Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study

Impact of Natural Disasters on Mental Health: Evidence and Implications

Natural disasters are large-scale catastrophic events, and they are increasing in frequency and severity. Converging evidence indicates that the mental health consequences of disasters are extensive and are often associated with trauma and the disruption of personal and socioeconomic factors in people's lives. Although most individuals experiencing disaster-related traumatic events do not develop mental illnesses, some experience adverse psychological effects of disasters. These mental health effects begin immediately following a disaster and may persist for extended periods. In this article, we summarize the literature findings to provide a narrative review that focuses on the mental health consequences of natural disasters. An overview of the disaster mental health research field is provided, and the findings are ordered into theoretical frameworks. Then, the development and course of psychopathology regarding disaster aftermath are described in a methodological context. Next, understanding a disaster as an event of transition is highlighted, and the impact of this disaster-specific transition is discussed. Lastly, a potential relationship between the transitional impact of a disaster and mental health consequences is speculated on, and the implications are discussed. The impact of disasters on mental health can be direct or indirect, short-term or long-term, and to some extent depends on the recovery process of the affected community. Also, we propose the possible merits of using the Transitional Impact Scale in the context of disaster mental health research by assessing the features of disaster-related transition and its effects on mental health. We conclude by suggesting a direction for future research in terms of measuring the disaster mental health effects in community settings (affected vs. non-affected) and also considering cross-cultural and cross-regional differences. In recent decades, a large amount of knowledge has been gathered from disaster mental health research, but, still, more research is needed to resolve some irregular findings through refining the methodological variations.

Longitudinal patterns of natural hazard exposures and anxiety and depression symptoms among young adults in four low- and middle-income countries

We estimated the effect of community-level natural hazard exposure during prior developmental stages on later anxiety and depression symptoms among young adults and potential differences stratified by gender. We analyzed longitudinal data (2002-2020) on 5585 young adults between 19 and 26 years in Ethiopia, India, Peru, and Vietnam. A binary question identified community-level exposure, and psychometrically validated scales measured recent anxiety and depression symptoms. Young adults with three exposure histories ("time point 1," "time point 2," and "both time points") were contrasted with their unexposed peers. We applied a longitudinal targeted minimum loss-based estimator with an ensemble of machine learning algorithms for estimation. Young adults living in exposed communities did not exhibit substantially different anxiety or depression symptoms from their unexposed peers, except for young women in Ethiopia who exhibited less anxiety symptoms (average causal effect [ACE] estimate = - 8.86 [95% CI: - 17.04, - 0.68] anxiety score). In this study, singular and repeated natural hazard exposures generally were not associated with later anxiety and depression symptoms. Further examination is needed to understand how distal natural hazard exposures affect lifelong mental health, which aspects of natural hazards are most salient, how disaster relief may modify symptoms, and gendered, age-specific, and contextual differences.

Beyond disasters: Long-run effect of earthquakes on energy poverty in China

While earthquakes are considered one of the most prevalent natural disasters in China, there is limited empirical evidence regarding the long-term effects of earthquakes on energy poverty. Using data from China Family Panel Studies and China's historical earthquake catalog, this study investigates the long-term effects of earthquake intensity on energy poverty among households in China, and analyzes the long-term effects over different time spans. Our findings indicate that, higher earthquake intensities have an overall worsening long-term impact on energy poverty. When segmented into different time spans, households in regions with higher earthquake intensities are less likely to fall into energy poverty over the past 20 years and the past 20 to 50 years, whereas more likely to be energy poor over the longer time span. Moreover, we uncover that public infrastructure, government assistance, and mental well-being serve as channels through which earthquakes affect household energy poverty, with divergent effects over different time spans. In addition, we observe nonlinear evidence of earthquake intensity's long-term impact on energy poverty, and the long-term impacts are heterogeneous across different regions, as well as households with different registration statuses and household fuel types. These insights can inform policy interventions aimed at alleviating long-term energy poverty in areas affected by natural disasters.

Neuropsychological Consequences of Massive Trauma: Implications and Clinical Interventions

Traumatic events, especially massive trauma resulting from catastrophic incidents, wars, or severe abuse can elicit significant neuropsychological alterations, with profound implications for cognitive, emotional, and behavioral functioning. This mini-review delineates the primary neural changes post-trauma and underscores the importance of timely neuropsychological and clinical interventions. Specific brain regions, including the amygdala and prefrontal cortex, undergo physiological changes that can lead to memory impairments, attention deficits, and emotional disturbances. PTSD, a commonly diagnosed condition post-trauma, exemplifies the intricate relationship between trauma and memory processing. Furthermore, the concept of neuroplasticity, the brain's inherent ability to adapt and rewire, offers hope for recovery. Current clinical interventions, such as cognitive behavioral therapy, mindfulness practices, and biofeedback, leverage this neuroplastic potential to foster healing. The review underscores the vital importance of early intervention to mitigate long-term neuropsychological impacts, emphasizing the role of timely and targeted clinical interventions. The synthesis of this knowledge is crucial for clinicians, allowing for informed therapeutic approaches that holistically address both the physiological and psychological dimensions of trauma.

Sleep Disturbances and Delayed Sleep Timing are Associated with Greater Post-Traumatic Stress Symptoms in Youth Following Hurricane Harvey

Sleep patterns following a natural disaster are associated with mental health difficulties, but research in youth samples has been limited to subjective reports of sleep. Participants (N = 68, 8-17 years old) completed an assessment 6-9 months after Hurricane Harvey, which included subjective measures of sleep, chronotype, hurricane-related post-traumatic stress symptoms, and one week of actigraphy. Prior to the hurricane, parents provided reports on emotional symptoms. Controlling for age, sex, socioeconomic status, participation time, and pre-hurricane emotional symptoms, subjective sleep disturbances and an eveningness chronotype were associated with greater post-traumatic stress, with the strongest effects observed for re-experiencing, negative cognitions/mood, and arousal/reactivity symptoms. Later sleep timing as measured by actigraphy was associated with greater arousal/reactivity symptoms and shorter sleep duration was associated with greater avoidance symptoms. As extreme weather-related events are expected to become more frequent and severe, these findings contribute to models of youth risk and resilience.

