The Long-Term Mental Health Impact of Disasters: A Systematic Review and Multilevel Meta-Analysis of Longitudinal Epidemiological Studies.

Introduction: The long-term mental health impact of disasters is still poorly understood. This multilevel meta-analysis aimed to assess the impact of the number of fatalities while simultaneously controlling for multiple factors. The objective was to verify whether there is an association between the extent of fatal casualties during a disaster and the mental health impact on exposed populations. Methods: Medline, PsycInfo, PTSDpubs, Web of Science, and SocINDEX were searched for studies published from January 1946 to July 2024 (PROSPERO 2020, CRD42020108528). Longitudinal data from 71 studies (76 disaster-exposed samples) were extracted and augmented with fatality data sourced from Wikipedia. Fatality categories (<10, 10-99, 100-999, 1,000-9,999, >10,000), disaster type (natural vs. human-made), category (e.g., earthquakes, floods, terrorist attacks), mental health outcome (e.g., post-traumatic stress disorder, depression, anxiety, grief, suicidality), population age groups, disaster year, measurement month, study quality, and country income were included in the analysis. Results: The pooled average prevalence of mental health problems was 21.81% (95% CI [10.07-40.98]). From months 1 to 300, the post-disaster mental health burden decreased after an initial peak in the first months, followed by a second peak before declining again (p < 0.001). The prevalence of mental health problems did not differ significantly between mental health outcomes, disaster types or categories, population age groups, disaster year, study quality classification, or country income context. When controlling for these factors, fatality categories (reference: <10) had no significant effect on mental health. The proportion of fatalities differed between income groups. In 67% of disasters in upper-middle-income countries, fatalities exceeded 10,000, while 63% of disasters in high-income countries had fewer than 100 deaths. Conclusion: Although this controlled multilevel meta-analysis demonstrates that the mental health impact of disaster exposure is profound and long-lasting, it did not confirm that a more excessive number of fatalities was related to increased mental health problems.

Linnemayr, Sebastian PhD; Barreras, Joanna L. PhD; Izenberg, Max MSc; Brooks, Ronald A. PhD; Gonzalez, Ana BA; MacCarthy, Sarah DSc Author Information

Asians are likely to experience a high burden of chronic conditions, including, but not limited to, diabetes, cardiovascular disease, and cancer, due to differences in biologic, genetic, and environmental factors across Asian ethnic groups. A diagnosis of any chronic condition can contribute to increased mental health burdens, including depression, psychological distress, and posttraumatic stress disorder (PTSD). However, few studies have examined these comorbid conditions across distinct Asian ethnic groups-an important limitation given the differences in social, cultural, and behavioral drivers of mental health burdens within and across Asian ethnicities. To understand the disparities in mental health burdens among Asians living with a chronic health condition, we conducted a systematic literature review of relevant, peer-reviewed publication databases to identify studies reporting on mental health burdens (e.g., depression, anxiety, distress, PTSD) in distinct Asian ethnic groups in North America. Thirteen studies met the inclusion criteria for this review and collectively demonstrated a high burden of depression, psychological distress, and PTSD among Asians living with chronic conditions. Moreover, there were distinct disparities in mental health burdens across chronic conditions and across Asian ethnic groups. Despite the detrimental impact of poor mental health on chronic disease-specific outcomes, such as death and poor quality of life, few data exist that characterize mental health outcomes among Asian ethnicities living in North America with chronic conditions. Future work should prioritize estimating the national prevalence of mental health outcomes among adults with chronic conditions, by Asian ethnicities, to inform culturally tailored interventions to address this public health burden.

