Mental health and the psychosocial consequences of natural disasters in Asia

Effects of the Kahramanmaras, Turkey 2023 earthquakes on balance perception, dizziness and post-traumatic stress: A relational screening model between subjective balance problems and post-traumatic stress

OBJECTIVE

The aim of the present study was to investigate the effects of the February 6, 2023, earthquakes in Turkey and recurrent aftershocks on balance and post-traumatic stress in surviving victims.

METHODS

Our study included 1004 participants aged 18-65 years who were exposed to the February 6 earthquakes and aftershocks in Turkey. After obtaining online consent from all participants, the Vertigo Symptom Scale (VSS), the Dizziness Handicap Index (DHI), and the Posttraumatic Post-Traumatic Disorder Checklist Scale (PCL-5) were administered online, and the interactions between the variable sets were examined using a correlational screening model.

RESULTS

As a result of the structural equation model established with the observed variables, it was found that VSS total scores had a statistically significant positive effect on PCL-5 (β1 = 0.56; p = 0.001 < 0.05). In addition, statistically significant positive high-level correlations were found between VSS and DHI (covVSS-DHI = 0.71), and a positive low level correlation with the number of days with dizziness (covVSS-number of days with dizziness = 0.34), and a positive low level correlation with frequency of days with dizziness (covVSS-frequency of days with dizziness = 0.37). A statistically significant positive low-level relationship was found between DHI and the number of days with dizziness (covDHI-number of days with dizziness = 0.34) and a positive low-level correlation between DHI and the frequency of days with dizziness (covDHI-frequency of days with dizziness = 0.29).

CONCLUSION

The structural equation modeling analysis showed that post-traumatic stress disorder had a significant effect on balance and dizziness.

Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

Mental health and psychosocial interventions to limit the adverse psychological effects of disasters and emergencies in China: a scoping review

Exposure to disasters and public health emergencies negatively affects mental health. Research documenting the psychosocial responses to these calamities in China increased dramatically after the 2008 Wenchuan earthquake. However, there is no comprehensive assessment of the available literature on China's mental health and psychosocial support (MHPSS) responses to these events. This scoping review systematically maps existing published research and grey literature sources regarding MHPSS to disasters and emergencies in China. We examined relevant literature in English and Chinese from six databases and official websites from Jan 1, 2000, to Aug 13, 2021, and included 77 full-text records in this review. The main types of interventions reported included a) stepped care intervention models, b) individual structured psychotherapy and pharmacotherapy, c) mental health education, d) psychological counselling, and e) government-based policy interventions. Most interventions were evaluated using quantitative methods that assessed the treatment of common mental disorders. The review found that rapid national mobilization, emphasis on resilience-strengthening interventions, and the widespread use of step-care models were essential components of reducing the adverse psychosocial effects of disasters. The review also identified remaining gaps, including a) a lack of integration of disaster-related services with the pre-existing health care system, b) inadequate supervision of MHPSS providers, and c) limited monitoring and evaluation of the services provided. These results show where additional research is needed in China to improve mental health services. It also provides a framework that other countries can adapt when developing and evaluating MHPSS policies and plans in response to disasters.

Psychosocial etiology of post-traumatic stress disorder caused by war trauma among Iran-Iraq war immigrants in Mehran, Iran

Background

Post-traumatic stress disorder (PTSD) is one of the most important and common disorders caused by war trauma. The aim of this study was to determine the relationship between psychosocial factors and PTSD in war-torn immigrants in Mehran, Iran.

Method

The present study was conducted by descriptive and correlational method. The data were collected from 245 people (121 women and 124 men) from war-torn immigrants 45 years and older who migrated from Mehran to Ilam during the Iran-Iraq war. The measuring tools were as follows: Post Traumatic Stress Disorder Scale, Multidimensional Scale of Perceived Social Support (MDPSS), Coping Strategies Scale (CSS-R), Multidimensional Health Locus of Control scale.

Results

The prevalence rate of PTSD among war-torn immigrants in Mehran was 35.1 %. A significant negative correlation was observed between perceived social support and PTSD (p < .01). Coping strategies, including seeking social support, reappraisal/adaptation, problem-focused coping, and active coping, all showed significant negative correlations with PTSD (p < .01). Conversely, a significant positive correlation was found between avoidance coping strategies and self-control and PTSD (p < .01). In addition, there was a significant positive correlation between the external locus of control (believing in chance) and PTSD (P < 0.01) and significant negative correlation between internal locus of control and PTSD (P < .01).

Conclusion

Weakness in social support, locus of control and also inappropriate coping strategies against war trauma were among the strong risk factors for PTSD. Therefore, social and behavioral interventions are recommended to increase social support, teaching problem-solving skills and strengthen individual control among war-torn immigrants to reduce the risk of developing PTSD.

Trauma Level, Coping with Stress and Post-Traumatic Change in University Students Experiencing Kahramanmaraş Centered Earthquake: A Cross-Sectional Study

OBJECTIVE

The aim of this research is to examine the levels of post-traumatic stress, coping with stress, and post-traumatic change in university students after the Kahramanmaraş-centered earthquakes in February 2023.

METHOD

The research is descriptive and relational. The sample of the study consists of 221 university students. Personal Information Form, Post-earthquake Trauma Level Determination Scale, Strategies for Coping with Earthquake Stress Scale, and Post-Traumatic Change Scale were used as data collection tools. Descriptive analyses (percentage, arithmetic mean), correlation analysis, and regression analysis were used in the analysis of the data.

RESULTS

It was determined that the students were highly traumatized after the earthquake, and post-traumatic stress symptoms were observed in a significant majority of the students. It was determined that the students used the post-earthquake coping strategies effectively. Post-traumatic change is positive. Inter-scale correlations are significant (P < 0.05). According to regression analysis, the level of post-earthquake trauma and the level of coping with earthquake stress are significant predictors of post-traumatic change. In addition, the damage to houses during the earthquake significantly affects the post-traumatic change.

CONCLUSIONS

We think that pre-planning the psychological support services, increasing social supports, and teaching methods of coping with stress that can be applied after disasters such as earthquakes will be effective in preventing post-traumatic problems in university students at risk after trauma. It is hoped that the findings of this study will assist researchers, practitioners, and policymakers in implementing effective strategies for post-disaster.

Resilience Mediates the Relationship Between Parental Attachment and Posttraumatic Growth in Adolescents: A Longitudinal Study

OBJECTIVE

Previous studies have shown that parental attachment was associated with higher levels of posttraumatic growth (PTG) in individuals who have experienced traumatic events. The aim of the current longitudinal study is to investigate resilience as one pathway through which parental attachment is related to PTG among Chinese adolescents following the Yancheng tornado.

