Psychosocial Support Activities Research Articles

Evaluating Student Equity Initiatives: A Student-Centred Approach

The robust evaluation of student equity initiatives is now an expected activity in Australian universities. This paper reports on the development of Swinburne’s Higher Education Participation and Partnerships Program (HEPPP) Evaluation Framework in which the project team adopted a student-centred design approach. The needs of Aboriginal and Torres Strait Islander students were positioned at the heart of the methodology and provided the starting point of explorations of student experiences in interviews and focus groups. We found that psychosocial support activities were critical to Indigenous students and those from low socioeconomic statue and/or regional or remote backgrounds and identified several additional Outcome factors of equity programs. Furthermore, we propose ‘Prosperity’ as a new Impact factor for evaluating equity programs to capture a broader notion of ‘success’. We argue that insights from existing institutional evaluation frameworks need to complement the Student Equity in Higher Education Evaluation Framework (SEHEEF) as Australia’s national framework and inform its continuous improvement.

Opinions of Psychological Counselor and Guidance Teachers Taking Work in Earthquake Psychosocıal Support Works (Malatya Province Example)

This study was carried out with psychological counselor/guidance teachers working within the scope of psychosocial support services in the earthquake region of Malatya in 2020. The research was carried out by using the phenomenological design, one of the qualitative research models, with the focus group interview method. 11 psychological counselors/guidance teachers participated in the study. During the interview, video and audio recordings were taken and the interviews were deciphered. Content analysis method was used to analyze the findings. When the findings of the study were examined, it was revealed that the motivation of the participants to provide psychosocial support services was prior experience and encouragement. Encouragement; In the title, the support and experience of the Guidance and Research Center Directorate (RAM), attending the coordination meeting and communicating with colleagues are mainly included. Findings were obtained that the participants did not feel professionally competent before starting psychosocial support activities. However, towards the end of the studies, there are also findings regarding the development of professional competence. It was found as the most extraordinary event that some of the relatives of the people who died due to the earthquake found solace in death. Participants stated their expectations and suggestions regarding post-earthquake psychosocial support activities.

Prevalence of depression, anxiety, and associated factors in immigrant pregnant women in Türkiye: A cross-sectional study

The prevalence of depression and anxiety in pregnant women is increasing and this is more important in migrants who are in the vulnerable group. The aim of this study was to evaluate the prevalence of depression and anxiety in Syrian immigrant pregnant women admitted to a Migrant Health Center and the associated factors. The study is a cross-sectional study. A questionnaire prepared using sociodemographic characteristics and the Beck depression and anxiety inventories in Arabic was applied to the participants. The study was conducted with immigrant pregnant women who applied to the Migrant Health Center between July 8, 2022, and December 31, 2022. The study was conducted through health workers who speak Arabic and had received training on the subject beforehand. The mean age of the research group was 26.67 ± 5.98 years. Of the participants, 73.0 percent (%) had primary education or less, 95.0% had low income, 87.2% had 3 or less children and 98.5% described their health status as good or very good. The mean Beck anxiety inventory score of the participants was found to be 4.65 ± 3.17. The mean Beck depression inventory score was found to be 4.48 ± 2.53. Smoking and first pregnancy status were found to be associated with anxiety, whereas smoking and history of delivery beyond 42 weeks were found to be associated with depression (P ˂ .05). Anxiety and depression levels of immigrant pregnant women were found to be very low. Minimal anxiety was found in 99.3% of the immigrant pregnant women and 97.1% had no symptoms of depression. It is thought that effective psychosocial support activities for immigrant pregnant women should be carried out in a way to cover the entire target group.

Views of Psychological Counselors Involved in Post-Earthquake Psychosocial Support Activities Regarding the Support Process

The purpose of this research is to reveal the views and recommendations of guidance counselors involved in psychosocial support activities regarding the support process after the earthquake centered in Kahramanmaraş, known as one of most catastrophic disasters of the century. The research is structured in the form of a case study design, which is one of the qualitative research types. The study group consists of 21 participants who are psychological counselors working in Samsun and who volunteered to provide psychosocial support by travelling to the earthquake-affected region. In the research, a demographic information form and a semi-structured interview form were used as data collection tools. The research data were analyzed using the content analysis method. The research data were categorized into three themes: process, coping skills, and recommendations. In the research, it was determined that guidance counselors involved in psychosocial support activities were affected by trauma, therefore, it is essential to emphasize preventive mental health studies for those involved in psychosocial support activities and volunteers who want to contribute to the support process should be strengthened through pre-process training before the process.

