Long-Term Mental Health Among Low-Income, Minority Women Following Exposure to Multiple Natural Disasters in Early and Late Adolescence Compared to Adulthood

Post-traumatic stress and depression following disaster: examining the mediating role of disaster resilience

The current study used structural equation modeling to examine the role of disaster resilience as a mediator between disaster exposure and post-traumatic stress and depressive symptoms among a sample of 625 U.S. adults who experienced a disaster event. Results found that disaster resilience mediated the relationship between disaster exposure as a predictor and depression and post-traumatic stress as dependent variables. These findings have important implications for understanding the mechanisms by which disaster resilience supports post-disaster mental health and can inform future disaster mental health interventions and practice models.

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.

The association between COVID-19-related stressors and mental health outcomes for survivors of past interpersonal and non-interpersonal trauma

The mental health difficulties of trauma survivors during the COVID-19 pandemic have been under-reported. This study explored the moderating role of trauma history and trauma type (interpersonal and non-interpersonal) in the association between COVID-19-related stressors and depression, anxiety, and stress. A sample of n = 321 participants ages 19 to 71 (M = 36.63, SD = 10.36) was recruited from across the United States through MTurk. Participants reported the number of COVID-19-related stressors, trauma history and psychological symptoms. Hierarchical multiple regression analyses, controlling for age, race, ethnicity, gender, education, and income levels, were used to determine (a) whether COVID-19-related stressors are associated with adverse mental health outcomes; (b) whether trauma history and (c) trauma type moderated this association. Results revealed significant interactions; for those with a trauma history, exposure to COVID-19-related stressors was associated with higher levels of depression (β = .21, p < .05) and anxiety (β = .19, p < .05). For those with a history of interpersonal trauma specifically, COVID-19-related stressors were associated with depression (β = .16, p < .05) more so than for those without a trauma history. These findings highlight the vulnerability of trauma survivors to the unprecedented COVID-19-related stress.

Economic and mental health impacts of multiple adverse events: Hurricane Harvey, other flooding events, and the COVID-19 pandemic

OBJECTIVES

To assess the economic and mental health impacts of COVID-19 in the presence of previous exposure to flooding events.

METHODS

Starting in April 2018, the Texas Flood Registry (TFR) invited residents to complete an online survey regarding their experiences with Hurricane Harvey and subsequent flooding events. Starting in April 2020, participants nationwide were invited to complete a brief online survey on their experiences during the pandemic. This study includes participants in the TFR (N = 20,754) and the COVID-19 Registry (N = 8568) through October 2020 (joint N = 2929). Logistic regression and generalized estimating equations were used to examine the relationship between exposure to flooding events and the economic and mental health impacts of COVID-19.

RESULTS

Among COVID-19 registrants, 21% experienced moderate to severe anxiety during the pandemic, and 7% and 12% of households had difficulty paying rent and bills, respectively. Approximately 17% of Black and 15% of Hispanic households had difficulty paying rent, compared to 5% of non-Hispanic white households. The odds of COVID-19 income loss are 1.20 (1.02, 1.40) times higher for those who previously had storm-related home damage compared to those who did not and 3.84 (3.25-4.55) times higher for those who experienced Harvey income loss compared to those who did not. For registrants for whom Harvey was a severe impact event, the odds of having more severe anxiety during the pandemic are 5.14 (4.02, 6.58) times higher than among registrants for whom Harvey was a no meaningful impact event.

CONCLUSIONS

Multiple crises can jointly and cumulatively shape health and wellbeing outcomes. This knowledge can help craft emergency preparation and intervention programs.

