First responders: mental health consequences of natural and human-made disasters for public health and public safety workers

The importance of cultural understanding and practical solutions during the handover of a psychotherapy and psychotraumatology program in Northern Iraq into local hands

In post war regions, especially in low-income countries, the health care systems often require immediate support. For example, after the terror of the so-called Islamic State of Iraq and Syria (ISIS) in 2014, many internally displaced persons took refuge in the Kurdistan Region of Iraq (KRI). Those displaced by war have had to face the reality that psychotherapy did not exist as a service in the Kurdish health system. Many projects and Non-Government-Organizations (NGOs) that work in post-conflict regions focus on short term and quick response and/or basic psychological services. The implementation of the "Institute for Psychotherapy and Psychotraumatology" (IPP) at the University of Dohuk, follows a long-term approach. The 3-year-program teaches students to become professional psychotherapists, with respect to evidence-based and culturally adapted methods of psychotherapy. To achieve sustainability, the project is working towards handing over the teaching and organizational responsibilities into local hands. This article highlights the chances and challenges during this transition, as well as the importance of cultural understanding and realistic, practical solutions. An honest reflection on existing cultural challenges, e.g. inflexible hierarchical structures or an "old-fashioned" religious view of homosexuality, can then lead to practical solutions. These include winning over local authorities by including them in the process, culturally adapting to customs with the help of educated locals, demonstrating non-authoritarian forms of leadership, and explicitly promoting newly graduated young lecturers into positions of authority.

Post-traumatic stress disorder and associated factors among inpatients at Eastern Command Referral Hospital in Dire Dawa, Eastern Ethiopia

Background

Post-traumatic stress disorder (PTSD) is characterized by heightened stress and anxiety after experiencing a traumatic event. While numerous studies have been conducted to investigate the magnitude and factors associated with PTSD, there is limited evidence available on specific study populations of military personnel.

Objective

The study aimed to determine the magnitude of post-traumatic stress disorder and associated factors among military personnel admitted to the Eastern Command Referral Hospital in Eastern Ethiopia from May 1 to 30, 2023.

Methods and materials

A cross-sectional study was carried out at an institution. Face-to-face interviews were conducted to collect data using the post-traumatic stress disorder military version checklist for the Diagnostic and Statistical Manual, Fifth Edition. Data were entered and analyzed using EpiData version 3.1 and STATA version 14. Descriptive statistics were employed to summarize the information. To investigate factors linked with outcome variables, bivariate and multivariate logistic regression analyses were conducted. The results were presented using odds ratios with 95% confidence intervals, with statistical significance given at a p-value of 0.05.

Results

This study found that approximately 23.6% (95% CI = 19.9-27.8) of admitted military members fulfilled the diagnostic criteria for PTSD. Participants' history of mental illness [adjusted odds ratio (AOR) = 5.73, 95% CI = 2.66-12.31], family history of mental illness (AOR = 10.38, 95% CI = 5.36-20.10), current chewing of khat (AOR = 2.21, 95% CI = 1.13-4.32), physical trauma (AOR = 2.03, 95% CI = 1.00-4.13), moderate social support (AOR = 0.27, 95% CI = 0.1-4.53), strong social support (AOR = 0.09, 95% CI = 0.02-0.35), and severe depression (AOR = 2.06, 95% CI = 1.74-5.71) were factors significantly associated with post-traumatic stress disorder.

Conclusions

The magnitude of post-traumatic stress disorder is high among military personnel. Factors such as participants' history of mental illness, family history of mental illness, depression, lack of social support, current use of khat, and physical trauma are significantly associated with PTSD. It is crucial to identify and intervene early in individuals with these risk factors to address PTSD effectively.

Long-term mental health and resilience of the first responders in Japanese ground self-defense forces engaging body recovery after the great east Japan earthquake

Handling human remains is extremely difficult and stressful task, and it can contribute to the development of stress-related mental health problems. To prevent disaster from the development of mental disorders in first responders, it will be important to elucidate factors sustaining psychological well-being following the events requiring handling of human remains. Japanese Ground Self-Defense Forces (JGSDF) first responders (n = 146), involved in human remains recovery after the Great East Japan Earthquake (GEJE) participated. We examined the psychological resilience (S-H Resilience Test), depressive symptoms (SDS), and psychological distress (GHQ-28) 6 years after GEJE, in three groups; Group A: no contact no view of human remains, B: view only of human remains, and C: direct handling of human remains. S-H Resilience test evaluated the 3 subclasses of resilience; Social Support, Self Efficacy, Sociality. One-way ANOVA revealed the significant difference in resilience scores between Group B and C without any differences in depressive symptoms or psychological distress among the 3 groups. Multiple regression analyses revealed that depressive symptoms and resilience were associated with psychological distress in all participants. Path analyses showed that whereas one subtype of resilience indirectly reduced psychological distress through lower depressive symptoms in Group A (Social Support) and Group B (Sociality), both subtypes of resilience indirectly reduced psychological distress by lowering depressive symptoms in Group C. These findings suggest that exposure to higher stressful situation may decrease the psychological resilience based on the S-H Resilience test, and two subtypes of resilience may be necessary to sustain the psychological well-being.

Psychoactive substance consumption after the Fundão dam mine tailing disaster in Minas Gerais State, Brazil

Disasters cause changes in morbidity, mortality, and medicine use. Brazil is one of the main producers of mineral ores at great environmental cost. Mine tailings are stored in dams and ruptures have led to major disasters. We investigated the consumption of psychoactive medicines in the municipalities affected by the Fundão dam disaster in Minas Gerais State. An ecological study was carried out on drug consumption, estimated using public purchases in Minas Gerais and dispensing data from private retail pharmacies. Consumption (in number of defined daily doses/100,000 inhabitants per day) was analyzed descriptively in eight municipalities, stratified according to consumption level during a 25-month period. Six comparisons of mean consumption values for both data sets were done for pre- and post-disaster periods. The means of medicine consumption before and after the event were plotted and linear trends were added. Public purchase data evinced high consumption levels. Only pharmaceutical retail showed significant differences between the strata in the pre-disaster versus two post-disaster periods. Smaller municipalities showed an increase in consumption 15 months after the disaster. Clonazepam led the way in pharmaceutical retail consumption, followed by fluoxetine. Medicines showed an upward trend after the disaster. The high public provision may have stifled significant consumption patterns of psychoactive drugs; however, peak consumption were observed in private retail, suggesting a modification in use patterns after the disaster. The decrease in consumption immediately after the event was probably related to lower care-seeking behavior on the part of the population, and significant peaks after the disaster may reflect economic consequences of it.

Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework

Background

Within Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT.

Methods

In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance.

Results

The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support).

Implications

Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.

Training, Deployment Preparation, and Behavioral Health of New York National Guard Personnel Deployed to Assist with COVID-19 Decedent Work

INTRODUCTION

A small body of research conducted mostly among civilians has shown that adequate training and preparation can prevent or reduce the development of behavioral health problems in first responders. Several civilian studies have shown that social support is protective against behavioral health problems. However, very few studies have examined the impact of these factors on the behavioral health of military first responders. Military first responders, who serve in the aftermath of natural disasters and disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic, are often members of the National Guard (NG). The purpose of this study was to examine the impact of mortuary affairs training/handling human remains, role preparation, equipment preparation, and unit social support provided to families on the behavioral health of New York (NY) NG personnel deployed to assist the NY Office of Chief Medical Examiner with handling the remains of COVID-19 decedents.

