Use of mental health services among disaster survivors: predisposing factors

<p>Abstract</p> <p>Background</p> <p>Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000).</p> <p>Methods</p> <p>Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2–3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0–18 months and 18–36 months post-disaster were examined using multiple logistic regression models.</p> <p>Results</p> <p>In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48–5.53), hostility (OR:2.04; CI:1.28–3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25–2.65), injuries as a result of the disaster (OR:1.80;CI:1.13–2.86), social functioning problems (OR:1.61;CI:1.05–2.44) and younger age (OR:0.98;CI:0.96–0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04–5.07) and hostility (OR:3.77;CI:1.51–9.40) predicted MHS utilization following 18 months post-disaster.</p> <p>Conclusion</p> <p>This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.</p

Mental health services required after disasters: Learning from the lasting effects of disasters

Extent: 13p.Disasters test civil administrations’ and health services’ capacity to act in a flexible but well-coordinated manner because each disaster is unique and poses unusual challenges. The health services required differ markedly according to the nature of the disaster and the geographical spread of those affected. Epidemiology has shown that services need to be equipped to deal with major depressive disorder and grief, not just posttraumatic stress disorder, and not only for victims of the disaster itself but also the emergency service workers. The challenge is for specialist advisers to respect and understand the existing health care and support networks of those affected while also recognizing their limitations. In the initial aftermath of these events, a great deal of effort goes into the development of early support systems but the longer term needs of these populations are often underestimated. These services need to be structured, taking into account the pre-existing psychiatric morbidity within the community. Disasters are an opportunity for improving services for patients with posttraumatic psychopathology in general but can later be utilized for improving services for victims of more common traumas in modern society, such as accidents and interpersonal violence.A. C. McFarlane and Richard William

Emergency Training, Education and Perceived Clinical Skills for Tsunami Care Among Nurses in Banda Aceh, Indonesia

Background: Nurses are a part of health care provider who has responsibility to respond to disaster. The nurses ought to have sufficient knowledge and skills in caring for patients in disasters such as in a tsunami. Clinical skills of nurses effectively help the nurses in handling the tsunami emergency response.Objectives: To describe the levels of perceived clinical skills for tsunami care in acute response phase (6 months) after tsunami struck, and to examine the relationship between emergency training, education, and perceived clinical skills for tsunami care in Banda Aceh, Indonesia.Methods: This was a correlational study. Systematic random sampling was employed to recruit 97 nurses in a hospital in Banda Aceh, Indonesia. Data were collected using questionnaires developed by the researchers and colleagues. The questionnaires consisted of two main parts: The Demographic Data Questionnaire (DDQ) and The Tsunami Care Questionnaire (TCQ).Results: Overall, perceived clinical skills for tsunami care were at a moderate level with the total mean score of 3.52 (SD = 0.86). Pearson product moment correlation coefficients indicated significant relationships between perceived clinical skills for tsunami care and attending emergency training and education (r = .23, p< .05).Conclusion: The nurses in the hospital should maintain and improve their knowledge and skills by regularly attending emergency training and education in order to respond to disaster more effectively

The Calm in the Storm: Women Leaders in Gulf Coast Recovery

Report outlining the importance of women in Gulf Coast Recovery actions.One year after Hurricanes Katrina and Rita, women stand at the forefront of constituencies who have taken up leadership for a fair and just recovery, drawing on a history of community-based organizing and the unflinching support of women's funds across the United States

Reproductive Health Coordination Gap, Services Ad hoc: Minimum Initial Service Package (MISP) Assessment in Kenya

