Parental Challenges During the COVID-19 Pandemic: Psychological Outcomes and Risk and Protective Factors.

PURPOSE OF REVIEW: This review examines the challenges faced by parents in the context of the COVID-19 pandemic, their emotional reactions, and risk and protective factors in their adjustment. Clinical and policy implications are discussed, and recommendations for future study are offered. RECENT FINDINGS: The literature reveals numerous stresses experienced by parents during the pandemic. Many parents facing COVID-19-related challenges suffered traumatic stress, depression, and/or anxiety, though most have adapted well over time. Demographic factors, pre-existing vulnerabilities, employment and household responsibilities, and family structure and cohesion influenced psychological outcomes. The pandemic lockdown created obstacles to accessing medical, mental health, educational, social, recreational, and other supportive programs and services for families, further increasing the burden on parents. The pandemic has exacerbated existing vulnerabilities and triggered pervasive parental stress. The lockdown affected families differently based on their pre-existing vulnerabilities and available resources. Additional research using more rigorous methodological approaches is warranted to identify and address the needs of parents during public health crises like pandemics.

Longitudinal assessment of mental health after a flood: roles of social support, hope, recovery stressors, and prior lifetime trauma.

OBJECTIVES: Severe weather events have mental health consequences for survivors that may change over time. We assessed post-flood mental health longitudinally in three groups of mostly middle-aged and older adults who varied in current and prior severe weather experiences. METHOD: Predictors of central interest were age, perceived social support, state hope (including agency and pathways), recovery stressors, and prior lifetime trauma. Criterion variables included symptoms of depression, post-traumatic stress disorder (PTSD), and worry. RESULTS: Analyses of variance yielded significant Disaster Exposure Group x Wave interactions for depression and PTSD symptoms. Those with flooded homes and properties had elevated symptoms at Wave 1 which were reduced at Wave 2. Older age was associated with fewer symptoms of depression, PTSD, and worry. Recovery stressors and lifetime trauma predicted more PTSD symptoms. Greater agency predicted less PTSD and depression symptoms, whereas pathways predicted less worry. CONCLUSION: These data show that mental health symptoms may decrease over time for those directly impacted by severe flooding. State hope appears to contribute to better mental health after exposure to a devastating flood. Implications for understanding the dynamic relationships among risk variables and positive factors that promote post-disaster mental health in the years after a flood are considered.

Disseminating early interventions for disaster mental health response using the ECHO model.

Extension for Community Healthcare Outcomes (ECHO)-based telementoring was evaluated for disseminating early disaster interventions, Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR), to school professionals throughout rural, disaster-affected communities further affected by COVID-19. PFA and SPR complemented their Multitiered System of Support: PFA complemented tier 1 (universal) and SPR tier 2 (targeted) prevention. We evaluated the outcomes of a pretraining webinar (164 participants, January 2021) and four-part PFA training (84 participants, June 2021) and SPR training (59 participants, July 2021) across five levels of Moore's continuing medical education evaluation framework: (1) participation, (2) satisfaction, (3) learning, (4) competence, and (5) performance, using pre-, post-, and 1-month follow-up surveys. Positive training outcomes were observed across all five levels, with high participation and satisfaction throughout, and high use at the 1-month follow-up. ECHO-based telementoring may successfully engage and train community providers in these underused early disaster response models. Recommendations regarding training format and using evaluation to improve training are provided.

Social cognitive mechanisms in healthcare worker resilience across time during the pandemic.

