic, labor, lifestyle, academic career, and on-line teaching features, which prevents students from identifying the main survey topic to be anxiety. This research aims at assessing the change in anxiety levels between the analyzed periods and the main determinants of such change, focusing on students' economic expectancies. Results from a Poisson regression model show that anxiety has increased compared to both the pre-pandemic level and the one quantified during the first lockdown. This increase is revealed to be mostly driven by economic and career-related uncertainties, rather than by job loss and proximity to COVID-19. Thus, policymakers should take action to provide certainties both in terms of economic prospects and reopening strategies, especially to avoid that the resulting increase in anxiety translates into an amplified suicide risk.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice

INTRODUCTION

Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters.

OBJECTIVE

There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition.

METHODS

A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported.

RESULTS

The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort.

CONCLUSION

This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

COVID-19: the perfect vector for a mental health epidemic

In times of crisis, people have historically had to band together to overcome. What happens when they cannot? This article examines the reality of people forced to isolate from one another during one of the most turbulent events of their lives: the COVID-19 pandemic. Connecting the dots of topics including fear, social stigmas, global public response and previous disease outbreaks, this article discusses the negative mental health effects that individuals and communities will likely suffer as the result of social distancing, isolation and physical infection.

A Concept Analysis on Disaster Resilience in Rescue Workers: The Psychological Perspective

OBJECTIVE

The term disaster resilience has not been well defined. The purpose of this article is to scrutinize the concept of disaster resilience in rescue workers.

METHODS

A systematic search was conducted of the PsychInfo, PubMed, ISI Web of Science, MEDLINE, CINAHL, Embase, and Scopus databases using the key terms. The framework from Walker and Avant was used to analyze the concept of disaster resilience.

RESULTS

A total of 26 papers was included in this analysis. The attributes of disaster resilience have been identified from the literature as including personality, perceived control, self-efficacy, coping strategies, and social support. The antecedents of disaster resilience are disastrous events and preparedness for disaster. The consequences of disaster resilience are psychological well-being, posttraumatic growth, and enhanced work engagement.

CONCLUSION

This concept analysis presents a definition of the concept of disaster resilience that could contribute to the development of a standardized screening or assessment tool and tailored training programs to strengthen disaster resilience among those who are willing to be deployed to engage in disaster rescue work and those who have been involved in such work.

An E-Mental Health Solution to Prevent and Manage Post-Traumatic Stress Injuries among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text4PTSI and Text4Wellbeing (Preprint)

Background

First responders are confronted with traumatic events in their work that has a substantial toll on their psychological health and may contribute to or result in posttraumatic stress injuries (PTSIs) for many responders. Persons with a PTSI usually seek management therapies. Evidence indicates that digital delivery of these therapies is an innovative, efficient, and effective way to improve PTSI symptoms as an adjunct to in-person delivery.

Objective

This project aims to implement and provide accessible, convenient, and economical SMS text messaging services, known as Text4PTSI and Text4Wellbeing, to first responders in Alberta, Canada; to prevent and improve the symptoms of PTSI among first responders; and to improve their overall quality of life. We will evaluate posttraumatic symptoms and the impact of Text4PTSI and Text4Wellbeing on stress, anxiety, and depression in relation to the correspondents’ demographic backgrounds.

Methods

First responders who subscribe to Text4PTSI or Text4Wellbeing receive daily supportive and psychoeducational SMS text messages for 6 months. The SMS text messages are preprogrammed into an online software program that delivers messages to subscribers. Baseline and follow-up data are collected through online questionnaires using validated scales at enrollment, 6 weeks, 12 weeks, and 24 weeks (end point). In-depth interviews will be conducted to assess satisfaction with the text-based intervention.

Results

We hypothesize that participants who enroll in this program will have improved PTSI symptoms; increased or improved quality of life; and significant reduction in associated stress, depression, and anxiety symptoms, among other psychological concerns. Improvement will be determined in comparison to established baseline parameters.

Conclusions

This research will be beneficial for practitioners and will inform policy-making and decision-making regarding psychological interventions for PTSI. Lessons from this study will inform the scale-up of the intervention, a cost-effective, zero contact therapeutic option to manage PTSI.

