Psychosocial management before, during and after emergencies and disasters

Emergencies and disasters have significant implications for mental health. Exposure to disaster-related traumas, together with the cascading effects of displacement, bereavement, and resource loss, have the potential to cause significant psychological distress. Increased incidence of post-traumatic stress disorder, depression and anxiety have been documented across disaster-affected populations globally [1]. Growing cross-cultural evidence indicates that trauma is expressed through social, psychological, and spiritual means in many populations[2]. For most people, the effects of grief and trauma lessen over time. Others continue to experience psychological distress in the months and years following disasters [3]. Despite growing evidence that disaster exposure is associated with ongoing psychological difficulties, it is not clear whether patterns of mental health outcomes are consistent across hazards and populations.

This research project was initiated to seek better understanding of the long-term mental health impacts of health emergencies and disasters, and the potential mitigating factors. This project also explored the optimal frameworks for measuring intervention impact. Asia is regularly affected by climatic, geological and technological disasters. In 2020, the region accounted for 41% of total disaster events and 64% of people affected globally [4]. Due to the elevated burden of disasters in this region, this project established the Asia Pacific Disaster Mental Health Network to coordinate research in this area. This Network was utilised to conduct an expert consultation to identify region-specific research needs and best practices.

[1] Beaglehole, B.; Mulder, R.T.; Frampton, C.M.; Boden, J.M.; Newton-Howes, G.; Bell, C.J. Psychological distress and psychiatric disorder after natural disasters: Systematic review and meta-analysis. Br. J. Psychiatry 2018, 213, 716–722. 

[2] Gibson, K.; Haslam, N.; Kaplan, I. Distressing encounters in the context of climate change: Idioms of distress, determinants, and responses to distress in Tuvalu. Transcult. Psychiatry 2019, 56, 667–696. 

[3] Bryant, R.A.; Gibbs, L.; Gallagher, H.C.; Pattison, P.; Lusher, D.; MacDougall, C.; Harms, L.; Block, K.; Sinnott, V.; Ireton, G. Longitudinal study of changing psychological outcomes following the Victorian black Saturday bushfires. Aust. N. Z. J. Psychiatry 2018, 52, 542–551. 

[4] CRED & UNDRR. 2020: The Non-COVID Year in Disasters. Brussels: CRED. 2021. 

1. Identify the long-term trajectories of disaster and pandemic-related mental
   health outcomes and associated risks and protective factors,
2. Assess the application of monitoring and evaluation tools in the field of disaster
   mental health, in line with the Inter-Agency Standing Committee (IASC) Common
   Monitoring and Evaluation Framework for Mental Health and Psychosocial Support
   in Emergency Settings,
3. Establish the Asia Pacific Disaster Mental Health Network to identify region-
   specific research needs and best practices within the region

1. Long term trajectories of mental health outcomes

A systematic review was conducted in English, Simplified Chinese, and Japanese to identify
studies that assessed longitudinal posttraumatic stress symptoms (PTSS), depression and
anxiety in populations affected by disasters and pandemics. Ten electronic databases -
Cochrane, MEDLINE, ProQuest, APA PsycINFO, PubMed, Web of Science, and CINAHL
(English), CNKI and SINOMED (Chinese), and CiNii (Japanese) were searched for studies
published between Jan 2000 and May 2022. The included studies were quality assessed
using the Systematic Assessment of Quality in Observational Research (SAQOR) scale.
Conditional growth modelling was applied to analyse mental health trajectories across ages
and disaster types. The reported risk and protective factors mitigating the relationship
between disaster and mental health trajectories were categorised, alongside any significant
effect sizes that were found in the analyses.

