Anger Dimensions and Mental Health Following a Disaster: Distribution and Implications After a Major Bushfire

'It sort of broke me': A thematic analysis of the psychological experiences and coping strategies employed by Australian fire-affected farmers

INTRODUCTION

People exposed to bushfires are known to be at heightened risk of experiencing mental health challenges. When farms are impacted, farmers often risk losing not only their homes but also their businesses, containing their livestock, infrastructure and identities.

OBJECTIVE

To understand the psychological experiences of farmers who have been exposed to fires on their farms and identify the coping strategies they already employ to recover and prepare psychologically for future bushfires.

DESIGN

In-depth, semi-structured interviews were conducted face-to-face or via Zoom. Thematic analysis was used to analyse the data, using a descriptive, essentialist approach. Sixteen farmers and/or their spouses (50% female; median age of 50.8 years), who owned and/or played an active role in the operation of a farming or pastoral enterprise and had been affected by a farm fire within the last 20 years, participated. Participants resided in inner regional, outer regional and remote South Australia and New South Wales.

FINDINGS

Seven overarching themes and 22 subthemes resulted: (1) intense emotions in the aftermath, (2) long-term psychological challenges, (3) deliberate focus on organising, prioritising and completing recovery-focused tasks, (4) importance of seeking and/or accessing support to rebuild, (5) adopting a positive attitude and outlook, (6) (dis)engaging from/with community and social connection and (7) various strategies employed to self-regulate emotions.

DISCUSSION/CONCLUSION

This study demonstrates the unique set of psychological challenges Australian farmers experience in the wake of a farm fire and the coping strategies they report using to help them manage. Findings will inform the development of contextually and culturally appropriate bushfire recovery and preparedness initiatives that are tailored to meet the unique needs of farmers and build upon their existing strengths.

Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study

BACKGROUND

Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events.

AIMS

This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure.

METHOD

The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode).

RESULTS

Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors.

CONCLUSIONS

Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Improving mental health following multiple disasters in Australia: a randomized controlled trial of the Skills for Life Adjustment and Resilience (SOLAR) programme

Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..

Validation of the Dimensions of Anger Reactions Scale (the DAR-5) in non-clinical South Korean adults

BACKGROUND

Posttraumatic anger is a commonly reported emotion among people who have experienced traumatic events. The current study aimed to demonstrate the reliability and validity of the South Korean version of the DAR-5 (DAR-5-K). The DAR-5 is a single scale with 5 items which measures posttraumatic anger. The DAR-5 is composed of five items that measure anger frequency, intensity, duration, aggression, and its interference with social relations.

METHODS

Data were collected from 814 South Korean adults who had experienced traumatic events and participated in the study and analyzed via the combination of exploratory factor analysis (n = 405) and confirmatory factor analysis (n = 409).

RESULTS

Results supported the one-factor structure, as reported in previous validation studies. The scale demonstrated robust internal reliability and concurrent validity with measures of posttraumatic stress disorder (PTSD) symptoms, depression, anxiety, and self-esteem. The DAR-5 cut-off score of 12 that was established in the original validation study successfully differentiated high from low scorers with regard to PTSD symptoms, depression, anxiety, and self-esteem.

CONCLUSION

The results confirm that the DAR-5-K is a brief and psychometrically robust measure of anger that can be used to examine South Korean adults who have experienced traumatic events.

Long-term impacts of non-occupational wildfire exposure on human health: A systematic review

The intensity and frequency of wildfires is increasing globally. The systematic review of the current evidence on long-term impacts of non-occupational wildfire exposure on human health has not been performed yet. To provide a systematic review and identify potential knowledge gaps in the current evidence of long-term impacts of non-occupational exposure to wildfire smoke and/or wildfire impacts on human health. We conducted a systematic search of the literature via MEDLINE, Embase and Scopus from the database inception to July 05, 2022. References from the included studies and relevant reviews were also considered. The Newcastle-Ottawa Scale (NOS) and a validated quality assessment framework were used to evaluate the quality of observational studies. Study results were synthesized descriptively. A total of 36 studies were included in our systematic review. Most studies were from developed countries (11 in Australia, 9 in Canada, 7 in the United States). Studies predominantly focused on mental health (21 studies, 58.33%), while evidence on long-term impacts of wildfire exposure on health outcomes other than mental health is limited. Current evidence indicated that long-term impacts of non-occupational wildfire exposure were associated with mortality (COVID-19 mortality, cardiovascular disease mortality and acute myocardial disease mortality), morbidity (mainly respiratory diseases), mental health disorders (mainly posttraumatic stress disorder), shorter height of children, reduced lung function and poorer general health status. However, no significant associations were observed for long-term impacts of wildfire exposure on child mortality and respiratory hospitalizations. The population-based high-quality evidence with quantitative analysis on this topic is still limited. Future well-designed studies considering extensive wildfire smoke air pollutants (e.g., particulate matter, ozone, nitrogen oxides) and estimating risk coefficient values for extensive health outcomes (e.g., mortality, morbidity) are warranted to fill current knowledge gaps.