International Registered Report Identifier (IRRID)

PRR1-10.2196/30680

Impact of containment and mitigation measures on children and youth with ASD during the COVID-19 pandemic: Report from the ELENA cohort

BACKGROUND

Containment, involving separation and restriction of movement of people due to the COVID-19 pandemic, and mitigation, also referred to as lockdown, involving closure of schools, universities and public venues, has had a profound impact on people's lives globally. The study focuses on the effects of containment and mitigation measures, on the behavior of children and youth (CaY) with Autism Spectrum Disorders (ASD). The study primary aim was to examine the impact of these urgent measures on the behaviors, communication, sleep, and nutritional status of the CaY. A secondary aim was to explore risk and protective factors on behavior change including sociodemographic variables, living conditions, ASD symptom severity and continuity of interventions.

METHODS

The study sample consisted of 239 ASD subjects, 2-21 years of age, enrolled in the ELENA cohort in France at Stage 3 confinement and mitigation measures announced on March 16, 2020. A parent informant completed the COVID-19 questionnaire.

RESULTS

Of the domains examined, challenging behaviors, communicative skills and sleep had the greatest impact; in terms of risk and protective factors, subject age, ASD severity, single parenthood, daily living skills, and intervention continuity were most likely to impact behaviors; living conditions were not linked to behavior change.

CONCLUSIONS

The findings highlight the topography of behavioral change in CaY with ASD following institution of containment and mitigation measures during the COVID-19 pandemic and help identify risk and protective factors to help better address needs and tailor interventions in the future.

The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy

OBJECTIVES

to assess the changes in prevalence, incidence and hospitalisation rates during the first four months of 2020, compared to the same period of 2019, in Friuli Venezia Giulia Mental Health Departments (MHDs); to analyse the features of MHDs patients tested for Sars-Cov-2, and to monitor whether MHDs applied and adhered to regional recommendations.

METHODS

Observational study using MHDs' administrative data and individual data on suspected and positive cases of Sars-Cov-2. Adherence to recommentations was assessed using 21 indicators. Changes in rates were calculated by Poisson regression analysis, while the Fisher exact test was used for assessing differences between suspected and positive cases.

RESULTS

The decrease in voluntary admission rates on 100,000 inhabitants in hospital services was significantly larger from January to April 2020, compared to the same period of 2019 (P<0.001), while no other data showed a significant decrease. Among the 82 cases tested for Sars-Cov-2, five were positive, and they significantly differ from suspected cases only in that they were at home or in supported housing facilities prior to the test. The MHDs mostly complied with the indicators in the month after the publication of recommendations.

CONCLUSIONS

Outpatient services continued to work normally during the emergency, while hospital services decreased their activities. A low number of positive cases was found among MHDs' users, which might be linked to a rapid reconversion of services, with an extensive use of home visits and telepsychiatry. These preliminary data should be interpreted with caution, due to the small size and the limited period of observation.

The psychosocial response to a terrorist attack at Manchester Arena, 2017: a process evaluation

BACKGROUND

A 2017 terrorist attack in Manchester, UK, affected large numbers of adults and young people. During the response phase (first seven weeks), a multi-sector collaborative co-ordinated a decentralised response. In the subsequent recovery phase they implemented a centralised assertive outreach programme, 'The Resilience Hub', to screen and refer those affected. We present a process evaluation conducted after 1 year.

METHODS

Case study, involving a logic modelling approach, aggregate routine data, and semi-structured interviews topic guides based on the Inter-Agency Collaboration Framework and May's Normalisation Process Theory. Leaders from health, education and voluntary sectors (n = 21) and frontline Resilience Hub workers (n = 6) were sampled for maximum variation or theoretically, then consented and interviewed. Framework analysis of transcripts was undertaken by two researchers.

RESULTS

Devolved government, a collaborative culture, and existing clinical networks meant that, in the response phase, a collaboration was quickly established between health and education. All but one leader evaluated the response positively, although they were not involved in pre-disaster statutory planning. However, despite overwhelming positive feedback there were clear difficulties. (1) Some voluntary sector colleagues felt that it took some time for them to be involved. (2) Other VCSE organisations were accused of inappropriate, harmful use of early intervention. (3) The health sector were accused of overlooking those below the threshold for clinical treatment. (4) There was a perception that there were barriers to information sharing across organisations, which was particularly evident in relation to attempts to outreach to first responders and other professionals who may have been affected by the incident. (5) Hub workers encountered barriers to referring people who live outside of Greater Manchester. After 1 year of the recovery phase, 877 children and young people and 2375 adults had completed screening via the Resilience Hub, 79% of whom lived outside Greater Manchester.

CONCLUSIONS

The psychosocial response to terrorist attacks and other contingencies should be planned and practiced before the event, including reviews of communications, protocols, data sharing procedures and workforce capacity. Further research is needed to understand how the health and voluntary sectors can best collaborate in the wake of future incidents.

