Disaster Mental Health Services Research Articles

Health-Care and Supportive Services in General Population Disaster Shelters.

The Communication (C), Maintaining Health (M), Independence (I), Services, Support and Self-Determination (S), and Transportation (T) is a framework (C-MIST) for identifying functional needs in an emergency response. A C-MIST documentation tool provides shelter staff with a list of potential client needs and actions to address them. This retrospective review describes the needs and actions indicated on completed C-MIST documentation tools (ie, records) within domestic general population shelters following Hurricane Florence in 2018. A convenience sample of 1209 records completed by shelter disaster health services personnel was provided by the American Red Cross. The records correspond to client stays in 19 shelters between September and October 2018. Data abstracted from hardcopy forms were de-identified and recorded in a database. Summary statistics were computed. High incidence needs included medical supplies for everyday care (including medications) not related to mobility (15.4%), medically or culturally needed diets (12.2%), durable medical equipment (9.7%), mental health care (8.8%), and transportation (8.4%). High incidence actions included replacement medication (9.3%), refer to Disaster Mental Health Services (6.4%), provide assistive mobility equipment (5.1%), provide diabetes management supplies (5.0%), provide alternative food and beverages (4.1%), and provide transportation (3.9%). The process for identifying health and functional support needs in shelters should be standardized through the use of the C-MIST framework.

Mental Health in Disaster Medical Response Teams: An Assessment of Existing Resources and Applications for Telemedicine

Background/Introduction:Disaster responders operate in situations that are cognitively, emotionally, and morally distressing. The prevalence of mental health sequelae amongst disaster responders is well-documented. The World Health Organization (WHO) has published minimum standards for Emergency Medical Teams (EMTs), which requires them to assess the mental health and psychosocial support needs of their patients and staff, provide first aid, and ensure referral pathways for follow-up care are available. Specific to EMT staff and volunteers, the standards require that support services are always accessible. However, there is no requirement for EMTs to have their own mental health specialists, nor is having a mental health specialist assigned to each team and mission necessarily practical.Objectives:This study will assess the existing mental health resources of WHO EMTs and their use of telemedicine in mental health care.Method/Description:A survey will be distributed to the leadership of all WHO EMTs that are currently credentialed to capture descriptive statistics.Results/Outcomes:Data expected to be collected and analyzed by October 1, 2022.Conclusion:The absence of a mental health specialist significantly limits the availability of support services for EMT personnel. Given that the use of telemedicine in both disaster response and mental health services has been well-documented, telemedicine could be a low-resource method to link WHO EMT staff and volunteers with mental health specialists throughout the deployment cycle.

Mental Health Impacts of Hurricane Harvey: Examining the Roles of Intimate Partner Violence and Resilience

Abstract Prior research has found that the prevalence and severity of intimate partner violence (IPV) increase in communities experiencing a disaster. Less studied are the associations between IPV, disaster exposure, and mental health outcomes following disaster events. In the current study, authors examined the prevalence of IPV before and after Hurricane Harvey and the direct and indirect effects of risk (i.e., disaster exposure, IPV) and resilience on mental health outcomes using structural equation modeling with 382 adults. Results indicate that exposure to Hurricane Harvey was significantly associated with risk for IPV, posttraumatic stress (PTS) symptoms, and depression symptoms. In addition, IPV mediated the relationships between disaster exposure and PTS and depression symptoms. These findings support the need to incorporate IPV services and resources into disaster mental health services.

재난유형과 피해특성이 외상 후 스트레스 및 우울에 미치는 영향

The goal of this study is to identify the effect of disaster type and characteristics of damage on PTSD and depression and to suggest effective intervention for mental health among victims of disasters. The main findings from the study are as follows. First, the participants of the study experienced typhoons 26.8%, torrential rain 25.8%, earthquakes 32.5%, and fire 14.8%. They experienced life-threatening event 42.3%, physical injury 6.3%, and material damage 79.7%. Second, the risk groups of PTSD represented 35.6% and depression 14.6% among the participants. Third, PTSD had significant differences according to the type and time of the disaster, threatened life, physical injury, and material damage. The depression had significant differences according to the type and time of the disaster, physical injury, and material damage. Fourth, the type and time of the disaster, threatened life, and physical injury were found to have a significant effect on both PTSD and depression. Based on the results, the effective disaster mental health services were suggested.

재난심리지원 업무 종사자의 소진에 대한 이해와 대책

Individuals who perform disaster mental health services face a variety of stresses, including workloads, time pressures, role conflicts and ambiguities, and uncertain environments. They are also exposed to the pain of the victim and are required to maintain emotional empathy. These demands placed on disaster mental health workers increase the risk of burnout. Burnout is developed within the work context and characterized by three dimensions; emotional exhaustion, depersonalization, and low personal accomplishment. According to Job demands-resources model, organization should manage work demands and support organization resources for disaster mental health workers. Given the nature of disaster-related work, efficient organizational structure, well-defined roles, supportive organizational culture, and education are important factors in preventing burnout.

