Mental health of vulnerable groups experiencing a drought or bushfire: A systematic review.

Natural hazards are increasing because of climate change, and they disproportionately affect vulnerable populations. Prior reviews of the mental health consequences of natural hazard events have not focused on the particular experiences of vulnerable groups. Based on the expected increase in fires and droughts in the coming years, the aim of this systematic review is to synthesize the global evidence about the mental health of vulnerable populations after experiencing natural hazards. We searched databases such as Ovid MEDLINE, EMBASE, CINAHL and Ovid PsycInfo using a systematic strategy, which yielded 3,401 publications. We identified 18 eligible studies conducted in five different countries with 15,959 participants. The most common vulnerabilities were living in a rural area, occupying a low socioeconomic position, being a member of an ethnic minority and having a medical condition. Common experiences reported by vulnerable individuals affected by drought included worry, hopelessness, isolation and suicidal thoughts and behaviors. Those affected by fire reported experiencing posttraumatic stress disorder (PTSD) and anger. These mental health problems exacerbated existing health and socioeconomic challenges. The evidence base about mental health in vulnerable communities affected by natural hazards can be improved by including standardized measures and comparison groups, examining the role of intersectional vulnerabilities, and disaggregating data routinely to allow for analyses of the particular experiences of vulnerable communities. Such efforts will help ensure that programs are informed by an understanding of the unique needs of these communities.

Mental Health and Community Resilience among Vulnerable Populations Affected by Natural Hazards: Protocol for Scoping Reviews.

INTRODUCTION: Exposure to natural hazards such as fire, drought, floods, and earthquakes can have negative impacts on physical and mental health and wellbeing. The social and structural factors contributing to individual and community vulnerability also influence responses to disaster and the resulting consequences on health and wellbeing. Experiencing disasters like bushfires amplifies the impacts of inequality, magnifying existing disparities and contributing to additional psychological burdens of grief, trauma and adaptive challenge. There is a need to understand how vulnerability can influence responses to disaster, and to identify factors that develop and foster resilience in the context of increasing disasters and vulnerability. MATERIALS AND METHODS: This protocol will describe the methodology of two scoping reviews: the first will describe the mental health outcomes of vulnerable populations after droughts and bushfires; the second will identify and describe strategies that promote community resilience in vulnerable populations in the context of a disaster. A thorough search will be conducted in relevant databases. Studies will be limited to English language. The reviews will be reported using the 22-item checklist for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodological quality of the included papers will be assessed using the Joanna Briggs Institute's critical appraisal tools. RESULTS & CONCLUSIONS: The two scoping reviews described in this protocol will have broad relevance in the context of increasing and intensifying disasters, and will especially consider the compounded impact of disaster on vulnerable communities. Findings will contribute directly to the design and implementation of solutions to improve post-disaster health and wellbeing and community resilience.

Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic - COVISION study protocol.

Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected. Aim: To increase the understanding of home and community-based strategies that contribute to children and young people's capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children's actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted. Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration of children and young people's perspective of COVID-19 via creative outlets and reflections; and participatory learning and action through co-production.

Peer supervision for assuring the quality of non-specialist provider delivered psychological intervention: Lessons from a trial for perinatal depression in Goa, India.