Perceived Psychological Feelings Make Important Contributions to the Symptoms of Common Mental Disorders of Medical Staff During the COVID-19

OBJECTIVE

Lack of information about mental health status among medical staff during the epidemic of COVID-19 in China is one of the major barriers to psychological interventions. This paper aims to evaluate the contributions of perceived psychological feelings to the symptoms of common mental disorders among medical staff during the epidemic of COVID-19 in China.

METHOD

A large sample of medical staff based on a non-probability sampling design was collected from February 17 to 24, 2020. The symptoms of common mental disorders were screened based on self-reported instruments to evaluate psychological distress, anxious symptoms, and depressive symptoms during the past week. Perceived psychological feelings were based on self-report. Logistic regressions and elastic net regularizations were used to evaluate the independent effect of the psychological feelings controlled by hospitals and participants characteristics.

RESULTS

Totally 4,677 medical staff completed the survey. The prevalence of psychological distress, anxious symptoms, and depressive symptoms were 15.9% (95% CI 14.8-16.9), 16.0% (95% CI 15.0-17.1), and 34.6% (95% CI 33.2-35.9). Feelings of having adequate personal protective equipment, receiving enough emotional supports from both family members and colleagues were significantly associated with fewer symptoms of common mental disorders, while the feelings of overloaded work and insufficient rest times contributed to more psychological problems.

CONCLUSIONS

Psychological feelings make important contributions to the symptoms of common mental disorders of medical staff during the epidemic of COVID-19. Strategies of psychological aids or interventions could be developed based on these feelings.

Characteristics of Resilience Among Disaster Rescue Workers: A Systematic Review

Disasters can cause long-lasting damage to survivors and rescue workers. Some rescue workers suffer negative physical and psychological consequences, while others do not. Thus, it is of value to fully understand the characteristics of rescuers who have not been affected by rescue activities. Resilience refers to the ability or capacity to cope with adversity. The aim of this review is to explore and identify the characteristics of resilience among rescue workers. A systematic literature search was conducted of seven electronic databases from inception to May 2019, using keywords and medical subject heading terms related to the resilience of rescuers. Hand searches and searches of leading authors were also performed. A total of 31 articles were eligible for review. Six domains were identified to characterize the resilience of rescuers namely, demographic and physical characteristics, personality traits, coping strategies, perceived resources, being equipped with special skills for disaster rescue, and having less adverse consequences from exposure to disaster. Researchers and disaster managers can take note of these characteristics to comprehensively understand the 'positive concept' of resilience. This enhanced understanding of 'positive resilience' can in turn be used to develop a framework to assess and establish interventions, and consequently to improve the psychological wellbeing of rescuers after disaster rescue efforts.

PTSD and post-traumatic stress spectrum in the Italian Navy Operational Divers Group and corps of Coast Guard Divers employed in search and rescue activities in the Mediterranean refugees emergences and Costa Concordia shipwreck

Rescue personnel is at high risk for Post-traumatic Stress Disorder (PTSD) because of the possible repetitive exposition to "cruel details of traumatic events" (DSM-5). Literature reported PTSD rates in combat exposed veterans, although the Italian Navy military personnel has been frequently involved in no-war activities in most recent years, such as Search and Rescue (SAR) activities of civilians involved in catastrophic events. The study aimed at exploring the prevalence of PTSD and its impact on social and work functioning among divers of the Italian Navy employed in the SAR activities for the Costa Concordia shipwreck (2012), the collapsed control tower of the Genoa harbour (2013), and the "Mare Nostrum" and "Triton" immigrant emergency Operations in the Mediterranean Sea. The 85 Italian Navy and Coast Guard Divers on duty for these activities were involved in the study and forty fulfilled the assessments, including the: Impact Event Scale (IES-r), Trauma and Loss Spectrum Self-Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). In the three years before enrollment 77.5% of the sample (n = 31) performed at least one rescue operation, with full and partial DSM-5 PTSD rates being 7.5% and 22.5%, respectively. A correlation emerged between WSAS domains or total scores and TALS-SR score domains for PTSD. Rescue Navy personnel resulted to be at risk for post-traumatic stress symptoms, and these subthreshold PTSD manifestations appear to impact on functioning. Further studies are needed to better investigate PTSD risk and resilience factors in this particular group of workers.