MATERIALS AND METHODS

We invited 410 NYNG personnel who deployed for the Office of Chief Medical Examiner mission to complete an anonymous online questionnaire 3 to 6 months post-mission. Of the 158 participants, we used the data of the 141 participants who provided consent. Standard behavioral health measures (depression, anxiety, post-traumatic stress disorder, alcohol misuse, and insomnia) as well as study-specific items designed to understand the unique dynamics of this deployment were included. Hierarchical logistic regression analysis was used to examine the relationships between mortuary training, role preparation, equipment preparation, and unit support with behavioral health.

RESULTS

Close to two-thirds of the sample reported that they had not been trained in mortuary affairs/handling human remains before the mission. We also found that that lower levels of role preparation and unit support provided to the service members' families increased the odds of meeting criteria for one or more behavioral health problems, but that training in mortuary affairs and equipment preparation was unrelated to behavioral health.

CONCLUSIONS

Our research points to the importance of emotionally and cognitively preparing service members for the specific dynamics of a deployment and the roles that that they are expected to play. Furthermore, it suggests that supporting the families of NG personnel during domestic missions can benefit the behavioral health of the NG personnel. Additional research is needed to corroborate these findings, particularly the impact of unit support provided to family members on service members' behavioral health.

The Psychological Impact of Exposure to Battle on Medics: A Cross-Sectional Study of Ex-Soldiers Who Sought Help From the IDF Combat Reaction Unit

INTRODUCTION

The present study's central aim was to examine two questions: (1) Will there be differences in mental health outcomes between medics and non-medics who sought help at the Israeli Combat Reaction Unit (CRU)? (2) Will there be differences in mental health outcomes between combatants and non-combatants?

MATERIALS AND METHODS

This cross-sectional study included files of 1,474 Israeli Defense Forces ex-service members (89% combatants, of whom 13% were medics; 11% non-combatants, of whom 6% were medics), who filled out questionnaires on admission for evaluation at the CRU.Dependent variables were mental health measures and included two PTSD measures (Clinician-Administered PTSD Scale and PTSD Checklist for DSM-5), Beck Depression Inventory, Dissociative Experience Scale, and Brief Symptom Inventory. Military profession (medics vs. non-medics) and status (combatant vs. non-combatant) were the independent variables. Background variables were also examined.

RESULTS

We found no substantial differences between medics and non-medics in the mental health measures. When looking at combat and non-combat separately, the non-combat medics (CMs), in general, were in better mental health conditions than the other three groups- CMs, non-medic combatants, and non-medic non-combatants-all of whom had similar scores in the mental health measures. However, compared to the rest, non-CMs took considerably longer years before approaching the CRU.

CONCLUSIONS

The elapsed time to seek help for non-MCs was explained by their reluctance to seek help, not being combatants, and being medics who are portrayed as resilient. Recommendations for encouraging this subgroup to seek help were given.

The Female Emergency Medical Services Experience: A Mixed Methods Study

BACKGROUND

Emergency Medical Services (EMS) is a challenging profession. Little is known if there are gender differences in the experiences among EMS clinicians. Therefore, our aim was to understand and characterize the occupational experiences of female EMS clinicians.

METHODS

A mixed methodological study was conducted among currently licensed female EMS clinicians via focus group and self-report survey data. Three focus groups (n = 5, 4, 13, respectively) were conducted with participants purposively recruited from primarily Northeastern EMS agencies. Through ongoing collaborations, a recruitment advertisement was provided to EMS leadership at respective agencies for distribution among their female staff. Sessions were recorded and transcribed for thematic analysis. A six-phase inductive analytical approach was utilized to evaluate focus group data. Qualitative findings were utilized to inform a cross-sectional, self-report survey consisting of occupational specific experiences, such as harassment and pregnancy, and validated measures of mental wellbeing. Descriptive statistics were used to describe the study sample and female EMS clinician occupational and personal experiences.

RESULTS

A total of 22 female EMS clinicians participated across the three focus group sessions. Four major themes were identified: 1) the female EMS experience; 2) impact on personal wellbeing; 3) impact on occupational wellbeing; and 4) coping mechanisms. Each theme had multiple subthemes. There were 161 participants that attempted the 72-item survey, 13 partial and 148 competed surveys. Median age was 32 years (IQR: 25-42), and the majority were EMT-Bs (55.1%). Approximately 70.0% met the criteria for probable anxiety, 53.9% probable depression and 40.9% elevated symptoms of burnout. Almost 73.0% reported workplace harassment, with most experiences being perpetrated by patients and coworkers. Over 61.0% reported reconsideration of their career in EMS. Overall, survey data indicated interactions with peers and leadership, and social support were positive.

CONCLUSIONS

Findings highlight the need to improve the occupational experiences of female EMS clinicians to preserve and encourage the continuation of their participation in this workforce. Specifically tailored interventions aimed at protecting and improving their overall wellbeing are critical, particularly considering the increased occupational burden resulting from the pandemic. Future research should aim to understand specific predictors of adverse mental health outcomes among this population.

Understanding problematic substance use among first responders during the COVID-19 pandemic: A survey of law enforcement, fire, and EMS workers in the United States

BACKGROUND

First responders have experienced increased levels of stress, anxiety, and depression due to job-related pressures associated with the COVID-19 pandemic. However, little is known about the factors associated with first responder drug and alcohol use during this time.

METHODS

We conducted a nationwide survey of first responders (n = 2801) to understand the relationship between work pressures, workplace support strategies, and problematic substance use during the early stages of the COVID-19 pandemic. We employed structural equation modeling to analyze whether burnout mediated these relationships.

RESULTS

Descriptive statistics showed that 60.8 % reported no concerns with substance use. While general workplace support strategies were negatively associated with problematic substance use, specific COVID-related strategies, such as providing compensation during quarantine, were positively associated with problematic substance use. Burnout fully mediated relationships between workplace support strategies and problematic substance use. Finally, providing spaces at work to decompress was negatively associated with problematic substance use and burnout.

CONCLUSION

Although work pressures increased burnout and problematic substance use among first responders, general workplace support strategies (e.g., decompression spaces) reduced problematic substance use while some COVID-related strategies (e.g. compensation during quarantine) increased problematic substance use. Policy interventions to address problematic substance use should focus on providing spaces for first responders to decompress at work, as well as implementing strategies (e.g., access to mental health services, time off) to reduce burnout. However, organizations should be mindful that not all interventions will have their intended impact and some interventions may unintentionally contribute to negative employee outcomes.

Wellness Warriors: a qualitative exploration of healthcare staff learning to support their colleagues in the aftermath of the Australian bushfires

PURPOSE

Healthcare staff are on the frontline during disasters despite any personal adversity and vicarious trauma they may be experiencing. Wellness Warrior training is a post-disaster intervention developed in response to the 2019-2020 Australian bushfires to support staff in a rural hospital located on the South Coast of New South Wales, Australia.

METHOD

This study explored the experiences and perspectives of 18 healthcare staff who were trained to provide emotional and peer support to their colleagues in the aftermath of a crisis. All the Wellness Warriors participated in semi-structured interviews between March and April 2020. Data were analysed using the reflexive thematic approach.

RESULTS

Healthcare staff reported developing interpersonal skills around deep listening and connecting with others which allowed for hearing the core of their colleagues' concerns. The training also helped staff to feel differently about work and restored their faith in healthcare leadership.

CONCLUSION

Wellness Warrior training provided staff with knowledge and skills to support their colleagues in the aftermath of a natural disaster and later during the COVID-19 pandemic. As such, these findings suggest that peer support programs such as Wellness Warriors could be one way healthcare organisations can attempt to alleviate the psychological impact of natural disasters.