PURPOSE: Healthcare workers are at increased risk for mental health problems during disasters such as the COVID-19 pandemic. Identifying resilience mechanisms can inform development of interventions for this population. The current study examined pathways that may support healthcare worker resilience, specifically testing enabling (social support enabled self-efficacy) and cultivation (self-efficacy cultivating support) models. METHODS: Healthcare workers (N = 828) in the Rocky Mountain West completed self-report measures at four time points (once per month from April to July of 2020). We estimated structural equation models to explore the potential mediating effects that received social support and coping self-efficacy had (at time 2 and time 3) between traumatic stress symptom severity (at time 1 and time 4). Models included covariates gender, age, minority status, and time lagged co-variations between the proposed mediators (social support and coping self-efficacy). RESULTS: The full model fit the data well, CFI = .993, SRMR = .027, RMSEA = .036 [90% CIs (0.013, 0.057)]. Tests of sequential mediation supported enabling model dynamics. Specifically, the effects of time 1 traumatic stress severity were mediated through received social support at time 2 and time 3 coping self-efficacy, in sequential order to reduce time 4 traumatic stress severity. CONCLUSIONS: Findings show the importance of received social support and coping self-efficacy in mitigating psychopathology risk. Interventions can support mental health by focusing on social resource engagement that facilitates coping empowerment, which may decrease risk for mental health job-related problems among frontline healthcare workers exposed to highly stressful events.

Children's Psychological Reactions to the COVID-19 Pandemic.

PURPOSE OF REVIEW: This paper reviews the literature on the psychological effects of the COVID-19 pandemic on children and the reactions of vulnerable children. RECENT FINDINGS: Research reveals increases in clinically significant depression, suicidal ideation and behavior, and some anxiety symptoms. Substance use studies suggest an inadvertent decrease in substance use in some youth though findings are inconsistent across substances and for males and females. Children with pre-existing emotional and behavioral problems are especially vulnerable though some children appear to improve in the context of public health measures which have decreased the stresses associated with school and socialization. In addition, children with pre-existing problems are likely to have established resources and relationships that may protect them relative to other children. COVID-19 has had a major effect on the mental health of children around the world, but findings should be considered preliminary until more rigorous research has been conducted.

Adapting RISE: meeting the needs of healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has placed extraordinary stresses on healthcare workers. Combined with disruptions to daily life outside of work, health care professionals experience a high prevalence of anxiety, depression, acute stress reaction, burnout, and PTSD. Top leaders at Johns Hopkins Medicine appreciated the mission-critical importance of maintaining the well-being and resilience of its essential workers. In March 2020 they asked the Johns Hopkins RISE (Resilience in Stressful Events) peer support program to help organize support for all staff. RISE made several adjustments, including adding virtual encounters to the usual in-person support, training additional peer responders, and rounding proactively on active units. Communication was broadened to reach less visible and lower wage workers. RISE collaborated actively with hospital epidemiology and infection control and began reporting regularly at incident command centre briefings. RISE also began to coordinate efforts with the other helping programs within the institution including the Office of Well-being, Employee Assistance, Spiritual Care, and Psychiatry. The number of calls and staff supported rose sharply. RISE supported over 4226 workers in the first 9 months of the pandemic. The adoption of RISE programs was accelerated at affiliated hospitals, as well as at other hospitals across the country in partnership with the Maryland Patient Safety Center. Experience with large scale disasters predicted correctly that worker distress would increase and persist beyond the initial wave of the pandemic. With subsequent surges of COVID-19, exhaustion and moral distress became nearly universal among workers. It is urgent for institutions to provide mechanisms to help their workers cope with the ongoing crisis and other crises that will inevitably occur in the future.

EAP 2.0: reimagining the role of the employee assistance program in the new workplace.

Mental illness is a highly prevalent problem that affects millions of individuals. Like many other previous natural disasters and terrorist attacks, the recent Covid-19 pandemic has placed an enormous stress on the world and its workforce. In many ways the pandemic revealed gaps in the quality and availability of mental health resources, and, by magnifying the intense demand, it also spurred innovation. Telemedicine and virtual trauma-related services became examples of ways in which evaluation, treatment and counselling services could be delivered directly and efficiently to people who were confined to their dwellings and hospital beds. For many, the workplace has been a source of stress but also a vital component of one's self-worth, day-to-day purpose, and a resource for wellness programs and brief counselling services, not to mention, at least in many countries like the United States, a source for health insurance. The employee assistance program (EAP) is an example of a workplace-counselling and triage service that has enormous potential to meet the growing needs of individuals both in 'normal' times and during disasters. By better understanding the EAP's current structure alongside the advent of new technologies, it may be possible to develop a new and improved EAP model to meet a changing global landscape. For EAP to succeed and ultimately be scalable in an increasingly competitive and value-conscious marketplace, its processes of care will first require a bottom-up review with meaningful outcomes data. This will be necessary to drive continuous quality improvement and to demonstrate EAP 2.0's value to both employer and employee alike.