METHODS

A total of 351 adolescent survivors participated in this longitudinal study. Participants completed the revised version of Inventory of Parent and Peer Attachment (IPPA-R) at 12 months (T1), and the revised Chinese version of the Post-Traumatic Growth Inventory (PTGI-R) and the Connor and Davidson's Resilience Scale (CD-RISC) at 18 months (T2) after the tornado, respectively.

RESULTS

It indicated that parental attachment at T1 has direct and positive effect on PTG at T2, and resilience at T2 fully mediated the relationship between parental attachment at T1 and PTG at T2.

CONCLUSION

The findings revealed that parental attachment and resilience are two key resources that promote adolescent's PTG, and parental attachment acts through resilience to promote PTG in adolescents.

Post-Traumatic Stress Disorder after the 6.1 Magnitude Earthquake in Piura, Peru: A Cross-Sectional Study

In Peru, major disasters like the 2007 Pisco earthquake have produced high rates of post-traumatic stress. However, evidence is still needed to strengthen interventions. In 2021, a major earthquake struck Piura, in northern Peru. In this context, we aimed to assess the prevalence of PTSD and its associated factors. A cross-sectional study was conducted during August-September 2021 in people who experienced the 6.1 Piura earthquake on 30 July 2021. The questionnaire included the PCL-C, CD-RISC, ISI, HFIAS, and additional demographic data. Generalized linear models were used. The prevalence of PTSD was 20.3%. Household income was between PEN 2001 and 3000 (PR = 4.26, 95% CI: 1.08-16.75), smoking (PR = 2.49, 95% CI: 1.03-6.01), experience of a nervous breakdown (PR = 1.83, 95% CI: 1.09-3.09), moderate food insecurity (PR = 2.91, 95% CI: 1.10-7.73), and severe insomnia (PR = 8.25, 95% CI: 2.22-30.71) increased the prevalence of PTSD. One out of five individuals experienced post-traumatic stress symptoms after the 2021 earthquake in Piura, which varies depending on socioeconomic, psychosocial, and individual factors. Further research should strengthen these findings to ensure a fair and early mental health intervention against new seismic events in this and other Peruvian regions.

Prevalence of Post-traumatic Stress Disorder After Flood: A Systematic Review and Meta-Analysis

Introduction

Flood as the most common kind of the natural disasters has unpleased short, medium, and long-term consequences on the victims' welfare, relationships, and physical and mental health. One of the most common mental health disorders in these victims is Post-traumatic stress disorder (PTSD). The aim of this study is to investigate the prevalence of PTSD on the flood victims.

Methods

Data resources including PubMed, Scopus, Web of Science, Science Direct, Embase, Google Scholar, conference and congress papers, key journals, the reference list of selected articles as well as systematic reviews were searched to identify studies that reported the prevalence of PTSD in flood victims. Random Effect Model was used to perform meta-analysis of the studies. Cochran test and I2 indicator were used to explore heterogeneity between the studies. Publication bias of the study was evaluated using Begg'test. Data were analyzed by STATA (version 14) software.

Results

After a comprehensive search, 515 papers were extracted. After eliminating duplicates and final screening, 23 studies were selected and entered the meta-analysis phase after qualitative evaluation. The results showed that the prevalence of PTSD in flood victims is 29.48% (95% CI: 18.64-40.31, I2 = 99.3%, p-value < 0.001).

Conclusion

The results of the present study showed that the prevalence of PTSD is relatively high in the flood victims. So, it is necessary to take preventive, supportive, therapeutic and effective actions for them.

The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service

Background

The SARS-CoV-2 pandemic caused a public health emergency with profound consequences on physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period.

Methods

This monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so called "COVID-19 period") and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so called "pre-COVID-19 period"). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data, were statistically analyzed through STATA 12-2011.

Results

In ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania.

Conclusion

In light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals' ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people.

Post-Hurricane Distress Scale (PHDS): Determination of General and Disorder-Specific Cutoff Scores

The Post-Hurricane Distress Scale (PHDS) was developed to assess mental health risk in the aftermath of hurricanes. We derive both disorder-specific cutoff values and a single nonspecific cutoff for the PHDS for field use by disaster relief and mental health workers. Data from 672 adult residents of Puerto Rico, sampled 3 to 12 months after Hurricane Maria, were collected. Participants completed a five-tool questionnaire packet: PHDS, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Post-Traumatic Stress Disorder Checklist for DSM V (PCL-5). ROC curves, AUC values, sensitivities, specificities, Youden’s index, and LR+ ratios are reported. The recommended single cutoff value for the PHDS is 41, whereby a respondent with a PHDS score of 41 or above is deemed high-risk for a mental health disorder. The single field use PHDS cutoff demonstrated high specificity (0.80), an LR + ratio (2.84), and a sensitivity of 0.56. The mean ROC values of PHDS for Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and PCL-5 were all above 0.74. The derived cutoff for the PHDS allows efficient assessment of respondents’ and/or a community’s risk status for mental health disorders in the aftermath of hurricanes and natural disasters.

Revealing Unknown Benefits of Existing Medications to Aid the Discovery of New Treatments for Post‐Traumatic Stress Disorder

Objective

To systematically identify novel pharmacological strategies for preventing or treating post‐traumatic stress disorder (PTSD) by leveraging large‐scale analysis of real‐world observational data.

Methods

Using a self‐controlled study design, the association between 1399 medications and the incidence of PTSD across four US insurance claims databases covering commercially insured, Medicare eligible, and Medicaid patients was examined. A validated algorithm for identifying PTSD in claims data was used, and medications were identified by their RxNorm ingredient. Medications used to treat PTSD or its symptoms (e.g., antidepressants, antipsychotics) were excluded. Medications associated with ≥30% reduction in risk of PTSD in ≥2 databases were identified.

Results

A total of 137,182,179 individuals were included in the analysis. Fifteen medications met the threshold criteria for a potential protective effect on PTSD; six were categorized as “primary signals” while the remaining nine were considered “potential signals”. The primary signals include a beta blocker that has been previously studied for PTSD, and five medications used to treat attention‐deficit/hyperactivity disorder. The potential signals include four medications used to treat substance use disorders and five medications used to treat sleep disorders.

Discussion

The medications identified in this analysis provide targets for further research in studies that are designed to examine specific hypotheses regarding these medications and the incidence of PTSD. This work may aid in discovering novel therapeutic approaches to treat PTSD, wherein new and effective treatments are badly needed.