Light Personality Style and Moral Injury Among Chinese Health Professionals

Moral injury has attracted attention widely in various occupations, particularly health professionals. Personality traits involve the professional values in clinical decision-making associated with mental outcomes. The current study examines the relationship between "light personality" style and moral injury. Scores on three subscales of the Light Triad Scale were negatively correlated with the Moral Injury Symptoms Scale-Health Professional. Health professionals more likely to have light personality styles may be less likely to suffer from moral injury under high-stake situations. The findings provide evidence to better understand the inner core of the moral injury, suggesting a potential pathway to improve the moral well-being of health professionals by strengthening key elements of light personality.

Modeling Brain Dynamics During Virtual Reality-Based Emergency Response Learning Under Stress

BACKGROUND

Stress affects learning during training, and virtual reality (VR) based training systems that manipulate stress can improve retention and retrieval performance for firefighters. Brain imaging using functional Near Infrared Spectroscopy (fNIRS) can facilitate development of VR-based adaptive training systems that can continuously assess the trainee's states of learning and cognition.

OBJECTIVE

The aim of this study was to model the neural dynamics associated with learning and retrieval under stress in a VR-based emergency response training exercise.

METHODS

Forty firefighters underwent an emergency shutdown training in VR and were randomly assigned to either a control or a stress group. The stress group experienced stressors including smoke, fire, and explosions during the familiarization and training phase. Both groups underwent a stress memory retrieval and no-stress memory retrieval condition. Participant's performance scores, fNIRS-based neural activity, and functional connectivity between the prefrontal cortex (PFC) and motor regions were obtained for the training and retrieval phases.

RESULTS

The performance scores indicate that the rate of learning was slower in the stress group compared to the control group, but both groups performed similarly during each retrieval condition. Compared to the control group, the stress group exhibited suppressed PFC activation. However, they showed stronger connectivity within the PFC regions during the training and between PFC and motor regions during the retrieval phases.

DISCUSSION

While stress impaired performance during training, adoption of stress-adaptive neural strategies (i.e., stronger brain connectivity) were associated with comparable performance between the stress and the control groups during the retrieval phase.

COVID-19 Vaccine Refusal and Medical Distrust Held by Correctional Officers

This study explores COVID-19 vaccine acceptance among prison security staff and the extent to which they trust varied sources of information about the vaccines. Cross-sectional survey data were obtained from a state-wide sample of corrections officers (COs, hereafter; n = 1208) in February 2021. Group differences, disaggregated by demographic characteristics, were examined using F-tests and t-tests. Despite the comparatively limited risk of contracting the virus, non-security staff reported they would accept a COVID-19 vaccine at no cost (74%), compared to their more vulnerable CO counterparts (49%). We observed vaccine refusal correlations between COs' reported gender, age, and length of time working as a CO, but none with their self-reported race. Vaccine refusal was more prevalent among womxn officers, younger officers, and those who had spent less time working as prison security staff. Our findings also suggest that the only trusted source of information about vaccines were family members and only for officers who would refuse the vaccine; the quality of trust placed in those sources, however, was not substantially positive and did not vary greatly across CO racial groups. By highlighting characteristics of the observed gaps in COVID-19 vaccine acceptance between COs and their non-security staff coworkers, as well as between corrections officers of varied demographic backgrounds, these findings can inform the development of responsive and accepted occupational health policies for communities both inside and intrinsically linked to prisons.

An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015-2017

INTRODUCTION

First responders, including law enforcement officers (LEOs), firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, face unique occupational stressors and may be at elevated risk for suicide. This study characterized suicides among first responders and identifies potential opportunities for additional data collection.

METHODS

Using suicides identified from the three most recent years of National Violent Death Reporting System data with industry and occupation codes from the NIOSH Industry and Occupation Computerized Coding System (2015-2017), decedents were categorized as first responders or non-first responders based on usual occupation. Chi-square tests were used to evaluate differences in sociodemographic and suicide circumstances between first and non-first responders.

RESULTS

First responder decedents made up 1% of all suicides. Over half of first responders (58%) were LEOs, 21% were firefighters, 18% were EMS clinicians, and 2% were public safety telecommunicators. Compared to non-first responder decedents, more first responders served in the military (23% vs. 11%) and used a firearm as the method of injury (69% vs. 44%). Among first responder decedents for whom circumstances were known, intimate partner problems, job problems, and physical health problems were most frequent. Some common risk factors for suicide (history of suicidal thoughts, previous suicide attempt, alcohol/substance abuse problem) were significantly lower among first responders. Selected sociodemographics and characteristics were compared across first responder occupations. Compared to firefighters and EMS clinicians, LEO decedents had slightly lower percentages of depressed mood, mental health problems, history of suicidal thoughts, and history of suicide attempts.

CONCLUSIONS

While this analysis provides a small glimpse into some of these stressors, more detailed research may help inform future suicide prevention efforts and interventions.

PRACTICAL APPLICATION

Understanding stressors and their relation to suicide and suicidal behaviors can facilitate suicide prevention among this critical workforce.

Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based Emergency Medical Services Responders: A Tale of Two Samples (The RAPID Study I)

OBJECTIVE

This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes.

METHODS

Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department-specific and pooled scores were calculated. Linear regression was used to model trends.

RESULTS

We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression.

CONCLUSIONS

Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.

Physical and psychological challenges faced by military, medical and public safety personnel relief workers supporting natural disaster operations: a systematic review

Natural disasters, including floods, earthquakes, and hurricanes, result in devastating consequences at the individual and community levels. To date, much of the research reflecting the consequences of natural disasters focuses heavily on victims, with little attention paid to the personnel responding to such disasters. We conducted a systematic review of the challenges faced by military, medical and public safety personnel supporting natural disaster relief operations. Specifically, we report on the current evidence reflecting challenges faced, as well as positive outcomes experienced by military, medical and public safety personnel following deployment to natural disasters. The review included 382 studies. A large proportion of the studies documented experiences of medical workers, followed by volunteers from humanitarian organizations and military personnel. The most frequently reported challenges across the studies were structural (i.e., interactions with the infrastructure or structural institutions), followed by resource limitations, psychological, physical, and social challenges. Over 60% of the articles reviewed documented positive or transformative outcomes following engagement in relief work (e.g., the provision of additional resources, support, and training), as well as self-growth and fulfillment. The current results emphasize the importance of pre-deployment training to better prepare relief workers to manage expected challenges, as well as post-deployment supportive services to mitigate adverse outcomes and support relief workers’ well-being.

Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

BACKGROUND

Public safety personnel experience various mental health conditions due to their work's complex and demanding nature. There are barriers to seeking support and treatment; hence, providing innovative and cost-effective interventions can help improve mental health symptoms in public safety personnel.

OBJECTIVE

The study aimed to evaluate the impact of Text4PTSI on depression, anxiety, trauma, and stress-related symptoms, and the resilience of public safety personnel after six months of providing supportive text message intervention.

METHODS

Public safety personnel subscribed to Text4PTSI and received daily supportive and psychoeducational SMS text messages for six months. Participants were invited to complete standardized self-rated web-based questionnaires to assess depression, anxiety, posttraumatic stress disorder (PTSD), and resilience symptoms measured on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale (GAD-7), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the Brief Resilience Scale (BRS), respectively. The assessment of mental health conditions was conducted at baseline (enrolment) and six weeks, three months, and six months after enrollment.