The post-election violence in Kenya in the early months of 2008 displaced more than 500,000 people. In any humanitarian crisis, certain priority reproductive health (RH) services must be put in place from the earliest stages of an emergency. These essential activities are defined in the Minimum Initial Services Package (MISP) -- the established international standard for providing RH care in emergencies. They include activities to prevent sexual violence and treat survivors; protect against the transmission of HIV; ensure delivery supplies and emergency care for pregnant women and newborns; and lay the groundwork for comprehensive RH services once conditions allow. The Women's Commission for Refugee Women and Children (Women's Commission) undertook a mission to Kenya in April 2008 to assess the progress the humanitarian community has made in the institutionalization of the MISP in emergency response operations. The assessment took place four months after the crisis erupted and included visits to camp settings in the Nairobi, Kisumu, Kitale, Eldoret and Nakuru regions.Key Findings1) Despite the ongoing and urgent needs of large numbers of displaced persons, the Women's Commission found that funding was clearly inadequate to meet the unaddressed health needs of the displaced. UN emergency appeals to address humanitarian needs related to the post-election violence remained significantly underfunded at the time of the assessment, and organizations that could have continued to respond were bringing their emergency response operations to a close.2) The most significant and overarching gap in the implementation of the MISP was the absence of RH coordination at all levels.3) Awareness of the MISP among humanitarian workers in Kenya was higher than awareness levels registered in two earlier MISP assessments conducted by the Women's Commission. However, the MISP was not guiding action in Kenya which meant there were still unacceptable gaps in protection and key RH services.4) Planning to prevent high levels of sexual violence, inlcuding sexual exploitation and abuse, were strong at the national level but still inadequate at the field level. Poor security measures were noted at all but one camp and the assessment team received numerous disturbing reports of sexual exploitation and abuse by humanitarian workers, police and others.5) Mechanisms to respond to sexual violence, inlcuding sexual exploitation and abuse, were also weak at the field level. Displaced persons and representatives of humanitarian organizations reported a general atmosphere of impunity toward perpetrators of sexual violence. Health workers also suggested that many of the displaced did not know the importance of seeking treatment for sexual assault or where it was offered. Many displaced women were only slowly seeking care months after the height of the violence.6) In terms of priority activities taken to protect against HIV transmission, the findings were mostly positive. It was encouraging that health care providers were concerned from the start of the crisis about the need to prevent the transmission of HIV and to ensure people living with AIDS had continuing access to antiretroviral medicines. By all accounts, there were sufficient supplies of male condoms; however, some displaced persons reported that they were still not freely available or easy to obtain.7) The Women's Commission found that referral systems to care for pregnancy-related emergencies were not uniformly in place, and transportation for women and girls suffering from complications of their pregnancy or delivery was highly problematic in some places. While clean delivery kits were available in some settings, they were not consistently distributed to visibly pregnant women and there were shortages in some settings. In addition, no displaced women we spoke with were aware of or had heard of clean delivery kits.8) Young people appeared to be the most severely affected, with many reporting idleness due to a lack of jobs and opportunities to attend secondary school and university. In addition, young people noted that the sudden movement from their busy lives in rural areas to overcrowded urban camps where they were now idle created more exposure to the opposite sex. A sudden increase in sexual activity enhanced their vulnerability to sexually transmitted infections, including HIV, and unwanted pregnancies.Although the Kenya crisis has disappeared from the headlines, daily life remains a crisis for people who are still displaced from their homes and communities. The Kenyan government and international aid agencies must take immediate and coordinated action to address the priority RH needs of the displaced populations. In particular, the needs of young people should be prioritized considering their vulnerability to sexual exploitation and abuse and heightened risk of unsafe sex as they remain displaced or return to their homes.More broadly, this assessment highlights the need for a deeper commitment on the part of donors and the humanitarian community to the institutionalization of the MISP in humanitarian crises, particularly to ensure RH coordination from the beginning of an emergency. Adequate funding for MISP activities must be provided at the onset of an emergency, and more humanitarian workers must be trained and skilled in MISP implementation.Key RecommendationsThe United Nations Population Fund (UNFPA) and the Ministry of Health's Division of Reproductive Health should initiate reproductive health coordination, as people continue to be displaced in camps, transit camps and communities, and those returning can also benefit from such services.All agencies working to prevent sexual violence and provide care to survivors should enforce rules and procedures to prevent and manage sexual violence, address the issue of impunity, and inform communities of where and how to report incidents and the importance of seeking medical care.All agencies working in or funding the health sector should strengthen the health care system to provide care for pregnancy-related problems, especially as international agencies hand over their projects to the government and local organizations.All organizations should better engage young people in the recovery process, enhance their educational and job opportunities, and address their specific reproductive health needs