Four large US‐based administrative claims databases were used to analyze the association between all marketed prescription medications and the outcome of incident post‐traumatic stress disorder (PTSD)

Of the 1399 medications examined, there were 15 that met the strict filtering criteria for showing consistent, moderate‐to‐strong, protective effects against the outcome

Medications fell into four main classes: (1) a beta blocker (propranolol), (2) five medications used to treat attention‐deficit/hyperactivity disorder (ADHD), (3) four medications used to treat substance use disorders and (4) five medications used to treat sleep disorders

These findings identify rational starting points for future hypothesis‐driven research to explore these associations in greater detail

Impact of Natural Disasters on Mental Health: A Cross-Sectional Study Based on the 2014 China Family Panel Survey

Mental health problems are a leading cause of disability in both developed and developing countries, and the consequences of mental health disorders for individuals, families, and society as a whole could be severe and costly. To supplement relevant research and provide insightful policy suggestions to families, government and societies, this study investigates the nexus between natural disasters and mental health for middle-aged and older adults in rural China. Based on data of 8721 observations from the 2014 China Family Panel Studies, we estimate the effects of natural disasters on mental health using ordinary least squares and propensity score matching. Our findings suggest that natural disasters have a significant negative effect on middle-aged and older adults' mental health in the case of rural China. This effect is heterogeneous depending on individuals' education level and their agricultural production status. Finally, individuals' happiness and life satisfaction are shown to be the potential mechanism through which the effect of natural disasters on mental health operates.

Changes in lifestyle, diet, and body weight during the first COVID 19 'lockdown' in a student sample

Changes in lifestyle and body weight were examined retrospectively in students at a German university during the first COVID-19 lockdown period (March 12- May 3, 2020) using an online survey. Data from a total of 827 participants was used. Almost half of the students reported perceived body weight changes with about 27% gaining weight and around 22% losing weight. Regression analyses showed that consumption changes in the following food categories: fruits, sweets and cakes, bread and bakery products, pasta, savoury snacks, and meats and sausages were predictive of weight changes. Additionally, changes in the frequency of cooking with fresh ingredients, physical activity, exercise, smoking, and alcohol consumption as well as pre-lockdown BMI were all predictive of weight changes. Given the continuous global pandemic, increased and innovative public health efforts to support this population group are needed.

COVID-19 related depression and anxiety among quarantined respondents

OBJECTIVE

The outbreak of the coronavirus disease (COVID-19) poses an unprecedented threat to public health. Current measures to control the spread include social distancing and quarantine, which may trigger mental health problems.

DESIGN AND MAIN OUTCOME MEASURES

The sample (N = 1160) constituted three groups: people quarantined in an affected area, unaffected areas, and people not in quarantine. The Center for Epidemiological Studies Depression Scale (CES-D-20) and the Goldberg Depression and Anxiety Scale (GAD-7) were administered as measures of depression and anxiety, respectively. The multi-variant logistic and multiple linear regression identified factors associated with depression and anxiety.

RESULTS

Probable depression and anxiety were reported by 26.47% and 70.78% of all respondents, respectively. After adjusting for demographic and community variables, quarantined respondents reported a higher likelihood to exhibit symptoms of depression and anxiety than those not quarantined. Respondents living in communities where screening for COVID-19 was required were less likely to report depression and anxiety symptoms.

CONCLUSION

The incidence of depression and anxiety among quarantined respondents was significantly higher than that of respondents not quarantined, and twice as common among quarantined respondents in unaffected areas as those in affected areas. Appropriate community screening may reduce the risk of depression and anxiety during an epidemic.

The Management of Psychiatric Emergencies in Situations of Public Calamity

The prevalence of mental health problems in the general population during a public calamity is high. In calamities, the number of patients who present with mental disorder outbreaks or crises may increase, but the necessary support systems to help them may be impaired if they have not been planned for. Although there are several models for addressing psychiatric emergencies, the general rules are the same, especially when it comes to making these services easily available to the affected population. In this article, we seek to review and present recommendations for the management of psychiatric emergencies in situations of public calamity, including disasters, physical and medical catastrophes, epidemics, and pandemics.

Trauma stabilization as an effective treatment for children with post-traumatic stress problems in South-East Asia

High numbers of children and adolescents in South-East Asia are traumatized by either natural disasters or human-made violence. Addressing traumatic sequelae in local populations with empirically based trauma treatments is challenged by the insufficiency inappropriately trained mental health provision. To meet this need for qualified therapists, the humanitarian/trauma capacity-building organization, Trauma Aid Germany, trained 37 therapists in psychotraumatology, including trauma stabilization. This study analyses the impact of trauma stabilization as a sole treatment intervention for post-traumatic stress (PTS) problems in children and adolescents. Each client was screened for PTS problems pre- and post-treatment using the Child Behaviour Checklist. Trauma stabilization (including psychoeducation) was the focus for subsequent data analysis. Those excluded were clients in receipt of trauma confrontation interventions. Trauma stabilization, as a sole treatment intervention, appeared to be sufficiently effective in reducing the PTS problems. The data set suggests that trauma stabilization has the potential to be effective, efficient, and sufficient treatment intervention for PTS problems in children and adolescents. Trauma stabilization techniques have the advantage of being relatively straightforward to teach and easy to integrate into practice. They are clinically safe, flexible, adaptable to the development stage and age of the client, and culturally and spiritually sensitive. A further advantage of trauma stabilization interventions is that they are bespoke - adjusted and adapted to the specific needs of the client. The discussion considers the implications for the potential utilization of mental health nurses and paraprofessionals in low- and middle-income countries in trauma stabilization interventions.

Dimensionality of DSM-5 PTSD symptoms: Validation of the Chinese version of the posttraumatic diagnostic scale for DSM-5 across multiple trauma samples

The Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) is an updated DSM-5 version of the PDS, a widely used measure for PTSD. The PDS-5 has recently been shown to possess sound psychometric properties and awaits cross-cultural validation. The present study aimed first, to evaluate the psychometric properties of the Chinese version of the PDS-5; second, to evaluate alternative factor models of DSM-5 PTSD symptoms with multiple trauma samples. Data were collected from five samples of Taiwanese trauma-exposed individuals (total N = 903): 138 burn injury survivors, 403 earthquake survivors, 181 trauma-exposed young adults, 91 trauma-exposed undergraduates, and 90 female domestic violence survivors. The Chinese PDS-5 possessed excellent internal consistency (α s = .94-.95) and satisfactory five-week (r = .80) and one-year temporal stability (r = 0.76). Convergent, concurrent, and discriminant validity were also established. Consistent with recent studies, confirmatory factor analyses demonstrated the best fit of a seven-factor Hybrid model, followed by a six-factor Anhedonia model across multiple trauma samples.