RESULTS

One hundred and thirty-one subscribers participated in the Text4PTSI program, and eighteen completed both the baseline and any follow-up survey. A total of 31 participants completed the baseline survey and 107 total surveys were recorded at all follow-up time points. The baseline prevalence of psychological problems among public safety personnel were as follows: likely major depressive disorder (MDD) was 47.1%, likely generalized anxiety disorder (GAD) was 37.5%, low resilience was 22.2%, and likely PTSD was 13.3%. At six months post-intervention, the prevalence of likely MDD, likely GAD, and likely PTSD among respondents reduced; however, a statistically significant reduction was reported only for likely MDD (-35.3%, X² (1) = 2.55, p = 0.03). There was no significant change in the prevalence of low resilience between baseline and post-intervention. There was a decrease in the mean scores on the PHQ-9, GAD-7, PCL-C, and the BRS from baseline to post-intervention by 25.8%, 24.7%, 9.5%, and 0.3%, respectively. However, the decrease was only statistically significant for the mean change in GAD-7 scores with a low effect size (t (15) = 2.73, p = 0.02).

CONCLUSIONS

The results of this study suggest a significant reduction in the prevalence of likely MDD as well as the severity of anxiety symptoms from baseline to post-intervention for subscribers of the Text4PTSI program. Text4PTSI is a cost-effective, convenient, and easily scalable program that can augment other services for managing the mental health burdens of public safety personnel.

The roles of risk perception, negative emotions and perceived efficacy in the association between COVID-19 infection cues and preventive behaviors: a moderated mediation model

Preventive behaviors during the COVID-19 pandemic are especially critical to the protection of individuals whose family members or acquaintances have been infected. However, limited research has explored the influence of infection cues on preventive behaviors. This study proposed an interaction model of environment-cognitive/affective-behavior to elucidate the mechanism by which infection cues influence preventive behaviors and the roles of risk perception, negative emotions, and perceived efficacy in that influence. To explore the relationships among these factors, we conducted a cross-sectional online survey in 34 provinces in China during the first wave of the COVID-19 pandemic. A total of 26,511 participants responded to the survey, and 20,205 valid responses (76.2%) were obtained for further analysis. The moderated mediation results show that infection cues positively predicted preventive behaviors in a manner mediated by risk perception and negative emotions. Moreover, perceived efficacy moderated the influence of infection cues not only on preventive behaviors but also on risk perception and negative emotions. The higher the perceived efficacy, the stronger these influences were. These findings validated our model, which elucidates the mechanisms underlying the promoting effect of infection cues on preventive behaviors during the initial stage of the COVID-19 pandemic. The implications of these results for the COVID-19 pandemic and beyond are discussed.

Exceeding the Ordinary: A Framework for Examining Teams Across the Extremeness Continuum and Its Impact on Future Research

Work teams increasingly face unprecedented challenges in volatile, uncertain, complex, and often ambiguous environments. In response, team researchers have begun to focus more on teams whose work revolves around mitigating risks in these dynamic environments. Some highly insightful contributions to team research and organizational studies have originated from investigating teams that face unconventional or extreme events. Despite this increased attention to extreme teams, however, a comprehensive theoretical framework is missing. We introduce such a framework that envisions team extremeness as a continuous, multidimensional variable consisting of environmental extremeness (i.e., external team context) and task extremeness (i.e., internal team context). The proposed framework allows every team to be placed on the team extremeness continuum, bridging the gap between literature on extreme and more traditional teams. Furthermore, we present six propositions addressing how team extremeness may interact with team processes, emergent states, and outcomes using core variables for team effectiveness and the well-established input–mediator–output–input model to structure our theorizing. Finally, we outline some potential directions for future research by elaborating on temporal considerations (i.e., patterns and trajectories), measurement approaches, and consideration of multilevel relationships involving team extremeness. We hope that our theoretical framework and theorizing can create a path forward, stimulating future research within the organizational team literature to further examine the impact of team extremeness on team dynamics and effectiveness.

Turning to 'Trusted Others': A Narrative Review of Providing Social Support to First Responders

First responders, such as paramedics and firefighters, encounter duty-related traumatic exposures, which can lead to post-traumatic stress (PTS). Although social support protects against PTS, we know little about how first responders' families, spouses/partners, friends, and care-partners (i.e., 'trusted others') provide social support. This narrative review explores support behaviors, coping strategies, and resources trusted others use to support first responders. A structured literature search yielded 24 articles. We used House's (1981) conceptual framework to inform our analysis. We identified three main themes: providing support, finding support, and support needs. Additionally, we describe trusted others' self-reported preparedness, coping strategies, and barriers to providing social support. We found that trusted others provided different types of support: (a) emotional (fostering a safe space, giving autonomy over recovery, facilitating coping mechanisms, prioritizing first responders' emotional needs); (b) instrumental (prioritizing first responders' practical needs, handling household tasks, supporting recovery); (c) appraisal (active monitoring, verbal reassurance, positive reframing), and (d) informational (seeking informal learning). In their role, trusted others sought formal (organizational) and informal (peer and personal) support and resources, alongside intrapersonal and interpersonal coping strategies. Identified barriers include inadequate communication skills, maladaptive coping, and disempowering beliefs. Thus, we offer practical, treatment, and social support recommendations.

Pre-COVID-19 Physician Awareness of Mental Health Resources During and After Natural and Human-Made Disasters

OBJECTIVE

Physician mental health is critical during the recovery of natural and human-made disasters (NHDs), yet the accessibility of mental health resources to physicians has not been characterized. This study examined emergency medicine and trauma physician knowledge of and access to mental health resources in NHD settings.

METHODS

The survey was electronically disseminated to the American College of Emergency Physicians and the American Association of the Surgery of Trauma between February 4, 2020, and March 9, 2020. The 17-question survey assessed physician awareness and access to emergency preparedness resources at their institutions.

RESULTS

Of the responders, 86% (n = 229) were aware of written emergency response plans for their facility. While 31% were aware of the hospital's mental health policies and resources outside of the emergency response plan, only 25% knew how to access these resources during and after NHDs. Finally, 10% reported the incorporation of mental health resources during institutional practice drills.

CONCLUSIONS

Physicians reported knowledge of emergency preparedness policies; however, significant gaps remain in physician knowledge and access to mental health resources NHD settings. As NHDs increase on a global scale, it is critical for health systems to ensure accessible infrastructure to support the mental well-being of health professionals.

Surviving the storm: A pragmatic non-randomised examination of a brief intervention for disaster-affected health and social care providers

Disasters affect the well-being of individuals, families and communities. Health and social care providers are essential in response and recovery efforts and are among the most vulnerable to negative physical and mental health impacts of a disaster. Few evidence-based interventions are available to address the psychological needs of providers. The aim of this study was to examine the psychological distress of health and social care providers before and after participating in the brief group intervention, Resilience and Coping for the Healthcare Community (RCHC) and its expanded version, RCHC+. We conducted a pragmatic non-randomised cluster trial with 762 health and social care providers in south Texas and Puerto Rico post-Hurricanes Harvey and Maria. Participants completed surveys assessing post-traumatic stress (PTSD), anxiety, burnout and secondary traumatic stress (STS) prior to intervention delivery and at two time points post-intervention. We calculated the frequency of symptom cut-off scores at baseline, then estimated multilevel ordinal models to examine changes in symptoms across time. Prior to participation in the RCHC (approximately 12 months after the hurricanes), providers reported high levels of PTSD, anxiety and STS symptoms. After participation, providers in both intervention conditions reported a significant reduction in PTSD symptoms from baseline that was sustained over both time points. The likelihood of a reduction in symptoms of anxiety and STS from baseline was sustained at both time points for participants in the RCHC+ condition. These findings indicate that both the RCHC and RCHC+ interventions may reduce psychological distress for health and social care providers and could be an important part of advance planning to support provider's mental health during and after a disaster. Further examination of the RCHC in other disaster contexts could provide additional insight into the responsiveness of the intervention to reducing psychological distress symptoms.

Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis

Background

Shift work and irregular work schedules among first responders have been associated with physical and psychological problems such as sleep disorders. We conducted the first meta-analysis to explore and estimate the prevalence of sleep disorders among first responders for medical emergencies.

Methods

We searched four databases: Web of Science, Psych Info, CINAHL, and PubMed. The Generalized Linear Mixed model (GLMM) was used to estimate the prevalence estimates of sleep disorders in R software and the DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis was used to explore associated comorbidities for OSA and insomnia, presented as odds ratios (ORs) and confidence intervals (CIs). The Cochran's Q, τ², and the statistics were used to assess heterogeneity and the moderator analysis was conducted to identify moderator variables.

Results

Twenty-eight studies with 100 080 first responders were included from the total of 1119 studies retrieved from the databases. The prevalence rates for sleep disorders were 31% (95% CI = 15%-53%) for shift work disorder (SWD), 30% (95% CI = 18%-46%) for obstructive sleep apnea (OSA), 28% (95% CI = 19%-39%) for insomnia, 28% (95% CI = 24%-33%) for excessive daytime sleepiness (EDS), 2% (95% CI = 1%-4%) for restless leg syndrome, and 1% (95% CI = 0%-5%) for narcolepsy. Anxiety (OR = 2.46; 95% CI = 1.99%-3.03%), cardiovascular disease (CVD) (OR = 2.03; 95% CI = 1.43-2.88), diabetes mellitus (DM) (OR = 1.93; 95% CI = 1.41-2.65), depression (OR = 1.89; 95% CI = 1.01-3.56), gastroesophageal reflux disease (GERD) (OR = 1.83; 95% CI = 150-2.22), and post-traumatic stress disorder (PTSD) (OR = 1.78; 95% CI = 1.33-2.39) were associated with OSA. Depression (OR = 9.74; 95% CI = 4.67-20.3), anxiety (OR = 9.22; 95% CI = 3.81-22.3), and PTSD (OR = 7.13; 95% CI = 6.27-8.10) were associated with insomnia. Age, gender, first responders, continent, study quality, study design, and assessment tool were significant moderator variables for OSA, insomnia, and EDS.

Conclusions

This meta-analysis found a substantially high prevalence of sleep disorders including SWD, OSA, insomnia, and EDS among first responders for medical emergencies. Early assessment and management of sleep disorders among first responders is necessary to promote good, quality sleep to help prevent anxiety, depression, CVD, DM, GERD, and PTSD.

Stratified changes in emotional distress during the COVID-19 pandemic: Evidence from a longitudinal survey of residents in Hubei province, China

BACKGROUND

The COVID-19 pandemic has had a significant impact on individuals' emotional wellbeing and mental health. However, little research has examined emotional resilience during the pandemic. This study investigated the changes in emotional distress among residents in Hubei, the epicenter of the pandemic in China during the early stage of the pandemic, and we examined the sociodemographic differences in their emotional recovery.

METHODS

We undertook a two-wave panel survey of 3816 residents aged ≥18 in Hubei, China. The baseline survey was conducted during early February 2020, the peak of the outbreak. The follow-up survey was carried out when the pandemic was mainly under control. The data enabled us to investigate the within-person changes in COVID-19-related negative emotions. Mixed-effect regression models with a random effect for participants were used to accommodate repeated measures.

RESULTS

Respondents reported high levels of emotional distress at the peak of the pandemic and experienced a decline in emotional distress when the pandemic was under control. Moreover, respondents aged 35-49, with a college education or above, were employed, and having better self-rated health experienced a more substantial decrease in negative emotions during the COVID-19 pandemic.

CONCLUSION

This study identified vulnerable populations who may experience prolonged emotional distress during the COVID-19 pandemic in China. The results suggest that respondents who aged over 50, with no college education, were not employed, and with worse self-rated health were less resilient during the COVID-19 pandemic in China.

The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis

Background

First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders.

Methods

Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress.

Results

15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 –- 0.39), depression (SDM = -0.63; 95% CI = -0.94 –-0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 –-0.05) but not stress (SDM = -0.13; 95% CI = -0.51–0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies.

Conclusions

Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.

Psychological Distress in Healthcare Workers During the Covid-19 Pandemic: Development and Validation of the Italian Version of the Healthcare Workers Emergency Distress Questionnaire (HEDQ)

Objective

The COVID-19 pandemic has presented unprecedented challenges for health systems as it has proven to be an extraordinary emergency. Exposure to such chronic stress can have detrimental effects on the psychophysical well-being of healthcare workers, with possible manifestation of stress-related symptoms. The present study aimed to develop and validate the Healthcare Workers Emergency Distress Questionnaire (HEDQ), a self-report screening questionnaire with the purpose of identifying the healthcare workers at risk for psychological and moral distress, and PTSD-related symptoms during emergencies.

Method

The HEDQ was administered to 250 healthcare workers of the AULSS 3 Serenissima and 47 citizens from the general population in Venice (Italy) during the health emergency period (from April to June 2020). In the second administration (from August to September 2020), data were collected from 101 of the 250 healthcare workers who had participated in the first administration. To test for the convergent validity, the Depression Anxiety Stress Scale (DASS-21) was also administered.

Results

Exploratory and hierarchical confirmatory factor analyses validated the 21-item structure of the questionnaire. Internal consistency, and factorial and convergent validity were good. Moreover, the HEDQ discriminated between those who worked in COVID-19 hospital units and those who did not (including the general population), showing good known-group validity. The two-month temporal stability of the questionnaire was excellent. The HEDQ scale scores significantly decreased from the first to the second administration, thus supporting that the tool is a measure of acute stress in healthcare workers.

Conclusions

Our results provide support for the use of the HEDQ as a brief, multidimensional measure of emergency-related stress reactions in healthcare workers. Consequently, the HEDQ can be considered a useful instrument supporting clinical activity to identify those who may be more easily affected by stress reactions in the event of atypically high levels of risk exposure during crises.

The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications

Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.

Addressing Operational Challenges Faced by COVID-19 Public Health Rapid Response Teams in Non-United States Settings

The coronavirus disease 2019 (COVID-19) global response underscores the need for a multidisciplinary approach that integrates and coordinates various public health systems-surveillance, laboratory, and health-care systems/networks, among others-as part of a larger emergency response system. Multidisciplinary public health rapid response teams (RRTs) are one mechanism used within a larger COVID-19 outbreak response strategy. As COVID-19 RRTs are deployed, countries are facing operational challenges in optimizing their RRT's impact, while ensuring the safety of their RRT responders. From March to May 2020, United States Centers for Disease Control and Prevention received requests from 12 countries for technical assistance related to COVID-19 RRTs and emergency operations support. Challenges included: (1) an insufficient number of RRT responders available for COVID-19 deployments; (2) limited capacity to monitor RRT responders' health, safety, and resiliency; (3) difficulty converting critical in-person RRT operational processes to remote information technology platforms; and (4) stigmatization of RRT responders hindering COVID-19 interventions. Although geographically and socioeconomically diverse, these 12 countries experienced similar RRT operational challenges, indicating potential applicability to other countries. As the response has highlighted the critical need for immediate and effective implementation measures, addressing these challenges is essential to ensuring an impactful and sustainable COVID-19 response strategy globally.