Community disaster exposure and first onset of depression: A panel analysis of nationally representative South African data, 2008-2017

Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effects of disasters. Despite the potential danger of such cumulative community disaster exposure on mental health (e.g. depression), large-scale population-level evidence for the region is limited. We investigated the association between exposure to cumulative disaster and the first onset of depression in a nationally representative survey in South Africa. We used panel data from the South African National Income Dynamics Study (SA-NIDS) from 2008-2017, consisting of 17,255 adult study participants who were depression free at baseline. Risk of first depression onset between individuals exposed and unexposed to community disaster was measured, accounting for multiple disaster exposure over time by fitting generalized estimating equation (GEE) regression models. Data on the geographic location of disasters were obtained from the South African government gazette, and mapped with the government delineated SA-NIDS households' locations. Of the sampled individuals, 2,986 were exposed to disaster during the study duration (17.3%). Increased cumulative community disaster was significantly associated with the likelihood of depression onset (adjusted relative risk [aRR] = 1.20, p<0.01, 95% CI: 1.09-1.33), even after controlling for socio-demographic factors. In sub-group analyses, greater likelihood of depression onset was found among females [but not in men] (aRR = 1.23, p<0.01, 95% CI: 1.09-1.38), Black African [but not in other population group] (aRR = 1.21, p<0.01, 95% CI: 1.09-1.36), lower education attainment group [but not in tertiary and above educational attainment group] (aRR = 1.20, p<0.01, 95% CI: 1.08-1.33), and lower income attainment group [but not in the top income quartile group] (aRR = 1.24, p<0.01, 95% CI: 1.11-1.38), due to cumulative community disaster. Although cumulative community disaster exposure was significantly associated with the first onset of depression, its negative impact may be more pronounced among individuals considered chronically socially vulnerable (i.e. the groups above) in South Africa. Given that many individuals in South Africa rely on social, food parcel relief, and health services from government/public sector, timely access to community-based supportive intervention is needed for disaster survivors, prioritizing socially vulnerable groups to help mitigate problems associated with mental health challenges.

ICD-11 Posttraumatic Stress Disorder and Complex PTSD Among Hospital Medical Workers in China: Impacts of Wenchuan Earthquake Exposure, Workplaces, and Sociodemographic Factors

BACKGROUND

Previous studies address posttraumatic stress disorder (PTSD) following disasters as a public health issue. However, few studies investigate the long-term effect of disaster exposure on PTSD among hospital medical workers (HMWs).

OBJECTIVES

This study aimed to study the prevalence of ICD-11 PTSD and complex PTSD (CPTSD) among exposed and non-exposed HMWs 11 years after the Wenchuan earthquake in China, to identify the factors associated with PTSD and CPTSD scores, and to examine the factor structures of PTSD and CPTSD models.

METHODS

A cross-sectional study was conducted using a self-administered online questionnaire. Two thousand fifty-nine valid samples were collected from four hospitals in 2019. Descriptive statistical analysis, multivariate regression models, and confirmatory factor analysis (CFA) were performed.

RESULTS

The prevalence of PTSD and CPTSD was 0.58 and 0.34%, respectively. The unexposed group reported higher PTSD and CPTSD scores than the exposed group. The type of workplace and marital status were significantly associated with the PTSD and CPTSD scores of HMWs. The CFA results indicate that both the correlated first-order model and the correlated two-layer model were a good fit to explain the structure of PTSD and CPTSD.

CONCLUSION

These findings suggest that few HMWs who were exposed to the Wenchuan earthquake suffered from PTSD or CPTSD 11 years following the disaster. However, psychological support was still necessary for all HMWs, especially for unmarried HMWs who were Working in smaller hospitals. Further research is required to analyze mental health status using ICD-11 PTSD and CPTSD to provide ongoing evidence to help HWMs cope effectively with the challenges of future disasters.

The Mental Health Impacts of Successive Disasters: Examining the Roles of Individual and Community Resilience Following a Tornado and COVID-19

Prior research has found that exposure to natural hazards and infectious disease are associated with adverse mental health outcomes. Less studied are the ways that individual-level and community-level resilience can protect against problematic mental health outcomes following exposure to successive disaster events. In the current study, we examine the role of individual and community resilience on mental health outcomes among 412 adults in Nashville, Tennessee exposed to an EF-3 tornado followed by the COVID-19 pandemic. Results found the cumulative impact of exposure to the tornado and COVID-19 was related to higher levels of PTS and depression symptoms. Individual resilience had a protective, inverse relationship with PTS and depression symptoms and mediated the relationship between community resilience and adverse mental health outcomes. Findings support the development of a multi-system disaster resilience framework that links individual resilience capacities to broader community resilience capacities to activate and sustain healthy adaptation following exposure to successive disasters.

