Daily stressors and mental health following disaster: A school-based assessment of adolescent disaster survivors in China and Nepal

Population-level effects of Hurricane Sandy on adolescent health

BACKGROUND

Disasters are increasing in frequency and intensity due to climate change. Youth are the largest and most vulnerable group exposed to disasters. More evidence is needed regarding how youth mental health and health behaviors vary based on disaster exposure, how mental health influences health behaviors, and how diverse groups of youth may be differentially affected.

METHODS

Using data from the Youth Risk Behavior Survey and Federal Emergency Management Agency, we examined the impact of Hurricane Sandy (2012) on mental health (sadness, suicidality) and health behaviors (substance use, physical activity, screen time, sexual behaviors) of 240,365 youth. Difference-in-differences regression analyses evaluated pre-disaster (2005-2011) and post-disaster (2013-2019) changes.

RESULTS

There were 83,442 (34.7 %) adolescents (51.2 % female, 18.1 % non-Hispanic White) located in 6 districts exposed to Hurricane Sandy and 156,923 (65.3 %) adolescents located in 13 non-exposed districts. Exposure was associated with differences in substance use, physical (in)activity, and risky sexual behaviors, but not mental health outcomes. Mental health did not moderate the association between disaster exposure and health behaviors. Hispanic adolescents and those identifying as Other races/ethnicities were most vulnerable to post-disaster negative health outcomes.

LIMITATIONS

Study limitations include questionnaire design, cross-sectional data, sampling, and possible response biases.

CONCLUSIONS

Findings provide critical information about youth mental health and health behaviors following disasters, as well as how youth may differ in their responses. Findings provide guidance for early identification and resource allocation for youth at higher risk for post-disaster health issues.

Adolescent mental distress in the wake of climate disasters

Objective

Retrospective exposure to a higher number and prolonged duration of climate-related disasters could be positively associated with adolescent mental distress.

Methods

Person-level data came from 38,616 high-school students residing in 22 urban public-school districts in 14 states (U.S. Youth Risk Behavior Survey, 2019). Each district's federally declared climate-related catastrophes (severe storms, floods, wildfire, etc.) came from the Federal Emergency Management Agency. Logistic regression models estimated the adjusted odds ratios (aOR) of adolescent mental distress (MD, using survey responses feeling prolonged sadness/ hopelessness and short sleep duration) according to disaster events and days during three exposure periods (past 2-, 5-, 10-years); adjusted for age, gender, race/ethnicity, socio-economic disadvantage, feeling unsafe at school, district area size, district poverty, and region.

Results

Over 10 years, the median number of disaster events was 3 and total disaster days was 64. Adolescents experiencing the highest number of disaster days (top quartile vs. less) had 25% higher odds of MD when exposed within the past 2-years (aOR 1.25 [95% CI 1.14, 1.38]), and 20% higher odds of MD when exposed within the past 5-years (aOR 1.20 95% CI 1.07, 1.35). The odds of MD were not statistically associated with exposure periods that extended to 10 years, nor disaster events (instead of disaster days, all p-values > 0.1).

Conclusions

Severe weather will become more frequent and last longer with human-induced climate warming. More studies like this are needed to understand the broad range of adverse effects and enhance planning and preparedness including preparing for worsening mental health among adolescents.

Resource allocation, individual social network, community trust and recovery from depression among rural survivors in the Wenchuan Earthquake

Using the three-wave longitudinal survey data of the Wenchuan disaster area, this study employed Hierarchical Linear Modeling (HLM) to explore the recovery trajectory from depression of rural survivors after the Wenchuan earthquake. Across the three waves, 221 respondents (118 male, 103 female) provided complete data. We found that, at the individual level, the survivors' individual social networks had a significant effect on the change in depression scores in the four years following the earthquake, implying that a strong social network could help survivors recover from depression. At the community level, community trust had a significant effect both on the initial depression score at the time of the earthquake and on the survivors' change in depression scores after the earthquake. Survivors with high community trust had significantly lower depression scores, compared with those with low community trust at the time of the earthquake; however, the depression scores of the former increased in the four years following the earthquake and gradually approached the average depression level. At the social level, relief resource allocation also had a significant effect on the change in survivors' post-disaster depression; those who deemed the resource allocation to be very fair had a decrease in depression scores. The results of our study show that rich individual social networks and allocation of relief resources contribute to earthquake survivors' recovery from depression. Therefore, besides providing more adequate relief resources to survivors, we should also emphasize the rebuilding of their social networks.

Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal

BACKGROUND

Child and adolescent mental health problems are major contributors to the global burden of disease in low- and middle-income country (LMIC) settings. To advance the evidence base for adolescent mental health interventions in LMICs, we evaluated the feasibility and acceptability of a school-based emotion regulation prevention intervention (READY-Nepal) for adolescents who had a recent exposure to a humanitarian disaster.

METHODS

A mixed-method, non-randomized controlled trial was conducted with Nepali secondary school students in one heavily affected post-earthquake district. Students (N = 102; aged 13 to 17 years) were enrolled in the intervention (n = 42) and waitlist control (n = 60) conditions. Feasibility and acceptability were examined via attendance, and by qualitative interviews with a subset of students (n = 15), teachers (n = 2), and caregivers (n = 3). Preliminary efficacy was examined on primary outcome (emotion regulation) and secondary outcomes (anxiety symptoms, posttraumatic stress symptoms, functional impairment, resilience, coping skills), which were measured at baseline and post-intervention (four weeks).

RESULTS

Delivering the intervention was feasible and acceptable, as demonstrated by low dropout (8%) and high program attendance (6.7 of 8 sessions). Qualitative data suggested high uptake of anger regulation skills, but lower uptake of mindfulness skills. Despite this, there were no significant differences by condition on primary or secondary outcomes at four-week follow-up. Students provided suggestions for improvement of the program.

CONCLUSION

Further research on longitudinal outcome measurement, use of alternatives to retrospective self-report data, and rigorous development of culturally grounded models of emotion regulation is necessary to explore the utility of school-based emotion regulation interventions in Nepal and other LMICs.

Long term mental health trajectories after disasters and pandemics: A multilingual systematic review of prevalence, risk and protective factors

The patterns of long-term psychological response after disasters and pandemics remain unclear. We aimed to determine the trajectories for post-traumatic stress symptoms (PTSS), depression and anxiety prevalence following disasters and pandemic exposure; and identify associated risk and protective factors. A systematic review of the English, Chinese, and Japanese longitudinal mental health literature was conducted. We searched Cochrane, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and CINAHL (English), CNKI and SINOMED (Chinese) and CiNii (Japanese) for studies published between January 2000 and May 2022. Following a pre-specified protocol (PROSPERO: CRD42020206424), conditional linear growth curve models and ANOVA analyses were conducted. The search identified 77,891 papers, with a final sample of 234: 206 English, 24 Chinese, and 4 Japanese-language papers. PTSS rates improved for all ages (p = .018, eta² = 0.035). In contrast, depression and anxiety prevalence remained elevated for years following exposure (p = .424, eta² = 0.019 and p = .051, eta² = 0.064, respectively), with significantly higher rates for children and adolescents (p < .005, eta² > 0.056). Earthquakes and pandemics were associated with higher prevalence of PTSS (p < .019, eta² > 0.019). Multi-level risk and protective factors were identified. The chronicity of mental health outcomes highlights a critical need for tailored, sustainable mental health services, particularly for children and adolescents, in disaster- and pandemic-affected settings.