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

'Profound personal and professional impacts': A qualitative study of clinician experiences of a mental health disaster response to Australia's black summer bushfires

OBJECTIVE

To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019-2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia.

SETTING

A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW.

PARTICIPANTS

Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019-2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia.

DESIGN

An interpretive qualitative study design using semi-structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis.

RESULTS

Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response.

CONCLUSION

Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire-affected community and those responding from outside a bushfire-affected community, which may inform ongoing planning of responses to disaster in Australia.

A Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study

BACKGROUND

Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the "Black Summer Bushfires") resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety.

OBJECTIVE

This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community.

METHODS

Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions.

RESULTS

This study has received institutional review board approval and commenced phase 1 recruitment in October 2022.

CONCLUSIONS

The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53454.

Environmental pollution and extreme weather conditions: insights into the effect on mental health

Environmental pollution exposures, including air, soil, water, light, and noise pollution, are critical issues that may implicate adverse mental health outcomes. Extreme weather conditions, such as hurricanes, floods, wildfires, and droughts, may also cause long-term severe concerns. However, the knowledge about possible psychiatric disorders associated with these exposures is currently not well disseminated. In this review, we aim to summarize the current knowledge on the impact of environmental pollution and extreme weather conditions on mental health, focusing on anxiety spectrum disorders, autism spectrum disorders, schizophrenia, and depression. In air pollution studies, increased concentrations of PM2.5, NO2, and SO2 were the most strongly associated with the exacerbation of anxiety, schizophrenia, and depression symptoms. We provide an overview of the suggested underlying pathomechanisms involved. We highlight that the pathogenesis of environmental pollution-related diseases is multifactorial, including increased oxidative stress, systematic inflammation, disruption of the blood-brain barrier, and epigenetic dysregulation. Light pollution and noise pollution were correlated with an increased risk of neurodegenerative disorders, particularly Alzheimer's disease. Moreover, the impact of soil and water pollution is discussed. Such compounds as crude oil, heavy metals, natural gas, agro-chemicals (pesticides, herbicides, and fertilizers), polycyclic or polynuclear aromatic hydrocarbons (PAH), solvents, lead (Pb), and asbestos were associated with detrimental impact on mental health. Extreme weather conditions were linked to depression and anxiety spectrum disorders, namely PTSD. Several policy recommendations and awareness campaigns should be implemented, advocating for the advancement of high-quality urbanization, the mitigation of environmental pollution, and, consequently, the enhancement of residents' mental health.

Taking a trauma and adversity perspective to climate change mental health

The European Journal of Psychotraumatology has had a long interest in advancing the science around climate change and traumatic stress. In this special issue, we include papers that responded to a special call in this area. Six major themes emerge from these papers and together they contribute to trauma and adversity model of the mental health impacts of climate change. We argue that, in addition to individual vulnerability factors, we must consider the (i) cumulative trauma burden that is associated with exposure to ongoing climate change-related impacts; (ii) impact of both direct and indirect stressors; (iii) individual and community protective factors. These factors can then guide intervention models of recovery and ongoing resilience.

A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community

BACKGROUND

Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health.

METHODS

The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively.

RESULTS

Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign.

CONCLUSIONS

The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.

Psychotropic Medication Prescriptions and Large California Wildfires

Importance

Wildfires, intensified by climate change, have known effects on physical health but their effects on mental health are less well characterized. It has been hypothesized that the residential proximity to a large wildfire can exacerbate underlying mental health conditions as evidenced by increased prescriptions of psychotropic medications.

Objective

To evaluate the association between the occurrence of large wildfires and the prescription rates of psychotropic medications immediately following the start of the fire.

Design, Setting, and Participants

This cohortstudy used an interrupted time-series analysis to compare psychotropic medication prescriptions in the 6 weeks before and after each of 25 wildfires. The setting was California counties within metropolitan statistical areas (MSAs) experiencing large wildfires from 2011 through 2018. Participants included individuals residing in California MSAs with prescriptions of psychotropic medications recorded in the Merative MarketScan Research Database (MarketScan) during the study period. Statistical analysis was performed for these 25 large wildfires occurring between September 2011 and November 2018.

Exposure

Residential proximity to large wildfires that burned more than 25 000 acres occurring in a California county within an MSA.

Main Outcomes and Measures

Prescriptions of psychotropic medications, including antidepressants, antipsychotics, anxiolytics, hypnotics, and mood-stabilizers, with statins as a negative control outcome.

