An Open Label Pilot Study of a Brief Psychosocial Intervention for Disaster and Trauma Survivors

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53454.

Evaluation of system based psychological first aid training on the mental health proficiency of emergency medical first responders to natural disasters in China: a cluster randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of a system based psychological first aid (PFA) training programme for emergency medical first responders in China.

DESIGN

Parallel-group, assessor-blinded, cluster randomised controlled trial.

SETTING

42 clusters of health workers from various health facilities in China.

PARTICIPANTS

1399 health workers who provide emergency service for survivors of disasters.

INTERVENTIONS

One-day system based PFA training programme (PFA) or training as usual (TAU).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the PFA skills, knowledge and attitude (SKA-PFA) score at 2 months postintervention. Secondary outcomes included post-traumatic growth, self-efficacy and professional quality of life.

RESULTS

The intervention group (n=690) had significantly higher SKA-PFA scores than the control group (n=709) at 2 months postintervention (adjusted mean difference=4.44; 95% CI 1.17 to 7.52; p=0.007; Cohen's d=0.35). The intervention group also had higher scores on post-traumatic growth (p=0.113, d=0.24), self-efficacy (p=0.032, d=0.20) and professional quality of life (p=0.281, d=0.04).

CONCLUSIONS

The system based PFA training programme was more effective than the TAU in enhancing the PFA knowledge and skills of the emergency medical first responders and in increasing their competence to provide emergency service for survivors in China.

TRIAL REGISTRATION NUMBER

ChiCTR2200060464.

Taking a trauma and adversity perspective to climate change mental health

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

Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study

BACKGROUND

Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events.

AIMS

This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure.

METHOD

The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode).

RESULTS

Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors.

CONCLUSIONS

Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Effects of Psychotherapy on the Problem Behaviors of Humidifier Disinfectant Survivors: The Role of Individual Characteristics and Adaptive Functioning

This study aimed to examine group differences in the survivors of humidifier damage and the effect of individual psychotherapy on the psychological symptoms of the survivor groups, using the single group pre-post study design. A series of Wilcoxon-Mann-Whitney tests were conducted to investigate the level of psychological problems before and after psychotherapy, as well as the main and interaction effects of demographic characteristics and adaptive functioning on the treatment effects in 69 humidifier disinfectant survivors. The results demonstrated significant differences in problems with socioeconomic status (SES), life functioning, friendships, family relationships, and job adjustment in the survivor groups. Groups with high SES, low life functioning, and poor friend relationships had more problem behaviors than other groups. Problem behaviors related to friendship levels were different before and after psychotherapy. After psychotherapy, individuals with limited social connections exhibited a greater decrease in problem behaviors compared to those with strong friendships. This paper extends the international literature on the long-term consequences of environmental health hazards and the importance of tailored mental health interventions.

Adaptation Resources and Responses to Wildfire Smoke and Other Forms of Air Pollution in Low-Income Urban Settings: A Mixed-Methods Study

Little is known about how low-income residents of urban communities engage their knowledge, attitudes, behaviors, and resources to mitigate the health impacts of wildfire smoke and other forms of air pollution. We interviewed 40 adults in Los Angeles, California, to explore their threat assessments of days of poor air quality, adaptation resources and behaviors, and the impacts of air pollution and wildfire smoke on physical and mental health. Participants resided in census tracts that were disproportionately burdened by air pollution and socioeconomic vulnerability. All participants reported experiencing days of poor air quality due primarily to wildfire smoke. Sixty percent received advanced warnings of days of poor air quality or routinely monitored air quality via cell phone apps or news broadcasts. Adaptation behaviors included remaining indoors, circulating indoor air, and wearing face masks when outdoors. Most (82.5%) of the participants reported some physical or mental health problem or symptom during days of poor air quality, but several indicated that symptom severity was mitigated by their adaptive behaviors. Although low-income residents perceive themselves to be at risk for the physical and mental health impacts of air pollution, they have also adapted to that risk with limited resources.

Psychiatric sequelae and interventions in critically ill trauma survivors

PURPOSE OF REVIEW

Psychiatric disorders following trauma impact functional recovery in trauma survivors and are a significant source of disability. Although research has traditionally focused on the physical sequelae of trauma, more attention is being directed towards the significant morbidity and mortality associated with the psychologic sequelae of trauma. This review evaluates the existing literature.