This In Review features 2 articles that examine different aspects of mental health interventions in disaster settings. The article by Dr Anand Pandya1 describes mental health interventions provided in New York City after the September 11, 2001 (9/11), terrorist attacks on the World Trade Center. The article by Dr Betty Pfefferbaum and me2 addresses principles of disaster mental health interventions for children. Both articles1·2 consider fundamental conceptual issues about disaster mental health that have crystallized in the decade since the 9/11 terrorist attacks.Because the 9/11 terrorist attacks constituted a disaster of unprecedented scope and magnitude, this disaster created a watershed in the conceptualization of disaster mental health.3·4 It stimulated more thorough examination of different categories of trauma exposures and their relation to posttraumatic stress disorder (PTSD) and also presented the problem of how to most effectively assess PTSD in circumstances of large-scale chaos and catastrophe. In the post-9/11 setting, disaster responders faced complexities never before encountered in the delivery of services; authorities charted new territory in their efforts to assess and respond to mental health needs of broadly affected populations. Dr Pandya's review1 details the efforts of providers to meet the profound mental health consequences and the many creative solutions they applied in overcoming the difficulties they encountered in delivery of interventions.These 2 articles1,2 articulate 4 overarching principles for the provision of disaster mental health interventions: trauma exposure is of central importance in conceptualizing mental health outcomes within affected populations; valid and accurate measurement of mental health outcomes are essential for informing interventions; psychiatric disorders must be distinguished from normative distress; and different types of interventions are needed for psychiatric illness than for normative emotional distress. Attention to all 4 of these principles is needed in the approach to provision of appropriate and adequate postdisaster mental health interventions.The first of these disaster mental health intervention principles - conceptualization of disaster exposures - is essential for successful application of the other 3 principles. Before the history-changing 9/11 terrorist attacks, categorizing the disaster exposures of survivors was relatively straightforward: people were either in the disaster and thus directly exposed, or they were elsewhere and hence not exposed. Among exposed survivor groups, those with the highest exposure levels are generally expected to suffer the most severe mental health sequelae.5 The disaster exposure issue is pivotal for assessing the diagnosis of disaster-related PTSD, which, by definition, cannot occur in the absence of a qualifying exposure to disaster trauma.4It follows that the second principle of disaster mental health intervention - measurement of outcomes (specifically, the diagnosis of PTSD) - requires application of the first principle. PTSD is generally the most prevalent diagnosis after disaster, so consistently that it is considered a signature psychiatric diagnosis of disaster. Because PTSD cannot be diagnosed without a qualifying trauma exposure, the selfreport symptom scales that are popular for assessment of PTSD - largely because they are relatively easy to administer - are inadequate for accurate diagnosis of PTSD in individuals as well as for PTSD prevalence estimates in populations. Symptoms measured outside the construct of psychiatric diagnosis in disaster survivors largely represent measures of emotional distress. Many studies examining the mental health effects of the 9/11 attacks used symptom scales to measure PTSD and estimate its population prevalence. However, a study6 using full diagnostic assessment methods found that 35% of the people most highly exposed (that is, those in the World Trade Center towers and within 1 block of the site during the attacks) developed PTSD in the first 2 to 4 years after the attacks. …

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

Mental health outcomes during COVID-19: A scoping review & recommendations for geriatrics research

Post-traumatic stress, depression, and anxiety during the 2021 Myanmar conflict: a nationwide population-based survey

BackgroundThe ongoing COVID-19 pandemic has had an unprecedented impact on the lives of people globally and is expected to have profound effects on mental health. Here we aim to describe the mental health burden experienced in Sweden using baseline data of the Omtanke2020 Study. MethodWe analysed self-reported, cross-sectional baseline data collected over a 12-month period (June 9, 2020–June 8, 2021) from the Omtanke2020 Study including 27,950 adults in Sweden. Participants were volunteers or actively recruited through existing cohorts and, after providing informed consent, responded to online questionnaires on socio-demographics, mental and physical health, as well as COVID-19 infection and impact. Poisson regression was fitted to assess the relative risk of demonstrating high level symptoms of depression, anxiety, and COVID-19 related distress. ResultThe proportion of persons with high level of symptoms was 15.6 %, 9.5 % and 24.5 % for depression, anxiety, and COVID-19 specific post-traumatic stress disorder (PTSD), respectively. Overall, 43.4 % of the participants had significant, clinically relevant symptoms for at least one of the three mental health outcomes and 7.3 % had significant symptoms for all three outcomes. We also observed differences in the prevalence of these outcomes across strata of sex, age, recruitment type, COVID-19 status, region, and seasonality. ConclusionWhile the proportion of persons with high mental health burden remains higher than the ones reported in pre-pandemic publications, our estimates are lower than previously reported levels of depression, anxiety, and PTSD during the pandemic in Sweden and elsewhere.

Global mental health and HIV care: gaps and research priorities.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

BackgroundResearch cites a strong, dose–response relationship between adverse childhood experiences (ACEs) and poor adult mental health outcomes including anxiety, depression, post-traumatic stress disorder (PTSD), self-harm, suicidality, and psychotic-like experiences.AimTo systematically investigate the existence and strength of association between ACEs and adult mental health outcomes in prospective longitudinal studies. The review will focus on the outcomes: anxiety, depression, PTSD, self-harm, suicidal ideation, and psychotic-like experiences.MethodsTwelve electronic databases will be searched: Embase, PsycINFO, MEDLINE, and Global Health through the OVID interface. ProQuest will be used to search Public Affairs Information Service (PAIS), Dissertations and Theses, Sociology Database (including Sociological s and Social Services s), PTSDpubs (formerly The Published International Literature on Traumatic Stress (PILOTS) Database) and Applied Social Sciences Index and s (ASSIA). CINAHL, World Health Organisation (WHO) Global Index Medicus, and WHO Violence Info will also be searched. Eligible studies will be double screened, assessed, and their data will be extracted. Any disagreement throughout these processes will be settled by a third reviewer. If enough studies meet the criteria and the methodological quality of each study is sufficient, a meta-analysis will be conducted.AnalysisA narrative synthesis of included studies and the associations between ACEs and adult mental health will be completed. If the number of studies included per mental health outcome is two or more, a multi-level meta-analysis will be completed using odds ratio effect sizes as outcomes.DiscussionThis review will contribute to the existing body of literature supporting the long-term effects of ACEs on adult mental health. This review adds to previous reviews that have either synthesised cross-sectional associations between ACEs and mental health outcomes, synthesised longitudinal studies exploring the effect of ACEs on different physical and mental health outcomes or synthesised longitudinal studies exploring the effect of ACEs on the same mental health outcomes using different methods. This review aims to identify methodological weaknesses and knowledge gaps in current literature that can be addressed in future primary studies.Systematic review registrationThis protocol has been registered in PROSPERO (CRD42021297882).

