A cohort study of the long-term impact of a fire disaster on the physical and mental health of adolescents

Youth Suicidality in the Context of Disasters

PURPOSE OF REVIEW

The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters.

RECENT FINDINGS

There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.

Healthy minds live in healthy bodies – effect of physical health on mental health: Evidence from Australian longitudinal data

It is well known that physical and mental health are closely related, with growing evidence for biological and behavioural pathways. Mostly the research has focussed on mental health as the key driver of this inter-connection; the extent physical health shapes mental health has received less attention. We aim to derive robust estimates of the unique role physical health may play in shaping mental health outcomes. To do so we use a novel approach, incorporating longitudinal and instrumental variable methods which can address the reciprocal relationship between physical and mental health, and the endogeneity of physical health, before estimating the physical to mental health pathway. A sample of 209,442 observations (or 24,966 unique individuals) aged 15 and over spanning 18 years (2002–2019) was extracted from the Household Income and Labour Dynamics in Australian Survey (HILDA). We find that physical activity and health shocks erode mental health via their impact on physical health with a one point improvement (or worsening) in physical health scores (0–100) resulting in a rise (or decline) of 0.43 points (or 43%) in mental health score.

Understanding the concurrent risk of mental health and dangerous wildfire events in the COVID-19 pandemic

Little research has examined the mental health risks of concurrent disasters. For example, disasters like wildfires have been shown to have a strong association with psychological symptoms-the 2020 U.S. Western wildfire season was the worst on record and occurred while the country was still navigating the COVID-19 pandemic. We implemented two quasi-experimental analyses, an interrupted time series analysis, and a difference-in-difference analysis to evaluate the impacts of wildfires and COVID-19 on mental health crisis help-seeking patterns. Both methods showed no statistical association between exposure to wildfires and the seeking of mental health support during the COVID-19 pandemic. Results highlighted that 2020 wildfires were not associated with an acute increase in crisis texts for youth in the two months after the events, likely due to an already elevated text volume in response to the COVID-19 pandemic from March 2020 throughout the fall wildfire season (Aug to Oct 2020). Future research is needed outside of the context of the pandemic to understand the effects of extreme and concurrent climatic events on adolescent mental health, and targeted interventions are required to ensure youth and adolescents are receiving adequate support during these types of crisis events.

Long-Term Impact of Disasters on the Public Health System: A Multi-Case Analysis

As past events have shown, disasters can have a tremendous impact on the affected population’s health. However, research regarding the long-term impact on a systems level perspective is still scarce. In this multi-case study, we analyzed and compared the long-term impacts on the public health system of five disasters which took place in Europe: avalanche (Austria), terror attack (Spain), airplane crash (Luxembourg), cable-car tunnel fire (Austria), and a flood in Central Europe. We used a mixed-methods approach consisting of a document analysis and interviews with key stakeholders, to examine the various long-term impacts each of the disasters had on health-system performance, as well as on security and health protection. The results show manifold changes undertaken in the fields of psychosocial support, infrastructure, and contingency and preparedness planning. The holistic approach of this study shows the importance of analyzing long-term impacts from the perspective of the type (e.g., disasters associated with natural hazards) and characteristic (e.g., duration and extent) of a disaster, as well as the regional context where a disaster took place. However, the identified recurring themes demonstrate the opportunity of learning from case studies in order to customize the lessons and apply them to the own-disaster-management setting.

The Relationship Between Physical and Mental Health Outcomes in Children Exposed to Disasters

PURPOSE OF REVIEW

This paper reviews literature on the influence of disaster exposure on the intersection between physical and mental health in children, including risk and protective factors. We provide an update on recent studies and conclude with recommendations for future research.

RECENT FINDINGS

The limited existing research on this topic suggests that disasters can influence short and long-term physical and mental health of children. Although few studies explore both mental and physical health in the same study, studies that assess both show that they co-occur. Pre-existing conditions, severity of disaster exposure, socioeconomic status, and gender may influence the relation between disaster exposure and physical and mental health. Despite the growing number of studies exploring mental and physical health symptoms together in children post-disaster, a dearth of research examines this relationship in terms of nuances by age and developmental stage, longitudinal mechanisms, and risk and protective factors.

Evaluating a community fire as human-made vs. natural disaster moderates the relationship between peritraumatic distress and both PTSD symptoms and posttraumatic growth

Objective: This study examined whether attributing a cause of a community fire to a human-made vs. natural disaster moderated the association between peritraumatic distress (PD) and posttraumatic stress (PTSD) symptoms, as well as between PD and posttraumatic growth (PTG). Method: Participants lived in Israeli communities affected by wide-scale fires in November 2016. At Time 1 (within one month of the fires), 390 participants completed measures. At Time 2 (four months after the fires), 223 of the original participants completed follow-up-questionnaires. Participants reported their PD symptoms at Time 1, and their beliefs regarding the cause of the fire, PTSD symptoms, and PTG at Time 2. Results: Higher levels of PD at Time 1 were associated with higher levels of both PTSD symptoms and PTG at Time 2. Participants who believed that the fires were more of a human-made than natural disaster had stronger associations between PD and PTSD symptoms, and stronger associations between PD and PTG. Conclusions: Attributions regarding the cause of a disaster may be related to both PTSD symptoms as well as PTG. Balanced and responsible public announcements regarding the causes of traumatic events may reduce the deleterious effects in the aftermath of a traumatic event.