RECENT FINDINGS

Use of multidisciplinary collaborative programmes in combination with psychiatric treatment and pharmacotherapy may be necessary to improve the care of trauma patients with psychiatric sequelae. Improving identification of vulnerable patients may help in the prevention and treatment of psychiatric disorders and is an area of current research initiatives.

SUMMARY

There are few interventions that have demonstrated efficacy in managing the psychiatric sequelae of trauma. The development of strategies to guide early identification of at-risk patients and recommend prevention and treatment may improve the care of trauma survivors.

Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents

A substantial number of survivors of disasters, pandemics, and other severe stressors develop persistent distress that impairs mental health and well-being. However, only a few brief psychological interventions target distress or subclinical symptoms. This systematic review aimed to identify and describe brief psychological interventions to reduce distress or subclinical symptoms in survivors of disasters, pandemics, and other severe stressors. Based on a systematic literature search (MEDLINE, PsycINFO, PSYNDEX, PTSDpubs, and Web of Science), we reviewed published studies and study protocols on self-help, psychosocial support, or brief psychotherapeutic interventions to reduce distress and/or subclinical symptoms following natural hazards and man-made disasters, pandemics, or other traumatic events. We included 27 published studies or study protocols (n = 15 RCTs, n = 3 controlled pre-post studies, and n = 9 uncontrolled pre-post studies) describing 22 interventions. We found evidence for reducing psychological distress and/or subclinical symptoms in 9 out of 15 RCTs, 2 out of 3 controlled pre-post studies, and 9 out of 9 uncontrolled pre-post studies. One RCT provided evidence of increasing well-being. Innovative brief interventions have been developed to reduce distress and/or subclinical symptoms that have an emerging evidence base.

Design, development and randomised controlled trial protocol of a smartphone-delivered version of 'SOLAR' for emergency service workers to manage stress and trauma

IntroductionEmergency service workers are routinely exposed to stress and trauma, and there is a need to address mental health symptoms early to prevent chronic impairment and/or psychiatric disorder. Digital health innovations mean that face-to-face psychosocial interventions can now be delivered remotely, which is particularly appealing to populations who have strong preferences for digital delivery, such as emergency service workers. This two phase study aims to first adapt the Skills fOr Life Adjustment and Resilience (SOLAR) programme into a smartphone application ('app'), and then evaluate the effectiveness of this new app.

METHODS AND ANALYSES

First, focus groups and codesign activities with mental health professionals and emergency service workers will be conducted to develop and test the prototype smartphone version of SOLAR (ie, SOLAR-m). Second, a multicentre randomised controlled trial will investigate the effectiveness of the new app, compared with an active control app, in reducing symptoms of anxiety and depression (primary outcome), as well as other indicators of mental health and work performance. Firefighters from one of the largest urban fire and rescue services in Australia who are currently experiencing distress will be invited to participate. After screening and baseline assessment, 240 will be randomised to receive either SOLAR-m or the control app for 5 weeks, with measurements pre, post and 3-month follow-up. Analyses will be conducted within an intention-to-treat framework using mixed modelling.

ETHICS AND DISSEMINATION

The current trial has received ethics approval from the University of Melbourne Human Research Ethics Committee (2021-20632-18826-5). Study results will be disseminated through peer-reviewed journals and conferences, with a focus on how to expand the new app to other trauma-affected populations if proven effective.

TRIAL REGISTRATION NUMBER

ANZCTRN12621001141831.

Regional Research-Practice-Policy Partnerships in Response to Climate-Related Disparities: Promoting Health Equity in the Pacific

Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.

Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic

Purpose of review

In the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae.

Recent findings

Evidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD.

Summary

A disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources.

People's experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017

BACKGROUND

Distress after major incidents is widespread among survivors. The great majority do not meet the criteria for mental health disorders and rely on psychosocial care provided by their informal networks and official response services. There is a need to better understand their experiences of distress and psychosocial care needs.