2. Quality assessment of interventions according to the IASC Framework

In this systematic review, Ovid and MEDLINE databases were searched for studies published
between January 2013 and June 2022 (i.e., spanning the publication of the framework in
2017) that pertained to interventions for mental health and psychosocial support in disasters
and emergencies. All studies that did not report an intervention evaluation and those
without mental health and psychosocial outcomes were excluded. Quality of the included
studies was assessed using the SAQOR scale. Data were extracted for information related to
the nature of the disaster, conflict, or health emergency, the intervention type employed
(e.g., according to the IASC intervention pyramid) and evaluation information according to
the IASC Framework (e.g., outcomes and impact indicators). Descriptive analyses were
conducted to determine the consistency of reporting across published studies, and
alignment of intervention outcomes with the specific criteria for monitoring and evaluation
outlined in the IASC Framework.

1. Long term trajectories of mental health outcomes

• A final sample of 234 papers met inclusion criteria: 206 English, 24 Chinese, and
  4 Japanese language studies.
• PTSS rates gradually improved for all ages in the years following disaster and
  pandemic exposure.
• In contrast, the prevalence of depression and anxiety remained elevated and
  stable for disaster-affected populations.
• Concerningly, significantly higher levels of depression and anxiety symptoms were reported for children and adolescents, and these levels persist over time.
• Pandemics and earthquakes were associated with higher prevalence of PTSS, and
  industrial disasters and pandemics with higher rates of anxiety. Multi-level risk
  and protective factors associated with long-term psychological difficulties were
  identified.
• The chronicity of mental health concerns following disasters and pandemics
  highlights the critical need for sustainable mental health services, particularly for
  children and adolescents.

2. Quality assessment of interventions according to the IASC Framework
(Currently ongoing work and analysis)

• Relevant published studies since 2013, spanned 35 countries, most frequently
  from the United States (n=10) and China (n=8). Most interventions for mental
  health and psychosocial impacts were implemented to address the mental health
  and psychosocial consequences of the COVID-19 pandemic or in protracted
  conflict settings.
• The IASC Framework was found to provide a good foundation for strengthening
  consistency in reporting, however, significant gaps in outcome assessment were
  identified within the published literature.
• Improving application of the IASC Framework has potential to inform a more
  comprehensive understanding of systemic mental health concerns following
  humanitarian emergencies.

Asia Pacific Disaster Mental Health Network

• Asia Pacific Disaster Mental Health Network was established in June 2020 to
  foster innovative disaster mental health research, practice and policy across the
  region. The network brings together leading disaster psychiatry, psychology and
  public health experts from all over the region.
• The first meetings of the Network resulted in the development of a regional
  disaster mental health agenda with five priority areas: (1) Strengthening
  community engagement and the integration of diverse perspectives in planning,
  implementing and evaluating mental health and psychosocial response in
  disasters; (2) Supporting and assessing the capacity of mental health systems to
  respond to disasters; (3) Optimising emerging technologies in mental healthcare;
  (4) Understanding and responding appropriately to addressing the mental health
  impacts of climate change; (5) Prioritising mental health and psychosocial
  support for high-risk groups.
• The Network has launched new research projects aligned with the regional
  agenda, hosted an online webinar series, supported early career investigators’
  research projects, and developed policy briefs to highlight issues key to disaster
  mental health (including the rising incidence of domestic violence during COVID-
  19). Network members have presented original research findings in collaborative
  symposia and panels at international conferences, including the International
  Society for Traumatic Stress Studies Annual Meeting (2021) and United Nations’
  Global Platform for Disaster Risk Reduction (2022)

Mental health resources are scarce in low and middle-income countries and can be hard to
access in high-income countries during and after emergencies and disasters [8]. The
systematic review revealed a high-level prevalence of mental health difficulties among
disaster and pandemic survivors and persistence of mental health symptoms years after the
event. The incidence of psychological difficulties is even higher for children and adolescents.
These findings demand not only that mental health policy and programmes to be
implemented as part of the early response after disasters and pandemics, but also that
accessible and sustainable mental health services be established to provide long-term care
for survivors. The identification of key protective and risk factors for mental health outcomes
highlights important opportunities for systemic changes that support communities.

In addition to the findings of the global systematic review, expert consultation with the Asia
Pacific Disaster Mental Health Network suggested a variety of region-specific research
needs. Further efforts to expand this initiative to capture different region-specific research
needs are expected.