Trauma-informed schools: Child disaster exposure, community violence and somatic symptoms

BACKGROUND

Given the increasing prevalence of natural disasters, trauma-informed school settings should include efficient methods for assessing child health and mental health in post-disaster environments. To develop such methods, factors that contribute to children's vulnerability and key signs of distress reactions after disasters need to be understood. To address these issues, we evaluated pre-disaster community violence exposure as a vulnerability factor for children's post-disaster reactions and somatic symptoms as a key post-disaster outcome.

METHODS

We evaluated 426 children exposed to Hurricane Katrina at two timepoints (3-7 months and 13-17 months post-disaster). Structural equation models evaluated community violence exposure, hurricane exposure, and posttraumatic stress and somatic symptoms.

RESULTS

Community violence exposure was associated with increased levels of posttraumatic stress symptoms among disaster-impacted youth, and did not moderate the relationship between disaster exposure and posttraumatic stress symptoms. Posttraumatic stress symptoms were associated with somatic symptoms in the short-term recovery period (3-7 months), but not associated with somatic symptoms during the longer-term recovery period (13-17 months).

LIMITATIONS

This study did not include school-level factors, and somatic symptoms were based on parent reports. The study did not include parent functioning information or distinguish between whether somatic symptoms were medical or functional in nature.

CONCLUSIONS

Post-disaster school-based screeners may need to incorporate questions related to children's past exposure to community violence and their somatic symptoms to provide trauma-informed care for children.

Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse

BACKGROUND

Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use these data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in primary care settings, as in many countries, these are the first place patients turn to for most health problems.

OBJECTIVE

In this paper, we discuss whether data that are recorded routinely as part of the health care process in primary care are actually fit to use for other purposes such as research and quality of health care indicators, how the original purpose may affect the extent to which the data are fit for another purpose, and the mechanisms behind these effects. In doing so, we want to identify possible sources of bias that are relevant for the use and reuse of these type of data.

METHODS

This paper is based on the authors' experience as users of electronic health records data, as general practitioners, health informatics experts, and health services researchers. It is a product of the discussions they had during the Translational Research and Patient Safety in Europe (TRANSFoRm) project, which was funded by the European Commission and sought to develop, pilot, and evaluate a core information architecture for the learning health system in Europe, based on primary care electronic health records.

RESULTS

We first describe the different stages in the processing of electronic health record data, as well as the different purposes for which these data are used. Given the different data processing steps and purposes, we then discuss the possible mechanisms for each individual data processing step that can generate biased outcomes. We identified 13 possible sources of bias. Four of them are related to the organization of a health care system, whereas some are of a more technical nature.

CONCLUSIONS

There are a substantial number of possible sources of bias; very little is known about the size and direction of their impact. However, anyone that uses or reuses data that were recorded as part of the health care process (such as researchers and clinicians) should be aware of the associated data collection process and environmental influences that can affect the quality of the data. Our stepwise, actor- and purpose-oriented approach may help to identify these possible sources of bias. Unless data quality issues are better understood and unless adequate controls are embedded throughout the data lifecycle, data-driven health care will not live up to its expectations. We need a data quality research agenda to devise the appropriate instruments needed to assess the magnitude of each of the possible sources of bias, and then start measuring their impact. The possible sources of bias described in this paper serve as a starting point for this research agenda.

The Impact of Natural Disasters on Youth: A Focus on Emerging Research beyond Internalizing Disorders

PURPOSE OF REVIEW

This paper reviews youth outcomes following exposure to natural disaster, with a focus on three relatively understudied outcomes: externalizing behavior problems, physical health, and posttraumatic growth. Recent, high-impact studies focusing on each outcome are summarized.

RECENT FINDINGS

Studies highlighted in this review utilize innovative and comprehensive approaches to improve our current understanding of youth broad-based physical and mental health outcomes beyond PTSD. The review concludes with recommendations to advance the field of youth disaster research by exploring how disasters may impact children across multiple domains, as well as using cutting edge ecobiological approaches and advanced modeling strategies to better understand how youth adjust and thrive following natural disaster.

Health status of adolescents in the Tibetan plateau area of western China: 6 years after the Yushu earthquake

Background

An earthquake struck Yushu in Qinghai province of China on April 14, 2010, causing 2698 deaths and 12,135 injuries.The present study aimed to assess the health status, and associated determinants, of child survivors in the epicenter of the Yushu earthquake 6 years after the event.

Methods

A cross-sectional survey was performed among students from two junior schools in Yushu County. Descriptive statistics, t-tests, ANOVA, Wilcoxon rank sum tests, Kruskal-Wallis H tests and stepwise linear regression analysis were used for data analysis.