Health Impact and Risk Factors Affecting South and Southeast Asian Women Following Natural Disasters: A Systematic Review

(1) Background: Following natural disasters, women have a higher prevalence of adverse physical and mental health outcomes. Given that the South and Southeast Asia regions are highly disaster prone, a review was undertaken to identify the potential health impact and key risk factors affecting women after disasters in the countries located in South and Southeast Asia regions. (2) Methods: A systematic literature search of four databases yielded 16 studies meeting the inclusion criteria. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, between July 2008 and March 2021. (3) Results: The majority of studies reported women's negative/poor mental health, identifying a significant association of socio-demographics, during disaster exposure, post-disaster, and pre-existing risk factors. The six most-cited influences on women's mental health found in the reviewed literature were being female, adult age group, having no formal education, poverty or low economic status, poor physical health/physical injuries, and death of family members. Women's health during the post-disaster period was generally reported as poor among all the countries of the South and Southeast Asia regions. (4) Conclusions: Appropriate social support and the availability of free healthcare access for women are warranted in disaster-affected areas. This review offers a valuable contribution to the knowledge of women's health complications/challenges and associated risk factors related to disasters, essential for the development of strategies to help reduce this burden in the future. Further research is required on natural disasters to identify ways to reduce women's health impacts after natural disasters, especially in the context of low-income and lower-middle-income countries.

Social determinants of mental health of women living in slum: a systematic review

OBJECTIVE

With the rise of urbanization globally, the problem of living in slums has become a problem for the civil society. As a vulnerable segment, women make up half of the population in these regions; therefore, women's mental health has always been a concern. The purpose of this study was to review the social determinants of mental health in women living in slum areas.

METHODS

We systematically reviewed articles published between 2009 and 2019 on the social determinants of women's mental health in SID, Magiran, Google scholar, PubMed, Scopus, Science Direct, Embase, MEDLINE, PsychINFO, and PsychARTICLES databases using MeSH keywords according to PRISMA guidelines. The quality of the studies was assessed depending on the type of study using Ottawa Newcastle" scale and Joanna Briggs Institute quality assessment tools. Finally, 23 studies were analyzed.

RESULTS

Different social determinants influenced the mental health of women living in slum areas. Among the structural determinants, the socioeconomic level had the highest frequency, and gender was in the second rank with the highest correlation with poorer women's mental health status. Among the intermediate determinants, living conditions, food insecurity, social capital, and social support were most frequently associated with mental health status.

CONCLUSION

Women living in slum areas are prone to developing mental disorders and poorer mental health; therefore, supporting these women and creating job opportunities to raise their incomes and, subsequently, improve their social, economic, and living conditions should be taken into consideration. In addition, this requires careful planning and comprehensive social support.

Quasi-experimental evaluation of text-based crisis patterns in youth following Hurricane Florence in the Carolinas, 2018

IMPORTANCE

Crisis text lines have proven to be an effective and low-cost means for delivering texting-based mental health support to youth. Yet there has been limited research examining the use of these services in capturing the psychological impact on youth affected by a weather-related disaster.

OBJECTIVE

This ecologic study examined changes in help-seeking behavior for adolescents and young adults in North and South Carolina, USA, before and after Hurricane Florence (2018).

DESIGN AND MAIN OUTCOMES

A retrospective, interrupted time-series design was used to examine pre- and post-hurricane changes in crisis text volume among youth help seekers in the Carolinas for the following outcomes: (1) text for any reason; (2) stress & anxiety; (3) depression; and (4) suicidal thoughts.

RESULTS

Results showed an immediate and sustained increase in crisis texts for stress/anxiety and suicidal thoughts in the six weeks following Florence. Overall, an immediate 15% increase in crisis texts for anxiety/stress (SE = 0.05, p = .005) and a 17% increase in suicidal thoughts (SE = 0.07, p = .02) occurred during the week of the storm. Text volume for anxiety/stress increased 17% (SE = 0.08, p = .005) and 23% for suicidal ideation (SE = 0.08, p = .01) in the 6-week post-hurricane period. Finally, forecast models revealed observed text volume for all mental health outcomes was higher than expected in the 6 weeks post-Florence.