Responding to Repeated Disasters: Time to Recovery in Public Health Workers

OBJECTIVE

In times of repeated disaster events, including natural disasters and pandemics, public health workers must recover rapidly to respond to subsequent events. Understanding predictors of time to recovery and developing predictive models of time to recovery can aid planning and management.

METHODS

We examined 681 public health workers (21-72 y, M(standard deviation [SD]) = 48.25(10.15); 79% female) 1 mo before (T1) and 9 mo after (T2) the 2005 hurricane season. Demographics, trauma history, social support, time to recover from previous hurricane season, and predisaster work productivity were assessed at T1. T2 assessed previous disaster work, initial emotional response, and personal hurricane injury/damage. The primary outcome was time to recover from the most recent hurricane event.

RESULTS

Multivariate analyses found that less support (T1; odds ratio [OR] = .74[95% confidence interval [CI] = .60-.92]), longer previous recovery time (T1; OR = 5.22[95%CI = 3.01-9.08]), lower predisaster work productivity (T1; OR = 1.98[95%CI = 1.08-3.61]), disaster-related personal injury/damage (T2; OR = 3.08[95%CI = 1.70-5.58]), and initial emotional response (T2; OR = 1.71[95%CI = 1.34-2.19]) were associated with longer recovery time (T2).

CONCLUSIONS

Recovery time was adversely affected in disaster responders with a history of longer recovery time, personal injury/damage, lower work productivity following prior hurricanes, and initial emotional response, whereas responders with social support had shorter recovery time. Predictors of recovery time should be a focus for disaster preparedness planners.

Investigating Strategies of Emotion Regulation As Mediators of Occupational Stressors and Mental Health Outcomes in First Responders

The aim of this study was to investigate whether two emotion regulation strategies, expressive suppression or cognitive reappraisal, mediated the development of posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) in first responders (FR) who experienced occupational stressors, using cross-sectional data. An aggregate of 895 first responders (M = 37.32, SD = 12.09, 59.2% male, 91.3% Caucasian) who were recruited through professional organizations and social media sites across North and South American states participated in an online Qualtrics survey. Bivariate correlation analyses demonstrated that occupational stressors were positively correlated with expressive suppression and each mental health outcome but were not significantly correlated with cognitive reappraisal. Mediation analyses demonstrated expressive suppression as a significant mediator between occupational stressors and PTSD, MD, and GAD symptoms, but not cognitive reappraisal. Even though these findings are in purview of a cross-sectional research design, they suggest the importance of practices that bolster first responders’ ability to use more effective and adaptive emotion regulation strategies such as emotion expression, effective communication, and cognitive reappraisal that might help enhance psychological resilience.

Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review

BACKGROUND

Terrorist attacks have strong psychological effects on rescue workers, and there is a demand for effective and targeted interventions.

AIMS

The present systematic review aims to examine the mental health outcomes of exposed emergency service personnel over time, and to identify risk and resilience factors.

METHOD

A literature search was carried out on PubMed and PubPsych until 27 August 2021. Only studies with a real reported incident were included. The evaluation of the study quality was based on the Quality Assessment Tool for Quantitative Studies, and the synthesis used the 'Guidance on the Conduct of Narrative Synthesis in Systematic Reviews'.

RESULTS

Thirty-three articles including 159 621 individuals were identified, relating to five different incidents with a post-event time frame ranging from 2 weeks to 13 years. The post-traumatic stress disorder prevalence rates were between 1.3 and 16.5%, major depression rates were between 1.3 and 25.8%, and rates for specific anxiety disorders were between 0.7 and 14%. The highest prevalence rates were found after the World Trade Center attacks. Reported risk factors were gender, no emergency service training, peritraumatic dissociation, spatial proximity to the event and social isolation.

CONCLUSIONS

The inconsistency of the prevalence rates may be attributable to the different severities of the incidents. Identified risk factors could be used to optimise training for emergency personnel before and after catastrophic events. Voluntary repetitive screening of rescue workers for mental health symptoms is recommended.

Disaster Nursing Competency of Intensive Care Nurses in Jinan, China: A Multicenter Cross-Sectional Study

BACKGROUND

Patients in disaster areas require the most urgent assistance. In recent large-scale natural disasters, intensive care nurses have served as an important reserve component of disaster response teams. In disaster nursing, ability and attitude directly affect the quality and effectiveness of disaster rescues. However, few studies have examined the disaster nursing competency of intensive care nurses in China.

PURPOSE

This study was designed to describe the current status of disaster nursing competency among intensive care nurses, analyze the related factors affecting the disaster response effectiveness, and evaluate the values of disaster nursing continuing education and training in cultivating professional personnel with disaster emergency rescue competence.

METHODS

This cross-sectional study was conducted at six tertiary general government hospitals in Jinan, Shandong Province, China. A convenience sampling method was adopted, and the Wenjuanxing website was used to compile the network questionnaire, which participants completed via a WeChat group. Descriptive, correlation, and regression analyses were performed using SPSS software.

RESULTS

The participants in this study included 285 registered intensive care nurses employed at six hospitals in Jinan. Most were female (77.9%), and the mean age was 29.9 years. The mean total disaster nursing ability score was 122.98 (SD = 31.70), and the average scores for each item ranged from 2.78 to 3.70. The incident command system item earned the highest mean score (3.70, SD = 1.22), followed by triage (3.24, SD = 0.93). The biological preparedness item earned the lowest mean score (2.78, SD = 1.04). Being male, being < 30 years old, having an understanding of disaster nursing, having previously participated in disaster emergency simulation drills or training, and having a higher self-evaluation of rescue competence were all associated with higher disaster-nursing knowledge scores. Multiple linear regression analyses indicated that understanding of disaster nursing and experience participating in disaster emergency rescue drills or training had the most significant influence on the disaster nursing emergency knowledge score, followed by positive self-evaluation of disaster nursing ability and demand for training.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings of this study indicate that the participants had a moderate disaster-nursing competency and that this competency may be improved through disaster-related continuing education and training. The cognitive attitude of disaster nursing was found to correlate positively with self-efficacy. Simulated emergency drills may effectively improve the disaster nursing competency of critical care nurses. The findings emphasize that experiences other than direct clinical practice such as specialized simulated emergency drills and training as well as willingness for such training are stronger factors for identifying and developing overall disaster nursing competency.

Coping with oil spills: oil exposure and anxiety among residents of Gulf Coast states after the Deepwater Horizon Oil Spill

In April 2010, a fatal explosion on the Deepwater Horizon drilling rig in the Gulf of Mexico resulted in the largest marine oil spill in history. This research describes the association of oil exposure with anxiety after the Deepwater Horizon Oil Spill and evaluates effect modification by self-mastery, emotional support and cleanup participation. To assess the impacts of the Deepwater Horizon Oil Spill, the Centers for Disease Control and Prevention (CDC) conducted the Gulf States Population Survey (GSPS), a random-digit-dial telephone cross-sectional survey completed between December 2010 and December 2011 with 38,361 responses in four different Gulf Coast states: Louisiana, Florida, Alabama and Mississippi. Anxiety severity was measured using the Generalised Anxiety Disorder (GAD) symptom inventory. We used Tobit regression to model underlying anxiety as a function of oil exposure and hypothesised effect modifiers, adjusting for socio-demographics. Latent anxiety was higher among those with direct contact with oil than among those who did not have direct contact with oil in confounder-adjusted models [β = 2.84, 95% confidence interval (CI): 0.78, 4.91]. Among individuals with direct contact with oil, there was no significant interaction between participating in cleanup activities and emotional support for anxiety (p = 0.20). However, among those with direct contact with oil, in confounder-adjusted models, participation in oil spill cleanup activities was associated with lower latent anxiety (β = -3.55, 95% CI: -6.15, -0.95). Oil contact was associated with greater anxiety, but this association appeared to be mitigated by cleanup participation.