Implementing Skills for Psychological Recovery at a Psychology Training Clinic During COVID-19.

The COVID-19 global pandemic has disrupted the routine provision of community mental health services, which is especially concerning given that emerging data suggest a rise in mental health concerns related to the COVID-19 crisis (Xiong et al., 2020). Thus, it seems imperative to provide trauma-informed services that are tailored to clients' coping with the pandemic and can be effectively delivered via telehealth. The goals of these important services would be to mitigate current distress, help prevent the onset of long-term mental health problems, and facilitate client safety during a public health crisis. The present article provides an overview of adoption and telehealth implementation of the Skills for Psychological Recovery (SPR) secondary prevention program within a psychology training clinic. Initial clinical outcome data supported the program's success in reducing mental health symptoms among individuals in psychological distress due to the COVID-19 crisis; however, the results were more striking for adults than for youths. The article concludes with recommendations for broader implementation and future directions for clinicians, supervisors, organizations, and researchers.

Spatio-temporal distribution of negative emotions on Twitter during floods in Chennai, India, in 2015: a post hoc analysis.

BACKGROUND: Natural disasters are known to take their psychological toll immediately, and over the long term, on those living through them. Messages posted on Twitter provide an insight into the state of mind of citizens affected by such disasters and provide useful data on the emotional impact on groups of people. In 2015, Chennai, the capital city of Tamil Nadu state in southern India, experienced unprecedented flooding, which subsequently triggered economic losses and had considerable psychological impact on citizens. The objectives of this study are to (i) mine posts to Twitter to extract negative emotions of those posting tweets before, during and after the floods; (ii) examine the spatial and temporal variations of negative emotions across Chennai city via tweets; and (iii) analyse associations in the posts between the emotions observed before, during and after the disaster. METHODS: Using Twitter's application programming interface, tweets posted at the time of floods were aggregated for detailed categorisation and analysis. The different emotions were extracted and classified by using the National Research Council emotion lexicon. Both an analysis of variance (ANOVA) and mixed-effect analysis were performed to assess the temporal variations in negative emotion rates. Global and local Moran's I statistic were used to understand the spatial distribution and clusters of negative emotions across the Chennai region. Spatial regression was used to analyse over time the association in negative emotion rates from the tweets. RESULTS: In the 5696 tweets analysed around the time of the floods, negative emotions were in evidence 17.02% before, 29.45% during and 11.39% after the floods. The rates of negative emotions showed significant variation between tweets sent before, during and after the disaster. Negative emotions were highest at the time of disaster's peak and reduced considerably post disaster in all wards of Chennai. Spatial clusters of wards with high negative emotion rates were identified. CONCLUSIONS: Spatial analysis of emotions expressed on Twitter during disasters helps to identify geographic areas with high negative emotions and areas needing immediate emotional support. Analysing emotions temporally provides insight into early identification of mental health issues, and their consequences, for those affected by disasters.

Visualizing the Process of Disaster Mental Health Services in the Joso Flood by Network Analyses of Emails.

Joso City, Ibaraki Prefecture, Japan was severely affected by flooding of the River Kinugawa in September 2015. Local psychiatric organizations immediately began providing disaster mental health services (DMHS). In post-disaster settings, DMHS involving organizational interventions by multiple regional institutions are required to support disaster victims. However, little is known about the process of coordinating multiple institutions or determining whether appropriate support has been provided. To elucidate the characteristics of communications that enable effective disaster medical team formation, we conducted network analyses of sender-recipient pairs of emails during the period of DMHS activity. The network analysis is a research method that represents various objects as a network of nodes and edges and explores their structural characteristics. We obtained 2,450 time-series emails from five core members of DMHS, including 32,865 pairs of senders and recipients. The network generated by the emails was scale-free, and its structure changed according to the phases of disaster recovery. In the ultra-acute phase, which lasted about 1 week, spreading information and recruiting people to provide disaster support was given the highest priority. In the acute phase, which lasted about 1 month, support and swift decision-making were essential for directing large numbers of staff. In the mid- to long-term phase, support for staff to share information and experience in small groups was observed. Network analyses have revealed that disaster medical teams must change their communication styles during the mission to adapt to different health needs corresponding to each post-disaster phase.