BACKGROUND: The aims of the current study were three-fold: i) to estimate the reliability and predictive validity of a therapy quality measure for use by peers; ii) to assess the extent to which peer delivery agents could be trained to evaluate their peers' counsellors as reliably as experts; and iii) to identify barriers and facilitators of several implemented models of peer supervision. METHODS: 26 peers (called 'Sakhis' in the study context), with no previous experience or formal training in mental health care delivery, were trained by experts to deliver the Thinking Healthy Program Peer-delivered (THPP) and conduct peer-led supervision. Using the Therapy Quality Scale (TQS)-an 18 item Likert scale (0-2) measuring both general and treatment-specific skills-both peers and experts independently rated 167 individual sessions to estimate: a) the psychometric properties of TQS; and b) the mean difference between peer and expert TQS ratings; these data were analyzed using SAS 9.3. This was complemented with qualitative data (two rounds of in-depth interviews with four experts and focus group discussions with all Sakhis) which were analyzed using framework analysis. RESULTS: We observed good internal consistency on TQS ratings among expert (α = 0.814) and Sakhis (α = 0.843) and good to excellent scores of inter-rater reliability among experts (ICC = 0.779) and Sakhis (ICC = 0.714). TQS ratings were not significantly related to patient depressive symptoms at 6-months post-child birth but were significantly related to patient activation scores (r = 0.375, p < 0.01 for treatment-specific skills and 0.313, p < 0.01 for general skills) at 3-months post-child birth, which in turn were significantly related to depressive symptom scores at 6-months post-child birth (r = -0.455, p < 0.001), highlighting a potential temporal pathway between therapy quality, patient behaviours and patient outcomes. Following additional training and with growing expertise, Sakhis eventually evaluated their peers' counselling sessions as reliably as experts-demonstrating no significant mean differences on general (t = -0.42, p > 0.05) or treatment-specific (t = -1.44, p > 0.05) subscale scores. Qualitative findings were also consistent between experts and Sakhis: barriers included peers' initial difficulties in rating the TQS and leading supervision which declined over time. Most Sakhis and experts reported the benefits of using a structured scale to rate therapy quality which in turn facilitated consistent and relevant feedback and motivation to ultimately improve Sakhis' counselling skills. In addition, most Sakhis and experts found that peer supervision methods were acceptable and feasible, particularly when linked to financial incentives and expert supervisor. CONCLUSION: With time, non-specialist or lay providers can be trained to implement peer supervision and assess therapy quality as reliably as experts using a psychometrically-sound measure. However, peer supervision with experts was more preferred than peer supervision without experts to facilitate structured, reliable feedback. Additional studies are required to address this challenge and test solutions to facilitate the dissemination of non-specialist delivered psychosocial interventions at a global level.

Children in the 2015 South Indian floods: community members' views.

Little is known about children's experiences and involvement in disaster preparation and recovery, in particular in low- and middle-income countries. Eliciting community members' perspectives on the 2015 floods in Tamil Nadu, India, may generate useful insights for improving services in low-resource settings. This qualitative study aimed to understand how children in Chennai experienced the floods, as reported by the adults in their community, and to explore children's involvement in disaster preparedness, response and recovery efforts as reported from the adults' perspective. We conducted in-depth, semi-structured interviews (N = 48) with family members (n = 36), and with staff of non-governmental organizations (NGOs) (n = 12) who actively participated in relief and recovery efforts. We also conducted two focus group discussions (n = 14) with NGO staff about a year after the 2015 South Indian floods in Chennai, India. Six broad themes regarding children's experiences and behaviours during and after the floods emerged: (1) unexpectedness of the floods; (2) children's safety - barriers and facilitators; (3) parents' reactions - helplessness, fear and pride; (4) children's reactions - helping hands, fun and fear; (5) barriers to a return to 'normal'; and (6) a determination to be prepared for next time. Children and families were deeply impacted by the floods, in part owing to a lack of preparation, as perceived by the study participants. It was also clear from the data analysis that caste and socioeconomic status played an important role in the families' ability to evacuate safely. Helplessness on the part of the parents was apparent, as was children's concern over recurrence of the flood. Similarly, gender appeared to affect child safety, recovery and other outcomes such as continued education. Priorities for future efforts involve the development and evaluation of child-centred education about flood awareness, child participation and safety.