Results

For the study period, prescription data and patient-level attributes were extracted for 7 115 690 unique individuals (annual mean [range]: 889 461 [455 705-1 426 928] individuals) enrolled in MarketScan and residing in fire-affected MSAs. This study found a statistically significant increase in prescriptions of antidepressants (rate ratio [RR], 1.04 [95% CI, 1.01-1.07]), anxiolytics (RR, 1.05 [95% CI, 1.02-1.09]), and mood-stabilizing medications (RR, 1.06 [95% CI, 1.01-1.13]) in the fire period compared with the prefire baseline. However, the prescriptions of antipsychotics, hypnotics, and the negative control outcome, statins, showed no significant association.

Conclusions and Relevance

In this cohort study of large California wildfires, the occurrence of wildfire was associated with increased mental health burden as reflected in increased prescription rates of certain psychotropic medications. The findings underscore the need for further scientific examination into the mental health effects of wildfires and the allocation of mental health resources in disaster responses. California experienced a substantial burden of wildfires from 2011 to 2018, and as wildfires become more intense and frequent in the context of anthropogenic climate change, it is increasingly important to understand and address their mental health effects.

Health Effects of Wildfire Smoke Exposure

We review current knowledge on the trends and drivers of global wildfire activity, advances in the measurement of wildfire smoke exposure, and evidence on the health effects of this exposure. We describe methodological issues in estimating the causal effects of wildfire smoke exposures on health and quantify their importance, emphasizing the role of nonlinear and lagged effects. We conduct a systematic review and meta-analysis of the health effects of wildfire smoke exposure, finding positive impacts on all-cause mortality and respiratory hospitalizations but less consistent evidence on cardiovascular morbidity. We conclude by highlighting priority areas for future research, including leveraging recently developed spatially and temporally resolved wildfire-specific ambient air pollution data to improve estimates of the health effects of wildfire smoke exposure.

Exploring the use of masks for protection against the effects of wildfire smoke among people with preexisting respiratory conditions

BACKGROUND

The impact of wildfire smoke is a growing public health issue, especially for those living with preexisting respiratory conditions. Understanding perceptions and behaviors relevant to the use of individual protective strategies, and how these affect the adoption of these strategies, is critical for the development of future communication and support interventions. This study focused on the use of masks by people living in the Australian community with asthma or chronic obstructive pulmonary disease (COPD).

METHODS

Semi-structured phone interviews were undertaken with people living in the community aged 18 years and over. Participants lived in a bushfire-prone area and reported having been diagnosed with asthma or COPD.

RESULTS

Twenty interviews were undertaken between July and September 2021. We found that, during wildfire episodes, there was an overwhelming reliance on closing windows and staying inside as a means of mitigating exposure to smoke. There was limited use of masks for this purpose. Even among those who had worn a mask, there was little consideration given to the type of mask or respirator used. Reliance on sensory experiences with smoke was a common prompt to adopting an avoidance behavior. Participants lacked confidence in the information available from air-quality apps and websites, however they were receptive to the idea of using masks in the future.

CONCLUSIONS

Whilst COVID-19 has changed the nature of community mask use over the last couple of years, there is no guarantee that this event will influence an individual's mask behavior during other events like bushfires. Instead, we must create social support processes for early and appropriate mask use, including the use of air quality monitoring.

Climate change, environmental extremes, and human health in Australia: challenges, adaptation strategies, and policy gaps

Climate change presents a major public health concern in Australia, marked by unprecedented wildfires, heatwaves, floods, droughts, and the spread of climate-sensitive infectious diseases. Despite these challenges, Australia's response to the climate crisis has been inadequate and subject to change by politics, public sentiment, and global developments. This study illustrates the spatiotemporal patterns of selected climate-related environmental extremes (heatwaves, wildfires, floods, and droughts) across Australia during the past two decades, and summarizes climate adaptation measures and actions that have been taken by the national, state/territory, and local governments. Our findings reveal significant impacts of climate-related environmental extremes on the health and well-being of Australians. While governments have implemented various adaptation strategies, these plans must be further developed to yield concrete actions. Moreover, Indigenous Australians should not be left out in these adaptation efforts. A collaborative, comprehensive approach involving all levels of government is urgently needed to prevent, mitigate, and adapt to the health impacts of climate change.