Kansai Region including Hyogo Prefecture has implemented a series of innovations driven by
the lessons learnt from the Great Hanshin-Awaji Earthquake, 1995. These include the
establishment of the Hyogo Institute for Traumatic Stress (involved in this research project),
which has conducted longitudinal monitoring and assessment of the earthquake survivors.
The expert consultation with Asia Pacific Disaster Mental Health Network proposed further
research needs based on the experiences and knowledge of Kansai and Japan. Addressing
these region-specific research needs would inform the further improvement of policies and
programmes both locally and globally.

For further information see: World Mental Health Day 2022

1. Newnham EA, Mergelsberg E, Chen Y, Kim Y, Gibbs L, Dzidic P, Ishida DaSilva M,
   Chan EYY, Shimomura K, Narita Z, Huang Z, Leaning J. Long term mental health
   trajectories after disasters and pandemics: A multilingual systematic review of
   prevalence, risk and protective factors. Clinical Psychology Review. Vol. 97. 2022.
   102203. ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2022.102203.
2. Newnham EA, Dzidic PL, Mergelsberg ELP, Guragain B, Chan EYY, Kim Y, Leaning
   J, Kayano R, Wright M, Kaththiriarachchi L, Kato H, Osawa T, Gibbs L. The Asia
   Pacific Disaster Mental Health Network: Setting a Mental Health Agenda for the
   Region. Int. J. Environ. Res. Public Health 2020, 17,
   6144. https://doi.org/10.3390/ijerph17176144.
3. Newnham EA, Chen Y, Gibbs L, Dzidic P, Guragain B, Balsari S, Mergelsberg E,
   Leaning J. The mental health implications of domestic violence during COVID-19.
   Int. J. Public Health. 2022. 66. DOI=10.3389/ijph.2021.1604240. ISSN=1661-
   8564.

1. Newnham EA, Dzidic P, Chen Y, Gibbs L, Guragain B, Wright M, Chan EYY,
   Mergelsberg E, Leaning J. The mental health implications of increasing domestic
   violence during the COVID-19 pandemic: Evidence and recommendations. Policy
   Brief. 2021. World Health Organization Centre for Health Development.
2. Newnham EA, Mergelsberg E, Chen Y, Kim Y, Gibbs L, Dzidic P, Ishida Da Silva M,
   Chan EYY, Shimomura K, Leaning J. Long-term mental health following disasters
   and pandemics: Evidence and recommendations. Policy Brief. 2021. World Health
   Organization Centre for Health Development.

Panel: Newnham, E.A., Chan, E.Y.Y., Gibbs, L., Dzidic, P., Leaning, J. Responding to disasters:
Supporting communities to strengthen mental health after mass trauma. International
Society for Traumatic Stress Studies. 2021.

Symposium: Newnham, Gibbs, Mergelsberg, Kaththiriarachchi (2021). Psychological,
cognitive and academic outcomes for children and adolescents following disaster-related
trauma and adversity. International Society for Traumatic Stress Studies.

1. Gibbs L. & Nursey J. (2021). Longitudinal academic performance for children in
   bushfire affected school communities.
2. Mergelsberg ELP, Newnham EA, Kim Y, Gibbs L, Dzidic P, Chan EYY, Chen Y,
   Ishida M, Shimomura K, Wong CS, Leaning J. (2021). Longitudinal mental health
   outcomes for children and adolescents following disasters and health
   emergencies: A systematic review of prevalence, risk and protective factors.
3. Kaththiriarachchi L. (2021) Salivary cortisol levels and cognitive functions of Sri
   Lankan adolescents: A cross sectional study.
4. Newnham EA, Mergelsberg E, Gurgain B, Jiao F, Leaning J. (2021). Adolescent
   resilience after disasters: An assessment of risk and protective factors in China
   and Nepal.

Webinar presentations

1. Newnham, E.A., & Gibbs, L. (2021). Disaster mental health in the Asia Pacific
   region. CCOUC Ten Year Anniversary Webinar Series. Hosted by CCOUC and Dr
   Ryoma Kayano.