Worry About COVID-19 and Other Extreme Events Amongst Educators in Australia

The significant disruption of COVID-19 on schooling has heightened concerns about its impact on educators' wellbeing. The current study examined how educators' worry regarding the COVID-19 pandemic compared to their worry about other extreme events, such as natural disasters and critical incidents (a death or suicide of a child, young person, or colleague). Educators report that they were most worried about COVID-19. Educators working in preschools were more worried about COVID-19 and natural disasters than those in primary and secondary schools. However, worry regarding critical incidents increased with the age of students taught. Worry was influenced by socio-economic advantage (SEIFA), whereby educators working in higher SEIFA communities were less worried about natural disasters and critical incidents but shared similar levels of worry about COVID-19 as educators in lower SEIFA communities. With a better understanding about how different types of worry and levels of worry vary across different educator groups and different contexts, more effective supports can be developed and offered.

The impact of climate change on atopic dermatitis and mental health comorbidities: a review of the literature and examination of intersectionality

Climate change, fueled by increasing concentrations of greenhouse gases, is associated with rising temperatures, extreme weather events, increased aeroallergen production, and air pollution. Our understanding that many inflammatory cutaneous diseases carry important mental health comorbidities is expanding. Simultaneously, the detrimental impacts of climate change on human health are now widely recognized as a global public health crisis. Importantly, these climate-associated phenomena exacerbate the environmental triggers of atopic dermatitis (AD) and are also associated with amplification of comorbid mental health conditions in AD including depression, anxiety, trauma-related disorders, and psychotic spectrum disorders. This review is the first to examine the nexus of climate change, atopic dermatitis, and mental health comorbidities and emphasizes the disproportionate impacts of climate change in vulnerable and marginalized populations.

Long-term impacts of non-occupational wildfire exposure on human health: A systematic review

The intensity and frequency of wildfires is increasing globally. The systematic review of the current evidence on long-term impacts of non-occupational wildfire exposure on human health has not been performed yet. To provide a systematic review and identify potential knowledge gaps in the current evidence of long-term impacts of non-occupational exposure to wildfire smoke and/or wildfire impacts on human health. We conducted a systematic search of the literature via MEDLINE, Embase and Scopus from the database inception to July 05, 2022. References from the included studies and relevant reviews were also considered. The Newcastle-Ottawa Scale (NOS) and a validated quality assessment framework were used to evaluate the quality of observational studies. Study results were synthesized descriptively. A total of 36 studies were included in our systematic review. Most studies were from developed countries (11 in Australia, 9 in Canada, 7 in the United States). Studies predominantly focused on mental health (21 studies, 58.33%), while evidence on long-term impacts of wildfire exposure on health outcomes other than mental health is limited. Current evidence indicated that long-term impacts of non-occupational wildfire exposure were associated with mortality (COVID-19 mortality, cardiovascular disease mortality and acute myocardial disease mortality), morbidity (mainly respiratory diseases), mental health disorders (mainly posttraumatic stress disorder), shorter height of children, reduced lung function and poorer general health status. However, no significant associations were observed for long-term impacts of wildfire exposure on child mortality and respiratory hospitalizations. The population-based high-quality evidence with quantitative analysis on this topic is still limited. Future well-designed studies considering extensive wildfire smoke air pollutants (e.g., particulate matter, ozone, nitrogen oxides) and estimating risk coefficient values for extensive health outcomes (e.g., mortality, morbidity) are warranted to fill current knowledge gaps.

The long-term impacts of the Canterbury earthquakes on the mental health of the Christchurch Health and Development Study cohort

OBJECTIVE

Long-term studies following disasters are rare. It is important to quantify long-term effects of disasters to determine impacts on populations over time. We therefore aim to report the long-term associations between exposure to the Canterbury earthquakes and common mental disorders, taking into account potential confounding factors.

METHODS

The Christchurch Health and Development Study is a 40-year longitudinal study of a birth cohort of New Zealand children (635 males and 630 females). The Christchurch Health and Development Study includes 884 participants with data on earthquake exposure and mental health outcomes at ages 34 and 40 years. Rates of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) disorders were measured categorically and using an expanded definition that included sub-syndromal symptoms. The current impact of the earthquakes is reported using 12-month prevalence data 7 years after the earthquakes. The cumulative impact of the earthquakes over the 7 years since onset is also reported.

RESULTS

There was a linear trend towards increasing rates of disorder with increasing exposure to the earthquakes. After adjusting for covariates, the 12-month prevalence of anxiety disorder symptoms was significantly increased (p = 0.003). The earthquakes were also associated with cumulative increases in symptoms of post-traumatic stress disorder (p < 0.001), anxiety disorder (p = 0.016), nicotine dependence (p = 0.012), and the total number of disorders (p = 0.039).

CONCLUSION

The Canterbury earthquakes were associated with persistent increases in Anxiety Disorder symptoms 7 years after their onset. The earthquakes were also associated with cumulative increases in symptoms of common psychiatric disorders. The magnitude of these effects is small, may no longer be clinically significant and has decreased over time.

Long term mental health trajectories after disasters and pandemics: A multilingual systematic review of prevalence, risk and protective factors

The patterns of long-term psychological response after disasters and pandemics remain unclear. We aimed to determine the trajectories for post-traumatic stress symptoms (PTSS), depression and anxiety prevalence following disasters and pandemic exposure; and identify associated risk and protective factors. A systematic review of the English, Chinese, and Japanese longitudinal mental health literature was conducted. We searched Cochrane, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and CINAHL (English), CNKI and SINOMED (Chinese) and CiNii (Japanese) for studies published between January 2000 and May 2022. Following a pre-specified protocol (PROSPERO: CRD42020206424), conditional linear growth curve models and ANOVA analyses were conducted. The search identified 77,891 papers, with a final sample of 234: 206 English, 24 Chinese, and 4 Japanese-language papers. PTSS rates improved for all ages (p = .018, eta² = 0.035). In contrast, depression and anxiety prevalence remained elevated for years following exposure (p = .424, eta² = 0.019 and p = .051, eta² = 0.064, respectively), with significantly higher rates for children and adolescents (p < .005, eta² > 0.056). Earthquakes and pandemics were associated with higher prevalence of PTSS (p < .019, eta² > 0.019). Multi-level risk and protective factors were identified. The chronicity of mental health outcomes highlights a critical need for tailored, sustainable mental health services, particularly for children and adolescents, in disaster- and pandemic-affected settings.