Differential effect of Hurricane Sandy exposure on PTSD symptom severity: comparison of community members and responders.

OBJECTIVES: To evaluate whether the association between Hurricane Sandy exposures and post-traumatic stress disorder (PTSD) symptom severity was greater for exposed community members compared with responders. METHODS: Data were analysed from three existing studies with similar methodologies (N=1648): two community studies, Leaders in Gathering Hope Together (n=531) and Project Restoration (n=763); and the Sandy/World Trade Center Responders Study (n=354). Sandy-related PTSD symptoms were measured using the PTSD checklist-specific traumatic event and dichotomised as elevated (>30) versus low/no (<30) PTSD symptoms. Sandy exposures were measured with a summed checklist. Multivariable logistic regression was performed to evaluate the differential effect of exposures on PTSD by responder status, adjusting for demographics and time elapsed since Sandy. RESULTS: Responders were somewhat older (50.5 years (SD=8.3) vs 45.8 years (SD=20.0)), more likely to identify as white (92.4% vs 48.1%) and were male (90.7% vs 38.4%). Responders were less likely to have elevated PTSD symptoms than community members (8.6% vs 31.1%; adjusted OR=0.28, 95% CI 0.17 to 0.46). While exposure was significantly related to elevated PTSD status, the effects were similar for responders and community members. CONCLUSIONS: Responders appear to be more resilient to PTSD symptoms post-Sandy than community members. Understanding the mechanisms that foster such resilience can inform interventions aimed at populations that are more vulnerable to experiencing PTSD after natural disasters.

Sustaining Power of Nurses in a Damaged Hospital During the Great East Japan Earthquake.

PURPOSE: This study aimed to describe the experiences of nurses who were employed in a psychiatric hospital in Fukushima prefecture during the Great East Japan Earthquake and to explore what sustained the nurses while they worked in the damaged hospital. DESIGN AND METHODS: The research design was a qualitative descriptive study. The setting for the study was one of the Fukushima psychiatric hospitals where functions were disrupted by the earthquake and tsunami. Data were collected through a dialogic interview and Katarai (a form of group interview). Nine psychiatric nurses from the hospital participated. The interview and Katarai were transcribed and the narratives were analyzed using a phenomenological approach. FINDINGS: Themes identified from the transcripts were: (a) the nurses' internalized perception of their duties, (b) responsibility toward their patients, (c) conflicts among nurses and dilemmas nurses faced during this period, and (d) what sustained the nurses to continue working. CONCLUSIONS: Through the earthquake experience, the nurses in this study reconsidered their own ways of living and ways of nursing that they had not thought about before the disaster. The findings also revealed that the state of hospital management and nursing care under normal conditions are reflected during the crisis situation in a disaster. CLINICAL RELEVANCE: Clearly, whether it is natural disaster or conflict caused by man, healthcare infrastructures are challenged when unexpected disruptions occur. The findings of this study are applicable not only because they provide guidance about infrastructure development for disaster preparedness, but also because they provide practical methods to support nurses who are placed in strongly stressful situations and have to protect patients.

Post-Traumatic Growth and Resilience Among Medical Students After the March 2011 Disaster in Fukushima, Japan.