Two years after SARS-COV-2 was declared a public health emergency, global estimates of excess deaths from the Institute for Health Metrics and Evaluation indicate that 18·2 million people died due to the pandemic by Dec 31, 2021—three times higher than official records suggest. 100 million people have been plunged into extreme poverty by the pandemic, according to World Bank estimates. While the true burden of COVID-19 is being unravelled, is a mental health crisis being unmasked? The pandemic has exposed long-standing gaps and a global underinvestment in mental health care and prevention, disproportionately affecting young people and women.

BackgroundChildhood maltreatment and HIV are both associated with a greater risk for adverse mental health, including posttraumatic stress disorder (PTSD), depression, and increased systemic inflammation. However, it remains unknown whether childhood maltreatment and HIV interact to exacerbate PTSD, depression, and inflammation in a manner that may further increase the risk of adverse health outcomes in people living with HIV. This study investigated the interaction between childhood maltreatment and HIV status on PTSD and depression symptom severity, and on peripheral concentrations of lipopolysaccharide (LPS) and high sensitivity C-reactive protein (hsCRP) in women. We hypothesized that women living with HIV (WLWH) who report high levels of childhood maltreatment exposure would show the greatest PTSD and depressive symptoms, as well as the highest concentrations of LPS and hsCRP.MethodsWe conducted a cross-sectional study of 116 women (73 WLWH and 43 women without HIV). Participants completed interviews to measure trauma exposure, including childhood maltreatment, and PTSD and depression symptoms. They also provided blood samples that were analyzed for LPS and hsCRP concentrations.ResultsBoth women living with and without HIV reported high rates of trauma exposure and showed no statistically significant differences in overall rates of childhood maltreatment. Moderate to severe childhood maltreatment was associated with higher PTSD symptom severity (p =.005), greater depression severity (p =.005), and elevated plasma LPS concentrations (p =.045), regardless of HIV status. There were no effects of childhood maltreatment on hsCRP concentrations. There were no detectable significant effects of HIV status, or interactions between HIV status and childhood maltreatment, on PTSD and depression symptoms, or LPS and hsCRP concentrations (all p’s > 0.05).ConclusionsOur findings highlight the impact of childhood maltreatment on depression and PTSD symptoms and LPS concentrations in women. These results underscore the importance of trauma-informed health care in addressing childhood maltreatment to potentially improve both mental and physical health outcomes of adult women.

Introduction There is accumulating evidence of ineffective decision-making between birthing individuals and healthcare providers during childbirth. While research syntheses have demonstrated that negative birth experiences are associated with postpartum mental health, primary quantitative studies linking specific decision-making measures and mental health outcomes have not been synthesised. The present study aims to fill this gap in order to provide hands-on evidence on how to further improve perinatal care. Methods A systematic literature search using Bolean logic was conducted. A final set of 34 publications from 14 different countries could be included in our meta-analysis. Measures of intrapartum decision-making were consolidated into four key domains: information, respect, control, and involvement. We conducted multi-level meta-analyses to assess the overall relationship of intra-partum decision-making and mental-health outcomes, as well as the specific correlations associated with each decision-making domain. Results Our analysisrevealed that less effective intrapartum decision-making is associated with more postpartum overall mental health problems (r = -.25), depression (r = -.19), and posttraumatic stress disorder (r = -.29). More precisely, while all domains of intrapartum decision-making (information: r = -.22, involvement: r = -.23, respect: r = -.28, control: r = -.25) were associated with postpartum overall psychopathology, only information (r = -.18), respect (r = -.25), and control (r = -.12) were associated with depression, and only involvement (r = -.31), respect (r = -.32), and control (r = -.25) were associated with posttraumatic stress disorder. A higher percentange of planned cesarean sections in a sample and longer time lags between birth and post-effect measurement were identified as moderating variables. Conclusions Ineffective decision-making is a significant contributing factor to the development of adverse postpartum mental health problems outcomes. Implications for practice concern establishing numerous antenatal care contacts as a standard to enhance birth preparedness for both birthing individuals and providers. Additionally, measuring the experience of intrapartum decision-making as an indicator of quality of care as a default to monitor, analyse, and improve decision-making and to facilitate accountability systems.

Race, Ethnicity and Experienced Racism Are Associated with Adverse Physical and Mental Health Outcomes Among Cancer Survivors