Post-tsunami mental health: A cross-sectional survey of the predictors of common mental disorders in South India 9-11 months after the 2004 Tsunami

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.

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

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

Evaluating feasibility and acceptability of a group WHO trans-diagnostic intervention for women with common mental disorders in rural Pakistan: a cluster randomised controlled feasibility trial

AIMS

The aim of this feasibility trial was to evaluate the feasibility and acceptability of the locally adapted Group Problem Management Plus (PM+) intervention for women in the conflict affected settings in Swat, Pakistan.

METHODS

This mixed-methods study incorporated a quantitative component consisting of a two arm cluster randomised controlled feasibility trial, and qualitative evaluation of the acceptability of the Group PM+ to a range of stakeholder groups. For the quantitative component, on average from each of the 20 Lady Health Workers (LHWs) catchment area (20 clusters), six women were screened and recruited for the trial with score of >2 on the General Health Questionnaire and score of >16 on the WHO Disability Assessment Schedule. These LHW clusters were randomised on a 1 : 1 allocation ratio using a computer-based software through a simple randomisation method to the Group PM+ intervention or Enhanced Usual Care. The Group PM+ intervention consisted of five weekly sessions of 2 h duration delivered by local non-specialist females under supervision. The primary outcome was individual psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale at 7th week after baseline. Secondary outcomes include symptoms of depression, post-traumatic stress disorder (PTSD), general psychological profile, levels of functioning and generalised psychological distress. Intervention acceptability was explored through in-depth interviews.

RESULTS

The results show that lay-helpers with no prior mental health experience can be trained to achieve the desired competency to successfully deliver the intervention in community settings under supervision. There was a good intervention uptake, with Group PM+ considered useful by participants, their families and lay-helpers. The outcome evaluation, which was not based on a large enough study to identify statistically significant results, indicated statistically significant improvements in depression, anxiety, general psychological profile and functioning. The PTSD symptoms and depressive disorder scores showed a trend in favour of the intervention.

CONCLUSION

This trial showed robust acceptance in the local settings with delivery by non-specialists under supervision by local trained females. The trial paves the way for further adaptation and exploration of the outcomes through larger-scale implementation and definitive randomised controlled trials in the local settings.

Post-Flood Rapid Needs Assessment in Srinagar City, Jammu and Kashmir State, India, September, 2014

OBJECTIVES

Torrential rainfall and flooding from September 2-6, 2014 submerged >350 villages in Jammu and Kashmir state. We conducted rapid needs assessment in capital Srinagar from 27 September to 1 October to assess population health and safety needs.

METHODS

Based on Community Assessment for Public Health Emergency Response (CASPER) methodology, we selected 7 households each from 30 census blocks using 2-stage cluster sampling. We collected information on demographics, needs, and illnesses using structured questionnaire.

RESULTS

Of the 210 households surveyed, an estimated 57% (CI: 41%-73%) reported significant damage, 50% (CI: 36%-63%) were evacuated, and 16% (CI: 10%-22%) reported injuries. Households lacked electricity (22%; CI: 8.8%-36%), tap water (13%; CI: 5%-21%), working toilets (11%; CI: 4%-19%), and adequate food supply (14%; CI: 8%-20%). Moreover, 55% (CI: 45%-64%) of households reported cough, cold, fever, rashes, or diarrhea; 68% (CI: 59%-77%) experienced agitation, anxiety, depression, or nightmares since the flooding. Of the households with a member on medicines for non-communicable diseases, 40% did not have a week's supply. Restoring basic essentials (30%; CI: 22%-37%) and repairing houses (30%; CI: 19%-40%) were the most urgent needs expressed.

CONCLUSIONS

Floods damaged >1/2 of households in Srinagar, disrupting basic essentials, and causing mental trauma. These findings helped authorities prioritize assistance with psychological symptoms and availability of prescription medicines. (Disaster Med Public Health Preparedness. 2019;13:133-137).

Evaluating feasibility and acceptability of a local psycho-educational intervention for pregnant women with common mental problems affected by armed conflict in Swat, Pakistan: A parallel randomized controlled feasibility trial

BACKGROUND

The current research was conducted in the Swat valley, where widespread conflict and militancy had been experienced prior to the field activities. The aim of this trial was to evaluate the feasibility and acceptability of a locally developed psycho-educational intervention.

METHODS

This mixed-methods study incorporated a quantitative and qualitative component. For the quantitative component, trial participants were identified from a cross-sectional study conducted in the earlier phase of the research, with Self-Reporting Questionnaire (SRQ) score of ≥9. Participants with suicidal ideation, severe mental or medical illness, recently given birth or living with another woman with an SRQ score of 9 or above were excluded. Participants fulfilling eligibility were randomized on a 1:1 allocation ratio using simple randomization to the psycho-educational intervention or routine care arm. The intervention arm received two psycho-educational sessions at their homes delivered by local community health worker from the study area. The primary outcome was help-seeking for psychological distress, measured by a semi-structured interview by a researcher blind to the allocation status at 2 months post-intervention. Secondary outcomes include psychological distress and social support measured by SRQ and Multidimensional Scale of Perceived Social Support (MSPSS), respectively, at 2 months post-intervention. Intervention acceptability was explored through in-depth interviews.

RESULTS

Local community health workers with no mental health experience successfully delivered the psycho-educational sessions in the community. The uptake of intervention was good and the intervention was taken well by the families and the community health workers. The outcome evaluation was not powered; however, more women sought assistance for their distress from their community health workers in the intervention arm, compared to women in the control arm.

CONCLUSION

This trial showed good acceptance and feasible delivery of a locally developed psycho-educational intervention through community health workers following conflict, giving way for further adaptation and evaluation.

Relationships between Sleep Problems and Psychiatric Comorbidities among China's Wenchuan Earthquake Survivors Remaining in Temporary Housing Camps

Earthquake survivors are a diverse population. This study focused on a special group of earthquake survivors, who had still stayed in temporary housing camps for about 2 years after China's Wenchuan Earthquake rather than those who moved back to rebuild their lives or immigrated to large cities to seek new lives. The research goals were to (1) assess their sleep problems as well as their PTSD, depression and anxiety and (2) examine the relationship between different dimensions of sleep quality and PTSD, depression, and anxiety among these survivors. Three-hundred and eighty seven earthquake survivors who remained in temporary housing camps and had sleep problems were recruited 17-27 months after Wenchuan Earthquake. Four standardized instruments-The Pittsburgh Sleep Quality Index, PTSD Checklist-Civilian Version, Self-rating Depression Scale, Self-rating Anxiety Scale, and face-to-face one-on-one structured interviews were used to assess these survivors' sleep quality, PTSD, depression, and anxiety. It was found that (1) 83.20% of these survivors reported having sleep problems, and 79.33% of them considered insomnia as the most common sleep problem; (2) 12.14% suffered PTSD, 36.43% experienced depression, and 38.24% had anxiety; (3) sleep disturbance, sleep medication use, and subjective sleep quality were significantly related to PTSD; (4) habitual sleep efficiency, sleep disturbance, sleep medication use, and daytime dysfunction were significantly related to depression; and (5) sleep disturbance, sleep medication use, and daytime dysfunction were significantly related to anxiety. Clinic implications of the study are discussed.