CONCLUSIONS AND RELEVANCE

A low-cost, crisis texting platform provided 24/7 mental health support available to young people in the Carolinas impacted by Hurricane Florence. These findings highlight a new application for text-based crisis support services to address the mental health consequences in youth following a weather-related disaster, as well as the potential for these types of crisis platforms to measure situational awareness in impacted communities.

Psychological effects of the COVID-19 pandemic on Wuhan's high school students

OBJECTIVE

This study explored the protective mechanisms of resilience and positive emotion regulation against psychological trauma among Wuhan's high school students during the COVID-19 outbreak.

METHOD

We obtained 286 valid samples from four high schools in Wuhan, China. To construct a measurement model and a structural model, structural equation models using four measurement scales with valid items were adopted, including a scale of psychological trauma, a scale of resilience, a scale of positive emotional regulation, and a scale of mental health. Participants reported their answers to items on a 5-point Likert-like scale.

RESULTS

The results revealed that psychological trauma was a negative predictor of mental health, and resilience and positive emotion regulation mediated the relationship between psychological trauma and mental health.

CONCLUSIONS

Accordingly, we concluded that resilience and positive emotion regulation interrupted the direct impact of psychological trauma on mental health, thereby greatly protecting the mental health of Wuhan's high school students during the COVID-19 outbreak.

Women's health-related vulnerabilities in natural disasters: a systematic review protocol

INTRODUCTION

There is a paucity of evidence identifying both the physical and psychological health risks and underlying causes of women's health-related vulnerabilities related to natural disasters. Therefore, this systematic review will be conducted to determine the impact of natural disasters on women's health from a global perspective.

METHODS AND ANALYSIS

Five electronic databases of health research, including ProQuest, ProQuest Health and Medicine, PubMed, PsycINFO and CINAHL, will be searched to retrieve relevant literature where Medical Subject Headings terms and keywords will be used depending on the search method of each database. Google Scholar will also be searched for preliminary information on the topic and to check for further evidence that may have been missed. Inclusion and exclusion criteria will be developed and refined by the research team. We will restrict our search for empirical full-text articles published in the English language peer-reviewed journals between July 2008 and June 2018 to ensure contemporary evidence is retrieved. Two authors will participate in each step in the process, including title, abstract and full-text screening against inclusion criteria, data extraction and quality appraisal. The quality of selected studies will be assessed using the Mixed Method Appraisal Tool. Data synthesis will follow a sequential explanatory approach. Finally, the quantitative and qualitative findings will be merged under themes and described using a narrative approach.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as primary data will not be collected. The results will be published in an international peer-reviewed journal and presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42019123809.

Effect of psycho-social support by teachers on improving mental health and hope of adolescents in an earthquake-affected district in Nepal: A cluster randomized controlled trial

INTRODUCTION

Adolescents can be prone to mental health problems such as post-traumatic stress disorder (PTSD) and depression following disasters. School teachers can provide timely psycho-social support that could instill hope and improve mental health among adolescents in a post-earthquake situation in a low-resource setting. This study examined the effect of training for school teachers on psycho-social support on adolescents' mental health and hope in an earthquake affected district in Nepal.

METHODS

This cluster randomized controlled trial was conducted in 15 schools in Dhading, a severely affected district by the 2015 earthquake in Nepal. The schools were randomized, as a result, 8 were in the intervention group and 7 in the control group. A total of 1,220 adolescents were recruited at baseline of which 605 adolescents belonged to intervention group and 615 to control group. The follow-up rate at 6 months was 83%. This trial was registered with Clinicaltrials.gov with registration number NCT03387007.

RESULTS

The intervention did not show significant effects for PTSD symptoms (Intervention*time, β = 0.33, p = 0.536), depression symptoms (Intervention*time, β = 0.30, p = 0.249), and hope (Intervention*time, β = -0.23, p = 0.588), among the adolescents at 6 months follow-up.