The Effects of Maternal Disaster Exposure on Adolescent Mental Health 12 Years Later

Natural disasters adversely impact children's mental health, with increased parent or child exposure and subsequent parental distress predicting poorer outcomes. It remains unknown, however, whether the psychological consequences of disasters for children persist long-term, and if so, why and for whom. We therefore examined the effects of mothers' exposure to Hurricane Katrina on adolescent children's mental health 12 years later, distinguishing between direct effects of disaster exposure and effects mediated by maternal distress, and evaluating moderation by child age and gender. Data were from a 2003-2018 study of young, low-income, primarily African American mothers living in New Orleans when Hurricane Katrina occurred in 2005 (n = 328). Mothers rated their mental health about one year pre-Katrina and one, four, and 12 years afterwards. They reported on an adolescent child's (ages 10-17, mean = 14.46) internalizing and externalizing symptoms 12 years post-Katrina using the Strengths and Difficulties Questionnaire. Path analytic models adjusting for mothers' pre-disaster distress showed that, whereas the direct effects of maternal hurricane exposures on child mental health were not significant, the indirect effects were. Specifically, mothers who experienced more Katrina-related stressors had higher distress thereafter, which predicted poorer child outcomes. Results did not differ significantly by child age. Gender differences are discussed. Findings suggest that disasters can affect child mental health for many years, even for those who were very young or not yet born at the time, due to parents' disaster-related distress. Addressing parents' mental health needs in the aftermath of disasters may improve child well-being long-term.

Post-Traumatic Stress Disorder, Major Depressive Disorder, and Wildfires: A Fifth-Year Postdisaster Evaluation among Residents of Fort McMurray

Background: Over 90,000 residents had to be evacuated from Fort McMurray (FMM), Alberta, Canada due to the wildfire that engulfed the city in May 2016. Overall, about 2400 homes or 10% of the housing stock in Fort McMurray were destroyed. The fire consumed about 200,000 hectors of forest, reaching into Saskatchewan. During major disasters, communities’ infrastructure is disrupted, and psychological, economic, and environmental effects are felt for years afterwards. Objective: Five years after the wildfire disaster, this study assessed the prevalence rate of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) in Fort McMurray residents and determined the demographic, clinical, and other risk factors of probable MDD and PTSD. Methodology: A quantitative cross-sectional survey was conducted to collect data through an online questionnaire administered via REDCap between 24 April and 2 June 2021. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of MDD symptoms in respondents. The PTSD Checklist for DSM-5 (PCL-C) was used to assess likely PTSD in respondents. Descriptive, univariate, and multivariate regression analyses were employed. Results: 186 out of 249 individuals who accessed the survey link completed it (74.7% response rate). The median age of the subscribers was 42. The sample included a majority of 159 (85.5%) females; 98 (52.7%) > 40 years of age; 175 (94.1%) employed; and 132 (71%) in a relationship. The overall prevalence of MDD symptoms in our study sample was 45.0% (76). Four variables independently predicted MDD symptoms in the multivariate logistic regression model, including: unemployed (OR = 12.39; 95% CI: 1.21−126.37), have received a mental diagnosis of MDD (OR = 4.50; 95% CI: 1.57−12.92), taking sedative-hypnotics (OR = 5.27; 95% CI: 1.01−27.39), and willingness to receive mental health counseling (OR = 4.90; 95% CI: 1.95−12.31). The prevalence of likely PTSD among our respondents was 39.6% (65). Three independent variables: received a mental health depression diagnosis from a health professional (OR = 4.49; 95% CI: 1.40−14.44), would like to receive mental health counseling (OR = 4.36, 95% CI: 1.54−12.34), and have only limited or no support from family (OR = 11.01, 95% CI: 1.92−63.20) contributed significantly to the model for predicting likely PTSD among respondents while controlling the other factors in the regression model. Conclusions: According to this study, unemployment, taking sleeping pills, having a prior depression diagnosis, and the willingness to receive mental health counseling significantly increase the odds of having MDD and PTSD following wildfires. Family support may protect against the development of these conditions.

The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study

There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012. Additionally, an adapted CES-D-16 scale was used to assess depressive symptoms in 2012. A fitted multi-nominal logistic regression model identified predictors of different trajectories of depression. For the whole group, the rate of clinical depression dropped from 51.5% in 1991 to 31.7% in 2012. Earthquake intensity and experiencing strong fear at baseline were strongly associated with chronic (depressed at both assessments, 18.1%) and recovered (depressed only in 1991, 33.5%) depression trajectories compared with the healthy group, with odds ratios (OR) over 4.0 and 3.0, respectively. Predictors distinguishing chronic depression included earthquake-related nuclear-family deaths (OR=3.79), chronic illnesses at baseline (OR=1.24), and social support (OR=0.91). Predictors of the late-onset trajectory (depressed only in 2012, 13.5% of the cohort) included post-earthquake trauma (OR=1.42), socioeconomic status (OR=0.45), and social support (OR=0.86). The factors associated with the different trajectories of depression provide guidance for planning more effective mental health interventions after disasters.

Mental health effects of the Gangwon wildfires

Background

The April 2019 wildfires in Gangwon Province, South Korea forced the evacuation of 1500 individuals and cost more than $100 million in damages, making it the worst wildfire disaster in Korean history. The purpose of this paper was to investigate the mental health effects on survivors following the wildfires.

Methods

Between April and May 2019, outreach psychological support services were delivered to people impacted by the wildfires. Post-disaster psychological responses using a checklist and the Clinical Global Impression Scale-Severity (CGI-S) were evaluated for 206 wildfires survivors. The CGI-S was administered consequently at 1, 3, and 6 months after baseline measurement.

Results

Among four response categories, somatic responses (76.2%) were most frequently observed among the wildfire survivors. Specifically, insomnia (59.2%), anxiety (50%), chest tightness (34%), grief (33%), flashbacks (33%), and depression (32.5%) were reported by over 30% of the participants. The mean CGI-S scores were significantly decreased at 1 month (mean score = 1.94; SE = 0.09) compared to baseline (mean score = 2.94; SE = 0.08) and remained at the decreased level until 6 months (mean score = 1.66; SE = 0.11). However, participants with flashbacks showed significantly higher CGI-S scores compared to those without flashback at 6 months.

Conclusions

Wildfire survivors have various post-disaster responses, especially somatic responses. While most participants’ mental health improved over time, a few of them may have experienced prolonged psychological distress after 6 months. Flashbacks were particularly associated with continuing distress. These results suggest that the characteristics of responses should be considered in early phase intervention and in follow-up plans for disaster survivors.