Designing a conceptual framework for strategic selection of Bushfire mitigation approaches

Fires are an important aspect of environmental ecology; however, they are also one of the most widespread destructive forces impacting natural ecosystems as well as property, human health, water and other resources. Urban sprawl is driving the construction of new homes and facilities into fire-vulnerable areas. This growth, combined with a warmer climate, is likely to make the consequences of wildfires more severe. To reduce wildfires and associated risks, a variety of hazard reduction practices are implemented, such as prescribed burning (PB) and mechanical fuel load reduction (MFLR). PB can reduce forest fuel load; however, it has adverse effects on air quality and human health, and should not be applied close to residential areas due to risks of fire escape. On the other hand, MFLR releases less greenhouse gasses and does not impose risks to residential areas. However, it is more expensive to implement. We suggest that environmental, economic and social costs of various mitigation tools should be taken into account when choosing the most appropriate fire mitigation approach and propose a conceptual framework, which can do it. We show that applying GIS methods and life cycle assessment we can produce a more reasonable comparison that can, for example, include the benefits that can be generated by using collected biomass for bioenergy or in timber industries. This framework can assist decision makers to find the optimal combinations of hazard reduction practices for various specific conditions and locations.

A Review of Artificial Neural Network Models Applied to Predict Indoor Air Quality in Schools

BACKGROUND

Indoor air quality (IAQ) in schools can affect the performance and health of occupants, especially young children. Increased public attention on IAQ during the COVID-19 pandemic and bushfires have boosted the development and application of data-driven models, such as artificial neural networks (ANNs) that can be used to predict levels of pollutants and indoor exposures.

METHODS

This review summarises the types and sources of indoor air pollutants (IAP) and the indicators of IAQ. This is followed by a systematic evaluation of ANNs as predictive models of IAQ in schools, including predictive neural network algorithms and modelling processes. The methods for article selection and inclusion followed a systematic, four-step process: identification, screening, eligibility, and inclusion.

RESULTS

After screening and selection, nine predictive papers were included in this review. Traditional ANNs were used most frequently, while recurrent neural networks (RNNs) models analysed time-series issues such as IAQ better. Meanwhile, current prediction research mainly focused on using indoor PM2.5 and CO2 concentrations as output variables in schools and did not cover common air pollutants. Although studies have highlighted the impact of school building parameters and occupancy parameters on IAQ, it is difficult to incorporate them in predictive models.

CONCLUSIONS

This review presents the current state of IAQ predictive models and identifies the limitations and future research directions for schools.

Temperature and socioeconomic vulnerability: associations with cardiac event-induced posttraumatic stress symptoms

Background

Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population.

Methods

Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES.

Results

No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS.

Conclusion

Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.

Mental health of vulnerable groups experiencing a drought or bushfire: A systematic review

Natural hazards are increasing because of climate change, and they disproportionately affect vulnerable populations. Prior reviews of the mental health consequences of natural hazard events have not focused on the particular experiences of vulnerable groups. Based on the expected increase in fires and droughts in the coming years, the aim of this systematic review is to synthesize the global evidence about the mental health of vulnerable populations after experiencing natural hazards. We searched databases such as Ovid MEDLINE, EMBASE, CINAHL and Ovid PsycInfo using a systematic strategy, which yielded 3,401 publications. We identified 18 eligible studies conducted in five different countries with 15,959 participants. The most common vulnerabilities were living in a rural area, occupying a low socioeconomic position, being a member of an ethnic minority and having a medical condition. Common experiences reported by vulnerable individuals affected by drought included worry, hopelessness, isolation and suicidal thoughts and behaviors. Those affected by fire reported experiencing posttraumatic stress disorder (PTSD) and anger. These mental health problems exacerbated existing health and socioeconomic challenges. The evidence base about mental health in vulnerable communities affected by natural hazards can be improved by including standardized measures and comparison groups, examining the role of intersectional vulnerabilities, and disaggregating data routinely to allow for analyses of the particular experiences of vulnerable communities. Such efforts will help ensure that programs are informed by an understanding of the unique needs of these communities.

The impact of prolonged landscape fire smoke exposure on women with asthma in Australia

BACKGROUND

Little is known about the physical and mental health impact of exposure to landscape fire smoke in women with asthma. This study examined the health impacts and information-seeking behaviours of women with asthma exposed to the 2019/2020 Australian fires, including women who were pregnant.