Antecedentes: Se conoce poco acerca de las experiencias de los niños y su participación en la preparación y recuperación de desastres, en particular en países de bajos y medios ingresos. La obtención de las perspectivas de los miembros de la comunidad sobre las inundaciones de 2015 en Tamil Nadu, India, puede generar reflexiones útiles para mejorar los servicios en entornos de bajos recursos. Objetivo: Este estudio cualitativo apuntó a comprender a) Cómo experimentaron las inundaciones los niños en Chennai, según el reporte de los adultos en su comunidad, y b) explorar la participación de los niños en la preparación para el desastre, la respuesta y las labores de reconstrucción, según el reporte desde la perspectiva de los adultos. Método: Realizamos entrevistas semi estructuradas en profundidad (N=48) con miembros de la familia (n=36), y con miembros de organizaciones no gubernamentales (n=12) que participaron activamente en las labores de ayuda y reconstrucción. También realizamos dos grupos de discusión (n=14) con miembros de ONG, aproximadamente un año después de las inundaciones del sur de la India en 2015 en Chennai, India. Resultados: Surgieron seis amplios temas respecto a las experiencias de los niños y las conductas durante y después de las inundaciones: a) Lo inesperado de las inundaciones; b) Las barreras y facilitadores para la seguridad de los niños; c) La reacciones de los padres - impotencia, miedo y orgullo; d) Las reacciones de los niños ­ ayuda, diversión y miedo; e) Las barreras para el retorno a lo 'normal', y f) Una determinación para estar preparados para una próxima vez. Conclusión: Los niños y las familias estuvieron profundamente impactados por las inundaciones, en parte debido a una falta de preparación, según la percepción de los participantes del estudio. También fue claro desde el análisis de los datos que el status socioeconómico y de castas jugó un rol importante en la capacidad de las familias para evacuar en forma segura. La impotencia de parte de los padres fue evidente, así como también la preocupación de los niños por la recurrencia de la inundación. Así también, el género pareció afectar la seguridad, recuperación y otros resultados de los niños, como la continuidad en la educación, etc. Las prioridades para los esfuerzos futuros incluyen el desarrollo y evaluación de la educación centrada en los niños acerca de la concientización de las inundaciones, participación de los niños, y seguridad.

Aging and well-being in Goa, India: a qualitative study.

OBJECTIVES: The population of India is aging rapidly. This demographic shift brings with it a host of challenges to the health and well-being of older adults, including the increased prevalence of non-communicable diseases, among them depressive disorders. In this paper, we report on qualitative research intended to inform the development of a locally acceptable and appropriate intervention to improve the well-being of older adults in Goa, India and, specifically, to prevent late-life depression. METHOD: Semi-structured interviews with 20 individuals, aged 60 years and older, attending two primary care clinics in Goa, India. Transcripts were reviewed to identify emerging themes, a coding scheme was developed and thematic analyses were conducted. RESULTS: Analyses of the interview transcripts revealed the following key themes: (1) notions of old age tended to be negative and there were widespread fears of becoming widowed or incapacitated; (2) the most frequently reported health conditions were joint pain, diabetes and heart disease; (3) emotional distress was described using the terms 'tension', 'stress', 'worry' and 'thinking'; (4) family issues often involved financial matters, difficult relationships with daughters-in-law and conflicted feelings about living with the family or independently; (5) other than a pension scheme, participants did not know of community resources available to older adults. CONCLUSIONS: Our findings are in general agreement with those of previous research, and with our experiences of working with older adults in Pittsburgh and the Netherlands. This research will inform the development of an intervention to prevent depression in older adults in Goa.

Mother-to-mother therapy in India and Pakistan: adaptation and feasibility evaluation of the peer-delivered Thinking Healthy Programme.

BACKGROUND: Perinatal depression is highly prevalent in South Asia. Although effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. The aim of this study was to adapt an evidence-based intervention so that local women from the community (peers) could be trained to deliver it, and to test the adapted intervention for feasibility in India and Pakistan. METHODS: The study was conducted in Rawalpindi, Pakistan and Goa, India. To inform the adaptation process, qualitative data was collected through 7 focus groups (four in Pakistan and three in India) and 61 in-depth interviews (India only). Following adaptation, the intervention was delivered to depressed mothers (20 in Pakistan and 24 in India) for six months through 8 peers in Pakistan and nine in India. Post intervention data was collected from depressed mothers and peers through 41 in-depth interviews (29 in Pakistan and 12 in India) and eight focus groups (one in Pakistan and seven in India). Data was analysed using Framework Analysis approach. RESULTS: Most mothers perceived the intervention to be acceptable, useful, and viewed the peers as effective delivery-agents. The simple format using vignettes, pictures and everyday terms to describe distress made the intervention easy to understand and deliver. The peers were able to use techniques for behavioural activation with relative ease. Both the mothers and peers found that shared life-experiences and personal characteristics greatly facilitated the intervention-delivery. A minority of mothers had concerns about confidentiality and stigma related to their condition, and some peers felt the role was emotionally challenging. CONCLUSIONS: The study demonstrates the feasibility of using peers to provide interventions for perinatal depression in two South Asian settings. Peers can be a potential resource to deliver evidence-based psychosocial interventions. TRIAL REGISTRATION: Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014), India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).