Buffering PTSD in Canine Search and Rescue Teams? Associations with Resilience, Sense of Coherence, and Societal Acknowledgment

Rescue workers present an elevated risk for posttraumatic stress disorder (PTSD) and recently, research has begun to focus on coping styles and social support as protective factors in this population. Associations in the particular group of search and rescue dog handlers still lack evidence. The aim of the study is to investigate if functional cognitions and social support also decrease the risk for PTSD. Active voluntary rescue dog handlers (n = 116) rated levels of resilience, sense of coherence, and social acknowledgment (SAQ; subscales general disapproval, familial disapproval, recognition), in addition to a trauma checklist and PTSD symptoms. Linear regression analyses and two different graph models were calculated to explore associations, as well as potential pathways. Controlling for trauma exposure, the SAQ general disapproval emerged as the only significant predictor in the regression model. In the graph models, SAQ familial disapproval was linked to SAQ recognition and SAQ general disapproval. The latter, together with a sense of coherence manageability, affected PTSD re-experiencing symptoms through resilience. The findings are in line with earlier work. The study underlines the importance of targeting resilience and manageability, as well as enhancing social support in prevention programs for PTSD in canine search and rescue teams. Future research is warranted to further investigate model stability and replicate findings.

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

The usefulness of pre-employment and pre-deployment psychological screening for disaster relief workers: a systematic review

BACKGROUND

Individuals who conduct disaster relief work overseas are exposed to a variety of traumatic events that can cause distress and trigger psychological illnesses. Identification of which disaster relief workers may be at risk of experiencing psychological distress or mental health disorders is frequently carried out through pre-employment or pre-deployment psychological screening. The primary objective of our review was to assess the evidence for pre-employment and pre-deployment psychological screening of relief workers who work in disaster situations. We aimed to identify specific pre-employment and pre-deployment characteristics that predict impaired wellbeing of an individual following engaging in disaster-related work.

METHODS

A combined list of search terms was composed relating to disaster-related occupations, screening methods, psychological disorders, and study design. The databases used were PsycINFO, MEDLINE, EMBASE, and GlobalHealth. We included studies that used cross-sectional or longitudinal study designs; were published in the English language in peer-reviewed academic journals; reported on the association between pre-employment and pre-deployment features and post-deployment psychological disorders or distress; considered any occupational groups responding to a specified, discrete crisis; and used at least one validated measure of distress or disorder. We extracted data on the author; year of publication; disaster description; country of study; study design; population sample; disorder(s) outcome and the measures used; and results.

RESULTS

Sixty-two, high-quality studies were included in the review. Forty-one potential predictors were identified. Of these, only volunteer status and previous history of mental illness and life stressors emerged as reliable predictors of distress or disorder.

CONCLUSION

The results suggest that whilst it is attractive to screen for pre-employment and pre-deployment indicators of resilience, the evidence base for doing so is weak. At best, this sort of screening can only weakly suggest vulnerability and at worst may result in discrimination. Until better evidence about its usefulness becomes available, employers should exercise caution over its use.

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

Relationship between psychological distress and resilience in rescue workers

Objectives:

To assess the relationship between psychological distress and resilience in rescue workers. Following hypothesis was formulated; there would be negative correlation between psychological distress and resilience in rescue workers.

Method:

A correlational study was conducted from June-August 2015 in Rahim Yar Khan, Punjab, Pakistan. The sample of the present study consisted of 100 rescue workers. The age of the participants ranged from 23 to 40 year old with the mean age of 27.4±3.9 years. Demographic information form, Kessler psychological distress scale and adult resilience measure were administered on the participants to assess the level of psychological distress and resilience.

Results:

Pearson product moment coefficient of correlation was applied to analyze the relationship of psychological distress and resilience. Analysis of the result indicated that there is negative relationship between psychological distress and resilience (r= -0.203, p<0.01) in rescue workers. Further, contextual factors (r= -0.292, p<0.05) and its subcomponents including spiritual beliefs (r= -0.239, p<0.05) and cultural resources (r= -0.287, p<0.01) were also found to be inversely correlated with psychological distress.

Conclusion:

The research evidenced that rescue workers were experiencing psychological distress Resilience factors should be considered while designing trainings to preserve mental health and to enhance the psychological well-being of rescue workers.

