Anenberg, Susan

Folger, Shanell

English

George Washington University: Health Sciences Research Commons (HSRC)

Mental health outcomes following hydrological extreme weather events among Pacific Islanders: A Systematic Literature ReviewShanell Folgera & Susan Anenberg, PhD, MSaa Department of Environmental and Occupational Health, The George Washington University Milken Institute School of Public HealthStudy QuestionBackgroundPECO StatementMethodsResultsStudy QuestionNext StepsReferencesAcknowledgementsNext Steps“Does the prevalence of adverse mentalhealth outcomes increase among PacificIslanders after hydrological extremeweather events (HEWE)?”• Natural disasters can adversely affectphysical health, mental health, andcommunity health either directly or indirectly.• Along with rising global temperatures,increases in severity of extreme weatherevents have been attributed to climatechange.• 7,348 disaster events have been reportedglobally since 2000, ~75% increase comparedto between 1980-1999 (UNDRR, 2020).• Occurrence of natural disasters are increasingin the Pacific Island countries (PICs) (Fig. 1)(IMF, 2018).• PICs are among the most vulnerable to healthrisks related to climate related disastersFigure 1. Map showing the Pacific Island countries divided into three geographic regions.Population: Adults in Pacific IslandsExposure: HEWEsComparator: Adults in Pacific Islands not exposed to HEWEsOutcome: adverse mental health outcomesFollowed the Navigation Guide methodology for conducting systematic literature review.Study Selection Criteria:• In English• Peer-reviewed• Original data• Human studies• Exposure terms: cyclonic storms, floods, tsunamis, disasters, typhoon, hurricane, climate change• Outcome terms: mental health, mental disorders, psychological adaptation, psychological trauma, stress disorders, psychological stress• Located in a PIC (excluding high-income countries)502 records identified though database searching476 records identified for title screening52 records identified for abstract screening16 full-text articles assessed for eligibility6 studies included in qualitative synthesisRisk of Bias Domains:• Recruitment• Confounding• Exposure Assessment• Incomplete outcome data• Selective reporting• Other bias• Conflict of InterestQuality of Evidence:• Rated as either “high,” “moderate,” or “low”Strength of Evidence:• Rated as either “sufficient,” “limited,” or “inadequate”Figure 2. Flowchart of literature search.Risk of bias assessment: High risk of bias across most studies for confounding and other potential bias (Table 1).Quality of  Evidence: Overall quality of evidence was “Low” for high risk of bias and indirectnessStrength of Evidence: Overall strength of evidence was “limited” for low quality of evidence and constrained confidence in association1 2 3 4 5 6RecruitmentConfoundingExposure assessmentIncomplete outcome dataSelective reportingOther biasConflict of interestTable 1. Assessment of risk of bias across the 6 studies based on specified domains.Low riskProbably low riskProbably high riskHigh riskCharacteristics Studies (n=6)Study design cross-sectional (n=5); case-control (n=1)Time Frame 1983 - 2016Data Collection 29 days - 16 months following a HEWE*Sample size 39 - 2,291Location American Samoa, Fiji, Solomon Islands, Tuvalu (n=2), VanuatuExposures cyclones, sea levels rises, tsunamis, wave damages (floods)Outcome data self-report: in-depth qualitative interviews (n=2); questionnaires (n=4)Results All reported presence of adverse mental health outcomes (e.g. changes in outlook of everyday life, direct threat to life, partial post-traumatic stress syndrome, distress, anxiety, and depression-like symptoms)Table 2. Summary of study characteristics* Asugeni et al. 2015 did not specify a data collection time frameI concluded that there was “limited” evidence forthe association between HEWEs and adversemental health outcomes among PacificIslanders.Findings from this review make it critical tohighlight the mental health implicationsassociated with natural disasters, and morebroadly climate change, within the Pacific Islandswhere mental health services are underutilized,mental health needs remain unmet, and mentalhealth is still stigmatized.• Include comparators (i.e. not exposed to HEWEs) to quantify effect size of HEWEs on mental health outcomes• Quantifiable epidemiological data in PICs that are supplementary to qualitative studies• Cultural competency and sensitivity on mental health • Longitudinal studies to assess long term effects1. Asugeni, J. et al. (2015). https://doi.org/10.1177/1039856215609767.2. Fairley, M. et al. (1986). https://doi.org/10.1017/S0033291700010412.3. Gibson, K. et al. (2019). https://doi.org/10.1177/1363461519847057. 4. Gibson, K. et al. (2020). https://doi.org/10.1016/j.janxdis.2020.102237. 5. King, M. et al. (2013). https://doi.org/10.1001/dmp.2012.11. 6. Pomer, A. et al. (2019). https://doi.org/10.1007/s00737-019-00980-6.Special thanks to my culminating experience (CE) advisor Dr. Anenberg, CE course instructor  Dr. Lance Price, and my CE peers for their immense expertise, support and guidance for the duration of conducting this systematic literature review.Shanell Folgershanellnfolger@gwu.edu

Mental health outcomes following hydrological extreme weather events among Pacific Islanders: A Systematic Literature Review

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Mental health outcomes following hydrological extreme weather events among Pacific Islanders: A Systematic Literature Review

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