Feasibility and preliminary efficacy of a public mobile app to reduce symptoms of postdisaster distress in adolescent wildfire survivors: Sonoma rises

A scoping review of psychosocial interventions delivered by non-mental health workers following disaster events

Individuals exposed to disasters are at high risk of developing mental health conditions, yet the availability of mental health practitioners is often limited. The aim of this scoping review was to examine the quality of the evidence for psychosocial interventions that can be delivered by non-mental health workers in the context of disasters. Searches were performed in PsycInfo, EMBASE, Family & Society Studies Worldwide, CINAHL, Global Health, PubMed, and SCOPUS, from inception through to November 2024, to identify studies of relevance. Only studies investigating psychosocial interventions that could be delivered by non-mental health clinicians in a non-hospital or clinic setting were included. In total, 69 primary intervention studies examining 27 universal interventions and 10 indicated interventions were identified. Studies were rated on quality and risk of bias, and GRADE was used to rank the evidence for each intervention. For universal interventions, no study had an evidence rating above "very low" to support confidence in a significant impact on clinical outcomes. For indicated interventions, Problem Management Plus (PM+) and Self-Help Plus (SH+) had an evidence rating of "high" in the postdisaster context, and Skills for Life Adjustment and Resilience (SOLAR) had a "low" evidence rating; the remaining interventions were given "very low" ratings. Despite the high number of psychosocial interventions that target postdisaster distress, very few have been tested using rigorous methodologies with large samples. Future research should include methodologies that test interventions at scale and recognize the impacts of compounding disasters.

A pilot study of a brief and scalable psychosocial intervention for children and adolescents following disasters

OBJECTIVES

Following disaster exposure, a significant proportion of children/adolescents will develop levels of post-traumatic stress symptoms (PTSS) that do not meet diagnostic threshold for PTSD, but which cause ongoing distress. This paper describes the development and pilot testing of a brief, scalable, psychosocial intervention. SOLAR-Kids/Teens has been designed to be delivered by non-mental health professionals ('coaches') to children/adolescents experiencing moderate levels of PTSS following disasters.

METHODS

An international collaboration of experts developed The Skills fOr Life Adjustment and Resilience (SOLAR) for Kids and Teens programs. The programs were piloted-using a pre-post mixed methods design-with 10 children and adolescents (8-18 years), with the aims of examining the feasibility of the program's delivery model as well as the program's potential usefulness.

RESULTS

The pilot data indicated that after 1 day of training and with ongoing supervision, the SOLAR program was safe and feasible for coaches to deliver to children/adolescents experiencing PTSS. Coaches reported increased knowledge (p = .001), confidence (p = .001) and skills (p = .006). The programs were acceptable to coaches, children/adolescents and parents. Parents and children/adolescents reported reductions in trauma and anxiety symptoms from pre- to post-treatment, with moderate to large effect sizes.

CONCLUSIONS

The preliminary findings demonstrate that the SOLAR-Kids/Teens program is feasible, acceptable and safe to be delivered by trained non-mental health professionals to children and adolescents experiencing PTSS and anxiety following disaster exposure. Randomized controlled trials are required to evaluate the efficacy of the SOLAR-Kids/Teens programs.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War

OBJECTIVE

More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions.

METHOD

Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network.

RESULTS

The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear.

CONCLUSION

There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

PLAIN LANGUAGE SUMMARY

Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support for children and adolescents living in war affected regions. In this scoping review, the authors identified 1 study evaluating digital mental health interventions for children and adolescents affected by war and 5 for those affected by disasters. In addition, 35 interventions were identified through expert consultation as of possible relevance. The authors found very limited evidence for the use of digital mental health interventions for children and adolescents affected by war, and given this provide a framework to inform the development of new interventions.

DIVERSITY & INCLUSION STATEMENT

We actively worked to promote sex and gender balance in our author group.

STUDY PREREGISTRATION INFORMATION

Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review

BACKGROUND

Disasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management.

OBJECTIVE

This scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature.

METHODS

We identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

RESULTS

Of the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps' use as either the primary or secondary outcome.