Minority Participation in Randomized Controlled Trials for Prolonged Exposure Therapy: A Systematic Review of the Literature

Per the most recent census, non-Latinx White individuals comprise the majority of the U.S. population (76.6%); Latinx individuals make up 18.3% of the total U.S. population, followed by African Americans (13.4%) and Asians (5.9%). Given the high prevalence rates of posttraumatic stress disorder (PTSD) observed across many ethnoracial minority groups in the United States, the fact that PTSD presentation may vary across culture, and the National Institute of Health's mandates for the inclusion of women and minorities in clinical outcome research, the aim of the present systematic review was to examine minority inclusion in clinical outcome research for PTSD. Our review focused exclusively on one empirically supported treatment: prolonged exposure therapy (PE); we identified 38 studies that met the inclusion criteria. Apart from African Americans, who were overrepresented in 21 studies (inclusion rate range: 13.5%-73.9%), ethnoracial minority inclusion in RCTs examining PE was low. More specifically, across included studies that reported ethnoracial minority data, 58.9% of participants were White, 31.1% were African American, 4.9% were Latinx, 0.6% were Asian American or Pacific Islander, and 4.7% reported race as "other." Inclusion rates for ethnoracial minorities appeared to increase across time, and recruitment strategies did not appear to be associated with increased ethnoracial minority participation in RCTs for PE.

Post-traumatic stress disorder and the role of resilience, social support, anxiety and depression after the Jiuzhaigou earthquake: A structural equation model

This is the first study to investigate the mechanism of Post traumatic stress disorder (PTSD) after the 2017 7.0 Ritcher scale Jiuzhaigou earthquake. In order to identify the mechanism underling interactions among different factors associated with PTSD symptoms. Three months after the earthquake, 607 participants from the heavy damaged areas were recruited in this survey. Demographic information and scale measurements on social support, resilience, anxiety, depression, and PTSD were collected using standardized questionnaire. The result showed that PTSD, anxiety symptoms, and depressive symptoms prevalence in the severely affected area were 52.7 %, 53.8 % and 69.6 %, respectively. Resilience and social support had direct effects on PTSD, as well as indirect effects on PTSD through anxiety and depression. The proposed mechanism on PTSD explained the paths among the measured variables, which explained the risk and protective factors related to PTSD. This current study has important practical implications for understanding mental health status of earthquake victims.

Adolescents' perspectives on the psychological effects of natural disasters in China and Nepal

Adolescents are disproportionately represented in nations vulnerable to humanitarian crises. The mental health effects of exposure to trauma are significant, but evidence concerning the experience of disaster-affected adolescents in Asia is limited. The current study aimed to investigate expressions of psychological distress and behavioral effects of exposure to natural disasters among adolescents in China and Nepal. Key informant interviews and focus group discussions were conducted with adolescents, caregivers, teachers and experts in disaster-affected districts of Yunnan Province, China (n = 79), and Kathmandu Valley, Nepal (n = 62). Open coding and thematic content analysis were employed to examine themes within the data. Indicators of distress were categorized in four domains that reflected expressions of anxiety and stress, mood difficulties, somatic complaints, and behavioral changes for adolescent disaster survivors. Differential reports of psychological concerns by gender were evident in Nepal but not China. Post-traumatic growth and strengthened connections between adolescents and their families were described in both settings. The findings complement similar reports from disaster-affected populations globally that have highlighted cross-cultural elements manifest in adolescents' descriptions of distress. Sustainable mental health services that are sensitive to adolescents' experiences of trauma and their unique capabilities will be a necessary component of long-term rehabilitation following disasters.

FKBP5 Genotype Linked to Combined PTSD-Depression Symptom in Chinese Earthquake Survivors

BACKGROUND

Post-traumatic stress disorder (PTSD) and depression are common mental disorders in individuals experiencing traumatic events. To date, few studies have studied the relationship between genetic basis and phenotypic heterogeneity of traumatized individuals. The present study examined the effects of four FKBP5 SNPs (rs1360780, rs3800373, rs9296158, and rs9470080) in four postdisaster groups (low symptom, predominantly depressive, predominantly PTSD, and combined PTSD-depression symptom groups) as identified by latent profile analysis.

METHODS

A total of 1,140 adults who experienced the 2008 Wenchuan earthquake participated in our study. Earthquake-related trauma, PTSD, and depressive symptoms were measured using standard psychometric instruments. The four FKBP5 SNPs were genotyped using a custom-by-design 2 × 48-Plex SNP scan™ Kit.

RESULTS

After adjusting for covariates, the main and gene-environment interaction effects of rs9470080 were all significant when the combined PTSD-depression group was compared with the low symptoms, predominantly depression and predominantly PTSD groups. rs9470080 TT genotype carriers had a higher risk of developing high co-occurring PTSD and depression symptoms than the C allele carriers. However, when trauma exposure was severe, the TT genotype carriers and C allele carriers did not differ in the risk of developing high co-occurring PTSD and depressive symptoms. The other three SNPs demonstrated no significant effects. Moreover, the rs3800373-rs9296158-rs1360780-rs9470080 haplotype A-G-C-T was found significantly associated with combined PTSD-depression symptoms.

CONCLUSION

Our findings support the genetic basis of phenotypic heterogeneity in people exposed to trauma. Furthermore, the results reveal the possibility that the variants of FKBP5 gene may be associated with depression-PTSD comorbidity.

Post traumatic stress disorder and coping strategies among adult survivors of earthquake, Nepal

BACKGROUND

Post traumatic stress disorder (PTSD) is the most frequently reported psychiatric morbidity among the survivors of natural disasters. It is the main hindrance to rehabilitate their life. However its prevalence particularly in Nepal is largely unknown.

AIMS AND OBJECTIVES

To investigate the prevalence of post traumatic stress disorder and use of coping strategies among the adult survivors of earthquake.

METHODS

A cross- sectional descriptive study was carried out on a sample of 291 adult survivors after 10 months of Nepal Earthquake 2015. Study setting was Nuwakot district with multistage sampling (cluster sampling and systematic random sampling) method. PTSD checklist-5 was used to measure PTSD, and adapted and modified brief cope scale was used to assess coping strategies. Data were analyzed using descriptive and inferential statistics (independent t-test and one-way ANOVA) at 5% level of significance.