Factors Related to Perceptions of Financial Resources for Disaster Mental Health Services in South Korea

본 연구는 재난심리지원 서비스의 재원에 대한 국민들의 인식을 살펴보고, 개인부담과 조세 등 특정재원 선호에 영향을 미치는 변인을 확인하는 것을 목표로 한다. 이를 위해 연령별, 성별, 지역별할당을 적용하여 수집된 2928명의 데이터를 분석하였다. 우선 ‘특정재원 선호 없음’, ‘개인부담 선호’, ‘조세 선호’로 집단 구분 후 교차분석과 다중 로지스틱회귀분석을 실시하여 각 집단에서 연구변인들의 예측력을 확인하였다. 그 결과, ‘특정재원 선호 없음’에 비해 ‘개인부담 선호’집단을 유의하게 예측하는 변인은 성별, 연령, 심리회복에 필요한 기간 인식, 국가의 심리지원 중요성 인식, 서비스 이용에 대한 사회적 낙인이었다. 반면 ‘특정재원 선호 없음’에 비해 ‘조세 선호’집단을 유의하게예측하는 변인은 학력, 경제적 만족도, 정신건강 문제에 대한 외적귀인, 심리회복에 필요한 기간인식, 국가의 심리지원 중요성 인식, 서비스 이용에 대한 자기 및 사회적 낙인이었다.This study examined the factors influencing preferences for financial resources for post-disaster mental health services, such as out-of-pocket payment and tax burden. The data were collected from 2,928 individuals in South Korea who were classified into three groups according to their preference for financial resources: out-of-pocket payment, tax-based financing, or no preference. A logistic regression was performed to assess the predictive power of each variable in each group. The significant psychosocial factors influencing preference for out-of-pocket payment, compared to the no-preference group, included the perception of the time to recover from post-disaster mental health problems, the perception of importance of national support, and public stigma of seeking mental health services. On the other hands, external attribution for mental illness, the perception of the time to recover from post-disaster mental health problems, the perception of importance of national support, and self and public stigma of seeking mental health services significantly predicted the group who preferred tax-based financing.

Visualizing the Process of Disaster Mental Health Services in the Joso Flood by Network Analyses of Emails.

Joso City, Ibaraki Prefecture, Japan was severely affected by flooding of the River Kinugawa in September 2015. Local psychiatric organizations immediately began providing disaster mental health services (DMHS). In post-disaster settings, DMHS involving organizational interventions by multiple regional institutions are required to support disaster victims. However, little is known about the process of coordinating multiple institutions or determining whether appropriate support has been provided. To elucidate the characteristics of communications that enable effective disaster medical team formation, we conducted network analyses of sender-recipient pairs of emails during the period of DMHS activity. The network analysis is a research method that represents various objects as a network of nodes and edges and explores their structural characteristics. We obtained 2,450 time-series emails from five core members of DMHS, including 32,865 pairs of senders and recipients. The network generated by the emails was scale-free, and its structure changed according to the phases of disaster recovery. In the ultra-acute phase, which lasted about 1 week, spreading information and recruiting people to provide disaster support was given the highest priority. In the acute phase, which lasted about 1 month, support and swift decision-making were essential for directing large numbers of staff. In the mid- to long-term phase, support for staff to share information and experience in small groups was observed. Network analyses have revealed that disaster medical teams must change their communication styles during the mission to adapt to different health needs corresponding to each post-disaster phase.

Effect of Korean Version of Psychological First Aid Training Program on Training Disaster Mental Health Service Provider

Effect of Korean Version of Psychological First Aid Training Program on Training Disaster Mental Health Service Provider

Development of Korean Disaster Mental Health Support Guidelines: Results of a Scoping Review and a Delphi Survey.

ObjectiveIt is necessary to develop new guidelines to delineate the best ways of providing psychosocial care to ensure mental health following a disaster. MethodsThis study applied the scoping review method as a means of establishing evidence-based guidelines for disaster mental health services. A total of 440 literatures were selected through a scoping review of 20,864 documents. Twenty-three recognized experts were invited to participate in the survey and a two-round online Delphi survey was conducted. ResultsThe concordance rate in the Delphi Round 1 was 95.1%. Six items were excluded and new items were formulated with experts’ suggestions. A total of 23 statements were slightly modified to clarify their meaning. In the Delphi Round 2, all items were met with consensus. The three items with the highest consensus among the experts were related to the protection of personal information and privacy. The item with the lowest consensus among experts was related to debriefing. Other items were related to establishing mental health support centers and suicide prevention activities. Conclusion140 items were developed through scoping reviews based on evidence-based methodology. These items were used to describe the disaster mental health support identified in Delphi. The guideline will provide a foundation for effective preparation and response in disaster situations.