Characterizing psychosocial services in a pediatric urology practice

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4% were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4%), mental/behavioral/developmental health (29.1%), and referral and appointment management (19.9%). The largest proportion of time was spent on providing direct psychosocial support (45.9%), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9%). Relative time allocation across activities varied by provider type (p<0.001); care coordination constituted 64.2% of non-billable activities for the psychologist, 57.8% for the SW, and 12.3% for the CCLS. Activities were associated with treatment plan modification in 37.7% (n=357), outpatient coordination in 22.5% (n=213), and treatment plan adherence in 19.0% (n=180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Depressive symptoms, burnout, resilience, and psychosocial support in healthcare workers during the COVID-19 pandemic: A nationwide study in Japan.

The coronavirus disease 2019 pandemic has significantly impacted the mental health of healthcare workers. This study aimed to assess the mental health of healthcare workers and identify risk and protective factors. We surveyed 48,031 healthcare workers at 63 Japanese Red Cross hospitals from December 15, 2022 to January 15, 2023. Mental health was assessed using the Center for Epidemiologic Studies Depression Scale, the Japanese Burnout Scale, and 10-item Connor-Davidson Resilience Scale. Furthermore, we inquired about the psychosocial support activities provided to the healthcare workers within their workplaces. This study included 3815 healthcare workers (250 doctors, 32 residents, 2588 nurses, 504 co-medical staff, and 441 administrative staff). Symptoms of depression were noted in 31.5% of all participants and 46.9% of resident doctors. Women and those who were young, lived alone, had a nonmanagement position, had contact with coronavirus disease 2019 patients, or had passive motivation to coronavirus disease 2019 work had a significantly higher total Center for Epidemiologic Studies Depression Scale score than in the corresponding groups with the opposite characteristics. High emotional exhaustion and depersonalization scores on the Japanese Burnout Scale were risk factors for depressive symptoms, while living with family was a protective factor. Moreover, interventions such as job performance support (skills, knowledge, information, and safety), peer support, and organizational support (infection control team, patient care rotation systems) were effective. The impact of the prolonged coronavirus pandemic on mental health among healthcare workers is clear, and organized psychosocial support is needed.

Teachers’ Challenges and Coping Strategies in Conducting Mental Health and Psychosocial Support Activities

Mental Health and Psychosocial Support, or MHPSS, are significant in our wellbeing. During pre-pandemic, some professionals and practitioners were trained to conduct MHPSS. However, teachers are now recognized as providers because of the wide call for the integration of MHPSS in education. Thus, the researcher aimed to explore teachers' experiences conducting MHPSS for students. The study participants are classroom teachers with one to three years of experience in the Department of Education under a teacher induction program and assigned to a school with mental health practitioners like guidance counselors and school nurses. The data is analyzed using the case study model of Meriam and Tisdell. The study revealed the circumstances where students' support, activities conducted, challenges encountered, coping strategies, and responses of the recipients. The study served as an evaluation of the support and intervention in the school setting. Practitioners may use the result of this study to identify the areas where teachers need help the most. Future researchers may examine teachers' experiences assigned to schools without mental health professionals and practitioners to identify more challenges and coping strategies.