Problematic Anger in the Military: Focusing on the Forgotten Emotion

PURPOSE OF REVIEW

Problematic anger is common in veteran and military populations, yet understudied relative to other mental health difficulties. However, in recent years, more clinical and research attention has been turned to problematic anger. This paper highlights important new findings in the epidemiology, course, and neurobiology of anger, the associations of anger with other mental health problems and risk, and next steps for research and practice.

RECENT FINDINGS

In longitudinal research, findings show that problematic anger changes over the life course of military members and veterans, and that deployment increases the likelihood of problematic levels of anger. Problematic anger is related to a range of mental health issues, most perniciously aggression and suicidality. Promising new assessment and treatment approaches are emerging, including innovations that leverage digital technology. Key areas of research include advancing assessment of problematic anger to identify patterns of heterogeneity, as well as advancing the evidence base for anger treatments. Recommended progress in clinical practice include conducting routine assessment of problematic anger in veteran and military populations, developing prevention and early intervention for at risk individuals, and optimizing the timing of interventions throughout the military lifecycle.

Tourism operator mental health and its relationship with SME organisational resilience during disasters

Crises have a negative, and often long-lasting impact on mental health. The stress of dealing with the ongoing and unpredictable aspects of the COVID-19 pandemic has led to an unprecedented rise in mental health problems including low mood, depression and anxiety. Tourism businesses have faced ongoing challenges, with repeated lockdowns and drastically reduced tourist numbers and mental health challenges faced by operators may impact the resilience of tourism organisations and vice versa. Few studies have examined this. Our study in Victoria, Australia documents the mental health impacts of the COVID-19 crisis on owners and managers (operators) of small to medium tourism businesses and explores organisational factors that may impact or protect operator mental health during the crisis. Our findings show that the mental health of the cohort reached critically low levels over the course of the pandemic. We also identify positive associations between tourism organisational resilience and operator mental health.

Mental Health First Aid training and assessment in Australian medical, nursing and pharmacy curricula: a national perspective using content analysis

BACKGROUND

Suicide is among the leading causes of death among people aged 15 to 29 worldwide. Healthcare professionals interact with people at risk of suicide regularly, yet mental health and crisis first aid training is lacking in curricula. Mental Health First Aid (MHFA) training teaches crucial communication and crisis first aid skills and is increasingly recognised as integral to healthcare education. This study aimed to explore the extent of, as well as barriers and enablers to MHFA training delivery and assessment in Australian medical, nursing and pharmacy curricula.

METHODS

All accredited Australian medical, nursing and pharmacy program providers were identified through Australian Health Practitioner Regulation Agency and National Boards websites and invited to participate in a semi-structured interview. A purpose-designed interview guide explored if and how MHFA training was delivered and assessed in curricula, as well as perceptions of and barriers and enablers to MHFA training. Interview recordings were transcribed verbatim, allowing for deductive content analysis to compare MHFA training provision across programs.

RESULTS

Of 75 invited program providers, 36 (48%; 13 medical, 13 nursing and 10 pharmacy) participated, of which 15 representatives (42%; six medical, two nursing and six pharmacy) reported providing MHFA training to students. Differences in mandating training, year level of students completing training, type of training delivered and source of MHFA instructors were identified. Barriers to MHFA implementation included perceived adequacy of existing curricula, lack of funding and time, while facilitators included perceived benefit and availability of funding.

CONCLUSION

MHFA training is provided to more than one third of medical, nursing and pharmacy students in Australia. Increased funding may facilitate the integration of MHFA as a minimum standard of mental health training for future healthcare professionals. Further research exploring the effectiveness of MHFA in improving behaviours and its impact on patient outcomes is warranted.

TRIAL REGISTRATION

This study was approved by the University of Sydney Human Research Ethics Committee [Project number: 2020/087].