Early psychological intervention following the 2014 Nepal snowstorm

The following is a case study of the blizzard of October 2014, an Israeli rescue team, the Special Mental Health Team (SMHT) of the Israeli Defense Forces Medical Corps, was sent to the disaster area to rescue Israeli trekkers. The SMHT intervention was provided immediately following the traumatic events with the purpose of lowering stress-related symptoms, shortening recovery time and reducing post-traumatic stress disorder symptoms that could occur in the future. Forty Israeli trekkers were assessed by SMHT: 75 % (n = 30) had mild acute stress reaction (ASR) symptoms and 25 % (n = 10) had severe acute stress disorder (ASD) symptoms. All participating trekkers receiving the intervention as a way to alleviate symptoms reported no symptoms of ASR and ASD following the intervention. Trekkers with mild ASR reported full recovery after 1 week and trekkers with ASD reported full recovery after 3 months. This case study describes the psychological intervention conducted by SMHT for the surviving trekkers following the blizzard and aims to extend the knowledge base of mental health intervention at the early phases of disaster. A research study should be conducted to develop a measurement tool capable of evaluating the effect of a short-term intervention conducted in the field.

Stressors of Korean Disaster Relief Team Members during the Nepal Earthquake Dispatch: a Consensual Qualitative Research Analysis

We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future.

Who is going to rescue the rescuers? Post-traumatic stress disorder among rescue workers operating in Greece during the European refugee crisis

PURPOSE

During the European refugee crisis, numerous Greek and international rescue workers are operating in Lesvos, offering search, rescue, and first aid services. Exposure to stressful life events while engaging in this rescue work can result in developing Post-Traumatic Stress Disorder (PTSD). The study aimed to assess the prevalence of PTSD and explore potential differences between different categories of rescuers.

METHODS

A cross-sectional study was conducted among 217 rescue workers. Participants were grouped according to affiliation: "Greek Professionals Rescuers/GPR", "International Professionals Rescuers/IPR" and "Volunteer Rescuers/VR". The PTSD Checklist-Civilian Version (PCL-C) was utilized. All tests were two-tailed (a = 0.05). Mann-Whitney, Kruskal-Wallis, and multivariate logistic regression were performed.

RESULTS

Overall probable PTSD prevalence found was 17.1%. Rates varied significantly per rescuer's category; 23.1% in GPR, 11.8% in IPR, and 14.6% in VR (p = 0.02). GPR demonstrated the highest risk compared to IPR and VR (p < 0.001). Females had approximately two times higher risk. Other significant risk factors included marital status, age, and number of children. Lack of previous experience, longer operation period, longer shift hours, and handling dead refugees and dead children were also considered major risk factors.

CONCLUSIONS

Rescue workers providing substantial aid to the refugees and migrants at Lesvos experience significant psychological distress. The present findings indicate the urgent need for targeted interventions. Further studies are needed to address long-term effects of the refugee crisis on rescuers, and explore effective measures to prevent PTSD.

The effects of living environment on disaster workers: a one-year longitudinal study

BACKGROUND

Defense Force workers engaged in disaster relief activities might suffer from strong psychological stress due to the tasks that they had been involved. We evaluated how living environments, work environments, and individual factors psychologically affect those who engaged in disaster relief activities.

METHOD

Data generated with 1506 personnel engaged in the Great East Japan Earthquake relief activity were analyzed. Those who scored ≥25 points on the Impact of Events Scale-Revised and the Kessler Psychological Distress Scale (K10) were allocated into the high post-traumatic stress response (high-PTSR) group, and the high general psychological distress (high-GPD) group, respectively.

RESULTS

The multiple logistic regression analysis extracted living environment (camping within the shelter sites) as the significant risk factor for both high-PTSR (OR = 3.39, 95 % CI 2.04-5.64, p < 0.001) and high-GPD (OR = 3.35, 95 % CI 1.77-6.34, p < 0.001) groups.

CONCLUSION

It is desirable for disaster workers to have a living environment in which they can keep an appropriate distance from the victims.

Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review

BACKGROUND

When disasters occur, there are many different occupational groups involved in rescue, recovery and support efforts. This study aimed to conduct a systematic literature review to identify social and occupational factors affecting the psychological impact of disasters on responders.

METHODS

Four electronic literature databases (MEDLINE®, Embase, PsycINFO® and Web of Science) were searched and hand searches of reference lists were carried out. Papers were screened against specific inclusion criteria (e.g. published in peer-reviewed journal in English; included a quantitative measure of wellbeing; participants were disaster responders). Data was extracted from relevant papers and thematic analysis was used to develop a list of key factors affecting the wellbeing of disaster responders.

RESULTS

Eighteen thousand five papers were found and 111 included in the review. The psychological impact of disasters on responders appeared associated with pre-disaster factors (occupational factors; specialised training and preparedness; life events and health), during-disaster factors (exposure; duration on site and arrival time; emotional involvement; peri-traumatic distress/dissociation; role-related stressors; perceptions of safety, threat and risk; harm to self or close others; social support; professional support) and post-disaster factors (professional support; impact on life; life events; media; coping strategies).