Personal Transformation Process of Mental Health Relief Workers in Sichuan Earthquake.

After Sichuan earthquake, a few dedicated teams of psychological volunteers have been committed to helping the survivors of the disaster for a long period. Their personal transformation experiences were absent in the literatures. The purpose of this qualitative research was to adopt a qualitative research to examine individuals' lived experiences of personal transformation after long-term disaster mental health services. The study interviewed 10 psychological counselors, 3 psychiatric nurses, 4 psychiatrist, and 6 social workers. We built an explorative model to understand disaster relief workers personal transformation after long-term periods in disaster settings. The model proposes that existential learning is a key mediator factor from negative transformation to positive transformation. Cultivating the existential learning though training, caring and support involves a number of processes that includes acceptance, being authentic, and being mindful of here and now, which can transform their suffering to growth.

Disaster Mental Health Services Review of Care for Older Persons After Disasters.

As older persons make up an ever greater proportion of the world's population, a range of concerns are being voiced by policy-makers, program managers, and care providers about best or optimal practices for serving this population's needs during all stages of disasters. Given that age-related vulnerabilities are common in late life, this article describes existing systems of care in the United States for the provision of disaster mental health services. Second, it evaluates the evidence for disaster treatment interventions with this subgroup of the population. Third, it synthesizes the findings of recent studies focusing on screening, assessment, and treatment approaches. To advance our current system of care and to adequately respond to the mental health needs of older persons, it is advantageous to periodically review progress, identify current gaps and unmet needs, and describe opportunities for improvement. (Disaster Med Public Health Preparedness. 2018; 12: 366-372).

School based post disaster mental health services: decreased trauma symptoms in youth with multiple traumas

AbstractChildren exposed to disasters are at an increased likelihood for multiple trauma exposure. The objective of our study is to understand the efficacy of post disaster school based services for reducing trauma symptoms of youth exposed to multiple traumatic events. Students (N = 112) age 8–17 that were survivors of Hurricane Katrina received individual treatment for multiple traumas on site at school. We used repeated measures ANOVA to investigate the effectiveness in self-reported trauma symptoms over time. Results indicated significant reduction in overall posttraumatic stress symptoms as well as subscales assessing anxiety, anger, depression, dissociation, overt dissociation, and fantasy dissociation. The school based services for students with multiple traumas were effective at reducing trauma symptoms following disaster.

Development of a Disaster Mental Health Service Model and Expert Survey

Development of a Disaster Mental Health Service Model and Expert Survey

Practical Report on Long-term Disaster Mental Health Services Following the Great East Japan Earthquake: Psychological and Social Background of Evacuees in Sendai City in the Mid- to Long-term Post-disaster Period.

The Great East Japan Earthquake, which occurred on March 11, 2011, caused unprecedented damage. To address evacuees' psychosocial issues, our disaster mental health team provided psychosocial support in the form of careful listening and providing information for reconstruction. To summarize evacuees' psychosocial issues, we reviewed records of our daily activities and analyzed factors related to continuation or termination of support. Terminated support was defined as the resolution or improvement of psychological issues relative to the time of initial support. Based on logistic regression analysis, living in prefabricated temporary housing (odds ratio [OR]: 0.37; 95% confidence interval [CI]: 0.19-0.72), a high number of improved stress symptoms (0.81; 95% CI: 0.67-0.99), and higher support frequency (0.84; 95% CI: 0.78-0.90) were significantly associated with a lower likelihood of continuing support. Conversely, economic and resettlement issues (2.75; 95% CI: 1.63-4.64) and high numbers of stress symptoms (1.24; 95% CI: 1.06-1.45) were strongly and significantly associated with continuing support, particularly in the mid- to long-term phase following the earthquake (ie, after August 1, 2011). No significant association was found between support status and alcohol problems or disaster-related experiences (eg, loss of family or housing). Our findings highlight the need to be aware of evacuees' social issues such as resettlement in the mid- to long-term post-disaster phase. (Disaster Med Public Health Preparedness. 2017;11:439-450).

