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Building Community Mental Health Resilience for Disasters:

a Systematic Review

Jeffrey CarmanMPH, EOH Spring 2016

Background

• Community resilience

Source: Rockefeller Foundation

- People- Place- Knowledge - Organization

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Background

• Increasing number of Disasters GloballyThe gray area denotes the 1914 to 1945 time period.

Source: Harrison and Wolf, 2008

Source: Keiler, 2016

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Background

• When a disaster happens, mental health is often neglected

• Children are possible the hardest hit demographic.

Source: Deccan Chronicle

Objectives

• Collect and evaluate the evidence for community mental health resilience

• Disasters will happen, rapid recovery is possible through preparation.

• Evidence-based interventions

Source: http://neuro.questionsthatmatter.info/

Literature Search: Sources

•Himmelfarb Health Sciences Library at the George Washington University (GWU)

•Database search tools: –Scopus –Health Information @ Himmelfarb–Himmelfarb Library–PsychINFO–Health Policy Reference Center

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Literature Search: Criteria

•Primary source•Peer-reviewed•Pertaining to mental health in disaster preparedness

•Community trials and/or be quasi-experimental design.

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Literature Search: Terms

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• Search terms– Disaster resilience preparedness– Disaster resilience mental health intervention– Psychological community resilience preparedness– Community resilience preparedness– Community resilience

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Methods

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Study Characteristics

10Source: Niagara Gazette

Author(s). date of publication

Study Design Population Studied (number of participants)

Outcomes Measured How outcomes were measured

Chandra et al 2014 Quasi –Scientific

Community Intervention Trial

Adult Members of the Medical Reserve Corps in Los Angeles County

(n = 76)

Impact of Psychological First Aid Training (PFA)

Pre- and post-tests and attitude surveys

Wolmer et al. 2011 Quasi -Scientific

Case-Control Community Intervention Trial

 

Primary school-aged children from Southern Israel (n = 1,488 [748 intervention, 740 control])

Posttraumatic Stress Disorder (PTSD) after “Operation Cast Iron” (OCI)

Intervention: 9 months prior to OCI and follow-up was 3 months after OCI 

11Source: USC News

Study CharacteristicsAuthor(s). date of publication

Study Design Population Studied (number of participants)

Outcomes Measured

How outcomes were measured

McCabe et al. 2014

(Disaster Med Public Health Prep)  

Quasi-Scientific

Community Intervention Trial 

Trained volunteer and professional rural (Maryland and Iowa) and Urban cohorts (Maryland and Illinois) (n = 391)

Impact of PFA training and guided preparedness planning (GPP) training and practical application

Pre- and post-training tests on knowledge, skills and attitudes for PFA and GPP. Follow-up included percent of MRC applications submitted by PFA participants

GPP follow-up included disaster plans created.

McCabe et al. 2014

(Public Health Rep) 

Quasi -Scientific

Community Intervention Trial  

Trained volunteer and professional rural (Maryland and Iowa) and Urban cohorts (Maryland and Illinois) (n = 336)

Impact of PFA and GPP training and sustainable application

Pre- and post-training tests conducted on knowledge, skills and attitudes for PFA and GPP.

Measures conducted for project-attributable changes and post-intervention projects and partnerships

1212Source: USC News

Study CharacteristicsAuthor(s). date of publication

Study Design Population Studied (number of participants)

Outcomes Measured

How outcomes were measured

Ronan et al. 2003 

Quasi -Scientific

Community Intervention Trial

Intermediate school-aged children from the North Island of New Zealand

(n =213)

Impact of a brief school-based emotional and problem-focused coping program

Pre-/post-intervention tests in problem- and emotion-focused factors and a home-based questionnaire for child and their parents

Ronan et al. 2012  

Quasi -Scientific

Case-Control Community Intervention Trial

  

Primary and Intermediate school-aged children from the North Island of New Zealand

(n = 219 [115 intervention, 104 control]) 

Impact of a brief school-based disaster preparedness intervention program supplementing a community-wide effort

Pre-/post-intervention tests in four measures: Problem-and emotion-focused factors, knowledge surrounding civil defense alert, fear surrounding specific disasters and risk perceptions

Post-intervention test administered one week after training

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Study Characteristics

• Quasi-experimental community intervention trials

– 2,723 combined participants included in all the studies• 803 (including controls) study participants were adults while • 1,920 (including controls) were children of primary and

intermediate school age. – 3 of the included studies were conducted within the United States of

America– 2 were conducted in New Zealand – 1 study conducted in Israel

13Source: UNICEF

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Results: Risk of Bias

Author(s). date of publication

Major Results Significant Author(s). Data of publication

Major results Significance

McCabe et al. 2014

(Disaster Med Public Health Prep)

PFA: 11 of 14 test items improvedGPP: 8 of 15 test items showed improvement and 90% created disaster plans

Yes

Yes

Chandra et al. 2014

Participants’ correct in all questions from 43-49% and

(self reported) confidence increased from 40-54%

No

Yes

McCabe et al. 2014

(Public Health Rep)

PFA: 22 of 25 test items improveGPP: 17 of 18 test items improved

Follow-upPFA: 19.4% used in disaster 83.5% used in crisis, 78.4% reported improved skillsGPP: Between 81 and 91% submitted disaster plans

Yes

Yes

NA

Wolmer et al. 2011

PTSD control group: 10.3% (Girls 12.5%, Boys 10.2%)

PTSD intervention group: 7.2% (10.1% girls, 4.4% boys)

Yes

Results: Summary of Evidence

15Source: Action Press/ Rex Features

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Author(s). date of publication

Major Results Significant

Ronan 2003 Improvement in 5 of 6 measures of coping and knowledge measure (less significant improvements in coping)

Yes&No

Ronan 2012 5 of 7 improved in emotional factors (coping)4 of 6 improved in knowledge2 of 8 improved in fear factor (coping)9 of 16 improved in risk awareness

Yes

Yes

No

Yes

Results: Summary of Evidence

16Source:Peeter Viisimaa via BBC News

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Conclusions

• Mental health community interventions are generally shown to be effective

• Some negative effects of disasters to mental health can be mitigated by intervention

• More research needed

Source: Izissmile

Questions?

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Source: Andy Portch