One Year after the Flood: Prevalence and Correlates of Post-Traumatic Stress Disorder among Residents in Fort McMurray

Background: The 2020 Fort McMurray (FMM) and area flood caused more than $228 million in insured damage, affected over 1200 structures, and more than 13,000 people were evacuated. Objective: This study sought to determine the prevalence of post-traumatic stress disorder (PTSD)-like symptoms and the risk predictors among the population of FMM one year after the 2020 flooding. Methods: An online quantitative cross-sectional survey was distributed to residents of FMM via REDCap between 24 April to 2 June 2021 to collect sociodemographic, clinical, and flood-related information. The PTSD checklist for DSM-5 (PCL-C) was used to assess likely PTSD among respondents. Results: 186 of 249 respondents completed all essential self-assessment questionnaires in the analysis, yielding a response rate of 74.7%. The prevalence of likely PTSD was 39.6% (65). Respondents with a history of depression were more likely to develop PTSD symptoms (OR = 5.71; 95% CI: 1.68–19.36). Similarly, responders with limited and no family support after the disaster were more prone to report PTSD symptoms ((OR = 2.87; 95% CI: 1.02–8.05) and (OR = 2.87; 95% CI: 1.06–7.74), respectively). Conclusions: Our research indicated that history of depression and the need for mental health counseling significantly increased the risk of developing PTSD symptoms following flooding; family support is protective. Further studies are needed to explore the relations between the need to receive counseling and presenting with likely PTSD symptoms.

Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study

Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.

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

BACKGROUND

The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems.

OBJECTIVE

This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires.

METHOD

A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis.

RESULTS

We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact.

CONCLUSIONS

As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues.

HIGHLIGHTS

First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.

The Impact of Wildfires on Mental Health: A Scoping Review

One of the many consequences of climate change is an increase in the frequency, severity, and, thus, impact of wildfires across the globe. The destruction and loss of one's home, belongings, and surrounding community, and the threat to personal safety and the safety of loved ones can have significant consequences on survivors' mental health, which persist for years after. The objective of this scoping review was to identify primary studies examining the impact of wildfires on mental health and to summarize findings for PTSD, depression, anxiety, and substance use. Literature searches on Pubmed and Embase were conducted in February and April of 2021, respectively, with no date restrictions. A total of 254 studies were found in the two database searches, with 60 studies meeting the inclusion criteria. Three other studies were identified and included based on relevant in-text citations during data abstraction. The results show an increased rate of PTSD, depression, and generalized anxiety at several times of follow-up post-wildfire, from the subacute phase, to years after. An increased rate of mental health disorders post-wildfire has been found in both the adult and pediatric population, with a number of associated risk factors, the most significant being characteristics of the wildfire trauma itself. Several new terms have arisen in the literature secondary to an increased awareness and understanding of the impact of natural disasters on mental health, including ecological grief, solastalgia, and eco-anxiety. There are a number of patient factors and systemic changes that have been identified post-wildfire that can contribute to resilience and recovery.

The dynamic course of psychological outcomes following the Victorian Black Saturday bushfires

OBJECTIVES

To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster.

METHOD

The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1; 3-4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems.

RESULTS

Relative to their status 3-4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months.

CONCLUSION

Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.

The influence of natural disasters on violence, mental health, food insecurity, and stunting in the Philippines: Findings from a nationally representative cohort

Background

Climate change is leading to an increased number of natural disasters. Children from low- and middle-income countries are disproportionately affected. The impacts of exposure to multiple natural disasters on the development of children are not well understood. The Philippines had 6.5 million people affected by natural disasters in 2018 and is therefore an ideal country in which to study the cumulative effects of natural disasters on human development.

Methods

We used wave 1 (2016–17) of the Longitudinal Cohort Study on the Filipino Child, a nationally representative cohort study of 4952 10-year-old children, to examine the impact of natural disasters. For caregivers, we examined mental health, family violence, and food insecurity. For children, we examined exposure to violence and stunting. We used random effects models to estimate the associations between natural disasters and children's development outcomes and caregivers' outcomes, after adjusting for neighbourhood, demographic, and geographic variables. Disaster exposure was measured using caregiver-reported measures of cumulative exposure and cumulative impact of disasters, average neighbourhood reports and data linked from the International Disaster Database (EM-DAT), an independent measure of community exposure to disaster.

Findings

We found that experiencing natural disasters, as measured by neighbourhood reports, was associated with higher levels of family violence in the previous 12 months, parenting stress, children witnessing physical violence, physical abuse of children, stunting in children, and greater food insecurity. Associations with individual self-reported exposure showed was similar. Associations with natural disasters measured using EM-DAT data showed a similar pattern: exposure to greater numbers of natural disasters was associated with higher levels of family violence, physical abuse of children, stunting in children, and food insecurity. Impacts of disasters was associated with higher levels of family violence, depression and food insecurity.

Interpretation

This is the first national study to document that cumulative measures of natural disasters had small, but wide-ranging, impacts on children and their caregivers. Further research is needed to identify factors that will protect populations who are at risk of high levels of natural disasters to ensure the optimal development of children.

Funding

The Philippines Project, The Australian National University.

•

The implications of multiple natural disasters for child development are not well understood.

•

First national study on the impact of multiple natural disasters on children.

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More natural disasters associated with child physical abuse and family violence.

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Exposure to a greater number of natural disasters associated with stunting and food insecurity.

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More natural disasters led to worse caregivers' depression and stress.

25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression

BACKGROUND

There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors.

METHODS

At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate-severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D).

RESULTS

(1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1-22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses.

CONCLUSION

Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.

Psychological outcomes for young adults after disastrous events: A mixed-methods scoping review

RATIONALE

Young adulthood (18 to 34) is a time of transitional change where individuals can be highly susceptible to mental health concerns. Despite similar vulnerabilities to their adolescent counterparts, the psychological outcomes for young adults following disasters are not well understood.

OBJECTIVE

This scoping review aimed to explore the literature on the psychological outcomes for young adults after disaster events.

METHODS

A systematic search of the literature was conducted in seven electronic databases, including PsycINFO, Medline, CINAHL, PILOTS, EMBASE, Scopus, and ProQuest dissertations and theses global. In total, 91 reports from 15 countries were included.

RESULTS

Findings suggested that young adults experience a range of psychological consequences after disasters, including posttraumatic stress symptoms, depression, anxiety, and other psychological outcomes, such as general/non-specific psychological distress. Pre-disaster, peri-disaster, and post-disaster factors were also found to influence the degree of psychological outcomes experienced by young adults, including prior psychological functioning and disaster exposure, among a host of other factors.