CONCLUSION

The intervention did not improve mental health symptoms and hope among adolescents at 6 months follow-up. More focused and longer training could be necessary to address mental health among adolescents affected by earthquake. Additionally, longer follow-up could be necessary to assess the changes taking place over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03387007.

Cumulative Disaster Exposure and Mental and Physical Health Symptoms Among a Large Sample of Gulf Coast Residents

A large body of research has linked disaster exposure to adverse mental and physical health outcomes. Few studies, however, have explored the cumulative impact of exposure to multiple disasters. Participants (N = 8,366) from the National Institute of Environmental Health Sciences Gulf Long-Term Follow-Up Study were classified as having been exposed to both, either, or neither Hurricane Katrina and the Deepwater Horizon oil spill (DHOS). Participants also reported on a range of mental and physical health symptoms. Logistic regression models found that participants who were exposed to both disasters had significantly higher odds of probable generalized anxiety disorder, odds ratio (OR) = 1.72, 95% CI [1.52, 1.96]; major depression, OR = 1.53, 95% CI [1.32, 1.77]; and posttraumatic stress disorder, OR = 2.51, 95% CI [2.03, 3.10], than participants who were exposed to only one disaster, ps < .001. Additionally, a linear regression model found that participants who were exposed to both disasters had significantly more physical health symptoms at the time of the spill than those who were exposed to only one disaster, B = 0.99, SE = .20, p < .001. The results indicate that cumulative disaster exposure confers enhanced risk for adverse mental and physical health outcomes. The findings demonstrate that screening for prior exposure among disaster-affected individuals might identify those at greatest risk for adverse health outcomes.

The Deepwater Horizon Oil Spill Through the Lens of Human Health and the Ecosystem

This review examines current research ascertaining the impact of the Deepwater Horizon oil spill on human health and ecosystems. Driven by the need to strategically focus research funding, the authors also assess the implications of those findings and promote a transdisciplinary research agenda addressing critical gaps.Epidemiologic studies conducted in workers and vulnerable communities in the spill's aftermath showed that non-chemical stressors affect resilience. Ecosystem-wise salt marsh species showed variability in structural and functional changes, attributed to species-specific tolerance, oil exposure, and belowground plant organs damage.Lacking baseline exposure assessment data hampers assessing the impact of chemical stressors. Research priorities include leveraging existing women/child dyads and worker cohorts to advance exposure characterization and counter early adverse effects in most vulnerable populations. Key policy gaps include mandated just-in-time emergency resources to ascertain immediate post-event exposures and contemporary legislation addressing human and ecosystem health in an integrated rather than silo fashion.

Then and now: lessons learned from community- academic partnerships in environmental health research

On the occasion of the 50^th anniversary of the National Institutes of Environmental Health Sciences we reflect on how environmental research incorporating community members as active partners has evolved, benefited communities and advanced environmental health research. We highlight the commitment to community partnerships in the aftermath of the 2010 Deep Water Horizon Oil Spill, and how that commitment helped improve science. We provide examples of community-academic partnerships across the engagement spectrum. Finally, we offer suggestions to improve the community engagement in order to cultivate more long partnerships and better scientific research.

Women and health consequences of natural disasters: Challenge or opportunity?

Disasters do not affect people equally; the impact of disasters on the lives of women is different from other groups of a community. Women's fundamental rights to health and safety are violated after disasters. The authors of this study aimed to explore various factors of women's health with reference to previous natural disasters in Iran. A qualitative approach using in-depth unstructured interviews and field observations was employed to explore women's health factors in the affected regions. A total of 22 participants affected by disasters, as well as key informants, were interviewed applying the purposeful sampling method. Data were collected in 2014 in three provinces, including East Azerbaijan, Bushehr, and Mazandaran. A content analysis using the Graneheim approach was performed for analyzing the transcribed interviews. Two themes and four categories were extracted from the data. The themes that emerged included psycho-physical effects and women's health status. Physical and psycho-emotional effects and reproductive and environmental health effects were the four emergent categories. The findings implied that managing women's health challenges may result in reducing the distressing effects of disaster. These findings support identification and application of the mechanisms by which women's well-being in physical, mental, reproductive, and environmental aspects can be protected after disasters.