Substance use and functional impairment among adolescents directly exposed to the 2001 World Trade Center attacks

The relationship between exposure to the World Trade Center (WTC) attacks, increased substance use, functional impairment and mental health service use, controlling for depression and post-traumatic stress disorder, was assessed through an in-school survey of directly exposed students (N = 1040) attending the five middle and five high schools nearest the WTC. The survey was conducted 18 months after the attacks. Students with one WTC exposure risk factor had a five-fold increase in substance use, while those with three or more exposure risks had a nearly 19-fold increase. Increased substance use was associated with impaired school work, school behaviour and grades. Students reporting increased substance use were nearly twice as likely to want help but were no more likely than asymptomatic students to receive services. Adolescents reporting increased substance use, without co-morbidity, were less likely to receive psychological services than others. Attention to the needs of substance-using adolescents exposed to disaster is needed.     

Disaster mental health training programmes in New York City following September 11, 2001

The need for mental health resources to provide care to the community following large‐scale disasters is well documented. In the aftermath of the World Trade Center (WTC) disaster on September 11, 2001, many local agencies and organizations responded by providing informal mental health services, including disaster mental health training for practitioners. The quality of these programmes has not been assessed, however. The National Center for Disaster Preparedness at Columbia University's School of Public Health reviewed disaster mental health training programmes administered by community‐based organizations, professional associations, hospitals, and government agencies after September 11. Results indicate that the quality and the effectiveness of programmes are difficult to assess. A wide range of curricula and a widespread lack of recordkeeping and credentialing of trainers were noted. Most of the training programmes provided are no longer available. Recommendations for improving the quality of disaster mental health training programmes are provided.     

突发性灾难重大事件后公众对心理服务的认知和需求

为分析突发性灾难重大事件发生后公众对心理服务的认知和需求现状,采用随机抽样的方法在全国范围内抽取458名群众作为被试,使用“突发性灾难重大事件后公众心理服务认知和需求”调查问卷进行调查。结果显示:①不同性别人群、不同年龄阶段人群对“突发性灾难重大事件后心理服务”的认知存在显著差异(X^2=9.82,p<0.05;X^2=33.99,p<0.05)。②不同年龄阶段的人群对民众开展心理服务的必要性态度存在显著差异(X^2=15.84,p<0.05)。不同文化程度人群、不同性别人群对突发性灾难重大事件后心理服务活动的参与意愿存在显著差异(X^2=7.20,p<0.05;X^2=6.78,p<0.05)。③不同文化程度人群对心理服务知识和技能需求存在显著差异(X^2=28.65,p<0.05),在接受心理服务场所的选择上也存在显著差异(X^2=16.44,p<0.05)。不同年龄阶段人群对接受心理服务场所的选择上存在显著差异(X^2=21.52,p<0.05)。分析结果显示:在遭受突发性灾难重大事件时,公众对心理服务的了解程度一般,但参与意愿和需求强烈,因此,国家和社会应加快社会心理服务体系的建设,促进公众的心理健康。     

The 2004 tsunami and mental health in Thailand: a longitudinal analysis of one‐and two‐year post‐disaster data

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36‐item Short Form Health Survey (SF‐36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long‐lasting ramifications for mental health, and that diverse losses may influence mental health differently.     

Mental health in South Sudan: a case for community‐based support

This paper² provides a snapshot of the mental health situation in South Sudan between 2013 and 2016, taking account of the personal reflections of both authors who were engaged in mental health and psychosocial support (MHPSS)³ programming in the country at this time.⁴ It begins by presenting an overview of MHPSS activities from this period, including governmental and non‐governmental organisation (NGO) services, and relevant research and coordination mechanisms. It goes on to illustrate the challenges to the provision of support, as well as the overarching structural, governance, and human resource constraints faced by the sector. Finally, recommendations are put forward for improving services and care for people suffering from psychosocial and mental health issues, as well as suggestions for areas of focus in the future. The importance of an integrated, community‐based model is emphasised, and opportunities for organisations engaged in reconciliation efforts and mental health service provision to collaborate are proposed.     

An exploratory comparison of disasters, riots and terrorist acts

One question that emerged following the 11 September attacks was how to categorise and classify the event within existing disaster and conflict-event research frameworks. A decade ago, Quarantelli (1993) compared findings on the similarities and differences between consensus- and conflict-type events by illustrating a conceptual distinction between the two. In this paper, this discussion is expanded to include terrorist attacks by offering comparisons from research findings following 11 September. We provide analyses of individual, organisational, and community-level behaviour in crisis situations and suggest how 11 September is both similar to, and differs from, consensus- and conflict-type events as they were previously considered. Applications for emergency management are also suggested.     