In March of 2011, an earthquake, tsunami, and nuclear accident struck northern Japan causing profound damage to the surrounding area and lasting effects to all those who lived there. Fukushima Medical University (FMU), the closest hospital that remained open during the disaster, was greatly impacted and its students rallied to help the cause. Many of them were directly affected as their neighborhoods were ruined and family and friends were injured or killed. Our study sought to better understand how this disaster impacted their posttraumatic growth and resilience in the wake of the disaster and today, 8 years later. There were three goals of this study. First, we aimed to replicate previous research that showed positive effects of disaster volunteerism on medical students' posttraumatic growth. Second, we sought to better understand the role of resilience in the wellbeing of these students. Finally, we wanted to explore the advantages to our newly created 10-Factor Resilience Behavioral Scale, which we used alongside the Davidson Trauma Scale (DTS), Posttraumatic Growth Inventory (PTGI-X), and Connor-Davidson Resilience Scale (CD-RISC). Overall, 579 responses were collected (response rate of 71.9%). Volunteers continued to show greater PTG as well as greater overall resilience. Furthermore, there were positive correlations between students' feelings of confusion, anger, sadness, guilt or anxiety and their sense of resilience, both at the time of the disaster and in the most recent month, suggesting that within Japanese culture difficult emotions may promote resilient behaviors and actions.

The longitudinal mental health impact of Fukushima nuclear disaster exposures and public criticism among power plant workers: the Fukushima NEWS Project study.

BACKGROUND: The Fukushima Daiichi and Daini Nuclear Power Plant workers experienced multiple stressors as both victims and onsite workers after the 2011 Great East Japan Earthquake and subsequent nuclear accidents. Previous studies found that disaster-related exposures, including discrimination/slurs, were associated with their mental health. Their long-term impact has yet to be investigated. METHOD: A total of 968 plant workers (Daiichi, n = 571; Daini, n = 397) completed self-written questionnaires 2-3 months (time 1) and 14-15 months (time 2) after the disaster (response rate 55.0%). Sociodemographics, disaster-related experiences, and peritraumatic distress were assessed at time 1. At time 1 and time 2, general psychological distress (GPD) and post-traumatic stress response (PTSR) were measured, respectively, using the K6 scale and Impact of Event Scale Revised. We examined multivariate covariates of time 2 GPD and PTSR, adjusting for autocorrelations in the hierarchical multiple regression analyses. RESULTS: Higher GPD at time 2 was predicted by higher GPD at time 1 (ß = 0.491, p < 0.001) and discrimination/slurs experiences at time 1 (ß = 0.065, p = 0.025, adjusted R 2 = 0.24). Higher PTSR at time 2 was predicted with higher PTSR at time 1 (ß = 0.548, p < 0.001), higher age (ß = 0.085, p = 0.005), and discrimination/slurs experiences at time 1 (ß = 0.079, p = 0.003, adjusted R 2 = 0.36). CONCLUSIONS: Higher GPD at time 2 was predicted by higher GPD and discrimination/slurs experience at time 1. Higher PTSR at time 2 was predicted by higher PTSR, higher age, and discrimination/slurs experience at time 1.

Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention.

Several decades of research have informed our knowledge of children's reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.

Helping the Helpers: Assisting Staff and Volunteer Workers Before, During, and After Disaster Relief Operations.

Self-care strategies and system supports employed in preparation for, during, and after disaster relief operations (DROs) are crucial to relief worker well-being and the overall effectiveness of relief efforts. Relief organizations and management must structure DROs in a manner that promotes self-care and workers must implement proper self-care strategies. Proper self-care before, during, and after a DRO can reduce negative reactions to stressful emergency work and promote growth, mastery, and self-efficacy after the experience. Therefore, the purpose of this article is to discuss the importance of organizational supports and self-care strategies in disaster relief settings. This article emphasizes the role of both individual and management participation and commitment to relief worker support and positive experience in DROs and provides suggestions for doing so. These suggestions are derived from the empirical and experiential literature and extensions from the theoretical background, and from our experience as managers in DROs.

Disaster Mental Health and Positive Psychology: An Afterward to the Special Issue.