The effectiveness and cost-effectiveness of the peer-delivered Thinking Healthy Programme for perinatal depression in Pakistan and India: the SHARE study protocol for randomised controlled trials.

BACKGROUND: Rates of perinatal depression (antenatal and postnatal depression) in South Asia are among the highest in the world. The delivery of effective psychological treatments for perinatal depression through existing health systems is a challenge due to a lack of human resources. This paper reports on a trial protocol that aims to evaluate the effectiveness and cost-effectiveness of the Thinking Healthy Programme delivered by peers (Thinking Healthy Programme Peer-delivered; THPP), for women with moderate to severe perinatal depression in rural and urban settings in Pakistan and India. METHODS/DESIGN: THPP is evaluated with two randomised controlled trials: a cluster trial in Rawalpindi, Pakistan, and an individually randomised trial in Goa, India. Trial participants are pregnant women who are registered with the lady health workers in the study area in Pakistan and pregnant women attending outpatient antenatal clinics in India. They will be screened using the patient health questionnaire-9 (PHQ-9) for depression symptoms and will be eligible if their PHQ-9 is equal to or greater than 10 (PHQ-9 ≥ 10). The sample size will be 560 and 280 women in Pakistan and India, respectively. Women in the intervention arm (THPP) will be offered ten individual and four group sessions (Pakistan) or 6-14 individual sessions (India) delivered by a peer (defined as a mother from the same community who is trained and supervised in delivering the intervention). Women in the control arm (enhanced usual care) will receive health care as usual, enhanced by providing the gynaecologist or primary-health facilities with adapted WHO mhGAP guidelines for depression treatment, and providing the woman with her diagnosis and information on how to seek help for herself. The primary outcomes are remission and severity of depression symptoms at the 6-month postnatal follow-up. Secondary outcomes include remission and severity of depression symptoms at the 3-month postnatal follow-up, functional disability, perceived social support, breastfeeding rates, infant height and weight, and costs of health care at the 3- and 6-month postnatal follow-ups. The primary analysis will be intention-to-treat. DISCUSSION: The trials have the potential to strengthen the evidence on the effectiveness and cost-effectiveness of an evidence-based psychological treatment recommended by the World Health Organisation and delivered by peers for perinatal depression. The trials have the unique opportunity to overcome the shortage of human resources in global mental health and may advance our understanding about the use of peers who work in partnership with the existing health systems in low-resource settings. TRIAL REGISTRATION: Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014) India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).

Children's Mental Health and Well-Being After Parental Intimate Partner Homicide: A Systematic Review.

When one parent kills the other, children are confronted with multiple losses, involving their attachment figures and their direct living environment. In these complex situations, potentially drastic decisions are made, for example, regarding new living arrangements and contact with the perpetrating parent. We aimed to synthesize the empirical literature on children's mental health and well-being after parental intimate partner homicide. A systematic search identified 17 relevant peer-reviewed articles (13 independent samples). We recorded the theoretical background, methodology, and sample characteristics of the studies, and extracted all child outcomes as well as potential risk and protective factors. Children's outcomes varied widely and included psychological, social, physical, and academic consequences (e.g., post-traumatic stress, attachment difficulties, weight and appetite changes, and drops in school grades). Potential risk and protective factors for children's outcomes included 10 categories of pre-, peri-, and post-homicide characteristics such as cultural background of the family, whether the child witnessed the homicide, and the level of conflict between the families of the victim and the perpetrator. We integrated the findings into a conceptual model of risk factors to direct clinical reflection and further research.