CONCLUSION

Future research is recommended to better understand young adults' psychological outcomes, experiences, and service needs following disasters.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia.

STUDY DESIGN

Rapid review of articles published between January 2000 and May 2020.

DATA SOURCES

We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries.

DATA SYNTHESIS

Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding.

CONCLUSION

Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries.

STUDY DESIGN

We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references.

DATA SOURCES

We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence.

DATA SYNTHESIS

Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle.

CONCLUSION

There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia.

STUDY DESIGN

Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews.

DATA SOURCES

We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria.

DATA SYNTHESIS

Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma.

CONCLUSION

We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities.

STUDY DESIGN

Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km² .

DATA SOURCES

We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway.

DATA SYNTHESIS

We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3).

CONCLUSION

Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce.

STUDY DESIGN

We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool.

DATA SOURCES

We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites.

DATA SYNTHESIS

During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool.

CONCLUSION

We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings.

STUDY DESIGN

Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards.

DATA SOURCES

English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar.

DATA SYNTHESIS

Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation.

CONCLUSION

Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Mental Health Symptoms Unexpectedly Increased in Students Aged 11-19 Years During the 3.5 Years After the 2016 Fort McMurray Wildfire: Findings From 9,376 Survey Responses

In Fort McMurray, Alberta, Canada, the wildfire of May 2016 forced the population of 88,000 to rapidly evacuate in a traumatic and chaotic manner. Ten percentage of the homes in the city were destroyed, and many more structures were damaged. Since youth are particularly vulnerable to negative effects of natural disasters, we examined possible long-term psychological impacts. To assess this, we partnered with Fort McMurray Public and Catholic Schools, who surveyed Grade 7-12 students (aged 11-19) in November 2017, 2018, and 2019-i.e., at 1.5, 2.5, and 3.5 years after the wildfire. The survey included validated measurement scales for post-traumatic stress disorder (PTSD), depression, anxiety, drug use, alcohol use, tobacco use, quality of life, self-esteem, and resilience. Data analysis was done on large-scale anonymous surveys including 3,070 samples in 2017; 3,265 samples in 2018; and 3,041 samples in 2019. The results were unexpected and showed that all mental health symptoms increased from 2017 to 2019, with the exception of tobacco use. Consistent with this pattern, self-esteem and quality of life scores decreased. Resilience scores did not change significantly. Thus, mental health measures worsened, in contrast to our initial hypothesis that they would improve over time. Of note, we observed higher levels of mental health distress among older students, in females compared to male students, and in individuals with a minority gender identity, including transgender and gender-non-conforming individuals. These findings demonstrate that deleterious mental health effects can persist in youth for years following a wildfire disaster. This highlights the need for multi-year mental health support programs for youth in post-disaster situations. The indication that multi-year, post-disaster support is warranted is relatively novel, although not unknown. There is a need to systematically investigate factors associated with youth recovery following a wildfire disaster, as well as efficacy of psychosocial strategies during later phases of disaster recovery relative to early post-disaster interventions.

Longitudinal Trends and Risk Factors for Depressed Mood Among Canadian Adults During the First Wave of COVID-19

Background: The COVID-19 pandemic has raised serious concerns about the mental health impact of people directed and indirectly affected by the virus. Because this is a rapidly evolving situation, our goal was to explore potential risk factors and trends in feelings of anxiety and depression among the general population in Canada over the first 5 months of the pandemic. Methods: We completed on-line surveys of 3,127 unique individuals representative of the Canadian general population at 4 discreet periods every 6 weeks from April 15th to July 28th 2020. We assessed feelings of anxiety, depression and loss of interest with the interRAI self-reported mood scale using a multivariable generalized estimating equation model to examine factors associated with having a 5+ score on the scale (indicating potentially depressed mood). We also investigated potential longitudinal trends to examine temporal variation in mood scores. Results: More than 30% of participants felt highly anxious, depressed, and disinterested in everyday activities in the first survey (April), but this number decreased to about 20% over 4 months. Feeling lonely, younger age, feeling overwhelmed by one's health needs, having financial concerns, and living outside of Québec were significantly associated with depressed mood. Interpretation: The prevalence of depressed mood during the pandemic was between 2 and 3 times the pre-pandemic rate (especially among young people), but it can change rapidly in response to social changes. Thus, monitoring of psychological distress among vulnerable groups that may benefit from additional supports should be a priority.

Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study

Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9-14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.

Twelve years later: The long-term mental health consequences of Hurricane Katrina

In August 2005, Hurricane Katrina caused unprecedented damage, widespread population displacement, and exposed Gulf Coast residents to traumatic events. The hurricane's adverse impact on survivors' mental health was apparent shortly after the storm and persisted, but no study has examined the long-term effects now that more than a decade has transpired. Using new data from a panel study of low-income mothers interviewed once before Hurricane Katrina and now three times after, we document changes in mental health, and estimate the sociodemographic and hurricane-related factors associated with long-term trajectories of mental health. We find that post-traumatic stress symptoms (PTSS) declined at each of the three post-Katrina follow-ups, but 12 years after the hurricane, one in six still had symptoms indicative of probable post-traumatic stress disorder. The rate of non-specific psychological distress (PD) remained consistently higher in all three follow-ups, compared to the pre-disaster period. In full covariate-adjusted models, no sociodemographic variables predicted long-run combinations of PTSS and PD. However, 12 years later, exposure to hurricane-related traumatic events and pre-disaster PD significantly predicted co-occurring PTSS and PD. Hurricane-related housing damage predicted PTSS in earlier follow-ups, but no longer predicted PTSS in the long-term. Furthermore, hurricane-related traumatic events significantly differentiated the risk of having persistent PTSS, relative to recovering from PTSS. The results suggest that there is still a non-negligible group of survivors with continued need for recovery resources and that exposure to traumatic events is a primary predictor of adverse mental health more than a decade post-disaster.