RESULTS

Study findings revealed that PTSD was prevalent among 24.10% of adult survivors with highest intrusion symptoms (3.24 ± 0.71). It was significantly associated with age (p = 0.017), sex (p = 0.013), education (p < 0.0001) and injury to self (p = 0.003). Elderly, females, illiterates and those who were injured during earthquake are at more risk for PTSD. Highest used coping strategy was active coping (2.92 ± 0.51). Survivors not having PTSD scored more on active coping (p < 0.0001) and self distraction coping (p = 0.006) while those with PTSD mostly used passive coping (p < 0.0001), religious coping (p < 0.0001) and substance use coping (p < 0.0001).

CONCLUSION

Earthquake poses significant impact on mental health of the survivors. After 10 months of devastating earthquake, prevalence of PTSD among the survivors is high. Maladaptive coping strategies further increase possibility of PTSD. Effective screening and awareness program regarding promotion of positive coping strategies among the vulnerable groups should be reinforced for prevention of psychiatric morbidity among the survivors of earthquake.

Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

Addressing challenges in children's mental health in disaster-affected areas in Japan and the Philippines - highlights of the training program by the National Center for Global Health and Medicine

Background and purpose

Natural disasters such as earthquakes, typhoons, floods, and volcanic eruptions frequently occur in Republic of Philippines and mental health care for children affected by these natural disasters is a major public health concern. Aiming to train health professionals on children’s mental health, to conduct a situational analysis to identify the local needs and resources for children’s mental health, and to propose a mental health program for children that can be transferred from Japan to the Philippines, the National Center for Global Health and Medicine (NCGM) conducted a training program for children’s mental health in disaster-affected areas in Japan and the Philippines in June, October, and December, 2017. The training was organized by NCGM for the Program for International Promotion of Japan’s Healthcare Technologies and Services funded by Ministry of Health, Labour, & Welfare, Japan in relation to the Memorandum of Understanding in the Field of Healthcare between NCGM in Japan and University of the Philippines Manila, College of Public Health.

Key highlights

The training program consisted of classroom trainings, site visits, and round table discussions in Japan and the Philippines. The classroom trainings and site visits focused on two points: the experiences of individuals and families who survived the Great East Japan Earthquake (GEJE) in 2011 and super typhoon Haiyan in 2013 and the program and activities, especially on mental health, of various government and non-government organizations in helping the affected families and communities. The round table discussion, on the other hand, was conducted to identify challenges related to children’s mental health in disaster-affected areas and to develop recommendations to address these challenges.

The major recommendations for the Philippines were to give equal emphasis to physical and psychosocial preparedness and to develop a comprehensive program to care for carers. In Japan, public health and mental health should be integrated in the Disaster Medical Service. Experts from both countries should also generate evidence on the effectiveness of interventions in reducing mental health stigma and collaborate with school personnel and communities in order to learn more about psychosocial preparedness. Finally, mental health must be mainstreamed in programs not only in Japan but also in other countries.

Implications

The training program enabled key stakeholders to describe the current situation of mental health in Japan and the Philippines, to identify mental health challenges common to disaster-affected areas in both countries, and to propose short- and long-term plans and recommendations. The training program is expected to address the mental health needs of children in disaster-affected areas through a responsive community-based support network. The training participants agreed to form a network and build partnerships toward the common goal of mainstreaming community-based support for children’s mental health in disaster-affected areas in Japan and the Philippines.

Disturbed effective connectivity patterns in an intrinsic triple network model are associated with posttraumatic stress disorder

BACKGROUND

Disturbance of the triple network model was recently proposed to be associated with the occurrence of posttraumatic stress disorder (PTSD) symptoms. Based on resting-state dynamic causal modeling (rs-DCM) analysis, we investigated the neurobiological model at a neuronal level along with potential neuroimaging biomarkers for identifying individuals with PTSD.

METHODS

We recruited survivors of a devastating typhoon including 27 PTSD patients, 33 trauma-exposed controls (TECs), and 30 healthy controls without trauma exposure. All subjects underwent resting-state functional magnetic resonance imaging. Independent components analysis was used to identify triple networks. Detailed effective connectivity patterns were estimated by rs-DCM analysis. Spearman correlation analysis was performed on aberrant DCM parameters with clinical assessment results relevant to PTSD diagnosis. We also carried out step-wise binary logistic regression and receiver operating characteristic curve (ROC) analysis to confirm the capacity of altered effective connectivity parameters to distinguish PTSD patients.

RESULTS

Within the executive control network, enhanced positive connectivity from the left posterior parietal cortex to the left dorsolateral prefrontal cortex was correlated with intrusion symptoms and showed good performance (area under the receiver operating characteristic curve = 0.879) in detecting PTSD patients. In the salience network, we observed a decreased causal flow from the right amygdala to the right insula and a lower transit value for the right amygdala in PTSD patients relative to TECs.

CONCLUSION

Altered effective connectivity patterns in the triple network may reflect the occurrence of PTSD symptoms, providing a potential biomarker for detecting patients. Our findings shed new insight into the neural pathophysiology of PTSD.

Media Exposure and General Trust as Predictors of Post-traumatic Stress Disorder: Ten Years after the 5.12 Wenchuan Earthquake in China

There is a paucity of literature on the roles of media exposure, general trust, and their interactions in long-term post-traumatic stress disorder (PTSD) symptoms after a natural disaster. Trying to address this knowledge gap, our study aimed to (a) investigate whether exposure to media coverage during the traumatic event and general trust directly affected adult survivors’ long-term PTSD symptoms 10 years after the 5.12 Wenchuan earthquake, and (b) to identify the potential differential pattern of the influence of media exposure on PTSD symptoms for adult survivors with various levels of general trust. Using cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We assessed PTSD symptoms, media exposure, general trust, demographic characteristics, socioeconomic status, and earthquake exposure. Data were analyzed descriptively and with Tobit regression analyses. Reversed relationships between general trust and PTSD were verified, whereas no direct links were found between media exposure and PTSD. Interaction tests revealed that media exposure alleviated PTSD for high-trust survivors, but aggravated PTSD for low-trust survivors. These results suggest that general trust building should be considered in post-disaster construction activities.

Longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth in adolescents following the Yancheng tornado in China

Treatment of posttraumatic stress symptoms and facilitation of posttraumatic growth are two encouraging areas of research, yet little is understood about the relationships between trait mindfulness, posttraumatic stress symptoms, and posttraumatic growth. Previous work suggests the linkages among these variables, but most studies have been conducted in adult samples. The aim of this study was to examine longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth among adolescent survivors of the 2016 Jiangsu tornado in China. Data was collected at two secondary schools located in Yancheng city, where the severe catastrophic damage occurred during the tornado. The sample included 247 adolescent survivors (59.5% girls) aged 12-14 years who were directly affected by the tornado. Participants self-reported their trait mindfulness, posttraumatic stress symptoms, and posttraumatic growth at two time points: 6-month (T1) and 9-month post-tornado (T2; attrition rate 17.4%). Cross-lagged structural equation modelling analyses were conducted. Results showed that posttraumatic stress symptoms at T1 significantly predicted reduced trait mindfulness at T2 but not posttraumatic growth; trait mindfulness at T1 did not significantly predict posttraumatic stress symptoms nor posttraumatic growth at T2; and posttraumatic growth at T1 did not predict trait mindfulness nor posttraumatic stress symptoms at T2. These findings suggested that posttraumatic stress symptoms may negatively influence the development of trait mindfulness in disaster-affected adolescents in China, and that posttraumatic growth may have unique implications for this young population which was not associated with posttraumatic stress symptoms or trait mindfulness.

The long-term physical and psychological health impacts of flooding: A systematic mapping

BACKGROUND

Flooding has caused significant and wide ranging long-term health impacts for affected populations. However, until now, the long-term health outcomes, epidemiological trends and specific impact factors of flooding had not been identified. In this study, the relevant literature was systematically mapped to create the first synthesis of the evidence of the long-term health impacts of flooding.

METHODS

The systematic mapping method was used to collect and categorize all the relevant literature. A study was included if it had a description or measurement of health impacts over six months after flooding. The search was limited to peer reviewed articles and grey literature written in English, published from 1996 to 2016.

RESULTS

A total of 56 critical articles were extracted for the final map, including 5 qualitative and 51 quantitative studies. Most long-term studies investigated the psychological impacts of flooding, including PTSD, depression, anxiety, psychiatric disorders, sleep disorder and suicide. Others investigated the physiological impacts, including health-related quality of life, acute myocardial infarction, chronic diseases, and malnutrition. Social support was proved to be protective factors that can improve health outcomes in the long-term after flooding. To date, there have been relatively few reviews had focused on the long-term health impacts of flooding. This study coded and catalogued the existing evidence across a wide range of variables and described the long-term health consequences within a conceptual map.

DISCUSSION AND CONCLUSIONS

Although there was no boundary between the short-term and the long-term impacts of flooding, the identified health outcomes in this systematic mapping could be used to define long-term health impacts. The studies showed that the prevalence of psychological diseases had a reversed increasing trend occurred even in the long-term in relatively poor post-flooding environments. Further cohort or longitudinal research focused on disability, chronic diseases, relocation population, and social interventions after flooding, are urgently required.

Mind the gap: The role of mindfulness in adapting to increasing risk and climate change

It is becoming clear that increasingly complex global challenges cannot simply be solved by new technology or governments alone. We also need to develop new social practices and encourage a broader cultural shift towards sustainability. Against this background, this paper explores the role of mindfulness in adapting to increasing risk and climate change. Based on a literature review, it assesses current research on 'mindful climate adaptation', and explores how individual mindfulness is linked to climate adaptation. While in practice mindfulness-based approaches to climate adaptation have gained widespread recognition (e.g., by the United Nations), the results show that related research is scarce and fragmented. There is almost no research into the role of mindfulness in climate adaptation. At the same time, new scientific domains are opening up in cognate fields that illuminate the mindfulness-adaptation nexus from certain perspectives. These fields include: (1) disaster management; (2) individual well-being; (3) organisational management; (4) environmental behaviour; (5) social justice; and (6) knowledge production. As new concepts and approaches emerge, they require critical construct validation and empirical testing. The importance of further investigation is supported by a complementary empirical study, which shows that individual mindfulness disposition coincides with increased motivation to take (or support) climate adaptation actions. The paper concludes that mindfulness has the potential to facilitate adaptation at all scales (through cognitive, managerial, structural, ontological, and epistemological change processes) and should, therefore, become a core element in climate and associated sustainability research. Finally, it sketches the conceptual trajectories of the mindfulness-adaptation nexus and presents a pioneering, comprehensive framework for 'mindful climate adaptation'.

Disaster mental health preparedness in the community: A systematic review study

The objective of this study was to perform a systematic review of articles that cover aspects of disaster mental health preparedness. This assessment was done by a thorough review and summary of the available studies which provided a considerable background and amplified the gaps in knowledge about community mental health preparedness. By this systematic review, we tried to identify available concept of community mental health preparedness and related tools that communities and individuals will need to prepare for natural disasters. We found there is a lack of mental health preparedness in the majority of countries; valid and reliable tools and context-bound programs should be developed based on the experiences and perceptions of the community.

Chilean Men Exposed to the Major Earthquake in 2010

The article presents the results of a study involving 18 men, 4 years after one of South America's most powerful natural disasters: An earthquake occurring off the coast of Chile in February 2010. Participants reported having developed new psychological health problems in the months following the catastrophe. The manifestations most frequently reported by participants were the presence of depressive and stress symptoms, as well as sleep disorders. The majority of participants registered scores of 33 and above on the Impact of Event Scale-Revised, indicating that they were suffering from posttraumatic stress. Furthermore, although the majority of interviewed men reported having suffered psychological or physical health problems following the disaster, only a small minority had sought help from professional health services. The article develops insights into the men's social interactions and underlines the importance of supporting further research on red health topics, in particular the help-seeking behavior of men following exposure to natural disasters.

Estratégia de Saúde Mental e Atenção Psicossocial para Afetados da Boate Kiss

Resumo Eventos críticos (EC) são eventos que dão início a uma cadeia de incidentes, resultando em uma situação de desastre, a menos que um sistema de segurança interfira para evitá-lo ou minimizá-lo. Este artigo apresenta um relato de experiência durante um EC em que psicólogas elaboraram a estratégia de gestão da atenção psicossocial e saúde mental decorrente do incêndio na boate Kiss, ocorrido em 2013, na cidade de Santa Maria (RS). O objetivo deste relato de experiência é apresentar e analisar a estratégia elaborada de apoio psicossocial e de saúde mental. Fazendo uso de métodos qualitativos, iniciamos a discussão descrevendo a rede pública de Atenção Psicossocial do município na época em que ocorreu o incêndio. Na sequência, delineia-se uma análise descritiva das medidas tomadas nas primeiras 24 horas após esse evento e, finalmente, apresentam-se as estratégias elaboradas para os meses subsequentes. Para esse relato foram utilizados dados e referências do Sistema Único de Saúde e do Sistema Nacional de Proteção e Defesa Civil, contemplando o panorama nacional no momento da intervenção. Dentre os resultados destacam-se a imprescindibilidade do trabalho articulado no nível loco-regional e o delineamento da avaliação sistemática envolvendo os três entes federados. Atividades e ações elaboradas como resposta foram estruturadas de forma condizente com as necessidades psicossociais do público-alvo, bem como com as diretrizes e políticas (inter) nacionais, enfocando a criação de uma estratégia articulada e sustentável em um curto e médio prazo e visando o bem-estar psicossocial dos afetados.