Assessing the effectiveness and observing fidelity of a psychosocial support program for Rohingya refugee mothers and their children in Cox’s Bazar, Bangladesh

IntroductionDespite the well-recognized risk poor maternal mental health poses to early child development, it is still rarely addressed in global health programming, especially in humanitarian settings where access to health and mental health infrastructures may be limited. Recognizing the critical role of maternal psychosocial wellness in addressing the health and development of children in conflict, Action contre La Faim/Action Against Hunger (ACF) developed the Baby Friendly Spaces (BFS) program. BFS is a holistic, evidenced-based psychosocial support program that aims to enhance mothers’ wellbeing, internal resources, and child caring skills in order to create a buffer against the deleterious health and developmental impacts of conflict on children.ObjectivesIn Bangladesh, we sought to evaluate the effectiveness of a psychosocial support program for Rohingya refugee mothers and their malnourished children under two years old living in Cox’s Bazar’s camps.MethodsFor this study, we used a matched pair randomization, where ten BFS program sites were allocated to either continue providing services “as usual” or to an “enhanced BFS program” after re-training and providing continuous supportive supervision of the BFS staff throughout the trial period. 600 mothers and their children were enrolled in the study and attended psychosocial stimulation activities related to child care practices and care for women. Data were collected at baseline and 8-week follow-up. Primary outcomes included maternal distress and wellbeing, functioning, and coping. For implementation purpose, a survey was administered on confidence at work for all BFS staff and a fidelity observation assessment was conducted.ResultsRelative to “as usual” sites, mothers in enhanced implementation sites reported greater reductions in distress (B=-.30) and improvement in wellbeing (B=.58). These differences were small, but marginally significant (p=.058; p=.038) with standard estimation; There was no significant difference between the two groups for daily functioning and coping. BFS providers in “enhanced BFS program” reported higher confidence in service delivery than their colleagues (p=.01). Fidelity varied widely across different components, with some very high and some very low adherence. There tended to be better adherence to procedures in group versus individual sessions and for some specific activities across domains, for enhanced versus standard BFS.ConclusionsFindings highlight the value of innovative study approaches for real-world evidence generation. Small but feasible adjustments to implementation can both improve program delivery for maximizing impact. Consequently, low-intensity psychosocial support activities holds potential for reducing distress and improving subjective well-being of conflict affected mothers.Disclosure of InterestNone Declared

Mental Health and Psychosocial Support in Response to Onset of the COVID-19 Pandemic: Findings from Action Against Hunger’s Emotional and Stress Management Intervention in Ivory Coast, Liberia, and Sierra Leone

IntroductionIn 2020, as in the rest of the world, the COVID-19 pandemic spread in Africa and transformed people’s lives. Adding to the already existing burden of fragile health care systems, especially in low-resource settings, the pandemic response highlighted the need to address the health and well-being of populations in innovative ways. While research findings reported critical impacts on populations’ mental health, few studies assessed this progression within African countries. At the onset of the COVID-19 pandemic, Action Against Hunger (ACF), developed and delivered a brief Emotional and Stress Management Intervention (ESMI) to reduce symptoms of emotional distress and increase perceived social support through problem solving techniques and relaxation exercises among adults and youth living in vulnerable communities experiencing a relatively high prevalence of COVID-19 in urban and rural areas in Sierra Leone, Liberia and Ivory Coast.ObjectivesThe primary aim of this study is to evaluate whether individuals who received ESMI experienced changes in psychological distress and social support following the intervention and the association between change in psychological distress and change in social support for each country.MethodsThis study consisted of secondary analysis of data collected via routine monitoring of activities by ACF for their ESMI programs implemented in community-based centers and health facilities from May to December 2020. Service delivery mechanisms were adapted to each context and setting (i.e., face to face vs. remote, health facilities vs. home visits, etc.). The main outcomes were psychological distress and social support measured with culturally relevant visual analogue scales. All analyses were performed separately for each country.ResultsIn total, 1,412 adults and youth (11-17 years old) benefitted from the intervention across all countries and 1,350 were assessed at follow-up. As a result, changes for psychological support and social support with mean scores difference at baseline and follow up were significantly different in all countries. Correlations between changes in distress and changes in social support varied by country, and ranged from negative in Liberia, (r = -.88, p = 0.001), to positive in Ivory Coast (r = .55, p = 0.001), and null in Sierra Leone (r = -.07, p = 0.11). Across countries, the most commonly reported presenting problems were fear of infection, stigma, and socio-economic difficulties, with coping strategies differing by country.ConclusionsAt the onset of a pandemic crisis, low-intensity psychosocial support activities hold potential for reducing psychological distress and improving social support among adults and youth from vulnerable communities in the context of the COVID-19 pandemic.Disclosure of InterestNone Declared

'Like a family in the end': Improving mental health Recovery skills through Peer-to-Peer communication in Darwin, Australia.