CONCLUSIONS

There are steps that can be taken at all stages of a disaster (before, during and after) which may minimise risks to responders and enhance resilience. Preparedness (for the demands of the role and the potential psychological impact) and support (particularly from the organisation) are essential. The findings of this review could potentially be used to develop training workshops for professionals involved in disaster response.

PTSD Symptom Trajectories in Disaster Volunteers: The Role of Self-Efficacy, Social Acknowledgement, and Tasks Carried Out

Millions of volunteers respond after disasters, with a 24% to 46% risk of developing posttraumatic stress disorder (PTSD). It is unclear which symptom trajectories develop and how they differ between core (volunteering before the disaster) and noncore volunteers (joining after the disaster) and which factors predict trajectories. Symptoms of PTSD were assessed at 6-, 12-, and 18-months postearthquake in 449 volunteers in Indonesia. Demographics, previous mental health service use, self-efficacy, social acknowledgment, and type of tasks were assessed at 6 months. In both core and noncore volunteers, 2 PTSD symptom trajectories emerged: a resilient trajectory (moderate levels of symptoms with a slow decrease over time; 90.9%) and a chronic trajectory (higher levels of symptoms with an increase over time; 9.1%). In both trajectories, core volunteers had fewer symptoms than noncore volunteers. Core volunteers in the chronic trajectory were characterized by having sought prior mental help, reported lower levels of self-efficacy and social acknowledgment, and were more likely to have provided psychosocial support to beneficiaries (Cramér's V = .17 to .27, partial η(2) = .02 to .06). Aid organizations should identify and follow up chronic PTSD trajectories in volunteers, including the noncore, who may be out of sight to the organization after the acute response phase.

Latest developments in post-traumatic stress disorder: diagnosis and treatment

BACKGROUND

Most people will experience a traumatic event during their lives. However, not all will develop Post-Traumatic Stress Disorder (PTSD). There have been recent changes in diagnostic criteria for PTSD and there are a number of treatment options available.

SOURCES OF DATA

This review is based on published literature in the field of PTSD, its management and the recently published DSM-V.

AREAS OF AGREEMENT

The most influential risk factors relate to the post-incident environment rather than pre-incident or the incident itself. There are two established and effective psychological therapies; trauma-focussed cognitive behavioural therapy and eye movement desensitization and reprocessing.

AREAS OF CONTROVERSY

It is unclear what actually constitutes a traumatic event. Psychological debriefing or counselling interventions, shortly after trauma-exposure are found to be ineffective and may cause harm. Medication, whilst common practice, is not recommended as first line management.

GROWING POINTS

Future psychotherapies for PTSD may be just as effective if delivered in carefully considered group settings or through remote means.

AREAS TIMELY FOR DEVELOPING RESEARCH

Research into the most effective ways to prevent individuals at risk of developing PTSD is still at an early stage and development of effective early interventions could substantially reduce the morbidity associated with PTSD.

[Personal resilience and post-traumatic stress symptoms of local government employees: six months after the 2011 magnitude 9.0 East Japan Earthquake]

OBJECTIVES

The Great East Japan Earthquake caused severe infrastructure damage in the Kanto and Tohoku regions, but the psychological stress of public sector employees in the Kanto region where tsunami damage was small has received little attention. This study examined the association between personal resilience and post-traumatic stress symptoms of local government employees in the Kanto region.

METHODS

In this cross-sectional study, all employees (N=2,069) of a single municipality in the Kanto region were recruited in September 2011, six months after the earthquake, and 991 completed the questionnaire (response rate, 47.9%). After excluding respondents who had missing values, the data from 825 respondents (607 males and 218 females) were analyzed. Post-traumatic stress symptoms were measured using the Impact Event Scale-Revised. Resilience was measured using the Connor-Davidson Resilience Scale and divided into three groups on the basis of scores; low, moderate, and high. House damage and respondents or their families' experience of injury that were caused by the earthquake were assessed using single-item questions. Participants who reported house damage or injury were defined as being affected. Using multiple logistic regression analysis, the odds ratio of post-traumatic stress symptoms (IES-R score ≥25) was calculated for the upper, middle, and low resilience score groups.

RESULTS

Among the respondents, 4.6% experienced injuries within their families, 82.3% reported house damage, and thus 83.3% were affected by the Great East Japan Earthquake. Post-traumatic stress symptoms were significantly higher among the affected group and those with chronic diseases. After adjusting for the demographic and occupational characteristics, the likelihood of post-traumatic stress symptoms was greater in the low resilience group (Odds ratio: 2.10 [95% confidence interval = 1.31-3.37]). A significant negative relationship was observed between resilience and post-traumatic stress symptoms particularly in the affected group.