Associations Among Childhood Trauma, Childhood Mental Disorders, and Past-Year Posttraumatic Stress Disorder in Military and Civilian Men

To identify early life factors associated with posttraumatic stress disorder (PTSD), we investigated the association between childhood trauma and mental disorders with International Classification of Diseases (ICD)-diagnosed past-year PTSD in employed military and civilian men. Data were derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (N = 1,356) and the 2007 Australian Bureau of Statistics (ABS) National Survey of Mental Health and Wellbeing Study (N = 2,120) and analyzed using logistic regression and generalized structural equation modeling. After controlling for demographics, PTSD was associated with childhood anxiety, adjusted odds ratio (AOR) = 3.94, 95% CI [2.36, 6.58]; and depression, AOR = 7.01, 95% CI [2.98, 16.49], but not alcohol use disorders, in the ADF. In civilians, PTSD was associated with childhood anxiety only, AOR = 7.06, 95% CI [3.50, 14.22]. These associations remained significant after controlling for childhood and adult trauma in both populations and service factors and deployment, combat, or adult trauma in the ADF. In both populations, PTSD was associated with more than three types of childhood trauma: AOR = 2.97, 95% CI [1.53, 5.75] for ADF and AOR = 5.92, 95% CI [3.00, 11.70] for ABS; and childhood interpersonal, but not noninterpersonal, trauma: AOR = 3.08, 95% CI [1.61, 5.90] for ADF and AOR = 6.63, 95% CI [2.74, 16.06] for ABS. The association between childhood trauma and PTSD was fully mediated by childhood disorder in the ADF only. Taking a lifetime perspective, we have identified that the risk of PTSD from childhood trauma and disorder is potentially predictable and, therefore, modifiable.

Association Between Earthquake Exposures and Mental Health Outcomes in Phulpingdanda Village After the 2015 Nepal Earthquakes

In 2015, two strong earthquakes, as well as continuous, high magnitude aftershocks, struck Nepal. Phulpingdanda village was greatly impacted due to its lack of infrastructure and environmental remoteness. Adults from sampled households were surveyed 1-year later to examine the association between earthquake exposures and indicators of depression, post-traumatic stress disorder (PTSD), and resilience. Results showed 33% of surveyed residents screened positive for depression, 9% screened positive for severe PTSD, and 46% displayed moderate to high resilience. Additionally, participants experienced resource loss (100%), damaged home and goods (99%), and exposure to the grotesque (82%). Traumatic earthquake experiences related to personal harm were associated with symptoms of depression and PTSD and resource loss was associated with depressive symptoms. Earthquake experiences associated with less damage to home and goods, but greater exposure to the grotesque were associated with increased resilience. This research adds to our knowledge of the relationship between traumatic exposures and indicators of psychological distress and resilience following a disaster.

Associations of childhood trauma and childhood mental disorder with past-year mental disorder in military and civilian employed men

Childhood factors are pivotal to understanding mental health over the lifespan. However, there is a dearth of research exploring childhood trauma and childhood disorder simultaneously in determining adult mental disorder. We aimed to analyze childhood trauma and childhood disorder in determining past-year disorder in military and civilian employed men aged 18-60 years. Data derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study, and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing were analysed using logistic regression and Generalised Structural Equation Modelling (GSEM). All major findings were consistent across both populations. The association between childhood disorder and past-year disorder remained after controlling for demographics, childhood and adult trauma (and service factors in the ADF). Childhood non-interpersonal trauma was not associated with past-year disorder in either population. The pathway between childhood trauma and past-year disorder was fully mediated by the spectrum of common childhood disorders, but not by childhood anxiety, depression or alcohol use disorders alone. Identification, intervention and prevention of childhood disorders is imperative. Investment in interventions targeting the influence of childhood traumatic events on the whole spectrum of childhood disorder, not only PTSD or anxiety, is a priority.

Association between earthquake experience and depression 37 years after the Tangshan earthquake: a cross-sectional study

OBJECTIVE

To investigate the association between the Tangshan earthquake and depression after 37 years.

DESIGN AND SETTING

A cross-sectional study conducted in Tangshan from 2013 to 2014.

PARTICIPANTS

The sample included 5024 participants born before 28 July 1976 the date of the Tangshan earthquake, with available data on their earthquake experiences and depression 37 years post-earthquake.

OUTCOMES AND VARIABLES

The outcome was depression measured using the Center for Epidemiological Study and Depression Scale. The independent variable was earthquake experience, which was classified into three groups: no earthquake experience, earthquake experience without bereavement and earthquake experience with bereavement. Multivariable logistic regression analysis was used to evaluate the association between earthquake experience and depression after adjusting for gender, age at the time of the earthquake, smoking status, drinking status, education, income, residence in Tangshan 1 to 2 years post-earthquake, hypertension, diabetes and dyslipidaemia.

RESULTS

Of the 5024 participants, 641 experienced the Tangshan earthquake, and 98 experienced bereavement due to the earthquake. 37 years after the earthquake, survivors who had lost relatives during the earthquake were nearly three times (OR 2.82, 95% CI 1.24 to 6.39) as likely to have depression as those who had not experienced the earthquake, while those who had not lost relatives were 1.69 times as likely (OR 1.69, 95% CI 0.93 to 3.08). Stratified analyses showed that earthquake was significantly associated with depression in women with (OR 3.51, 95% CI 1.21 to 10.16) or without bereavement (OR 3.07, 95% CI 1.44 to 6.56) but not in men; this association was also significant in individuals over 18 years old at the time of the earthquake with (OR 13.16, 95% CI 3.08 to 56.3) or without bereavement (OR 3.39, 95% CI 1.31 to 8.87) but not in individuals less than 18 years old.

CONCLUSIONS

37 years after the Tangshan earthquake, earthquake experience was associated with depression among bereaved survivors, women and individuals over 18 years old at the time of the earthquake.

Mental health and media links based on five essential elements to promote psychosocial support for victims: the case of the earthquake in Chile in 2010

This paper reviews the role of news with respect to the mental health of a population exposed to a disaster. It is based on the five essential elements of psychosocial care presented by Stevan E. Hobfoll et al. (2007) that can be introduced after a potentially traumatic event: promoting a sense of safety, calming, self and collective efficacy, connectedness, and hope. This study developed a method to relate these elements to television coverage and applied it to the stories (n=1,169) aired by the main networks in Chile in the 72 hours after an 8.8 magnitude earthquake struck on 27 February 2010. Of the five elements, promoting a sense of safety occurred most often (82.72 per cent), whereas the others were barely present (less than 10 per cent). The study argues that these elements can increase the possibility of framing the news, given that the audience watching can also be affected by a disaster.