The existing psychosocial Support activities in the Northern Territory, Australia, are mostly delivered through individualised outreach and client-centred Support programs and do not currently have a strong Peer focus. To address this gap, a Peer-Led Education Pilot was developed and implemented in Darwin, Australia. The pilot was comprised of three separate but overarching stages, and each stage was independently evaluated. In this article, results from Stage 1 will be presented, with a specific focus on the role of Peer-to-Peer communication in improving participants' mental health and Recovery skills. This stage involved the delivery of the My Recovery program to self-nominated participants, and the evaluation was aimed at reporting on the appropriateness and effectiveness of the program. The evaluation was qualitative in design involving individual pre- and post-program interviews with program participants (npre =14, npost =16) between August and October 2019. The program was well received by participants and helped build their capacity to understand and self-manage their mental health and/or alcohol and other drug issues in an inclusive, non-clinical, non-judgemental space. The results highlighted the importance of including a strong Peer focus in the existing psychosocial Support services available for people with mental health issues in Darwin. The findings also underscored the inclusion of those with lived experience of mental health challenges in the design and delivery of such programs.

School-based Psychosocial Support: Asset-based Approach for Positioning Guidance and Counselling as a Core Component

The necessity for school-based psychosocial support (SBPSS) provision has become a fundamental issue in global education systems. However, for many schools in Lesotho, and in other Sub-Saharan countries, there seem to be no clarity on the position of guidance and counselling (GC) in school psychosocial support (PSS) undertakings. This paper considers G/C as an essential component of psychosocial support provision in schools, and argues that G/C should be well positioned so that it becomes the core component of PSS activities. The paper intents to address issues raised by international research that against the backdrop of ever increasing complex societal challenges that impact negatively on school going population and school life in general, there is need strengthen G/C as part of PSS activities. The interplay of the various challenges often makes the adverse experiences more complex, subsequently causing adjustment disorders among students. Underpinned by asset-based approach and relational leadership theory, this study employed qualitative semi-structured questionnaires, online free attitude interviews and focus group discussions to explore teachers’ perspectives on possibilities for positioning GC as the core component of SBPSS. This study uncovered various factors contributing to undecided position of GC. The study concluded that schools need to tap into asset-based approach to strategically position GC in SBPSS undertakings.

Psychosocial and mental health during the COVID-19 lockdown: A rapid qualitative study in migrant shelters at the Mexico-United States border

Introduction. Migrants could be at increased risk of the psychosocial and mental health consequences of the COVID-19 pandemic. Research is needed to assess their needs and the most useful interventions in this regard. Objective. To describe the mental health consequences of the pandemic and lockdown measures among migrants living in shelters in Tijuana, Mexico, during the COVID-19 pandemic, barriers to mental healthcare during this period, and the key elements of psychosocial support provided by civil society organizations (CSOs), as described by shelters’ staff. Method. In April-May 2020, we conducted a rapid qualitative study through interviews with persons providing services at eight migrant shelters, complementing the information with data from an ongoing ethnographic project. We situated the results within the levels of the United Nations’ Inter-Agency Standing Committee (IASC) pyramid of psychosocial and mental health support. Results. In addition to fear of contagion and economic insecurity, migrants experienced emotional distress associated with hardening migration policies, and the difficulties of having to find shelter in place in non-private spaces. Some CSOs continued or adapted previous psychosocial support activities, helping migrants navigate these issues, but other activities stopped amidst physical distancing measures and because of limited resources. Migrants themselves implemented some group activities. There was a surge of civil society initiatives of online support, but some shelters laeked the technological and other resources to benefit from them. Discussion and conclusion. Migrants require a tailor made response to their mental health needs in the COVID-19 pandemic, such as the one provided by CSOs.