The articles in this Special Issue are devoted to integrating the fields of disaster mental health and positive psychology. Their focus on resilience building, individual and community preparation, meaning making, and posttraumatic growth represents an important new development in disaster mental health. The overarching goal of this effort is to inform strategies to help both individuals-including children, adolescent, adult disaster survivors, and relief workers-and communities prepare for, respond to, recover from, and possibly even grow stronger in the face of adversity. To achieve this goal, this body of literature suggests that it is important for disaster mental health workers to partner with community leaders, organizations, and the population at large to understand community vulnerabilities, take advantage of existing strengths, and respect cultural factors implicated in disaster recovery. It further suggests that an effective community-based approach to disaster recovery will make psychosocial support and skill-building programs available to large numbers of survivors, which is critical for responding to future national and international disasters. Continued high-quality research that is comprehensive and considers not only relevant psychological, social, cultural, and biological factors but also interrelations between individuals, organizations and communities is needed to advance this relatively new and important direction of the disaster mental health field.

Disaster Mental Health and Positive Psychology-Considering the Context of Natural and Technological Disasters: An Introduction to the Special Issue.

This article serves as an introduction to the Journal of Clinical Psychology's special issue on disaster mental health and positive psychology. The special issue comprises two sections. The first section presents a series of data-driven articles and research-informed reviews examining meaning and resilience in the context of natural and technological disasters. The second section presents key topics in the area of disaster mental health, with particular relevance for positive psychology and related frameworks. The special issue is intended to bridge the gap between these two areas of applied science, with the audience being experienced clinicians or clinicians in training.

Assessment of Meaning in Adolescents Receiving Clinical Services in Mississippi Following the Deepwater Horizon Oil Spill: An Application of the Purpose in Life Test-Short Form (PIL-SF).

OBJECTIVES: This study's purpose was to assess perceived meaning in adolescents. Specifically, our goals were to examine the psychometric properties of the Purpose in Life test-Short Form (PIL-SF) and its ability to predict psychological outcomes in an adolescent sample. METHOD: Aspects of well-being (self-efficacy, life satisfaction, and resilience) and psychological distress (posttraumatic stress, depression, anxiety, and general stress) were assessed in a sample of adolescents (N = 91; 58.2% female; mean age = 14.89) receiving clinical services following the Deepwater Horizon Oil Spill. RESULTS: Meaning was positively associated with life satisfaction, self-efficacy, and resilience, and negatively associated with posttraumatic stress and depression. Meaning was not significantly related to anxiety or general stress. Females reported significantly more meaning than males, while no significant differences were noted by race/ethnicity. CONCLUSIONS: The PIL-SF is a useful measure with adolescents. Moreover, meaning is an important concept to consider with respect to disasters.

Post-traumatic Stress and Growth Among Medical Student Volunteers After the March 2011 Disaster in Fukushima, Japan: Implications for Student Involvement with Future Disasters.

The March 2011 "triple disaster" (earthquake, tsunami, and nuclear accident) had a profound effect on northern Japan. Many medical students at Fukushima Medical University volunteered in the relief effort. We aimed to investigate the nature of students' post-disaster involvement and examine the psychological impact of their experiences using a survey containing elements from the Davidson Trauma Scale and Posttraumatic Growth Inventory. We collected 494 surveys (70 % response rate), of which 132 students (26.7 %) had volunteered. Volunteers were more likely to be older, have witnessed the disaster in person, had their hometowns affected, and had a family member or close friend injured. In the month after 3/11, volunteers were more likely to want to help, feel capable of helping, and report an increased desire to become a physician. Both in the month after 3/11 and the most recent month before the survey, there were no significant differences in distressing symptoms, such as confusion, anger, or sadness, between volunteers and non-volunteers. Volunteers reported a significantly higher level of posttraumatic growth than non-volunteers. Participating in a greater variety of volunteer activities was associated with a higher level of posttraumatic growth, particularly in the Personal Strength domain. There may be self-selection in some criteria, since students who were likely to be resistant to confusion/anxiety/sadness may have felt more capable of helping and been predisposed to volunteer. However, participation in post-disaster relief efforts did not appear to have a harmful effect on medical students, an important consideration for mobilizing volunteers after future disasters.