CONCLUSIONS

Low personal resilience predicted post-traumatic stress symptoms among local government employees who experienced some house damage or injury during the Great East Japan Earthquake. This result may indicate that resilience reduces the onset of post-traumatic stress symptoms, even when faced by the difficulties imposed by a natural disaster such as an earthquake.

Mental health of Turkish women in Germany: resilience and risk factors

BACKGROUND

The purpose of the present study was to examine the protective and risk factors of mental distress among Turkish women living in Germany.

METHOD

105 Turkish immigrant women living in Berlin were investigated with measures of extraversion/neuroticism (NEO-FFI), general self-efficacy (GSE), social support (BSSS), social strain (F-SOZU) and mental distress (GHQ-28). Interrelations between psychosocial variables were assessed using simple Pearson correlations.

RESULTS

In all subjects, social strain (Pearson's r=.26(**), p=.008) and neuroticism (r=.34(**), p<.001) were positively associated with mental distress. In contrast, perceived self-efficacy (r=-.38(**), p<.001) and extraversion (r=-.36(**), p<.001) were negatively associated with mental distress.

CONCLUSION

Protective factors such as extraversion and self-efficacy seem to have a buffering effect on the process of migration. However, in addition to neuroticism, social strain seems to be positively associated with mental distress.

Mental health problems among search and rescue workers deployed in the Haïti earthquake 2010: a pre-post comparison

Search and rescue workers play an important role in rescuing trapped disaster victims. However, it is unclear whether they are at risk for post-disaster mental health problems. For this purpose we prospectively examined pre- and post-deployment health among Dutch search and rescue workers (USAR NL) deployed in the devastating Haiti earthquake disaster (2010). The evening before departure (T1, response=100%) and 3 months post-deployment (T2, response=91%), Search and rescue workers were administered standardized questionnaires assessing health (SCL-90-R, RAND-36), including use of substances and mental health services utilization (N=51). At T2 event-related PTSD-symptoms (IES) and coping self-efficacy (CSE), and experiences during and after deployment were examined. At both surveys health problems were almost absent and no significant increases in health problems and use of substances were found. PTSD-symptomatology was very low and coping self-efficacy rather high. Protective factors such as good team functioning, recognition and job satisfaction were clearly present, while risk factors such as sustained injuries or death of a co-worker were absent. Findings suggest that post-disaster health problems may (partly) be prevented by enhancing or restoring protective factors.

First Responders after Disasters: A Review of Stress Reactions, At-Risk, Vulnerability, and Resilience Factors

Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities.The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfi ll their roles.This review will explore these themes by highlighting important findings and areas of uncertainty.

Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers

PURPOSE

We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.

METHODS

A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.

RESULTS

A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.

CONCLUSIONS

Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.

Psychological resilience in OEF-OIF Veterans: application of a novel classification approach and examination of demographic and psychosocial correlates

A growing number of studies have examined the prevalence and correlates of psychopathology in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF), but few have examined determinants of resilience in this population. This study employed a novel approach to classify psychological resilience in a cross-sectional sample of OEF-OIF Veterans. A total of 272 predominantly older reserve/National Guard OEF/OIF Veterans completed a mail survey that assessed combat exposure, psychopathology, psychosocial functioning, and aspects of social support. Cluster analysis of scores on measures of combat exposure and PTSD symptoms revealed that a three-group solution best fit the data: Controls (low combat exposure, low PTSD symptoms); PTSD (high combat exposure, high PTSD symptoms); and Resilient (high combat exposure, low PTSD symptoms). Compared to the PTSD group, the Resilient group was more likely to be in a relationship and active duty; they also scored lower on a measure of psychosocial dysfunction, and higher on measures of psychological resilience and postdeployment social support. Logistic regression analysis revealed that being in a relationship, having fewer psychosocial difficulties, and reporting greater perceptions of purpose/control and family support and understanding were significantly associated with resilient group membership. Results of this study demonstrate a novel approach to classifying psychological resilience and suggest that interventions to mitigate psychosocial difficulties, enhance perceptions of purpose and control, and bolster family support and understanding may help promote resilience to combat-related PTSD in OEF-OIF Veterans.