Impact Report of Apar Foundation Limited on Educational, Health, Nutrition and Psychosocial support Activities, Kampala, Uganda

Impact Report of Apar Foundation Limited on Educational, Health, Nutrition and Psychosocial support Activities, Kampala, Uganda

Creating a Tool to Measure Children's Wellbeing: A PSS Intervention in South Sudan

Since 2015, more than 560,000 South Sudanese primary school children have received psychosocial support (PSS) through the USAID-funded Integrated Essential Emergency Education Services program implemented by UNICEF. Several South Sudan-based nongovernmental organizations partnered with UNICEF to train local teachers to implement the PSS activities in child-friendly spaces. To evaluate the impact this intervention had on students' wellbeing and academic performance, a multi-institutional consortium of multidisciplinary partners purposively sampled 2,982 students and 580 teachers in 64 schools from five states in the Republic of South Sudan. Critical to the evaluation's aims was the design of a contextually relevant, rigorously validated instrument to measure students' wellbeing in a region where research on PSS outcomes in education in emergencies is needed. In this article, we first present the process by which these survey instruments were designed through the collaborative efforts of experts on measuring psychosocial support outcomes in conflict settings and experts on the local context. We then describe how we tested for the construct validity of the resulting instrument and present the results of our confirmatory factor analysis of its three-factor model of social wellbeing, emotional wellbeing, and resilience/coping. Finally, based on our process and the resulting instrument, we make recommendations for future research on PSS outcomes in emergency settings.

Consular Crisis Management Operations: Special Considerations and Challenges.

Assisting the increasing number of tourists and foreign nationals exposed to crises situations in third countries-many of them far from home and extremely vulnerable-presents significant challenges. Despite the need to explore consular crisis management from an operational perspective, there are few studies that address the issue. This paper aims to describe the characteristics and context of consular crisis management operations based on personal experiences, scientific papers, grey literature, and key informant interviews.Consular crisis management operations are conducted in a context where the stakeholders and the legal environment may differ from humanitarian or civil protection operations. The physical distance causes logistical challenges and demands specific considerations for both civilian and medical evacuation. Consular crisis management operations often include medical care, psychosocial support activities, and disaster victim identification (DVI) activities. Political and media interest may also add significant challenges to such operations. Therefore, specific knowledge, skills, and preparations are needed for both diplomatic crisis management professionals and health professionals. Further research on consular crisis management activities-as well as the concept of consular crisis management itself-is strongly needed.

Demands and Factors Associated to Psychosocial Support of Cancer Patients at Vietnam National Cancer Hospital

Cancer patients in Vietnam are increasing exponentially in numbers, with great demands for psychosocial support. This study explored the demands for the psychosocial support of cancer patients at Vietnam National Cancer Hospital and several associated factors. This is a cross-sectional survey, qualitative and quantitative study, and conducted from April to September 2017. This study utilized the structured questionnaire of 418 cancer patients, 8 in-depth interviews and 3 focus group discussions. Results of the study showed that cancer patients have different demands for 6 types of psychosocial support services, specifically: visiting about health and family difficulties (86.1%), providing information on supporting networks for cancer patients (75.7%), psychological counseling and consultation (68.4%), psychotherapy (49.9%), Consultation on self-care for appearance (39.1%), and Consultation on social communication (38.6%). Factors associated to cancer patients’ demands for psychosocial support at Vietnam National Cancer Hospital are gender, the number of treatments, and psychological states. In addition, to improve the quality of life for cancer patients, Vietnam National Cancer Hospital should promote psychosocial support activities for cancer patients, based on associated factors.