Trajectories of PTSD symptoms among children who survived the Lushan earthquake: A four-year longitudinal study

BACKGROUND

This study aimed to explore the trajectories of posttraumatic stress disorder (PTSD) symptoms among child survivors of the Lushan earthquake by using latent category growth analysis.

METHODS

In total, 304 students from a school located in Lushan County were assessed by UCLA PTSD-RI at 1.5, 6, 12, 24 and 48 months after the earthquake. The children ages ranged from 9 to 17 years old at the time of the first assessment, and the sample included 140 males and 164 females.

RESULTS

Four trajectories of PTSD symptoms were found, namely, resilience (53.8%), low symptoms (32.6%), recovery (7.0%), and chronic dysfunction (6.6%). Then, a logistic regression analysis that controlled for gender and grade showed that compared with the resilience group, children with an injury or probable acute stress disorder (ASD) were likely to be in the recovery group, children with probable ASD were more likely to be in the low-symptoms group, and children with a bad relationship with their father were more likely to be in the chronic group.

LIMITATIONS

The participants were selected by convenience principle. All children received an intervention after the earthquake.

CONCLUSIONS

These findings suggest that increasing children's social support may relieve children's PTSD symptoms. We should consider both perceived threat and object exposure in future studies. The posttraumatic stress response was very high and was unstable during the first month after the earthquake, which suggests that psychological first aid is necessary in posttraumatic events.

Time course of panic disorder and posttraumatic stress disorder onsets

PURPOSE

Posttraumatic stress disorder (PTSD) often co-occurs with panic disorder (PD), with some etiological models positing a causal role of panic reactivity in PTSD onset; however, data addressing the temporal ordering of these conditions are lacking. The aim of this study was to examine the bi-directional associations between PD and PTSD in a nationally representative, epidemiologic sample of trauma-exposed adults.

METHODS

Participants were community-dwelling adults (62.6% women; Mage = 48.9, SD 16.3) with lifetime DSM-IV PTSD criterion A trauma exposure drawn from the 2001/2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and re-interviewed in 2004/5 (N = 12,467). Cox discrete-time proportional hazards models with time-varying covariates were used to investigate the bi-directional associations between lifetime PD and PTSD, accounting for demographic characteristics, trauma load, and lifetime history of major depression, generalized anxiety disorder, and social anxiety disorder.

RESULTS

PD was significantly associated with subsequent onset of PTSD (HR 1.210, 95%CI = 1.207-1.214, p < .001), and PTSD was significantly associated with onset of PD (HR 1.601, 95% CI 1.597-1.604, p < .001). The association between PTSD and subsequent PD was stronger in magnitude than that between PD and subsequent PTSD (Z = - 275.21, p < .01). Men evidenced stronger associations between PD and PTSD compared to women.

CONCLUSIONS

Results were consistent with a bidirectional pathway of risk, whereby PD significantly increased risk for the development of PTSD, and PTSD significantly increased risk for PD. Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic-specific interventions, such as interoceptive exposure, to prevent or treat this disabling comorbidity.

Delayed Disaster Impacts on Academic Performance of Primary School Children

Social disruption caused by natural disasters often interrupts educational opportunities for children. However, little is known about children's learning in the following years. This study examined change in academic scores for children variably exposed to a major bushfire in Australia. Comparisons were made between children attending high, medium, and low disaster-affected primary schools 2-4 years after the disaster (n = 24,642; 9-12 years). The results showed that in reading and numeracy expected gains from Year 3 to Year 5 scores were reduced in schools with higher levels of bushfire impact. The findings highlight the extended period of academic impact and identify important opportunities for intervention in the education system to enable children to achieve their academic potential.

Long-term mental health and social support in victims of disaster: comparison with a general population sample

BACKGROUND

Trauma and traumatic bereavement have well-known consequences for mental health, but little is known about long-term adjustment, particularly with respect to health-protective factors.AimsTo assess the levels of anxiety/depression and perceived social support among the survivors and the bereaved 26 years after the Scandinavian Star ferry disaster compared with expected levels from the general population.

METHOD

Anxiety/depression and social support were assessed in face-to-face interviews with the survivors and the bereaved (N = 165, response rate 58%). Expected scores were calculated for each participant based on the means and proportions for each age and gender combination from a general population sample. We computed the ratio between expected and observed scores, standardised mean differences with 95% confidence intervals and standardised effect sizes.

RESULTS

We found an elevated level of anxiety/depression symptoms in the victims (Mdiff = 0.28, 95% CI 0.18, 0.38; effect size 0.43, 95% CI 0.31, 0.55) and a significant excess of individuals with a clinically significant level of symptoms. The observed level of perceived social support was significantly lower than that expected (Mdiff = -0.57, 95% CI -0.70, -0.44; effect size -0.73, 95% CI -0.89, -0.57). This was the case for both survivors and those who were bereaved and for both men and women.

CONCLUSIONS

This study reveals that disaster survivors and the bereaved reported elevated levels of anxiety and depression symptoms 26 years after the event. They also reported a markedly reduced level of social support. Traumas and post-traumatic responses may thus cause lasting harm to interpersonal relationships.Declaration of interestNone.

Disaster Impacts on Students and Staff from a Specialist, Trauma-Informed Australian School

Children from disadvantaged backgrounds often experience high levels of traumatic stress, however, little is known about their experiences and the responses of their teachers following disasters. The aim of this study was to examine, from the perspective of teachers, the impact of a critical community-wide traumatic event on student and staff wellbeing, and student learning and teaching practices at a specialist school for disadvantaged and displaced youth in Australia. Eight school staff were interviewed, including administrative, teaching, and support personnel, with their responses interpreted using Interpretative Phenomenological Analysis. Results focused largely on the impact of the event and the resultant relocation of the school on staff and student health, reduced opportunities for learning, changes to teaching and student engagement, and the strengths and limitations of the trauma-informed approach of the school. Implications for teacher education and school trauma-informed models are discussed.

Acute stress and subsequent health outcomes: A systematic review

OBJECTIVE

To systematically review the relationship between acute posttraumatic stress symptoms (<1 month) and subsequent physical and mental health outcomes other than posttraumatic stress disorder (PTSD).

METHODS

A systematic search of electronic databases (PubMed, PsycINFO, CINAHL, and Web of Science) was conducted to identify longitudinal studies examining the link between acute posttraumatic stress and physical and mental health. Inclusion criteria required assessment of acute posttraumatic stress (<1 month post-event) and at least one follow-up assessment of a physical or mental health outcome (not PTSD).