COVID-19 vs. terrorism: Contribution of the COR theory to the process of coping with invisible threats

Two years have passed since the outbreak of the COVID-19 pandemic. The entire world is still struggling with the virus and its mutations, and governments have been imposing various restrictions, including social distancing and quarantine. This paper leans on the Conservation of Resources (COR) theoretical model in comparing the impact of COVID-19 with that of an ongoing threat of terror attacks, allowing us to understand the similarities and differences between them. Such exploration could result in an understanding that may guide devising psycho-social interventions to minimize the negative psychological consequences of a continuous life-threatening situation. By applying the extensive available literature on the aftermath of terrorist attacks to the little-known long-run consequences of the COVID-19 pandemic, this paper comes up with several guidelines such as increasing online social support and enhancing adaptive coping with stress, that are applicable on the individual, community, and societal levels.

Burnout and Psychological Vulnerability in First Responders: Monitoring Depersonalization and Phobic Anxiety during the COVID-19 Pandemic

Background: It is common knowledge that first responders are among the helping professionals most at risk of burnout and psychological vulnerability. During the COVID-19 pandemic, their mental health has been subjected to various risk factors. Methods: Data on socio-demographic characteristics, the Maslach Burnout Inventory (MBI) and psychological vulnerability (SCL-90-R) were obtained from 228 subjects (55.3% female; M age = 45.23, SD = 13.14) grouped on the basis of their actual involvement during the emergency phases (82% First Responders and 18% Second Responders). Results: First responders exceeded the MBI clinical cut-off, while SRs did not (χ² ≥ 0.5); specifically, EE = 89.8%, DP = 85.8%, and PA = 82.1%. The FR group showed a higher mean in the global severity index (GSI = 49.37) than did the SRs (=43.95), and the FR group exceeded the clinical cut-off in the SCL-90-R scales of SOM (51.06), ANX (52.40), and PHOB (53.60), while the SF group did so only for the PHOB scale (50.41). The MBI dimensions correlated significantly (p = 0.05) with all investigated clinical scales of the SCL-90-R. Conclusions: Emergency situations expose first responders to specific risk factors related to work performance and relational aspects, which contribute to increased psychological vulnerability and burnout.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice

Introduction: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. Objective: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. Methods: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. Results: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. Conclusion: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

The role of anthropometrics in predicting the maximum oxygen consumption in emergency medicine students

BACKGROUND

Maximum oxygen consumption (VO2 max) is an important measure of cardiovascular capacity to deliver oxygen to the working muscle at maximal exercise. Anthropometrics is one of the factors that contribute to the maximum oxygen consumption.

OBJECTIVE

This study aimed to predict the maximum oxygen consumption based on anthropometrics in the emergency medicine students.

METHODS

This cross-sectional study was conducted on the emergency medicine students (n = 56) at Qazvin University of Medical Sciences. Before the data collection, participants completed the consent form and Physical Activity Readiness Questionnaire (PAR-Q). Then, the maximum oxygen consumption and anthropometrics (dimensions and compositions) were measured using Gerkin treadmill test and using tape, anthropometer device and digital caliper respectively. Data were analyzed using Pearson correlation, one-way analysis of variance and multivariate linear regression.

RESULTS

The mean of maximum oxygen consumption was 4.11 lit/min in the emergency medicine students. There was a significant relationship between maximum oxygen consumption and anthropometrics (body dimensions and compositions including body fat, waist to hip circumference, and BMI) (p <  0.05). Also, the leg length, the body fat, and the BMI predicted 72% of oxygen consumption. The leg length and BMI had an important role in predicting the maximum oxygen consumption.

CONCLUSIONS

The body dimensions and compositions should be taken into consideration to select students and match their capabilities with required energy for the job.

A Methodological Framework to Capture Neuromuscular Fatigue Mechanisms Under Stress

Neuromuscular fatigue is exacerbated under stress and is characterized by shorter endurance time, greater perceived effort, lower force steadiness, and higher electromyographic activity. However, the underlying mechanisms of fatigue under stress are not well-understood. This review investigated existing methods of identifying central mechanisms of neuromuscular fatigue and the potential mechanisms of the influence of stress on neuromuscular fatigue. We found that the influence of stress on the activity of the prefrontal cortex, which are also involved in exercise regulation, may contribute to exacerbated fatigue under stress. We also found that the traditional methods involve the synchronized use of transcranial magnetic stimulation, peripheral nerve stimulation, and electromyography to identify the contribution of supraspinal fatigue, through measures such as voluntary activation, motor evoked potential, and silent period. However, these popular techniques are unable to provide information about neural alterations upstream of the descending drive that may contribute to supraspinal fatigue development. To address this gap, we propose that functional brain imaging techniques, which provide insights on activation and information flow between brain regions, need to be combined with the traditional measures of measuring central fatigue to fully understand the mechanisms behind the influence of stress on fatigue.

A Qualitative Study of the COVID-19 Response Experiences of Public Health Workers in the United States

The mental health impacts of the COVID-19 pandemic on frontline, patient-facing healthcare staff have been described in several studies, but the effects of the COVID-19 response on the US public health workforce have not been well characterized. In early 2021, we conducted interviews with a subset of public health practitioners in the United States who participated in a cross-sectional survey and indicated their willingness to participate in a follow-up interview. An interview guide was developed to collect information about professional roles since the start of the pandemic, aspects of the individual COVID-19 response that impacted mental health, and aspects of the organizational/institutional COVID-19 response that impacted mental health, as well as the strengths and weaknesses of, opportunities for, and threats to public health professionals and organizations going forward. Interviews were transcribed and inductively coded to identify themes. Of the 48 people invited to participate, 24 completed an interview between January 28 and February 23, 2021. Five key themes were identified through inductive coding of interview transcripts: (1) teamwork and workplace camaraderie, (2) potential for growth in the field of public health, (3) considerations for adaptive work environments (eg, remote work, work out of jurisdiction, transition to telework), (4) politicization of response, and (5) constrained hiring capacity and burnout. After more than a year of public health emergency response to the COVID-19 pandemic, it is critically important to understand the detrimental and supportive factors of good mental health among the public health workforce.

Strategies for Implementing a One Welfare Framework into Emergency Management

Simple Summary

During emergencies, people’s decision-making and actions are strongly influenced by their relationship with their animals. In emergency management, a holistic approach is needed which recognises the important interrelationships between animal welfare, human well-being, and the physical and social environment. It is also vital to break down barriers of collaboration between individuals, organisations, and the community. One Welfare, a concept with human–animal-environment interdependencies at its core, provides a framework to achieve this. Successful implementation of a transformative change will require positive strategies to deal with challenges and to ensure that animals are truly integrated into emergency management, not just included as an aside.

Abstract

Responding to emergencies requires many different individuals and organisations to work well together under extraordinary circumstances. Unfortunately, the management of animal welfare in emergencies remains largely disconnected from emergency management overall. This is due predominately to professional silos and a failure to understand the importance of human–animal-environment (h-a-e) interdependencies. One Welfare (OW) is a concept with these interrelationships at its core. This paper argues that by adopting an OW framework it will be possible to achieve a transdisciplinary approach to emergency management in which all stakeholders acknowledge the importance of the h-a-e interdependencies and work to implement a framework to support this. Acknowledging that such a transformational change will not be easy, this paper proposes several strategies to overcome the challenges and optimise the outcomes for animal welfare emergency management (AWEM). These include legislation and policy changes including h-a-e interface interactions as business as usual, improving knowledge through interprofessional education and training, incorporating One Welfare champions, and recognising the role of animals as vital conduits into communities.