Certification testing as an acute naturalistic stressor for disaster dog handlers

USA Federal Disaster Canine Teams, consisting of a handler and a dog, are essential for locating survivors following a disaster. Certification, required by the Federal Emergency Management Agency Urban Search and Rescue organization, requires two successful mock searches. Confirmation of the certification testing process as an acute stressor might offer further opportunities to consider stress effects on handlers and dogs in a controlled environment. This study used a pretest-posttest design to evaluate relationships between salivary hormone concentrations (cortisol and testosterone) and subjective stress ratings in handlers and controls, handler assessments of stress in their dogs, and posttest temperature and pulse rate in dogs. Posttest, both subjective stress ratings and salivary cortisol concentration were higher in handlers than controls with both correlated to handlers' assessment of stress in their dogs. Handlers' posttest salivary cortisol concentration was associated with posttest dog pulse and temperature. Posttest cortisol concentration was lower in handlers who were successfully certified compared with those who failed, and was also lower in handlers whose primary occupation was "firefighter". Salivary testosterone concentrations increased from pretest to posttest in handlers but decreased in controls, and higher posttest handler testosterone concentration was negatively associated with posttest dog pulse rate. These findings confirm certification testing as an acute stressor, suggest a relationship between stress and performance moderated by occupation, and demonstrate an interaction between handler stress and dog physiological responses. This certification testing offers a controlled environment for targeted evaluation of effects of an acute naturalistic stressor on disaster dog handlers and dogs.

Resilience and crime victimization

What do we know about resilience in crime victimization? In this article, the authors discuss resilience defined as protective factors (e.g., personality characteristics, biological characteristics, social and cultural factors, and community characteristics); as a process of adaptation (e.g., self-enhancement, positive cognitive appraisals, coping styles, and spirituality), including an iterative perspective on resilience as a cascade of protective processes; and as positive outcomes (e.g., lack of symptoms) following exposure to adverse events. Within each of these definitional frameworks, they consider general conceptual issues pertaining to resilience and then the small body of research that has focused specifically on resilience and some type of crime victimization. Research and clinical implications are discussed.

Stressful but rewarding: Norwegian personnel mobilised for the 2004 tsunami disaster

Adequate responses to disasters and emergency situations rely, among other factors, on coping abilities in disaster workers and emergency personnel. In this study, different aspects of disaster-related stressors and training/experience were investigated in Norwegian personnel (n = 581) mobilised for the 2004 tsunami disaster. The level of stress reactions, measured nine to ten months after the tsunami, was relatively low in this sample, indicating that the personnel coped well with the challenges of the disaster. The level of intrusive memories was higher in disaster-area personnel (n = 335) than in home-base personnel (n = 246). Stress reactions were significantly associated with witnessing experiences (disaster-area group) and with having to reject victims in need of help (both groups). Specific preparation for the mission was associated with a lower level of stress reactions in disaster-area personnel. Such factors may be considered in training and preparation programmes for disaster workers.

Resilience and depression: perspectives from primary care

Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience — ordinary magic and personal medicine — which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 people, drawn from a longitudinal study of the management of depression in primary care in Victoria, Australia. We also assess how respondents rate personal resilience in comparison with help received from professional sources. Our data are obtained from semi-structured telephone interviews, and analysed inductively through refinement of our theoretical framework. We find substantial evidence of resilience both in terms of ordinary magic — drawing on existing social support and affectional bonds; and in terms of personal medicine — building on personal strengths and expanding positive emotions. There is a strong preference for personal over professional approaches to dealing with mental health problems. We conclude that personal resilience is important in the minds of our respondents, and that these elements should be actively considered in future research involving people with experience of mental health problems.

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

First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed.

Resilience: research evidence and conceptual considerations for posttraumatic stress disorder

The growing recognition and occurrence of traumatic exposure in the general population has given increased salience to the need to understand the concept of resilience. More than just the "flip side" of a risk factor, the notion of resilience encompasses psychological and biological characteristics, intrinsic to an individual, that might be modifiable and that confer protection against the development of psychopathology in the face of stress. In this review, we provide some perspective on the concept of "resilience" by examining early use of the term in research on "children at risk" and discuss the relationship between risk and resilience factors. We then review psychological and biological factors that may confer resilience to the development of posttraumatic stress disorder (PTSD) following trauma, examine how resilience has been assessed and measured, and discuss issues to be addressed in furthering our understanding of this critical concept going forward.

Mental health following terrorist attacks

We review the current literature relating to mental health following terrorist attacks. Studies assessing symptoms of stress in the general population and those assessing the mental health of direct victims are considered. Use of mental health services following an attack is reviewed and recommendations are offered.