METHODS

Women with asthma were recruited from the Breathing for Life Trial in Australia. Following the landscape fire exposure period, self-reported data were collected regarding symptoms (respiratory and non-respiratory), asthma exacerbations, wellbeing, quality of life, information seeking, and landscape fire smoke exposure mitigation strategies. Participants' primary residential location and fixed site monitoring was used to geolocate and estimate exposure to landscape fire-related fine Particulate Matter (PM_2.5).

RESULTS

The survey was completed by 81 pregnant, 70 breastfeeding and 232 non-pregnant and non-breastfeeding women with asthma. Participants had a median daily average of 17 μg/m³ PM_2.5 and 105 μg/m³ peak PM_2.5 exposure over the fire period (October 2019 to February 2020). Over 80% of participants reported non-respiratory and respiratory symptoms during the fire period and 41% reported persistent symptoms. Over 82% reported asthma symptoms and exacerbations of asthma during the fire period. Half the participants sought advice from a health professional for their symptoms. Most (97%) kept windows/doors shut when inside and 94% stayed indoors to minimise exposure to landscape fire smoke. Over two in five (43%) participants reported that their capacity to participate in usual activities was reduced due to prolonged smoke exposure during the fire period. Participants reported greater anxiety during the fire period than after the fire period (mean (SD) = 53(13) versus 39 (13); p < 0.001). Two in five (38%) pregnant participants reported having concerns about the effect of fire events on their pregnancy.

CONCLUSION

Prolonged landscape fire smoke exposure during the 2019/2020 Australian fire period had a significant impact on the health and wellbeing of women with asthma, including pregnant women with asthma. This was despite most women taking actions to minimise exposure to landscape fire smoke. Effective and consistent public health messaging is needed during landscape fire events to guard the health of women with asthma.

Impacts of the 2019/20 bushfires and COVID-19 pandemic on the physical and mental health of older Australians: a cross-sectional survey

BACKGROUND

In 2019/20 major bushfires devastated Australia's East Coast. Shortly afterward the COVID-19 pandemic was declared. Older people are disproportionately affected by disasters and are at high risk from respiratory pandemics. However, little is known about how these events impact on older peoples' health and well-being and engagement with services such as primary care.

OBJECTIVE

To explore the health impacts of the 2019/20 bushfires and the COVID-19 pandemic on older Australians' health and well-being.

METHODS

One hundred and fifty-five people aged over 65 years living in South-eastern New South Wales, Australia participated in an online survey. The survey measured the impacts of the bushfires and COVID-19 on physical and mental health and the capacity of older people to manage these impacts.

RESULTS

Most respondents felt that the bushfires caused them to feel anxious/worried (86.2%) and negatively affected their physical (59.9%) and mental (57.2%) health. While many participants had similar feelings about COVID-19, significantly fewer felt these physical and mental health impacts than from the bushfires. A significantly greater perceived level of impact was observed for females and those with health problems. More respondents described negative mental health than physical health effects. Those who felt more impacted by the events had lower levels of resilience, social connection and support, and self-rated health.

CONCLUSION

The health impacts identified in this study represent an opportunity for primary care to intervene to both ensure that people with support needs are identified and provided timely support and that older people are prepared for future disasters.

Wildfire smoke and symptoms affecting mental health among adults in the U.S. state of Oregon

The physical and mental health impacts of wildfires are wide-ranging. We assessed associations between exposure to wildfire smoke and self-reported symptoms affecting mental health among adults living in Oregon. We linked by interview date and county of residence survey responses from 5807 adults who responded to the 2018 Behavioral Risk Factor Surveillance System's depression and anxiety module with smoke plume density, a proxy for wildfires and wildfire smoke exposure. Associations between weeks in the past year with medium and heavy smoke plume densities and symptoms affecting mental health during the two weeks before the interview date were estimated using predicted marginal probabilities from logistic regression models. In the year before completing the interview, 100% of respondents experienced ≥2 weeks of medium or heavy smoke, with an average exposure duration of 32 days. Nearly 10% reported being unable to stop or control their worrying more than half the time over the past two weeks. Medium or heavy smoke for 6 or more weeks in the past year, compared to ≤4 weeks in the past year, was associated with a 30% higher prevalence of being unable to stop or control worrying more than half the time during the past two weeks (prevalence ratio: 1.30, 95% confidence interval: 1.03, 1.65). Among adults in Oregon, selected symptoms affecting mental health were associated with extended durations of medium and heavy smoke. These findings highlight the burden of such symptoms among adults living in communities affected by wildfires and wildfire smoke.