Sports and physical activity in psychosocial interventions with adolescent groups of the Rohingya community in Bangladesh: potential, limitations and critical factors for success

The mental health and psychosocial needs of adolescent Rohingya refugees in Bangladesh are seriously underserved. There are few services and resources for them, and this population is hard to reach with conventional mental health and psychosocial support activities. Adolescent Rohingya refugees have very limited opportunities to express themselves and to engage in the community. This affects their mental health and psychosocial wellbeing negatively. This field report argues that the use of sports and physical activity could be a valuable means to provide psychosocial support to adolescent Rohingya refugees. A small number of research efforts and project evaluations have begun to help us understand the link between participation in sport and physical activity and mental health and psychosocial wellbeing. The data of this study were collected through focus group discussions and key informant interviews. The findings suggest that sports and physical activity may play a significant role in the psychosocial development and in strengthening positive social communication among adolescents. However, the development of sport activities in a humanitarian setting such as the Rohingya crisis is not easy. This field report explores challenges related to gender, local cultural context and community structure. Finally, some factors are discussed on how to design psychosocial programmes that include sport and physical activity and how to promote this with several stakeholders. *Both first authors contributed equally.

Individual and Community Psychosocial Support in the Immediate Response and Early Recovery of Hurricane Maria

Two hurricanes over a period of less than one month in Puerto Rico have caused catastrophic destruction in terms of infrastructure and the natural environment. After ninety days of field work, this paper provides a follow-up to the Disaster Mental Health and psychosocial support activities that occurred between the immediate response and three months of recovery in communities affected by Hurricane Maria. Communitybased psychosocial support during the immediate response and early recovery interventions are discussed. The summary discusses criteria that were used to make these interventions a part of a community-based psychosocial support program.

Social Network Analysis on Cooperation Network among Disaster Relief Organizations in Korea - Focused on the Sewol Ferry Disaster -

본 연구는 세월호 참사를 중심으로 재난심리지원을 위한 협력네트워크의 구조와 특성을 분석하고자 하였다. 국가적 규모의 재난 시 단일 기관의 대응만으로는 한계가 있으며, 다양한 유관 기관들이 유기적으로 협력하여 통합적인 재난심리지원 활동을 수행할 필요가 있다. 이에 본 연구에서는 사고 이후 재난심리지원 활동에 참여한 정부, 지역사회 및 민간 기관을 대상으로 정보 및 자료 교환, 재정및 물적자원 교환, 인적자원 교환, 공동사업 수행 및 공동행사 참여에 대한 관계데이터를 수집하고 사회네트워크분석(SNA)을 적용하여 협력네트워크의 특성을 분석하였다. 그 결과, 38개의 기관들이 전반적으로 낮은 협력관계를 맺고 있는 것으로 나타났다. 구체적으로, 인적자원 측면에서 기관 간협력의 정도나 효율성이 가장 낮은 수준으로 나타났고 이에 비해 정보/ 자료 측면에서의 협력은 상대적으로 활발하게 이루어진 것으로 나타났다. 중심성 분석 결과, ‘안산시 온마음센터’가 재난심 리지원 네트워크에서 가장 중추적인 역할을 하였으며, 이외의 주요 기관들은 주로 공공 부문에 집중 되어 있으며 민간 혹은 지역사회 기관의 기능은 다소 제한되어 있는 것으로 나타났다.The Sewol Ferry accident in 2014 had a significant impact on Korean society. In response to the national-scale disaster, there was a limit to what a single institution can do to facilitate an effective recovery of the society. This study aims to analyze the cooperative relations of 38 organizations which have participated in psychosocial support activities after the Sewol Ferry accident. The results from the social network analysis (SNA) showed that cooperative relationships among those institutions were generally low. Specifically, the degree of cooperation among the institutions was found to be lowest for human resources, but relatively high with respect to information/data transfer. The results from the centrality analysis indicated that ‘Ansan Mental Health Trauma Center’ played the most central role in disaster support network. In addition, the major players in this network were mainly public institutions, while private agencies or local community organizations were somewhat limited in their ability to mobilize support. Based on the findings, the implications on disaster support systems were discussed.

Hurricane Maria, personal and collective suffering, and psychosocial support as a cross-cutting intervention

Here we discuss the role of psychosocial support activities in the immediate aftermath of Hurricane Maria in Puerto Rico. We report comments from 630 survivors from 22 towns. The focus is given to reactions, risk factors and resilience. The responses of the survivors were divided into individual and community losses. We propose that the response to such a catastrophic event was psychosocial and give suggestions for psychosocial support during future disaster responses.