AIMS

The aims of our study were to enhance understanding of the experience of distress among people present at the Manchester Arena bombing in 2017, identify their experiences of psychosocial care after the incident and learn how to better deliver and target effective psychosocial care following major incidents.

METHOD

We conducted a thematic analysis of semi-structured interviews with 18 physically non-injured survivors of the Manchester Arena attack, who registered with the NHS Manchester Resilience Hub.

RESULTS

Distress was ubiquitous, with long-lasting health and social consequences. Initial reluctance to seek help from services was also common. Early and open access to authoritative sources of information and emotional support, and organised events for survivors, were viewed as helpful interventions. Inappropriate forms of psychosocial and mental healthcare were common and potent stressors that affected coping and recovery.

CONCLUSIONS

This paper extends our understanding of how people react to major events. Provision for the large group of people who are distressed and require psychosocial care may be inadequate after many incidents. There is a substantial agenda for developing awareness of people's needs for psychosocial interventions, and training practitioners to deliver them. The findings have substantial implications for policy and service design.

[Skills fOr Life Adjustment and Resilience Program]

Hintergrund

Nach Katastrophen, Traumata und anderen schweren Belastungen entwickelt ein Teil der Betroffenen eine psychische Erkrankung, während ein weiterer Teil anhaltende subklinische Belastungen zeigt, die das psychosoziale Funktionsniveau einschränken. Anhaltend subklinisch belastete Menschen erhalten jedoch selten psychosoziale Unterstützungsangebote.

Ziel der Arbeit

Vorgestellt wird das Programm „Skills fOr Life Adjustment and Resilience“ (SOLAR), eine Kurzintervention für Menschen mit anhaltender subklinischer Belastung nach Katastrophen und anderen schweren Belastungen. Erste Ergebnisse einer Pilotstudie zur Zufriedenheit mit dem Programm bei Betroffenen werden berichtet.

Methoden

Das SOLAR-Programm wurde von einem internationalen Konsortium, zusammengesetzt aus Katastrophen- und Traumaexperten, entwickelt. Es beinhaltet 5 wöchentliche Gruppensitzungen, in denen verhaltenstherapeutische Elemente vermittelt werden. Im Rahmen der Pilotstudie nahmen 15 Teilnehmende im Präsenzformat und 15 Teilnehmende mithilfe einer Videokonferenzschaltung während der „Coronavirus Disease 2019“ (COVID-19) Pandemie am SOLAR Programm teil. Nach Abschluss beantworteten die Teilnehmenden den Fragebogen zur Messung der Patientenzufriedenheit (ZUF-8).

Ergebnisse

Die Teilnehmenden waren „weitgehend“ bis „sehr zufrieden“. In der Präsenzgruppe war die Zufriedenheit über alle Aspekte hinweg geringfügig stärker ausgeprägt als in der Onlinegruppe. Die TrainerInnen bewerteten das Programm als gut durchführbar.

Schlussfolgerung

Das SOLAR-Programm ist eine vielversprechende Kurzintervention bei anhaltender subklinischer Belastung nach schweren Belastungen, die im Präsenz- oder im videogestützten Format weiter auf seine Wirksamkeit erprobt werden sollte. Im Beitrag werden Praxisempfehlungen zur Durchführung gegeben.

CORONAcrisis-An Observational Study on the Experience of Healthcare Professionals in a University Hospital during a Pandemic Emergency

The Coronavirus disease 2019 (COVID-19) pandemic continues to affect millions worldwide and has posed unique challenges to healthcare professionals. Caring for patients during a pandemic may have negative impacts on their mental health. We describe the first part of a study using a mixed-method sequential explanatory design (QUANT→QUAL). This quantitative part examines the experiences of healthcare professionals during the pandemic in a University Hospital in Italy. We performed a cross-sectional hospital-based survey involving all healthcare professionals between 19 May 2020 and 3 June 2020. Perceived Stress Scale, Patient Health Questionnaire, and General Anxiety Disorder scores were calculated, in order to assess how the pandemic emergency changed the occupational and social habits of the healthcare professionals. The mean age of the 275 respondents was 47 years and females accounted for 80.2%. A total of 29.8% had a Perceived Stress Scale (PSS) score ≥25, 22.9% scored ≥15 on the Patient Health Questionnaire (PHQ-9) scale, and 17.1% scored ≥15 on the General Anxiety Disorder (GAD) scale. Stress symptoms were mostly manifested for interviewees over 55, females, those who live far from their family, those who have only one child, and those who had a qualification lower than high school or who had a medical specialization. Our findings show a relevant level of psychological distress, anxiety, and depression in up to 30% of the sample, highlighting a significant psychological burden in all professionals.

