Suicide prevention during disasters and public health emergencies: a systematic review.

Background: Disasters and public health emergencies increasingly affect populations around the world, posing significant wide-ranging challenges for societies as well as for effective public health and suicide prevention. Intervention research is essential to inform evidence-based responses. Yet, despite evident public concern and growing research interest in heightened suicide risks and impacts, little is known about effective suicide prevention interventions in these contexts. We conducted a systematic review to examine the outcomes of suicide prevention strategies implemented in disasters and public health emergencies. Methods: We searched five databases (Medline, Embase, PsycINFO, Web of Science, PTSDpubs) from inception to December 2022 for peer-reviewed quantitative studies that reported relevant intervention outcomes (changes in the frequency of suicide, suicide attempts, self-harm) for populations affected by disasters and public health emergencies. We assessed the quality of eligible studies using the Quality Assessment Tool for Quantitative Studies, and distilled review findings through narrative synthesis. The study protocol was registered with PROSPERO (CRD42021276195). Results: Ten eligible and mostly observational studies were included in this review, which examined a range of universal, selective, and indicated interventions. Three of five studies of interventions in public health emergencies indicated the potential effectiveness and buffering effects of generic disaster related mental health support, access to urban parks, as well as the beneficial role of video-enabled tablets in facilitating treatment access and outcomes. Similarly, three of five studies of interventions in disaster contexts provided evidence of the beneficial role of universal economic security measures, national gun laws and buy back schemes, and volunteer-delivered mental health support. Overall, four of six studies with favorable outcomes examined interventions specifically deployed in disaster or public health emergency contexts, whereas two studies examined ongoing existing interventions. Three studies, respectively, of suicide prevention focused interventions or generic interventions reported favorable outcomes. The quality of included studies was variable, with two studies being rated as 'strong', four studies rated as 'moderate', and four studies rated as 'weak'. Conclusion: Notwithstanding the limited scope and variable quality of published evidence, our review findings highlight the breadth of interventions that have been applied in such contexts with some success. There is a need for further research on effective interventions and intervention adaptations to inform evidence-based suicide prevention responses to disasters and public health emergencies. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276195, PROSPERO ID CRD42021276195.

The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia.

Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.

Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm.

BACKGROUND: Prior self-harm represents the most significant risk factor for future self-harm or suicide. AIM: To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. METHOD: We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. RESULTS: The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. CONCLUSIONS: A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.

Disaster Mental Health Risk Reduction: Appraising Disaster Mental Health Research as If Risk Mattered.

The globally increasing frequency, intensity, and complexity of extreme climatic events and disasters poses significant challenges for the future health and wellbeing of affected populations around the world [...].

Utilisation and application of implementation science in complex suicide prevention interventions: A systematic review.

OBJECTIVES: Little is known about how complex, multilevel, and multicomponent suicide prevention interventions work in real life settings. Understanding the methods used to systematically adopt, deliver, and sustain these interventions could ensure that they have the best chance of unfolding their full effect. This systematic review aimed to examine the application and extent of utilisation of implementation science in understanding and evaluating complex suicide prevention interventions. METHODS: The review adhered to updated PRISMA guidelines and was prospectively registered with PROSPERO (CRD42021247950). PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL were searched. All English-language records (1990-2022) with suicide and/or self-harm as the primary aims or targets of intervention were eligible. A forward citation search and a reference search further bolstered the search strategy. Interventions were considered complex if they consisted of three or more components and were implemented across two or more levels of socio-ecology or levels of prevention. RESULTS: One hundred thirty-nine records describing 19 complex interventions were identified. In 13 interventions, use of implementation science approaches, primarily process evaluations, was explicitly stated. However, extent of utilisation of implementation science approaches was found to be inconsistent and incomprehensive. LIMITATIONS: The inclusion criteria, along with a narrow definition of complex interventions may have limited our findings. CONCLUSION: Understanding the implementation of complex interventions is crucial for unlocking key questions about theory-practice knowledge translation. Inconsistent reporting and inadequate understanding of implementation processes can lead to loss of critical, experiential knowledge related to what works to prevent suicide in real world settings.

Evaluating the Effectiveness of Components of National Suicide Prevention Strategies.

Background: National suicide prevention strategies support development of suicide prevention activities and their evaluation. Aims: To describe components included in national suicide prevention strategies and analyze the potential contribution of individual components to reduce suicide rates. Method: We conducted a narrative review and statistical analysis of national suicide prevention strategies. The narrative review was based on a framework of 12 components and included 29 countries (14 lower middle-income countries [LMICs] and 15 high-income countries [HICs]) with a national suicide prevention strategy. The statistical analyses covered suicide mortality data for 24 countries with a national strategy (9 LMICs and 15 HICs). Results: The number of components adopted in national strategies ranged from 4 to 11, and training and education were included in 96.5% of strategies. Estimated period effects for total suicide rates in individual countries ranged from a significant decrease in the yearly suicide rate (RR = 0.80; 95% CI 0.69-0.93) to a significant increase (RR = 1.12; 95% CI 1.05-1.19). There were no changes in suicide mortality associated with individual components of national strategies. Limitations: The limitations of existing suicide mortality data apply to our study. Conclusion: Further detailed evaluations will help identify the specific contribution of individual components to the impact national strategies. Until then, countries should be encouraged to implement and evaluate comprehensive national suicide prevention strategies.