The incidence of post-traumatic stress disorder among survivors after earthquakes:a systematic review and meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a common psychological disorder caused by unusual threats or catastrophic events. Little is known about the combined incidence of PTSD after earthquakes. This study aimed at evaluating the combined incidence of PTSD among survivors after earthquakes using systematic review and meta-analysis.

METHODS

The electronic databases of PubMed, Embase, Web of Science and PsycARTICLES were searched for relevant articles in this study. Loney criteria were used to assess the quality of eligible articles. The combined incidence of PTSD was estimated by using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted using the following variables: the time of PTSD assessment, gender, educational level, marital status, damage to one's house, bereavement, injury of body and witnessing death.

RESULTS

Forty-six eligible articles containing 76,101 earthquake survivors met the inclusion criteria, of which 17,706 were diagnosed as having PTSD. Using a random effects model, the combined incidence of PTSD after earthquakes was 23.66 %. Moreover, the combined incidence of PTSD among survivors who were diagnosed at not more than 9 months after earthquake was 28.76 %, while for survivors who were diagnosed at over nine months after earthquake the combined incidence was 19.48 %. A high degree of heterogeneity (I(2) = 99.5 %, p<0.001) was observed in the results, with incidence ranging from 1.20 to 82.64 %. The subgroup analyses showed that the incidence of PTSD after earthquake varied significantly across studies in relation to the time of PTSD assessment, gender, educational level, damage to one's house, bereavement, injury of body and witnessing death. However, stratified analyses could not entirely explain the heterogeneity in the results.

CONCLUSIONS

Given the high heterogeneity observed in this study, future studies should aim at exploring more possible risk factors for PTSD after earthquakes, especially genetic factors. In spite of that, the results of this study suggest that nearly 1 in 4 earthquake survivors are diagnosed as having PTSD. Therefore, the local government should plan effective psychological interventions for earthquake survivors.

Evaluation of a Group-Based Resilience Intervention for Typhoon Haiyan Survivors

This study evaluated the impact of Katatagan, a culturally adapted, group-based, and mindfulness-informed resilience intervention developed for disaster survivors in the Philippines. The intervention aimed to teach six adaptive coping skills: harnessing strengths, managing physical reactions, managing thoughts and emotions, seeking solutions and support, identifying positive activities, and planning for the future. Pre- and post-intervention assessments were conducted with 163 Typhoon Haiyan survivors. Six-month follow-up assessments were obtained for 37 participants. Pre- and post-results showed improvements in participants’ self-efficacy on all six coping skills. The 6-month follow-up revealed significant improvements in four of the six coping skills. Focus group discussions conducted at follow-up revealed that mindfulness, self-care, strengths, and reframing were some of the topics that were most memorable to participants. Among these, participants identified mindfulness as a skill that they continued to use. Participants also shared that they felt stronger because of the intervention and have shared what they learned with others in their communities.

Disaster Management: Mental Health Perspective

Disaster mental health is based on the principles of 'preventive medicine' This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six 'R's such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.

Progress and challenges of disaster health management in China: a scoping review

Background

Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries.

Objective

This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity.

Design

A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims.

Results

The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue.

Conclusions

One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

The psychological impact of a dual-disaster caused by earthquakes and radioactive contamination in Ichinoseki after the Great East Japan Earthquake

BACKGROUND

The psychological impact of dual-disasters (earthquakes and a nuclear accident), on affected communities is unknown. This study investigated the impact of a dual-disaster (earthquakes and radioactive contamination) on the prevalence of psychological distress in a landlocked city within the Tohoku area, Japan.

METHODS

A cross-sectional mail-in survey with a random sample of inhabitants from Ichinoseki city was conducted eleven months after the disasters, and data from 902 respondents were analyzed by logistic regression models, with multiple imputation methodology. The K6 was used to determine psychological distress.

RESULTS

The estimated prevalence of psychological distress was 48.0 percent. House damage due to earthquakes and anxiety about radioactive contamination were significantly associated with psychological distress (p < 0.05), while an interactive effect between house damage and anxiety about radioactive contamination was not significant. Being female, middle-to-low educational status and unemployed were additional risk factors for psychological distress.

CONCLUSIONS

This dual-disaster was associated with a moderate prevalence of psychological distress in the area. The impact of the earthquake and radioactive contamination appeared additive.

Trauma-Related Symptoms in Sri Lankan Adult Survivors After the Tsunami

Limited research has addressed factors associated with psychological distress following disasters among non-Western populations. The 2004 tsunami affected 1.7 million people across South Asia and Africa, with considerable variations in trauma-related outcomes. Pretraumatic and peritraumatic conditions associated with trauma-related symptoms in 305 Sri Lankan adult survivors (28% male, aged 18-83 years; mean = 39.9 years; standard deviation = 15.3), clinically assessed 1 month posttsunami, were evaluated retrospectively. Outcome measures were total scores on 11 trauma-related symptoms. Multivariate linear regression analyses tested for associations between pretraumatic and peritraumatic conditions and symptom scores, with peritraumatic conditions adjusted for pretraumatic variables. Pretraumatic conditions of female gender, employment, prior health and social issues, and substance use and peritraumatic conditions of loss of family, witnessing the tsunami, or suffering an injury were associated with trauma-related symptoms. The findings facilitate understanding cultural contexts that define risk factors associated with trauma-related symptoms in Sri Lankans, which are critical for developing culturally appropriate interventions.

The 2004 Tsunami in Penang, Malaysia

Disasters, natural or man-made, bring numerous health care challenges. In any crisis, mental health programs are a requirement during both the acute and postemergency phases. In the Asian tsunami on December 26, 2004, some of the northwestern coastal areas of Malaysia, particularly the island of Penang, were affected with devastating effects on the residents. Such disasters can predispose to mental health problems among the affected people. An early mental health intervention program was carried out in Balik Pulau, Penang, an area badly affected by the tsunami. The objective of the intervention program was to identify the victims, counsel them, make referrals if necessary, and provide help and resources to prevent the development of mental health problems. Penang residents identified as tsunami victims by the local health authorities were recruited. A group of health care workers, school teachers, village authorities, and volunteers were trained to carry out the crisis intervention program by health care workers experienced in crisis interventions. A total of 299 adults participated in the crisis intervention program, with follow-up assessments being made 4 to 6 weeks later. At the follow-up assessment, 1% of the victims had a problem and they were then referred for further medical assessment. This indicates that the intervention program in the first 2 weeks after the tsunami disaster with referrals to medical services may have helped stabilize the victims.

Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers

PURPOSE

We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.

METHODS

A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.

RESULTS

A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.

CONCLUSIONS

Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.

Influence of the Wenchuan earthquake on self-reported irregular menstrual cycles in surviving women

OBJECTIVE

To explore the influence of stress induced by the Wenchuan earthquake on the menstrual cycles of surviving women.

METHODS

Self-reports of the menstrual cycles of 473 women that survived the Wenchuan earthquake were analyzed. Menstrual regularity was defined as menses between 21 and 35 days long. The death of a child or the loss of property and social resources was verified for all surviving women. The severity of these losses was assessed and graded as high, little, and none.

RESULTS

About 21% of the study participants reported that their menstrual cycles became irregular after the Wenchuan earthquake, and this percentage was significantly higher than before the earthquake (6%, p < 0.05). About 30% of the surviving women with a high degree of loss in the earthquake reported menstrual irregularity after the earthquake. Association analyses showed that some stressors of the Wenchuan earthquake were strongly associated with self-reports of menstrual irregularity, including the loss of children (RR: 1.58; 95% CI: 1.09, 2.28), large amounts of property (RR: 1.49; 95% CI: 1.03, 2.15), social resources (RR: 1.34; 95% CI: 1.00, 1.80) and the hormonal contraception use (RR: 1.62; 95% CI: 1.21, 1.83).

CONCLUSIONS

Self-reported menstrual irregularity is common in women that survived the Wenchuan earthquake, especially in those who lost children, large amounts of property and social resources.

Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China

This study examined the estimated prevalence rate of posttraumatic stress disorder (PTSD) symptoms and associated risk factors among Chinese adult survivors 7 to 8 months after the 2008 Sichuan earthquake. The sample was recruited from 2 areas close to the epicenter but of different distances. The estimated rate of PTSD symptoms was 55.6% and 26.4% respectively in the two areas. Loss of a child was a strong predictive factor for PTSD symptoms for the parents. Other predictive factors included female gender, loss of a parent, loss of friends or neighbors, residential house damage or collapse, and proximity to the epicenter. Effective and sustainable mental health services are needed and should be directed particularly to bereaved survivors.

Identification of post traumatic stress disorder and risk factors in military first responders 6 months after Wen Chuan earthquake in China

BACKGROUND

Military personnel commonly serve as first responders to natural disasters. Our aim is to identify Post-Traumatic Stress Disorder (PTSD) and determine risk in military responders to the Wen Chuan earthquake.

METHODS

Analyses were carried out on 1056 of the 1125 soldiers enrolled. In addition to social demographic characteristics, the Davidson Trauma Scale (DTS) and an Earthquake exposure screening scale were administered.

RESULTS

PTSD prevalence was 6.53% (69 cases). Logistic regression indicated that intensity of traumatic exposure (odds ratio 6.46, 95% CI 4.47-9.32, p<0.001), not having received psychological counseling (odds ratio 3.28, 95% CI 1.31-8.20, p<0.02) and regular drinking (odds ratio 2.42, 95% CI 1.04-5.62, p<0.05) were significant predictors of PTSD. Being a single-child, not being raised by both parents and regular smoking also independently predicted PTSD if intensity of earthquake traumatic exposure was not included in the model.

LIMITATIONS

The self-rated DTS was used to classify PTSD in this study and psychiatric co-morbidity outside of PTSD was not assessed in this sample.

CONCLUSION

PTSD is a concern for Military disaster responders; to identify those with high risk of developing PTSD would be important and beneficial.

Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review

BACKGROUND

Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD.

METHODS

Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites.

RESULTS

The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT.

CONCLUSION

There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action.

Symptoms of Posttraumatic Stress Disorder among Health Care Workers in Earthquake-Affected Areas in Southwest China

The symptoms of posttraumatic stress disorder and associated risk factors were investigated among health care workers in earthquake-affected areas in southwest China. 343 health care workers completed the Chinese version of the Impact of Event Scale–Revised 3 mo. after the Wenchuan Earthquake. The prevalence of probable PTSD was 19%. The significant risk factors identified for PTSD severity included being female, being bereaved, being injured, and higher intensity of initial fear. These findings suggest that PTSD is a common mental health problem among health care workers in earthquake-affected areas. The present information can be useful in directing, strengthening, and evaluating disaster-related mental health needs and interventions after an earthquake.

Symptoms of posttraumatic stress disorder among adult survivors two months after the Wenchuan earthquake

This study investigated the symptoms of Posttraumatic Stress Disorder (PTSD) and associated risk factors among adult survivors 2 mo. after the Wenchuan earthquake in China. 228 survivors completed the Chinese version of the Impact of Event Scale-Revised. The prevalence of probable PTSD was 43%. The significant predictive factors for the severity of PTSD symptoms included being female, having lower educational level, being bereaved, and witnessing death. Findings of this study suggest that PTSD is a common mental health problem among earthquake survivors in China. Given inadequate knowledge and practices concerning the mental health of disaster victims in China, the information provided by this study is useful for directing, strengthening, and evaluating disaster-related mental health needs and interventions after earthquakes.

Prevalence of tsunami-related PTSD and MDD in Thailand

Much has been written on the devasting effects of the 2004 tsunami in general but no report has reviewed the epidemiological data concerning major psychiatric disorders in Thai survivors. Therefore, this article aims to review the prevalence of tsunami-related mental disorders, especially posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). The data came from searching PUBMED and unindexed journals, and also from contacting researchers or authors. The prevalence of PTSD and PTSD symptoms varied from 6.3% to 13% while the prevalence of MDD and depressive symptoms varied from 1.1% to 30%. The rate of PTSD in affected students in two schools was 57.3% at 6 weeks but decreased to 7.6% at 2 years after the disaster. The rate of PTSD in children and PTSD symptoms in adults decreased over time, while MDD in children did not, and the depressive symptoms in adults showed a modest decrease at 9 months of follow-up. It is rather difficult to compare data from these reports as methodologies and reference sources of population from these studies were quite different. Therefore, further research on this topic, including protective factors, has been recommended.