The 2018 Japan Floods Increased the Frequency of Yokukansan Prescriptions Among Elderly: A Retrospective Cohort Study

Objective

The impact of the 2018 Japan Floods on prescriptions of Yokukansan was evaluated.

Methods

This was a retrospective cohort study based on the National Database of Health Insurance Claims which covers all the prescriptions issued in Japan. Participants were patients aged 65 or older who received any medical care at medical institutions located in the three most-severely affected prefectures between 1 year before and after the disaster. We analyzed the number of new prescriptions of Yokukansan and other Kampo drugs among those who had not been prescribed any Kampo for 1 year before the disaster. Kaplan-Meier analysis and a Cox proportional hazards model were used to evaluate the risk of the disaster for a new prescription.

Results

Subjects comprised 1,372,417 people (including 12,787 victims, 0.93%). The hazard ratio (HR) of the disaster for Yokukansan prescriptions was 1.49 [95% confidence intervals (CI): 1.25–1.78], and 1.54 (95% CI: 1.29–1.84) in the crude and age-sex adjusted model, respectively. The HR of the disaster for prescription of other Kampo drugs in the crude and adjusted model was 1.33 (95% CI: 1.27–1.39), and 1.32 (95% CI: 1.27–1.38), respectively. The magnitude of increase of victims prescribed Yokukansan (31.4%) was statistically higher than for those prescribed other Kampo drugs (19.3%) (p < 0.001).

Conclusion

The disaster increased prescriptions of both Yokukansan and other Kampo drugs among elderly victims. The increase was more remarkable in Yokukansan than other Kampo drugs. Clinicians and policymakers should be aware of the increased need for Yokukansan in times of natural disaster.

The long-term impact of bushfires on the mental health of Australians: a systematic review and meta-analysis

BACKGROUND

The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems.

OBJECTIVE

This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires.

METHOD

A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis.

RESULTS

We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact.

CONCLUSIONS

As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues.

HIGHLIGHTS

First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.

Modelling the relationship between poor sleep and problem anger in veterans: A dynamic structural equation modelling approach

OBJECTIVE

Problem anger and poor sleep are common, particularly in military and veteran populations, but the nature of the relationship is poorly understood, and treatment approaches would benefit from improved understanding of how these constructs interact. Ecological momentary assessment (EMA) is suitable for monitoring day-to-day fluctuations in symptoms, and modelling dynamic relationships between variables.

METHODS

This study aimed to examine these fluctuations and relationships involving sleep quality and anger experiences among veterans. A sample of n = 60 veterans with problem anger as assessed by the recommended cut off on the Dimensions of Anger Reactions 5 scale (DAR-5) completed daily assessments of sleep quality and four times daily assessments of anger frequency, over a 10-day period.

RESULTS

A Dynamic Structural Equation Model (DESM) estimated and revealed a unidirectional relationship across daily measurements, in that previous night poor sleep quality was associated with more frequent anger on the next day (φASi Estimate -0.791, one-tailed p = .075), but not the reverse.

CONCLUSIONS

These are the first longitudinal, naturalistic findings in relation to anger and sleep in a sample self-identifying with significant anger problems. The observed patterns point to the need for further research on mechanisms underpinning this relationship, and raises potential for early intervention for problem anger to include a focus on improving sleep quality.

The Impact of Wildfires on Mental Health: A Scoping Review

One of the many consequences of climate change is an increase in the frequency, severity, and, thus, impact of wildfires across the globe. The destruction and loss of one's home, belongings, and surrounding community, and the threat to personal safety and the safety of loved ones can have significant consequences on survivors' mental health, which persist for years after. The objective of this scoping review was to identify primary studies examining the impact of wildfires on mental health and to summarize findings for PTSD, depression, anxiety, and substance use. Literature searches on Pubmed and Embase were conducted in February and April of 2021, respectively, with no date restrictions. A total of 254 studies were found in the two database searches, with 60 studies meeting the inclusion criteria. Three other studies were identified and included based on relevant in-text citations during data abstraction. The results show an increased rate of PTSD, depression, and generalized anxiety at several times of follow-up post-wildfire, from the subacute phase, to years after. An increased rate of mental health disorders post-wildfire has been found in both the adult and pediatric population, with a number of associated risk factors, the most significant being characteristics of the wildfire trauma itself. Several new terms have arisen in the literature secondary to an increased awareness and understanding of the impact of natural disasters on mental health, including ecological grief, solastalgia, and eco-anxiety. There are a number of patient factors and systemic changes that have been identified post-wildfire that can contribute to resilience and recovery.