Ethical Issues to Consider in Designing Suicide Prevention Studies: An Expert Consensus Study.

AIM: Research is imperative to advance our understanding of suicidal behavior and its prevention. Suicide prevention research involves various ethical issues, many of which are not straightforward to address. Hence, suicide prevention researchers sometimes face particular issues when designing their research studies. This expert consensus study aimed to identify the most important ethical issues to consider when designing suicide prevention studies. METHODS: People with lived experience of suicide (N = 32) and suicide prevention researchers (N = 34) rated 80 statements on a 5-point Likert scale from "essential" to "should not be included." RESULTS: There was significant agreement between and within the two groups of participants with regard to the most highly rated statements. The most highly rated statements for both groups included the importance of the ethical principles of merit, integrity, justice, and beneficence. Additionally, lived experience participants placed emphasis on the support and care for researchers, and suicide prevention researchers placed emphasis on the risk management protocols and support services for participants. CONCLUSION: There was strong agreement between people with lived experience of suicide and suicide prevention researchers regarding what to consider when designing ethically sound suicide prevention research, including the importance of ethical principles and support for both participants and researchers.HIGHLIGHTSThere was strong agreement between people with lived experience of suicide and researchers.Researchers emphasized adherence to national guidelines.People with lived experience of suicide valued care for study participants and researchers.

Attributable risk of suicide for populations in Australia.

Objective: Each year approximately 3,000 Australians die by suicide. We estimated the population attributable risk for identified target populations to provide evidence on how much of the overall burden of suicide in the Australian population is experienced by each of them. Methods: We identified 17 demographic and clinical target populations at risk of suicide and calculated the population attributable fraction (PAF) using a single or pooled suicide risk and the proportional representation of each target population within Australia. Results: Large PAF estimates were found for men (52%, 95% confidence interval (CI) 51%-53%), people bereaved by suicide (35%, 95% CI 14%-64%), people with a mental health or behavioural condition (33%, 95%CI 17%-48%), people with a chronic physical condition (27%, 95%CI 18%-35%), adults aged 25-64 years (13%, 95%CI 12%-14%), LGB populations (9%, 95%CI 6%-13%), offenders (9%, 95%CI 8%-10%), and people employed in blue collar occupations (8%, 95%CI 4%-12%). Limitations: The PAF is limited by assumptions, namely, that risk factors are independent, and that the relationship between risk factors and outcomes are unidirectional and constant through time. Conclusions and implications for public health: Considerable reductions in the overall suicide rate in Australia may occur if risk factors are addressed in identified populations with large PAF estimates. These estimates should be considered as an adjunct to other important inputs into suicide prevention policy priorities.

Cost-effectiveness of media reporting guidelines for the prevention of suicide.

INTRODUCTION: Media guidelines for the responsible reporting of suicide are a recognized universal suicide prevention intervention. While implemented in numerous countries, including Australia, little is known about whether they are cost-effective. We aimed to determine the cost-effectiveness of Mindframe, the national initiative implementing media guidelines in Australia. METHOD: We conducted a modelled economic evaluation (5-year time-horizon) incorporating two types of economic analysis: (i) return-on-investment (ROI) comparing estimated cost savings from the intervention to the total intervention cost, and (ii) cost-effectiveness analysis comparing the net intervention costs to health outcomes: suicide deaths prevented and quality-adjusted life-years (QALYs). We also included uncertainty analyses to propagate parameter uncertainty and sensitivity analyses to test the robustness of the model outputs to changes in input parameters and assumptions. RESULTS: The estimated ROI ratio for the main analysis was 94:1 (95% uncertainty interval [UI]: 37 to 170). The intervention was associated with cost savings of A$596M (95% UI: A$228M to A$1,081M), 139 (95% UI: 55 to 252) suicides prevented and 107 (95% UI: 42 to 192) QALYs gained. The intervention was dominant, or cost-saving, compared with no intervention with results being robust to sensitivity analysis but varying based on the conservativeness of the parameters entered. CONCLUSION: Mindframe was found to be cost-saving, and therefore, worthy of investment and inclusion as part of national suicide prevention strategies.

The long-term impact of bushfires on the mental health of Australians: a systematic review and meta-analysis.

Background: The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. Objective: This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. Method: A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. Results: We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. Conclusions: As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. HIGHLIGHTS: First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.

