Prevalence of Post-traumatic Stress Disorder After Flood: A Systematic Review and Meta-Analysis

Reassessing 'good' medical practice and the climate crisis

In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of UK doctors. These updated guidelines offer some environmental considerations that previous standards did not include. This paper explores these latest additions to Good Medical Practice through the healthcare ethics lens of non-maleficence, beneficence, justice and autonomy, alongside trust and physician well-being, to make the case that the latest updates to Good Medical Practice do not go far enough in specifying the duties for doctors in responding to climate and ecological emergencies to be seen as ethically justifiable.The paper argues that given the health implications of the climate crisis and the harms associated with high-emission healthcare, as well as the co-benefits of climate action on health, there must be a stronger commitment from the medical regulator to ensure the groundwork is set for doctors to learn, understand and advocate for the importance and urgency of practicing sustainable healthcare. The case for this is strengthened by also examining the importance of maintaining public trust in the medical profession as advocates for public health, along with the notable societal and generational injustices that continue to deepen as the climate emergency escalates.The paper concludes by arguing that doctors can and should be a part of writing a new chapter for health in the climate era, but our standards for practice need to offer a strengthened starting point of consensus for what is expected of the medical profession for that to come to fruition and raise questions as to what doctors can and should do when they have questions over their own regulators' commitment to maintaining public health in relation to the climate and ecological crisis.

Change in emotional distress, anxiety, depression and PTSD from pre- to post-flood exposure in women residing in low-income settings in South Africa

Floods are increasing in frequency and may increase the risk for experiencing emotional distress, anxiety, depression and PTSD. The aim of this study was to determine the extent of damage, loss, injury and death resulting from floods that occurred in and around the city of Durban, South Africa, in April 2022, and associated changes in mental health pre- to post-floods in a low-income setting. Seventy-three women between the ages of 18 and 45, residing in flood affected, low-income settings, were interviewed prior to the floods occurring. Mental health measures were repeated with 69 of the 73 women during the post-flood interview along with a questionnaire measuring flood-related exposures. Loss of infrastructure (lacked access to drinking water, electricity, fresh food, could not travel to work, had to stay in a shelter and could not get hold of friends or family) was a predictor of post-flood change in levels of emotional distress and anxiety. Higher levels of prior trauma exposure were associated with higher post-flood levels of emotional distress. Higher pre-flood food insecurity was also associated with higher post-flood anxiety. Women affected by poverty, food insecurity and a history of trauma are vulnerable to the additive adverse mental health effects of floods. Proactive approaches to diminishing the impact of floods on the livelihood of women is needed and post-flood relieve efforts may be more affective if they are enhanced by providing mental health support.

Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident-a quasi-experimental cohort study

Introduction

There is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress.

Methods

N = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders.

Results

When comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0).

Discussion

These results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research.

Prevalence and determinants of post-traumatic stress disorder five months after the 2019 huge flooding in Iran

BACKGROUND

Despite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019.

METHODS

An analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants.

RESULTS

Out of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7-28.8%) and was significantly higher in Lorestan province (39.7%, P < 0.001). Determinants of PTSD, were unemployment (adjusted odds ratio [AOR] = 3.53, CI 95%: 1.38-9.00), primary (AOR = 2.44, CI 95%: 1.10-5.41) or high school (AOR = 2.35, CI 95%: 1.25-4.40) education (vs. university), a history of mental disorders (AOR = 2.36, CI 95%: 1.22-4.58), high damage to assets (AOR = 2.29, CI 95%: 1.40-3.75), limited access to health care services after the flood (AOR = 1.95, CI 95%: 1.20-3.19), not receiving compensation for flood damage (AOR = 1.94, CI 95%: 1.01-3.83), high wealth index (AOR = 1.90, CI 95%: 1.23-2.93), and flooded house with a height of more than one meter (AOR = 1.66, CI 95%: 1.02-2.76).

CONCLUSION

Results show a notable prevalence of PTSD, especially in Lorestan province, among adults affected by floods. Determinants of PTSD include unemployment, lower education, psychiatric history, extensive property damage, limited post-flood healthcare access, lack of compensation, and increased flood exposure. We recommend adopting an inclusive screening approach for high-risk groups and developing appropriate therapeutic and supportive interventions.