RESULTS

1,051 articles were screened; 22 met inclusion criteria. Fourteen studies examined physical health outcomes and 12 examined non-PTSD mental health outcomes. Early psychological responses to trauma were associated with a variety of short- (<1 year) and long- (≥1 year) term physical and mental health outcomes. Physical health outcomes included poor general physical health, increased pain and disability, lower quality of life, and higher risk of all-cause mortality. Significant psychological outcomes included more cumulative psychiatric disorders, depression, and anxiety. Significant psychosocial outcomes included increased family conflict.

CONCLUSIONS

Methodologically rigorous longitudinal studies support the utility of measuring acute psychological responses to traumatic events as they may be an important marker of preventable trauma-related morbidity and mortality that warrants long-term monitoring and/or early intervention.

Longitudinal study of changing psychological outcomes following the Victorian Black Saturday bushfires

OBJECTIVES

To map the changing prevalence and predictors of psychological outcomes in affected communities 5 years following the Black Saturday bushfires in Victoria.

METHOD

Follow-up assessment of longitudinal cohort study in high, medium and non-affected communities in Victoria, Australia. Participants included 1017 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 and January 2013, and 735 (76.1%) eligible participants were retested between July and November 2014 (Wave 2). The survey included measures of fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive episode, alcohol use and severe distress.

RESULTS

There were reduced rates of fire-related posttraumatic stress disorder (8.7% vs 12.1%), general posttraumatic stress disorder (14.7% vs 18.2%), major depressive episode (9.0% vs 10.9%) and serious mental illness (5.4% vs 7.8%). Rates of resilience increased over time (81.8% vs 77.1%), and problem alcohol use remained high across Wave 1 (22.1%) and Wave 2 (21.4%). The most robust predictor of later development of fire-related posttraumatic stress disorder (odds ratio: 2.11; 95% confidence interval: [1.22, 3.65]), general posttraumatic stress disorder (odds ratio: 3.15; 95% confidence interval: [1.98, 5.02]), major depressive episode (odds ratio: 2.86; 95% confidence interval: [1.74, 4.70]), serious mental illness (odds ratio: 2.67; 95% confidence interval: [0.57, 1.72]) or diminished resilience (odds ratio: 2.01; 95% confidence interval: [1.32, 3.05]) was extent of recent life stressors.

CONCLUSION

Although rates of mental health problems diminished over time, they remained higher than national levels. Findings suggest that policy-makers need to recognize that the mental health consequences of disasters can persist for many years after the event and need to allocate resources towards those who are most at risk as a result of substantive losses and ongoing life stressors.

Children exposed to a natural disaster: psychological consequences eight years after 2004 tsunami

BACKGROUND

There is a need for studies that follow up children and adolescents for many years post disaster since earlier studies have shown that exposure during natural disasters constitutes a risk factor for poor psychological health.

AIMS

The main aim was to examine whether there was an association between severity of exposures during a natural disaster experienced in childhood or adolescence and posttraumatic stress symptoms, psychological distress, self-rated health, diagnosis of depression, anxiety or worry, thoughts about or attempted suicide, physical symptoms or daily functioning eight years later in young adulthood. A second aim was to compare psychological distress and self-rated health of exposed young adults with a matched population-based sample.

METHOD

Young adults, who experienced the 2004 tsunami as children between 10 and 15 years of age, responded to a questionnaire eight years post disaster. The results were compared to a matched population sample.

RESULTS

The results showed that the likelihood for negative psychological outcomes was higher for those who had been exposed to several types of exposures during this natural disaster.

CONCLUSIONS

The negative psychological impact on children and adolescents can still be present eight years post-disaster and seems to have association with the type of exposure; loss, physical presence and subjective experience. It is important for clinicians, who meet young adults seeking help, to be conscious about the impact as long as eight years post disaster and to be aware of possible clinical implications associated with severity of exposures.

Separation from parents during childhood trauma predicts adult attachment security and post-traumatic stress disorder

BACKGROUND

Prolonged separation from parental support is a risk factor for psychopathology. This study assessed the impact of brief separation from parents during childhood trauma on adult attachment tendencies and post-traumatic stress.

METHOD

Children (n = 806) exposed to a major Australian bushfire disaster in 1983 and matched controls (n = 725) were assessed in the aftermath of the fires (mean age 7-8 years) via parent reports of trauma exposure and separation from parents during the fires. Participants (n = 500) were subsequently assessed 28 years after initial assessment on the Experiences in Close Relationships scale to assess attachment security, and post-traumatic stress disorder (PTSD) was assessed using the PTSD checklist.

RESULTS

Being separated from parents was significantly related to having an avoidant attachment style as an adult (B = -3.69, s.e. = 1.48, β = -0.23, p = 0.013). Avoidant attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.31, p = 0.045), avoidance (B = 0.03, s.e. = 0.01, β = 0.30, p = 0.001) and numbing (B = 0.03, s.e. = 0.01, β = 0.30, p < 0.001) symptoms. Anxious attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.18, p = 0.001), numbing (B = 0.03, β = 0.30, s.e. = 0.01, p < 0.001) and arousal (B = 0.04, s.e. = 0.01, β = 0.43, p < 0.001) symptoms.

CONCLUSIONS

These findings demonstrate that brief separation from attachments during childhood trauma can have long-lasting effects on one's attachment security, and that this can be associated with adult post-traumatic psychopathology.

The 2004 tsunami and mental health in Thailand: a longitudinal analysis of one-and two-year post-disaster data

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36-item Short Form Health Survey (SF-36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long-lasting ramifications for mental health, and that diverse losses may influence mental health differently.

Hurricane Sandy Exposure Alters the Development of Neural Reactivity to Negative Stimuli in Children

This study examined whether exposure to Hurricane Sandy-related stressors altered children's brain response to emotional information. An average of 8 months (M_age  = 9.19) before and 9 months after (M_age  = 10.95) Hurricane Sandy, 77 children experiencing high (n = 37) and low (n = 40) levels of hurricane-related stress exposure completed a task in which the late positive potential, a neural index of emotional reactivity, was measured in response to pleasant and unpleasant, compared to neutral, images. From pre- to post-Hurricane Sandy, children with high stress exposure failed to show the same decrease in emotional reactivity to unpleasant versus neutral stimuli as those with low stress exposure. Results provide compelling evidence that exposure to natural disaster-related stressors alters neural emotional reactivity to negatively valenced information.