Systematic Review, Community Mental Health Resilience

1. 1
Building Community Mental
Health Resilience for Disasters:
a Systematic Review
Jeffrey Carman
MPH, EOH Spring 2016

2. Background
• Community resilience
Source: Rockefeller Foundation
- People
- Place
- Knowledge
- Organization

3. 3 3
Background
• Increasing number of Disasters Globally
The gray area denotes the 1914 to 1945 time period.
Source: Harrison and Wolf, 2008
Source: Keiler, 2016

4. 4
Background
• When a disaster happens, mental health is
often neglected
• Children are possible the hardest hit
demographic.
Source: Deccan Chronicle

5. Objectives
• Collect and evaluate the evidence for
community mental healthresilience
• Disasters will happen, rapid recovery is
possible through preparation.
• Evidence-based
interventions
Source: http://neuro.questionsthatmatter.info/

6. Literature Search: Sources
•Himmelfarb Health Sciences Library at the
George Washington University (GWU)
•Database search tools:
–Scopus
–Health Information @ Himmelfarb
–Himmelfarb Library
–PsychINFO
–Health Policy Reference Center
6

7. Literature Search: Criteria
•Primary source
•Peer-reviewed
•Pertaining to mental health in disaster
preparedness
•Community trials and/or be quasi-
experimental design.
7

8. Literature Search: Terms
8
• Search terms
– Disaster resilience preparedness
– Disaster resilience mental health intervention
– Psychological community resilience preparedness
– Community resilience preparedness
– Community resilience

9. 9
Methods

10. 10
Study Characteristics
10
Source: Niagara Gazette
Author(s). date of
publication
Study Design Population Studied
(number of participants)
Outcomes Measured How outcomes were
measured
Chandra et al 2014 Quasi –Scientific
Community
Intervention Trial
Adult Members of the
Medical Reserve Corps in
Los Angeles County
(n = 76)
Impact of Psychological
First Aid Training (PFA)
Pre- and post-tests and attitude
surveys
Wolmer et al. 2011 Quasi -Scientific
Case-Control
Community
Intervention Trial
Primary school-aged
children from Southern
Israel
(n = 1,488 [748
intervention, 740 control])
Posttraumatic Stress
Disorder (PTSD) after
“Operation Cast Iron”
(OCI)
Intervention: 9 months prior to
OCI and follow-up was 3 months
after OCI

11. 11
Source: USC News
Study Characteristics
Author(s). date of
publication
Study Design Population Studied
(number of participants)
Outcomes
Measured
How outcomes were measured
McCabe et al. 2014
(Disaster Med
Public Health Prep)
Quasi-
Scientific
Community
Intervention
Trial
Trained volunteer and
professional rural (Maryland
and Iowa) and Urban
cohorts (Maryland and
Illinois)
(n = 391)
Impact of PFA
training and guided
preparedness
planning (GPP)
training and practical
application
Pre- and post-training tests on
knowledge, skills and attitudes for
PFA and GPP. Follow-up included
percent of MRC applications
submitted by PFA participants
GPP follow-up included disaster
plans created.
McCabe et al. 2014
(Public Health Rep)
Quasi -
Scientific
Community
Intervention
Trial
Trained volunteer and
professional rural (Maryland
and Iowa) and Urban
cohorts (Maryland and
Illinois)
(n = 336)
Impact of PFA and
GPP training and
sustainable
application
Pre- and post-training tests
conducted on knowledge, skills and
attitudes for PFA and GPP.
Measures conducted for project-
attributable changes and post-
intervention projects and
partnerships

12. 1212
Source: USC News
Study Characteristics
Author(s). date of
publication
Study Design Population Studied
(number of participants)
Outcomes
Measured
How outcomes were measured
Ronan et al. 2003 Quasi -Scientific
Community
Intervention Trial
Intermediate school-aged
children from the North
Island of New Zealand
(n =213)
Impact of a brief
school-based
emotional and
problem-focused
coping program
Pre-/post-intervention tests in
problem- and emotion-focused
factors and a home-based
questionnaire for child and their
parents
Ronan et al. 2012 Quasi -Scientific
Case-Control
Community
Intervention Trial
Primary and Intermediate
school-aged children from
the North Island of New
Zealand
(n = 219 [115
intervention, 104 control])
Impact of a brief
school-based
disaster
preparedness
intervention program
supplementing a
community-wide
effort
Pre-/post-intervention tests in four
measures: Problem-and emotion-
focused factors, knowledge
surrounding civil defense alert, fear
surrounding specific disasters and
risk perceptions
Post-intervention test administered
one week after training

13. 13
Study Characteristics
• Quasi-experimental community
intervention trials
– 2,723 combined participants included in all the studies
• 803 (including controls) study participants were adults while
• 1,920 (including controls) were children of primary and
intermediate school age.
– 3 of the included studies were conducted within the United States of
America
– 2 were conducted in New Zealand
– 1 study conducted in Israel
13
Source: UNICEF

14. 14
Results: Risk of Bias

15. Author(s). date of
publication
Major Results Significant Author(s). Data
of publication
Major results Significance
McCabe et al. 2014
(Disaster Med
Public Health Prep)
PFA: 11 of 14 test items
improved
GPP: 8 of 15 test items
showed improvement and
90% created disaster plans
Yes
Yes
Chandra et al.
2014
Participants’ correct in all
questions from 43-49% and
(self reported) confidence
increased from 40-54%
No
Yes
McCabe et al. 2014
(Public Health Rep)
PFA: 22 of 25 test items
improve
GPP: 17 of 18 test items
improved
Follow-up
PFA: 19.4% used in
disaster 83.5% used in
crisis, 78.4% reported
improved skills
GPP: Between 81 and 91%
submitted disaster plans
Yes
Yes
NA
Wolmer et al.
2011
PTSD control group: 10.3%
(Girls 12.5%, Boys 10.2%)
PTSD intervention group:
7.2% (10.1% girls, 4.4%
boys)
Yes
Results: Summary of Evidence
15
Source: Action Press/ Rex Features

16. 16
Author(s). date of
publication
Major Results Significant
Ronan 2003 Improvement in 5 of 6
measures of coping and
knowledge measure (less
significant improvements in
coping)
Yes
&
No
Ronan 2012 5 of 7 improved in emotional
factors (coping)
4 of 6 improved in
knowledge
2 of 8 improved in fear
factor (coping)
9 of 16 improved in risk
awareness
Yes
Yes
No
Yes
Results: Summary of Evidence
16
Source:Peeter Viisimaa via BBC News

17. 17
Conclusions
• Mental health community interventions are
generally shown to be effective
• Some negative effects of disasters to
mental health can
be mitigated by
intervention
• More research needed
Source: Izissmile

18. Questions?
18
Source: Andy Portch