CONCLUSIONS

A limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards.

Mental health and psychosocial interventions in the context of climate change: a scoping review

The evidence on the impacts of climate change on mental health and wellbeing is growing rapidly. The objective of this scoping review is to understand the extent and type of existing mental health and psychosocial interventions aimed at addressing the mental health and psychosocial impacts of climate change. A scoping review methodology was followed. MEDLINE, PsycINFO, and Web of Science databases were searched from inception to May 2022. Comprehensive gray literature search, including expert consultation, was conducted to identify interventions for which peer-reviewed academic literature may not yet be available. Data on intervention type, setting, climate stressor, mental health outcome, evaluation, and any other available details were extracted, and results were summarized narratively. Academic literature search identified 16 records and gray literature search identified a further 24 records. Altogether, 37 unique interventions or packages of interventions were identified. The interventions act at the levels of microsystem, mesosystem, exosystem, and macrosystem through diverse mechanisms. While most interventions have not been formally evaluated, promising preliminary results support interventions in low- and middle-income-country settings disproportionately affected by climate disasters. Interventions from multidisciplinary fields are emerging to reduce psychological distress and enhance mental health and wellbeing in the context of climate change. This scoping review details existing evidence on the interventions and summarizes intervention gaps and lessons learned to inform continued intervention development and scale-up interventions.

Mitigating Psychological Problems Associated with the 2023 Wildfires in Alberta and Nova Scotia: Six-Week Outcomes from the Text4Hope Program

Background: In 2023, wildfires led to widespread destruction of property and displacement of residents in Alberta and Nova Scotia, Canada. Previous research suggests that wildfires increase the psychological burden of impacted communities, necessitating population-level interventions. Cognitive Behavioural Therapy (CBT)-based text message interventions, Text4HopeAB and Text4HopeNS, were launched in Alberta and Nova Scotia, respectively, during the 2023 wildfire season to support the mental health of impacted individuals. Objectives: The study examines the effectiveness of Text4HopeNS and Text4HopeAB in alleviating psychological symptoms and improving wellbeing among subscribers. Methods: The study involved longitudinal and naturalistic controlled trial designs. The longitudinal study comprised subscribers who completed program surveys at baseline and six weeks post-enrolment, while the naturalistic controlled study compared psychological symptoms in subscribers who had received daily supportive text messages for six weeks (intervention group) and new subscribers who had enrolled in the program during the same period but had not yet received any text messages (control group). The severity of low resilience, poor mental wellbeing, likely Major Depressive Disorder (MDD), likely Generalized Anxiety Disorder (GAD), likely Post-Traumatic Stress Disorder (PTSD), and suicidal ideation were measured on the Brief Resilience Scale (BRS), the World Health Organization-5 Wellbeing Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) scale, PTSD Checklist-Civilian Version (PCL-C), and the ninth question on the PHQ-9, respectively. The paired and independent sample t-tests were employed in data analysis. Results: The results from the longitudinal study indicated a significant reduction in the mean scores on the PHQ-9 (-12.3%), GAD-7 (-14.8%), and the PCL-C (-5.8%), and an increase in the mean score on the WHO-5, but not on the BRS, from baseline to six weeks. In the naturalistic controlled study, the intervention group had a significantly lower mean score on the PHQ-9 (-30.1%), GAD-7 (-29.4%), PCL-C (-17.5%), and the ninth question on the PHQ-9 (-60.0%) which measures the intensity of suicidal ideation, and an increase in the mean score on the WHO-5 (+24.7%), but not on the BRS, from baseline to six weeks compared to the control group. Conclusions: The results of this study suggests that the Text4Hope program is an effective intervention for mitigating psychological symptoms in subscribers during wildfires. This CBT-based text messaging program can be adapted to provide effective support for individuals' mental health, especially in the context of traumatic events and adverse experiences such as those induced by climate change. Policymakers and mental health professionals should consider these findings when shaping strategies for future disaster response efforts, emphasizing the value of scalable and culturally sensitive mental health interventions.