Long-Term Effects of Hurricane Andrew: Revisiting Mental Health Indicators

Two population-based surveys of South Dade County, Florida, were conducted after Hurricane Andrew to compare hurricane-related symptoms of mental distress and describe the impact of mental health outreach teams. Households were selected by three-stage cluster sampling and findings from the two surveys, 13 months apart, were compared. Response rates were 75 per cent and 84 per cent. The prevalence of symptoms of mental distress decreased over time. However, in the households contacted by the teams (25 per cent of sample), the prevalence of symptoms (50 per cent) did not differ from households not contacted (43 per cent). Households contacted by teams that reported symptoms were just as likely to have been referred for help by the teams (72 per cent) as those without symptoms (68 per cent). Households reporting symptoms were equally likely to get counselling regardless of whether the teams visited. Mental health teams had no significant impact on mental health symptoms or the use of mental health services. Alternative approaches to mental health outreach teams need to be explored.     

An adaptive governance approach to disaster-related behavioural health services

This paper explores the provision of disaster-related behavioural and mental health (DBH) services as a problem of institutional collective action in the United States. This study reviews the challenges that providers have in surmounting multi-organizational disconnects, unstable professional legitimacy, ambiguous information, and shifting disaster needs in developing a system for delivering DBH services. Based on the adaptive governance framework, it argues that existing protocols such as the National Incident Management System (NIMS) and Incident Command System (ICS) may be helpful in advancing collective action, but that real progress will depend on a recognition of norms, expectations, and credentials across many spheres-in other words, on the ability of responders to continuously adjust their procedures and administrative boundaries for behavioural health institutions.     

Mental and social health in disasters: the Sphere standards and post‐tsunami psychosocial interventions in Asia

The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project's Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long‐term humanitarian psychosocial programmes in different countries in post‐tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long‐term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long‐term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication.     

Barriers to the long‐term recovery of individuals with disabilities following a disaster

This study examines how pre‐existing disabling conditions influenced the recovery process of survivors of Hurricane Katrina. It focuses specifically on the barriers that hindered the recovery process in these individuals. Focus groups were convened in four Gulf Coast states with 31 individuals with disabilities who lived in or around New Orleans, Louisiana, prior to Hurricane Katrina in August 2005. Qualitative data were analysed using grounded theory methodology. Five themes emerged as the most significant barriers to recovery: housing; transportation; employment; physical and mental health; and accessing recovery services. While these barriers to recovery were probably common to most survivors of the disaster, the research results suggest that disability status enhanced the challenges that participants experienced in negotiating the recovery process and in acquiring resources that accommodated their disabilities. The findings indicate that, when disaster recovery services and resources did not accommodate the needs of individuals with disabilities, recovery was hindered. Recovery efforts should include building accessible infrastructure and services that will allow for participation by all.     

The mental health of expatriate and Kosovar Albanian humanitarian aid workers

The mental health consequences of exposure to traumatic events and the risk factors for psychological morbidity among expatriate and Kosovar Albanian humanitarian aid workers have not been well studied. In June 2000, we used standardised screening tools to survey 285 (69.5%) of 410 expatriate aid workers and 325 (75.8%) of 429 Kosovar Albanian aid workers from 22 humanitarian organizations that were implementing health programmes in Kosovo. The mean number of trauma events experienced by expatriates was 2.8 (standard deviation: 2.7) and by Kosovar staff 3.2 (standard deviation: 2.8). Although only 1.1% of expatriate and 6.2% of Kosovar aid workers reported symptoms consistent with the diagnosis for post-traumatic stress disorder, 17.2% and 16.9%, respectively, reported symptoms satisfying the definition of depression. Regression analysis demonstrated that the number of trauma events experienced was significantly associated with depression for the two sets of workers. Organisational support services may be an important mediating factor and should be targeted at both groups.     

Mapping convergence points in the initial emergency response to 9/111

In response to extreme events, researchers have recognised the convergence of volunteers, emergency responders, and other individuals and organisations. In 2000, geographer Paul Routledge presented the concept of convergence spaces as a theoretical means to explain social movements. In applying this concept, this paper explores the geographic space in which organisations and individuals converged immediately following the 11 September 2001 attacks on the World Trade Center. The paper begins to answer the question of whether there were in fact any patterns of convergence among the locations utilised by organisations responding to the attacks. Using data collected from field documents, these geographic locations are mapped over 12 days to help identify possible patterns of clustering. Results of this analysis will begin to provide researchers, policy makers and practitioners with a better understanding of how emergency response evolves geographically following an event.     

There's nowhere to go: counting the costs of extreme weather to the homeless community

People experiencing homelessness are vulnerable to extreme weather in unique ways. The entrenched inequalities that underpin disaster vulnerability are compounded by extreme isolation and the stress of transient living on mental and physical health. However, the impacts of extreme weather on the homeless in Australia are largely undocumented and rarely incorporated in emergency planning. Interviews with and surveys of emergency and homeless services and service users revealed that the primary ramifications of losing shelter and worsening mental health deepen the cycle of homelessness and trauma. Consequently, homeless shelter losses, such as tents, should be included in pre‐ and post‐event impact statistics and subsequent recovery support. Extreme weather response plans should include early triggers and strategies for ‘non‐severe’ weather events, as the homeless community is affected earlier and by a wider range of meteorological conditions. Moreover, this study also explores the benefits of a trauma‐informed response to extreme weather when working with the homeless.     