Results

The mean scores onmental component summary (MCS)and physical component summary (PCS) were 42.13 (SD 7.32) and 42.04 (SD 8.07), respectively. Lower PCS in the aftermath of an earthquake was associated with being trapped/in danger, injured to self, receiving no escape training while lowerMCS in the aftermath of an earthquake was associated with a lower grade level, not living with parents, fear during the earthquake, death in the family, and not receiving psychological counseling after the earthquake.

Conclusions

In conclusion, the results of the present study help to expand our knowledge regarding the health status of child survivors 6 years after the Yushu earthquake. Our study provides evidence-based suggestions for specific long-term health interventions in such vulnerable populations.

Parent-Child Relationship Quality and Gender as Moderators of the Influence of Hurricane Exposure on Physical Health Among Children and Youth

OBJECTIVE

To investigate the long-term influence of disaster exposure, parent-child relationship quality (PCRQ), and gender on child and youth physical health.

METHODS

Parent-child dyads (N = 1,886) were randomly selected and interviewed approximately 18 months after Hurricane Georges hit Puerto Rico (1998), and reinterviewed 12 months later. The outcome variables were parent report of a global rating of children's physical health, and frequency of medical problems and medical visits in the past year.

RESULTS

Conservative analyses that accounted for a host of postdisaster health-relevant factors showed that hurricane exposure exerted detrimental influence on physical health at both 18 and 30 months after the event. The moderating role of PCRQ in the relation between hurricane exposure and physical health varied by gender.

CONCLUSION

Disasters have long-term potential to influence the physical health of children and adolescents. PCRQ serves as resource but its role in the context of disasters is complex.

The impact of the San Diego wildfires on a general mental health population residing in evacuation areas

San Diego County Mental Health system clients completed a questionnaire after the October 2007 wildfires. As compared to those not in an evacuation area, those residing in an evacuation area reported significantly more impact of the fires. Clients who evacuated were most affected, followed by those in an evacuation area who did not evacuate. Evacuation strongly impacted client-reported emotional effects of the fire, confusion about whether to evacuate, and ability to obtain medications. Gender and clinical diagnosis interacted with evacuation status for some fire impact variables. Loss of control and disruption of routine are discussed as possibly related factors.

Health problems among low-income parents in the aftermath of Hurricane Katrina

OBJECTIVE

Although the mental health consequences of disasters have been well documented, relatively less is known about their effects on survivors' physical health. Disaster studies have also generally lacked predisaster data, limiting researchers' ability to determine whether postdisaster physical health problems were influenced by disaster exposure, or whether they would have emerged even if the disaster had not occurred. The current study aimed to fill this gap.

METHOD

Participants were low-income, primarily non-Hispanic Black mothers (N = 334) who survived Hurricane Katrina and completed 4 survey assessments, 2 predisaster and 2 postdisaster. In each assessment, participants reported on whether they had experienced 3 common health problems (frequent headaches or migraines, back problems, and digestive problems) and completed 2 mental health measure (the K6 scale, the Perceived Stress Scale).

RESULTS

The descriptive results suggested that the hurricane led to at least short-term increases in the 3 health outcomes. Fixed effects modeling was conducted to explore how changes in various predictor variables related to changes in each health condition over the study. Bereavement and increases in psychological distress were significant predictors of increases in health problems.

CONCLUSIONS

Based on these results, further research that explores the processes through which disasters lead to both physical and mental health problems, postdisaster screenings for common health conditions and psychological distress, and interventions that boost survivors' stress management skills are suggested.

Physical health problems after single trauma exposure: when stress takes root in the body

Research has established that chronic stress, including traumatic events, leads to adverse health outcomes. The literature has primarily used two approaches: examining the effect of acute stress in a laboratory setting and examining the link between chronic stress and negative health outcomes. However, the potential health impact of a single or acute traumatic event is less clear. The goal of this literature review is to extend the literature linking both chronic trauma exposure and posttraumatic stress disorder to adverse health outcomes by examining current literature suggesting that a single trauma may also have negative consequences for physical health. The authors review studies on health, including cardiovascular, immune, gastrointestinal, neurohormonal, and musculoskeletal outcomes; describe potential pathways through which single, acute trauma exposure could adversely affect health; and consider research and clinical implications.

After the fire: the mental health consequences of fire disasters

PURPOSE OF REVIEW

This article aims to summarize recent findings relating to the impact of fire disasters on the mental health of victims, responders, families and communities within the context of the existing literature.

RECENT FINDINGS

Recent studies support previous findings that fire disasters are associated with a negative impact on the mental and physical health of victims, their families and professional and voluntary responders to the disasters. These effects can be delayed in onset and can persist over at least several years, although long-term follow-up studies over 20 years or more indicate that the psychological effects on victims are minimal relative to controls by this stage.

SUMMARY

Fire disasters, like other natural or man-made disasters, can have significant mental health impact on individuals directly and indirectly affected and on communities caught up in the events.