community mental health resilience
TRANSCRIPT
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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
3 3
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