Refugee health care: Similar but different?

The present review sets out to identify differences between refugees and other more stable communities living in less developed countries: demographic, mortality, morbidity, nutritional and selected epidemiological data are discussed. Although generalizations are difficult because of the variability of refugees and their differing circumstances, the health problems and diseases do not appear to differ qualitatively, although they may be quantitatively more severe.
The areas of particular concern lie not so much with the problems but with approaches to their solutions: the need to respond rapidly and appropriately to emergencies, the importance of attending to the priorities of nutrition, shelter, sanitation and water; and the necessity of providing services which are sufficiently flexible and sensitive to the changing needs of the refugees as they move from the acute emergency to the long-term settlements.
The review highlights certain areas where insufficient information is currently available, notably mental illness and the long-term issues of health and development, and outlines the implications of the conclusions for policy makers, with particular reference to training and research.     

Compliance with recommended protective actions during an H7N9 emergency: a risk perception perspective

This study investigates the factors determining an individual's response to official recommended protective measures, based on the Health Belief Model and the Protective Action Decision Model, to understand the adoption of protective behaviour during an H7N9 (Avian Influenza A) emergency. A public survey involving 1,375 respondents was conducted in Anhui Province, China, during the 2013 H7N9 outbreak to test the research model and hypotheses. The results indicate that protective, stakeholder, and risk perceptions influence positively an individual's willingness to take recommended actions. Protective and stakeholder perceptions also have a positive bearing on lay people's risk perceptions. A stakeholder perception is a vital determinant of a protective perception. More importantly, the effects of protective and stakeholder perceptions on behavioural responses to recommendations are mediated in part by risk perception. These findings can help public health officials to develop messages to encourage members of the population to protect themselves effectively during an influenza crisis.     

Completion of recommended WUI fire mitigation measures within urban households in Edmonton,Canada

The purpose of this study was to examine completion of recommended wildland—urban interface (WUI) fire mitigation measures by residents adjacent to the heavily vegetated North Saskatchewan river valley and ravine system in the City of Edmonton, Alberta. A mail survey was distributed to a random sample of households adjacent to this natural area. Almost all homeowners were found to be completing some recommended mitigation measures and in many cases were willing to complete most but not all of the measures that they had not yet completed, despite mixed motivations to act. Perceived responsibility for reducing risks, social bonds, beliefs that emergency services would protect homeowners' property in the event of a fire, and perceptions of the effectiveness of recommended mitigation measures, were not significantly related to completion of a higher average number of recommended mitigation measures. Importantly, most mitigation measures were completed for reasons other than WUI fire mitigation. The implications of these results and recommendations for emergency managers and communicators are discussed.     

Long‐term effects of Hurricane Katrina on the psychological well‐being of evacuees

Hurricane Katrina of August 2005 forced more than one million people to evacuate the Gulf Coast of the United States. This study examines the psychological health and well‐being of a subset of evacuees to determine the prevalence of ongoing mental health problems. Interviews were conducted with 101 adults who evacuated to Louisville, Kentucky, and were living in the state at the one‐year anniversary of the event or had recently returned to the Gulf Coast. The psychological health and well‐being of respondents was evaluated using several well‐validated measures. More than one‐half met the criteria for post‐traumatic stress disorder and a majority were suffering from depression and anxiety. The mean quality of life score was 0.6 on a scale from 0–1, suggesting that adaptation and return to pre‐hurricane well‐being had not occurred 12 months after the storm. The potential for long‐term psychological damage exists in this sample of Hurricane Katrina evacuees. Results suggest other evacuees may also be at heightened risk.     

The health sector gap in the southern Africa crisis in 2002/2003

The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to address the underlying problem of the health sector gap, a long-term strategy to ensure improved and sustainable health sector performance can only be accomplished with truly adequate resources. This will require renewed efforts on part of governments, donors and the international community. Public health interventions, complementing those addressing food insecurity, were and are still needed to reduce the impact of the crisis, and to allow people to re-establish their livelihoods. These will increase the population's resilience to prevent or mitigate future disasters.     

The responses of professional fire-fighters to disaster

This paper reports the results of a survey of the physical and mental reactions of a group ( N = 72) of members of the South Australian Metropolitan Fire Service (MFS) who were engaged in fighting the bushfires close to Adelaide, 16th-19th February 1983. A questionnaire, designed to elicit reports on both physical and mental reactions to exposure to the fire, as well as perceptions of several measures of social strain and social support, was administered to the firefighters when they came off duty. The results reported show the possible influence of role strain factors in predicting mental reactions, and also demonstrate what may be mediating effects of perceived social support. The paper also discusses methodological problems affecting this and other studies of the reactions of emergency service personnel to disaster.