自然灾害后的心理韧性:遭受不同程度洪水影响的社区中的资源利用过程

Background: Disasters negatively impact mental health and well-being. Studying how people adapt and recover after adversity is crucial for disaster preparedness and response. Objective: This study examined how differentially affected communities harness their resources to adapt to the aftermath of a flood. We predicted that stronger individual, interpersonal, and community resources protect against psychosocial resource loss and, through that, are related to fewer symptoms of posttraumatic stress and depression and higher life satisfaction. We also predicted that these effects would be stronger in a flooded community, compared to a threatened, but non-flooded community. Method: Participants were randomly sampled community members from two neighbouring municipalities. One municipality was severely flooded during the 2014 floods in South East Europe (affected community, na = 223), the other was threatened but not flooded (comparison community, nc = 224). Interviews were conducted one and a half years after the disaster using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale, the Psychosocial Resource Loss Scale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale Revised and the Satisfaction with Life Scale. Results: Stronger individual, interpersonal, and community resources were found to be related to better post-disaster outcomes directly and indirectly through psychosocial resource loss. In the affected community, interpersonal resources and community social capital and engagement were stronger predictors of positive adaptation. In the comparison community, community economic development and trust in community leadership were more important. Conclusion: This study provides evidence that people affected by disasters can harness their individual, interpersonal, and community resources to recover and adapt. Post-disaster interventions should aim to strengthen family and community ties, thus increasing available social support and community connectedness.Antecedentes: Las catástrofes tienen un impacto negativo en la salud mental y el bienestar. Estudiar cómo se adaptan y se recuperan las personas tras la adversidad es crucial para la preparación y la respuesta ante los desastres. Objetivo: Este estudio examinó cómo las comunidades afectadas de forma diferencial aprovechan sus recursos para adaptarse a las secuelas de una inundación. Predecimos que contar con recursos individuales, interpersonales y comunitarios más fuertes protegen contra la pérdida de recursos psicosociales y, a través de ello, se relacionan con menos síntomas de estrés postraumático y depresión y una mayor satisfacción vital. También predijimos que estos efectos serían más fuertes en una comunidad inundada, en comparación con una comunidad amenazada, pero no inundada. Método: Los participantes fueron miembros de la comunidad seleccionados al azar de dos municipios vecinos. Uno de los municipios sufrió graves inundaciones durante las inundaciones del 2014 en el sureste de Europa (comunidad afectada, na = 223), el otro, estuvo amenazado pero no se inundó (comunidad de comparación, nc = 224). Las entrevistas se realizaron un año y medio después del desastre, utilizando la versión de 10 ítems de la Escala de Resiliencia de Connor-Davidson, la Escala Multidimensional de Apoyo Social Percibido, la Escala de Recursos Comunitarios, la Escala de Pérdida de Recursos Psicosociales, la Lista de Verificación del TEPT para el DSM-5, la Escala de Depresión Revisada del Centro de Estudios Epidemiológicos y la Escala de Satisfacción con la Vida. Resultados: Los recursos individuales, interpersonales y comunitarios más fuertes se relacionaron con mejores resultados después de la catástrofe, directamente e indirectamente a través de la pérdida de recursos psicosociales. En la comunidad afectada, los recursos interpersonales y el capital social y el compromiso de la comunidad fueron los mayores predictores de una adaptación positiva. En la comunidad de comparación, el desarrollo económico de la comunidad y la confianza en el liderazgo comunitario fueron más importantes. Conclusión: Este estudio aporta pruebas de que las personas afectadas por catástrofes pueden aprovechar sus recursos individuales, interpersonales y comunitarios para recuperarse y adaptarse. Las intervenciones posteriores a las catástrofes deberían tener como objetivo reforzar los lazos familiares y comunitarios, aumentando así el apoyo social disponible y la conectividad de la comunidad.背景: 灾难对心理健康和幸福产生负面影响。研究人们在逆境后如何适应和恢复, 对于灾害预防和反应至关重要。 目的: 本研究考查了受到不同影响的社区如何利用其资源来适应洪水的后果。我们预测, 更强大的个人, 人际关系和社区资源可保护人们免受心理社会资源损失, 并因此与更少的创伤后应激和抑郁症状以及更高的生活满意度相关。我们还预测, 与受到洪水威胁但未遭遇洪水的社区相比, 在遭遇洪水的社区中, 这些效应会更强。 方法: 参与者是从两个邻近城市随机抽样的社区成员。一个城市在2014年东南欧洪水期间遭受了严重洪灾 (受影响社区, na = 223), 另一个城市则受到洪水威胁但未遭遇洪水 (对比社区, nc = 224) 。在灾难发生一年半后, 使用10条目版Connor-Davidson韧性量表, 感知社会支持多维量表, 社区资源量表, 社会心理资源损失量表, DSM-5 PTSD检查表, 流行病学研究中心抑郁量表修订版和生活满意度量表进行访谈。 结果: 人们发现, 更强大的个人, 人际关系和社区资源直接或间接地通过心理社会资源损失与更好的灾后结果有关。在受影响的社区中, 人际关系资源, 社区社会资本和参与度是积极适应的更强预测指标。在对比社区中, 社区经济发展和对社区领导的信任更重要。 结论: 本研究提供了受灾难影响的人们可以利用其个人, 人际关系和社区资源来恢复和适应的证据。灾后干预措施应旨在加强家庭与社区的联系, 从而增加可用的社会支持和社区联系

Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods.

The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings

Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes

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Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes

Background In order to provide effective primary care for refugees and to develop interventions tailored to them, we must know their needs. Little is known of the health needs and experiences of recently arrived refugees and other migrants throughout their journey through Europe. We aimed to gain insight into their health needs, barriers in access and wishes regarding primary health care. Methods In the spring of 2016, we conducted a qualitative, comparative case study in seven EU countries in a centre of first arrival, two transit centres, two intermediate-stay centres and two longer-stay centres using a Participatory Learning and Action research methodology. A total of 98 refugees and 25 healthcare workers participated in 43 sessions. Transcripts and sessions reports were coded and thematically analyzed by local researchers using the same format at all sites; data were synthesized and further analyzed by two other researchers independently. Results The main health problems of the participants related to war and to their harsh journey like common infections and psychological distress. They encountered important barriers in accessing healthcare: time pressure, linguistic and cultural differences and lack of continuity of care. They wish for compassionate, culturally sensitive healthcare workers and for more information on procedures and health promotion. Conclusion Health of refugees on the move in Europe is jeopardized by their bad living circumstances and barriers in access to healthcare. To address their needs, healthcare workers have to be trained in providing integrated, compassionate and cultural competent healthcare