Building Momentum to Sustain Social Change Evaluation of the of Katrina Women's Response Fund

In the time that has passed since powerful hurricanes decimated the Gulf Coast region in 2005, the recovery and rebuilding process continues to expose the deep vulnerabilities of a society that has not effectively addressed the legacy of racism. In response to the injustices, human suffering, destruction, and massive displacement caused by Hurricanes Katrina and Rita, the Ms. Foundation for Women, WFN and its partner funds, with the $1.3 million support of the W.K. Kellogg Foundation, continued to strengthen the Katrina Women's Response Fund (KWRF)

Project Reach: Implementation of Evidence-Based Psychotherapy Within Integrated Healthcare for Hurricane Harvey Affected Individuals

Project Reach was established to deliver evidence-based mental healthcare services to children and adults affected by Hurricane Harvey and its aftermath. Through Project Reach, an innovative multi-component assessment and treatment service is utilized to identify and treat in integrated healthcare settings both children and adults exhibiting significant behavioral health concerns in Houston. The aim is to provide sustainable, integrated mental health services through primary care and school-based settings to post-Harvey affected individuals whose emotional needs remain unmet. This paper describes the design and implementation of Project Reach as well as special considerations for implementation. The overall goal of Project Reach is to form a platform for expanding integrated services for those affected by Harvey that will maximize behavioral health outcomes while reducing cost and improving access

Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-event Disasters

Threats of bioterrorism and emerging infectious disease pandemics may result in fear related consequences. Fear based signs and symptoms, if left undetected and untreated, may be extremely debilitating and lead to chronic problems with risk of permanent damage to the brain’s locus coeruleus stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are best managed by timely and effective information, rapid evaluation, and possibly medication that uniquely addresses the locus-coeruleus driven noradrenalin overactivation. This article recommends that a fear and resilience (FR) checklist be included as an essential triage tool to identify those most at risk. This checklist has the utility of rapid usage and capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required in the future. It is important to note that a unique feature of the FR Checklist is that in addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, it simultaneously identifies individuals who are hyper-resilient who can be asked to volunteer and thus rapidly expand the surge capacity

Post- and peritraumatic stress in disaster survivors: An explorative study about the influence of individual and event characteristics across different types of disasters

Background: Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards. Objective: To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters. Additionally, to investigate individual and event characteristics. Design: In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event. Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R). Peritraumatic emotional stress and risk perception were rated retrospectively. Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed. Results: Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters. Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes. Conclusion: Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters. However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics. As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables

Community health workers and stand-alone or integrated case management of malaria: a systematic literature review.

A systematic literature review was conducted to assess the effectiveness of strategies to improve community case management (CCM) of malaria. Forty-three studies were included; most (38) reported indicators of community health worker (CHW) performance, 14 reported on malaria CCM integrated with other child health interventions, 16 reported on health system capacity, and 13 reported on referral. The CHWs are able to provide good quality malaria care, including performing procedures such as rapid diagnostic tests. Appropriate training, clear guidelines, and regular supportive supervision are important facilitating factors. Crucial to sustainable success of CHW programs is strengthening health system capacity to support commodity supply, supervision, and appropriate treatment of referred cases. The little evidence available on referral from community to health facility level suggests that this is an area that needs priority attention. The studies of integrated CCM suggest that additional tasks do not reduce the quality of malaria CCM provided sufficient training and supervision is maintained