The Occupational Health Effects of Responding to a Natural Gas Pipeline Explosion Among Emergency First Responders - Lincoln County, Kentucky, 2019

OBJECTIVE

The aim of the study was to assess occupational health effects 1 month after responding to a natural gas pipeline explosion.

METHODS

First responders to a pipeline explosion in Kentucky were interviewed about pre- and post-response health symptoms, post-response health care, and physical exertion and personal protective equipment (PPE) use during the response. Logistic regression was used to examine associations between several risk factors and development of post-response symptoms.

RESULTS

Among 173 first responders involved, 105 (firefighters [58%], emergency medical services [19%], law enforcement [10%], and others [12%]) were interviewed. Half (53%) reported at least 1 new or worsening symptom, including upper respiratory symptoms (39%), headache (18%), eye irritation (17%), and lower respiratory symptoms (16%). The majority (79%) of symptomatic responders did not seek post-response care. Compared with light-exertion responders, hard-exertion responders (48%) had significantly greater odds of upper respiratory symptoms (aOR: 2.99, 95% CI: 1.25-7.50). Forty-four percent of responders and 77% of non-firefighter responders reported not using any PPE.

CONCLUSIONS

Upper respiratory symptoms were common among first responders of a natural gas pipeline explosion and associated with hard-exertion activity. Emergency managers should ensure responders are trained in, equipped with, and properly use PPE during these incidents and encourage responders to seek post-response health care when needed.

The Impact of Natural Disasters on Suicide in the United States, 2003–2015

Abstract. Background: Natural disasters are increasing in frequency and severity and impacted populations develop mental health conditions at higher rates than those not impacted. Aims: In this study, we investigate the association between exposure to a major natural disaster and suicide in the US. Method: Using county-level data on disaster declarations, mortality files, and population data, suicide rates were estimated for three 12-month periods before and after the disaster. Pooled rates were estimated predisaster and compared with postdisaster suicide rates using Poisson-generated Z tests and 95% confidence intervals. Results: A total of 281 major disasters were included. The suicide rate increased for each type of disaster and across all disasters in the first 2 years of follow-up. The largest overall increases in suicide rates were seen 2 years postdisaster. Limitations: Limitations include the ecologic study design, county-level exposure, and low power. Conclusion: Increases in county-level suicide rates after disasters were not statistically significant, although there was evidence that increases were delayed until 2 years postdisaster. Additional studies are needed to improve understanding of nonfatal suicide attempts after disasters and the role elevated social support plays in suicide prevention postdisaster. Future studies should consider pre-existing mental health, secondary stressors, and proximity to hazards.

Development and Preliminary Italian Validation of the Emergency Response and Psychological Adjustment Scale

Evaluating the personal adaptation response to the emergency situations is very important for the prevention of mental distress, for the activation of network and community synergies and for the planning and implementation of appropriate psycho-social interventions. So far there are no short tools for the overall assessment of cognitive, emotional and behavioral responses of psychological adaptation to the emergency in the psychometric panorama. The Emergency Response and Psychological Adjustment Scale (ERPAS) was administered to a sample of 1,088 participants, while the concurrent validity was tested through a second administration to 600 participants along with the GSE (Generalized Self-Efficacy Scale) and the BDI-II (Beck Depression Inventory-II). Confirmatory factor analysis bore out a five-factor solution (including 18 items) with good fit indices of adaptation to data, χ²/df = 1.440, RMSEA = 0.028, RMSEA 90% CI = 0.018–0.038, GFI = 0.996, AGFI = 0.959, CFI = 0.982, and NFI = 0.944. Evidence of convergent validity was provided by the significant correlations with variables such as cognitive and somatic depression, and perceived general self-efficacy. The analyses also showed a strong invariance across gender. The ERPAS tool prefigures application during the assessment in multiple emergency contexts (e.g. earthquakes, floods, pandemics, terrorist attacks, war events, major accidents, major fires). This validation study of the ERPAS has shown that this version is a reliable and valid measurement for assessing people's modes of personal response (cognitive, emotional, behavioral) in emergency contexts.

Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters

Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74–0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.

Mental health consequences during alerting situations and recovering to a new normal of coronavirus epidemic in 2019: a cross-sectional study based on the affected population

BACKGROUND

As a major virus outbreak in the twenty-first century, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented hazards to mental health globally.

METHODS

We performed a cross-sectional study based on the results of an online survey. The survey was conducted 1 month after the outbreak (February 18-29, 2020) and repeated at the time of resuming activity (April 8-14, 2020). The 15-item Death Anxiety Scale (T-DAS) was used to assess the degree of death anxiety, and the Chinese version of PTSD checklist-civilian version (PCL-C), for PTSD symptom clusters. Through convenient sampling, a total of 7678 cases were collected.

RESULTS

Our findings showed that even after the lockdown was lifted, the prevalence of the symptoms of post-traumatic stress disorder (PTSD) and death anxiety remained significantly high in the general population affected by the outbreak. Regression model analysis showed that PTSD was significantly associated with age > 50 years, contact history/living community, poor health status of participants, past traumatic experience (PTE), and medical occupation. Moreover, death anxiety mediated the relationship between life-threatening PTE and PTSD, indicating that reducing death anxiety could buffer the negative effects of PTE on PTSD.

CONCLUSIONS

Despite the lifting of the lockdown, long-term adverse psychological effects remain in the affected general population. The management of mental health after major public health events is important, and high-risk groups such as the elderly and healthcare workers should receive targeted interventions. In addition, the study suggests that methods for alleviating death anxiety must be included in plans to manage the psychological impact of public health emergencies.

The psychology of climate anxiety

This paper focuses on climate anxiety and its role in the psychology of climate change, compared with responses to the COVID-19 global pandemic. Four psychological hypotheses for why we do not act on climate change will be reviewed, and the role of anxiety for each, as well as potential solutions. Different types of climate anxiety both inside and outside the clinic will be explored, along with associated defence mechanisms and treatment.

Posttraumatic stress disorder and professional burnout among local government staff seven years after the Wenchuan earthquake in China: A longitudinal study

Although local government staff are crucial in post-quake reconstruction, their long-term psychological and professional consequences remain unclear. This longitudinal study investigated changes of posttraumatic stress disorder (PTSD) and professional burnout over seven years, and their underlying relationship. The study assessed 250 staff at one year (T_1y) after the earthquake, and 162 (64.8 %) were followed up at seven years (T_7y). PTSD and professional burnout were assessed with the Short Screening Scale for DSM-IV PTSD and the burnout subscale of Professional Quality of Life Scale (ProQOL), respectively, at both time points. Longitudinal changes in PTSD and burnout were examined and cross-lagged panel analyses were conducted to test the relationship between PTSD and burnout. The rates of positive cases of PTSD screening were 23.2 % at T_1y and 11.1 % at T_7y. The percentages of moderate burnout were 61.7 % at T_1y and 23.5 % at T_7y. Scores of PTSD (z = -5.70, p < 0.001) and burnout (t = 10.07, p < 0.001) from T_1y to T_7y decreased. The cross-lagged analysis indicated that burnout at T_1y predicted PTSD at T_7y (β = 0.19, p = 0.025). In conclusion, the Wenchuan earthquake has long-lasting negative effects on local government staff, although they can recover over time. Interventions to reduce professional burnout after disaster may does be beneficial to decrease the risk of PTSD in the long run.