PTSD Symptom Trajectories in Disaster Volunteers: The Role of Self-Efficacy, Social Acknowledgement, and Tasks Carried Out.

Millions of volunteers respond after disasters, with a 24% to 46% risk of developing posttraumatic stress disorder (PTSD). It is unclear which symptom trajectories develop and how they differ between core (volunteering before the disaster) and noncore volunteers (joining after the disaster) and which factors predict trajectories. Symptoms of PTSD were assessed at 6-, 12-, and 18-months postearthquake in 449 volunteers in Indonesia. Demographics, previous mental health service use, self-efficacy, social acknowledgment, and type of tasks were assessed at 6 months. In both core and noncore volunteers, 2 PTSD symptom trajectories emerged: a resilient trajectory (moderate levels of symptoms with a slow decrease over time; 90.9%) and a chronic trajectory (higher levels of symptoms with an increase over time; 9.1%). In both trajectories, core volunteers had fewer symptoms than noncore volunteers. Core volunteers in the chronic trajectory were characterized by having sought prior mental help, reported lower levels of self-efficacy and social acknowledgment, and were more likely to have provided psychosocial support to beneficiaries (Cramér's V = .17 to .27, partial η(2) = .02 to .06). Aid organizations should identify and follow up chronic PTSD trajectories in volunteers, including the noncore, who may be out of sight to the organization after the acute response phase.

Investigating the PHQ-9 With Mokken Scale Analysis and Cognitive Interviews.

Scores on the Patient Health Questionnaire-9 (PHQ-9) are frequently used to assess depression both in research and in clinical practice. The aim was to examine the validity of the PHQ-9 sum score by using Mokken scale analysis (Study I) and cognitive interviews (Study II) on the Icelandic version of PHQ-9. A primary care sample of 618 individuals was used in Study I. The results indicate that the PHQ-9 items are not close enough to perfectly unidimensional for their sum score to accurately order people on the depression severity dimension. In Study II, the sample consisted of 53 individuals, with 28 having a history of depression and 25 not. The findings reveal a number of issues concerning respondents' use of the PHQ-9. No systematic differences were found in the results of the two groups. The PHQ-9 sum score should thus be interpreted and used with great care. We provide scale revision recommendations to improve the quality of PHQ-9.

Lay Knowledge About Dementia in Iceland: Symptoms and Risk and Protective Factors.

No studies are available on the lay knowledge about dementia in Nordic countries. A survey was sent to 829 Icelanders aged 25 to 65 (61.2% female). 60.8% resided in the capital area of Reykjavik. About 90% or more recognized eight of eleven dementia symptoms, with females recognizing them proportionally more often than males. About 50% believed that an individual's risk of developing dementia could be modified. For individual risk factors, agreement ranged from 4% (hearing loss) to 75.1% (history of brain injury). Knowledge about cardiovascular risk factors ranged from 24.8% (obese) to 43.6% (high blood pressure). Participants acknowledged the importance of a healthy diet and an active lifestyle, but only 8% identified a low education level as a risk factor. Public health campaigns and educational efforts about dementia should focus on the whole lifespan targeting all risk and protective factors operating throughout the lifespan.

The impact of disaster work on community volunteers: The role of peri-traumatic distress, level of personal affectedness, sleep quality and resource loss, on post-traumatic stress disorder symptoms and subjective health.

Disaster work has shown to cause PTSD symptoms and subjective health complaints in professional emergency personnel. However, very little is known about how disaster work affects community volunteers. This first time longitudinal study examined factors contributing to post-traumatic stress disorder symptoms (PTSD) and subjective health complaints in volunteers working in an earthquake setting. At six and eighteen months post disaster, a sample of 506 Indonesian Red Cross volunteers were assessed using the Impact of Event Scale-Revised and the Subjective Health Complaints Inventory. Factors analyzed in relation to the outcomes included: peri-traumatic distress, level of personal affectedness by the disaster, sleep quality and loss of resources as a consequence of the disaster. At 18 months post-disaster the findings showed high levels of PTSD symptoms and subjective health complaints. Quality of sleep was related to both outcomes but resource loss only to PTSD symptoms. Neither peri-traumatic distress nor level of affectedness by the disaster (external versus directly affected volunteers), were predictive of symptoms. This study indicates that characteristics of disaster work e.g. low quality of sleep, may be an important contributor to PTSD symptoms and subjective health complaints in volunteers.

Organizational factors and mental health in community volunteers. The role of exposure, preparation, training, tasks assigned, and support.

During disasters, aid organizations often respond using the resources of local volunteer members from the affected population who are not only inexperienced, but who additionally take on some of the more psychologically and physically difficult tasks in order to provide support for their community. Although not much empirical evidence exists to justify the claim, it is thought that preparation, training, and organizational support limit (or reduce) a volunteer's risk of developing later psychopathology. In this study, we examined the effects of preparation, training, and organizational support and assigned tasks on the mental health of 506 Indonesian Red Cross volunteers who participated in the response to a massive earthquake in Yogyakarta, Indonesia, in 2006. Controlling for exposure level, the volunteers were assessed for post-traumatic stress disorder (PTSD), anxiety, depression, and subjective health complaints (SHCs) 6, 12, and 18 months post-disaster. Results showed high levels of PTSD and SHCs up to 18 months post-disaster, while anxiety and depression levels remained in the normal range. Higher levels of exposure as well as certain tasks (e.g., provision of psychosocial support to beneficiaries, handling administration, or handing out food aid) made the volunteers more vulnerable. Sense of safety, expressed general need for support at 6 months, and a lack of perceived support from team leaders and the organization were also related to greater psychopathology at 18 months. The results highlight the importance of studying organizational factors. By incorporating these results into future volunteer management programs the negative effects of disaster work on volunteers can be ameliorated.

Translation and validation of the Nursing Outcomes Classification labels and definitions for acute care nursing in Iceland.

BACKGROUND: The Nursing Outcomes Classification (NOC), second edition, consists of 260 patient outcomes with definitions. This has been translated into five languages, but has not been clinically validated outside the United States of America (USA). AIM: The aim of this paper is to describe the translation of the labels and definitions from the NOC, second edition from English to Icelandic and validation for acute-care nursing in Iceland. METHOD: A survey that has been designed to identify nurses' perception of the percentage of patients' for whom each NOC outcome is relevant in clinical nursing practice was used for clinical validation in this study. The translation procedure involved source to target language translation, parallel comparison, pilot test and field test. Validation included test-retest to measure the reliability for each of the 260 outcome variables. Data collected from 140 clinical nurses from 54 departments within 13 nursing specialties at Landspitali University-Hospital in Iceland, in November 2001, were analysed to establish construct validity by confirmatory factor analysis. Internal consistency was calculated. RESULTS: Translation was successful. Test-retest showed that 181 of the 260 NOC outcomes were significant (P < 0.05) and moderately or highly correlated (r > 0.50) (Pearson's correlation). The confirmatory factor analysis showed that 22 of the 29 NOC classes had only one factor at the loading criteria > or =0.30. Of the 260 outcomes, 244 had loading on one factor (> or =0.30) within its class. Internal consistency was >0.80 (Cronbach's alpha). LIMITATIONS: Low response rate was a limitation. The indicators of each NOC outcome were not addressed. CONCLUSION: The Icelandic version of the NOC survey is a comprehensive tool that can be applied to nursing in acute-care for research purposes as well as to prepare for the implementation of NOC in clinical information systems.