A Rapid Assessment of Disaster Preparedness Needs and Resources during the COVID-19 Pandemic

Background: This year has seen the emergence of two major crises, a significant increase in the frequency and severity of hurricanes and the COVID-19 pandemic. However, little is known as to how each of these two events have impacted the other. A rapid qualitative assessment was conducted to determine the impact of the pandemic on preparedness and response to natural disasters and the impact of past experiences with natural disasters in responding to the pandemic. Methods: Semi-structured interviews were conducted with 26 representatives of 24 different community-based programs in southern Louisiana. Data were analyzed using procedures embedded in the Rapid Assessment Procedure-Informed Community Ethnography methodology, using techniques of immersion and crystallization and focused thematic analysis. Results: The pandemic has impacted the form and function of disaster preparedness, making it harder to plan for evacuations in the event of a hurricane. Specific concerns included being able to see people in person, providing food and other resources to residents who shelter in place, finding volunteers to assist in food distribution and other forms of disaster response, competing for funds to support disaster-related activities, developing new support infrastructures, and focusing on equity in disaster preparedness. However, several strengths based on disaster preparedness experience and capabilities were identified, including providing a framework for how to respond and adapt to COVID and integration of COVID response with their normal disaster preparedness activities. Conclusions: Although prior experience has enabled community-based organizations to respond to the pandemic, the pandemic is also creating new challenges to preparing for and responding to natural disasters.

M, J. N, A. TL, E. T, M. U, N. C, S. C, E. CV. Child and Adolescent Psychosocial Support Programs Following Natural Disasters-a Scoping Review of Emerging Evidence

PURPOSE OF REVIEW

This review aimed to identify and describe evidence published in the past 3 years from trials of psychosocial support programs for children and adolescents affected by natural disasters.

RECENT FINDINGS

Previous reviews have indicated these programs are beneficial overall. Positive impacts were documented in school-based programs conducted by trained teachers and paraprofessionals with stronger effects achieved by more qualified professionals. The review found supporting evidence for positive impacts of post-disaster psychosocial programs. However, the strength of evidence is limited due to heterogeneity in interventions and evaluations. The stepped care model was found to be useful in differentiating between programs and level of available evidence. Hobfoll's five essential elements of mass trauma intervention provide an additional means of guiding program content and assessments, particularly for universal programs. Identified gaps in evidence included groups likely to be at most risk: preschool children, ethnically diverse groups, those with disability, and social disadvantage. There were promising indications of program benefits for groups with repeated exposure to natural disasters.

Piloting a scalable, post-trauma psychosocial intervention in Tuvalu: the Skills for Life Adjustment and Resilience (SOLAR) program

BACKGROUND

The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster.

OBJECTIVES

We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu.

METHOD

This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group (n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group (n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up.

RESULTS

Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive.

CONCLUSIONS

Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted.

Strategies for Delivering Mental Health Services in Response to Global Climate Change: A Narrative Review

This narrative review examined strategies for preparedness and response to mental health impacts of three forms of climate change from a services perspective: (1) acute and extreme weather events such as hurricanes, floods, and wildfires, (2) sub-acute or long-term events such as droughts and heatwaves; and (3) the prospect of long-term and permanent changes, including higher temperatures, rising sea levels, and an uninhabitable physical environment. Strategies for acute events included development and implementation of programs and practices for monitoring and treating mental health problems and strengthening individual and community resilience, training of community health workers to deliver services, and conducting inventories of available resources and assessments of at-risk populations. Additional strategies for sub-acute changes included advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events, such as threats to livelihood, health and well-being, population displacement, environmental degradation, and civil conflict. Strategies for long-lasting changes included the implementation of evidence-based risk communication interventions that address the existing and potential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting psychological growth and resilience.