A randomized control trial establishing the effectiveness of using interactive television-based art, music, and poetry therapies for treating the post-traumatic stress disorder of children exposed to traumatic events

This study aimed to compare the effectiveness of interactive television-based music, art, and poetry therapies in reducing symptoms of posttraumatic stress disorder among school children who have experienced abduction. A randomized control trial was adopted using school children from three selected secondary schools in Northern Nigeria that have experienced the issue of kidnapping. The treatment is characterized by (1) group setting, (2) TV instruction (3) school collaboration, and (4) use of artistic mediation. The study sample comprised 470 students randomly divided into a control group of 235 and an experiment group of 235. The treatment group was further divided into art (N = 78), music (N = 78) and poetry (N = 79), respectively. Results suggest that interactive television art, music and poetry therapies are an effective intervention strategy for reducing the PTSD of school children who have experienced kidnapping in Nigeria. However, art therapy is more effective in reducing PTSD. This study has offered empirical evidence that could guide the planning and implementation of therapies aimed at assisting school children to recover from traumatic experiences.

Unveiling the Secrets of the Stressed Hippocampus: Exploring Proteomic Changes and Neurobiology of Posttraumatic Stress Disorder

Intense stress, especially traumatic stress, can trigger disabling responses and in some cases even lead to the development of posttraumatic stress disorder (PTSD). PTSD is heterogeneous, accompanied by a range of distress symptoms and treatment-resistant disorders that may be associated with a number of other psychopathologies. PTSD is a very heterogeneous disorder with different subtypes that depend on, among other factors, the type of stressor that provokes it. However, the neurobiological mechanisms are poorly understood. The study of early stress responses may hint at the way PTSD develops and improve the understanding of the neurobiological mechanisms involved in its onset, opening the opportunity for possible preventive treatments. Proteomics is a promising strategy for characterizing these early mechanisms underlying the development of PTSD. The aim of the work was to understand how exposure to acute and intense stress using water immersion restraint stress (WIRS), which could be reminiscent of natural disaster, may induce several PTSD-associated symptoms and changes in the hippocampal proteomic profile. The results showed that exposure to WIRS induced behavioural symptoms and corticosterone levels reminiscent of PTSD. Moreover, the expression profiles of hippocampal proteins at 1 h and 24 h after stress were deregulated in favour of increased inflammation and reduced neuroplasticity, which was validated by histological studies and cytokine determination. Taken together, these results suggest that neuroplastic and inflammatory dysregulation may be a therapeutic target for the treatment of post-traumatic stress disorders.

Scoping review of climate change and mental health in Germany - Direct and indirect impacts, vulnerable groups, resilience factors

Background

Climate change is a major threat to human health and has direct and indirect impacts on the human psyche.

Methods

To assess the state of knowledge on the impact of climate change on mental health in Germany, a scoping review was conducted for the focus topics extreme weather events, temperature increase, intra-psychological processing, sociological aspects, and resilience factors. Ten studies met the inclusion criteria of the searches in the databases Academic Search Complete, CINAHL, PubPsych, PubMed, and PsychInfo. The majority of the studies looked at correlative relationships in a cross-sectional design.

Results

There are indications of an accumulation of psychiatric disorders after extreme weather events; in addition, the risk of suicide increases with higher temperatures and it appears there is an increase in aggressive behaviour. The majority of people surveyed in Germany report concerns about the consequences of climate change, although these currently rarely lead to clinically significant impairments in mental health.

Conclusions

Overall, the evidence for Germany must be classified as insufficient. In addition to the absolute priority of climate protection (mitigation) by reducing emissions, there is a particular need for additional research with a focus on vulnerable groups and possibilities for prevention and adaptation.

The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section

BACKGROUND

The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section.

METHODS

A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version.

RESULTS

In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD.

CONCLUSIONS

Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.

Mental Health Impacts of Tornadoes: A Systematic Review

Tornadoes are one of the most prevalent natural hazards in the United States, yet they have been underrepresented in the disaster mental health comprehensive literature. In the current study, we systematically reviewed available scientific evidence within published research journals on tornadoes and mental health from 1994 to 2021. The electronic search strategy identified 384 potentially relevant articles. Of the 384 articles, 29 articles met the inclusion criteria, representing 27,534 participants. Four broad areas were identified: (i) Mental health impacts of tornadoes; (ii) Risk factors; (iii) Protective factors; and (iv) Mental health interventions. Overall, results showed adverse mental health symptoms (e.g., post-traumatic stress disorder, depression, anxiety) in both adult and pediatric populations. A number of risk factors were found to contribute to negative mental health, including demographics, tornado exposure, post-tornado stressors, and prior exposure to trauma. Protective factors found to contribute to positive outcomes included having access to physical, social, and psychological resources. Together, these findings can serve as an important resource for future mental health services in communities experiencing tornadoes.