Clinical Implications of Cultural Differences in Factors Influencing Resilience following Natural Disaster: A Narrative Review

Purpose In the immediate aftermath of disasters, unaffected individuals and organisations attempt to help in whatever capacity may be available to them - including the provision of mental health interventions. It is therefore important to identify the mental health outcomes of such disaster in order for such help to target culturally appropriate interventions for these populations. Objective The objectives of this literature review were to identify and describe the mental health outcomes, interventions, and resilience or coping skills of survivors following natural disasters - namely earthquakes, hurricanes, tsunamis and floods -across different cultural settings. Methods Due to the small number of studies identified, a narrative approach was employed to compile the data. Results Twelve studies were identified for this review and PTSD was the most common mental health outcome identified. Even though there were some differences in resilience and coping strategies of natural disaster survivors, on a micro-environmental level, social support appeared to be common. On a macro-systemic level, community factors, such as community services, cultural factors, spirituality and religion contributed to resilience across several cultures. However, mental health interventions adopted varied across different cultures. Conclusion Mental health professionals can increase the extent to which they are viewed by victims as a viable source of assistance following a disaster by being aware of the impacts of culture and social class on mental health outcomes. Furthermore, targeting diversity among group members in the planning of disaster mental health services can likewise increase the trust with which diverse ethnic groups view mental health professionals. In essence, mental health professionals have to be innovative and think outside the box to meet the needs of disaster victims.

A Survey on the Perception for the Disaster Mental Health Services among General Population

A Survey on the Perception for the Disaster Mental Health Services among General Population

Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention.

Several decades of research have informed our knowledge of children's reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.

2011 Joplin, Missouri Tornado Experience, Mental Health Reactions, and Service Utilization: Cross-Sectional Assessments at Approximately 6 Months and 2.5 Years Post-Event.

Introduction. On May 22, 2011 the deadliest tornado in the United States since 1947 struck Joplin, Missouri killing 161 people, injuring approximately 1,150 individuals, and causing approximately $2.8 billion in economic losses. Methods. This study examined the mental health effects of this event through a random digit dialing sample (N = 380) of Joplin adults at approximately 6 months post-disaster (Survey 1) and a purposive convenience sample (N = 438) of Joplin adults at approximately 2.5 years post-disaster (Survey 2). For both surveys we assessed tornado experience, posttraumatic stress, depression, mental health service utilization, and sociodemographics. For Survey 2 we also assessed social support and parent report of child strengths and difficulties. Results. Probable PTSD relevance was 12.63% at Survey 1 and 26.74% at Survey 2, while current depression prevalence was 20.82% at Survey 1 and 13.33% at Survey 2. Less education and more tornado experience was generally related to greater likelihood of experiencing probable PTSD and current depression for both surveys. Men and younger participants were more likely to report current depression at Survey 1. Low levels of social support (assessed only at Survey 2) were related to more probable PTSD and current depression. For both surveys, we observed low rates of mental health service utilization, and these rates were also low for participants reporting probable PTSD and current depression. At Survey 2 we assessed parent report of child (ages 4 to 17) strengths and difficulties and found that child difficulties were more frequent for younger children (ages 4 to 10) than older children (ages 11 to 17), and that parents reporting probable PTSD reported a greater frequency of children with borderline or abnormal difficulties. Discussion. Overall our results indicate that long-term (multi-year) community disaster mental health monitoring, assessment, referral, outreach, and services are needed following a major disaster like the 2011 Joplin tornado.

Toward the way forward: building an emergency mental health system for Israel.

A number of related changes have evolved over the past 25 years: the development of a truly national disaster mental health service in Israel; progress in the science of risk, resilience and evidence base care for those suffering from traumatic stress related disorders; and the development of conceptual models of population level disaster mental health response in the context of emergency management systems such as the Incident Command System.In a recent IJHPR article, Bodas, et al. report on the dynamic history of disaster mental health response in Israel, which informed by the all too numerous real world events affecting the region. What is most striking is that the system now in place reflects true “lessons learned” in that problems and issues identified in incidents informed deliberative planning, and the current system reflects many iterations of “lessons observed and learned”. There appears to be commitment across sectors of government in Israel that the mental health consequences of disasters and terrorism are important and a priority. This is advanced thinking and sound policy.As the system in Israel continues to evolve, additional possibilities are offered for further consideration, based on the author’s US-centric experience, to advance emergency response systems in Israel, the Middle East and around the world.

Systematic Consensus Building on Disaster Mental Health Services After the Great East Japan Earthquake by Phase.

We intended to build consensus on appropriate disaster mental health services among professionals working in the area affected by the Great East Japan Earthquake. We focused on the first 3 months after the disaster, divided into 3 phases: immediate aftermath, acute phase, and midphase. We adopted the Delphi process and asked our survey participants (n=115) to rate the appropriateness of specific mental health services in each phase and comment on them. We repeated this process 3 times, giving participants feedback on the results of the previous round. Through this process, we determined the criterion for positive consensus for each item as having the agreement of more than 80% of the participants. We found that the importance of acute psychiatric care and prescribing regular medication for psychiatric patients gained positive consensus in the immediate aftermath and acute phase. Counseling and psychoeducation after traumatic events or provision of information gained consensus in the acute phase and midphase, and screening of mental distress gained consensus in the midphase. Higher priority was given to continuous psychiatric services in the immediate aftermath and mental health activities in later phases.