Antecedentes: Los efectos a largo plazo de los incendios forestales sobre la salud incluyen la posibilidad de desencadenar problemas de salud mental nuevos y de exacerbar los ya existentes.Objetivo: Esta revisión tuvo como objetivo determinar la prevalencia de los problemas de salud mental a largo plazo en poblaciones australianas expuestas a incendios forestales.Métodos: Se realizó una revisión sistemática en cinco bases de datos (Embase, Medline, PsycINFO, Scopus y Web of Science) para identificar estudios enfocados en poblaciones australianas afectadas por incendios forestales con una prevalencia de problemas de salud mental reportados de dos años a más después de los incendios. Se empleó la herramienta de evaluación crítica de prevalencia del Instituto Joanna Briggs. Se realizó un metaanálisis para determinar la prevalencia de la angustia psicológica general en la población general y se realizó una síntesis narrativa.Resultados: Se incluyeron 21 artículos sobre la base de cinco estudios y realizados en tres diferentes incendios forestales. El metaanálisis mostró una prevalencia acumulada de 14 % (95 %, IC 12 %­16 %) para la angustia psicológica en la población general entre los 2 y 4 años luego del incendio forestal. La prevalencia general de los problemas psicológicos a largo plazo en los bomberos fue del 28 % al 47,6 % luego de 2 a 7 años de los incendios. La prevalencia de algunos problemas de salud mental disminuyó en el tiempo y fue directamente proporcional al nivel del impacto del incendio forestal.Conclusiones: Dado que la magnitud del impacto de los problemas de salud mental asociados a los incendios forestales en Australia es severa, es importante vigilar los problemas psicológicos y apoyar a las comunidades en el futuro. Las investigaciones posteriores necesitan incluir: a) más estudios sobre la magnitud completa del impacto psicológico de los incendios forestales a largo plazo y b) consensos en los instrumentos y los criterios diagnósticos para definir los problemas de salud mental.

Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia.

Importance: Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur. Objective: To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia. Design, Setting, and Participants: This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model. Interventions: Barriers installed at bridge and cliff sites. Main Outcomes and Measures: Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers. Results: A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95% uncertainty interval [UI], $90 to $160 million) could be saved in prevented suicides over 5 years, and US $270 million (95% UI, $176 to $298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used. Conclusions and Relevance: In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites.

Public health implications of multiple disaster exposures.

Disasters are an important public health issue; however, there is scarce evidence to date on what happens when communities and populations experience more than one disaster. This scoping review identifies literature on the effects of multiple disasters published until Aug 2, 2021, 1425 articles were identified, of which 150 articles were included. We analysed direct and indirect public health implications of multiple disasters. Our analysis suggests that exposure to multiple disasters can affect mental health, physical health, and wellbeing, with some evidence that the potential risks of multiple disaster exposure exceed those of single disaster exposure. We also identified indirect public health implications of multiple disaster exposure, related to changes in health-care facilities, changes in public risk perception, and governmental responses to multiple disasters. We present findings on community recovery and methodological challenges to the study of multiple disasters, and directions for future research.

Effectiveness of Psychosocial Interventions for Family Members and Other Informal Support Persons of Individuals Who Have Made a Suicide Attempt.

Background: Individuals recovering from a suicide attempt may benefit from support provided by informal carers, that is, family members and other support persons, who may require support themselves. Aims: This systematic review aims to identify and synthesize available literature on the effectiveness of psychosocial interventions for this carer population. Method: A search of peer-reviewed literature in five databases was carried out. Studies using any design were eligible and results were synthesized using a narrative review. Results: Eight articles reporting on seven quantitative studies met the eligibility criteria. This included three studies on interventions designed specifically for informal carers and four studies on interventions designed for persons who have made a suicide attempt, and which involved their informal carers. Overall, informal carers were satisfied with support and psychosocial interventions they received. Interventions were related to some improvements in carers' mental health outcomes, lowered burden, and improved ability to provide care. There were mixed results regarding family functioning and quality of life. Limitations: No studies from lower- and middle-income countries were identified and the small number of heterogeneous studies precluded conducting a meta-analysis. Conclusion: Given the low number of studies and their overall poor quality, this review can only draw preliminary conclusions. More high-quality intervention studies are needed to formulate recommendations for effective psychosocial support for family members and other informal support persons after a suicide attempt.

What Works in Community-Led Suicide Prevention: Perspectives of Wesley LifeForce Network Coordinators.

Community coalitions have been recognised as an important vehicle to advance health promotion and address relevant local health issues in communities, yet little is known about their effectiveness in the field of suicide prevention. The Wesley Lifeforce Suicide Prevention Networks program consists of a national cohort of local community-led suicide prevention networks. This study drew on a nationally representative survey and the perspectives of coordinators of these networks to identify the key factors underpinning positive perceived network member and community outcomes. Survey data were analysed through descriptive statistics and linear regression analyses. Networks typically reported better outcomes for network members and communities if they had been in existence for longer, had a focus on the general community, and had conducted more network meetings and internal processes, as well as specific community-focused activities. Study findings strengthen the evidence base for effective network operations and lend further support to the merit of community coalitions in the field of suicide prevention, with implications for similar initiatives, policymakers, and wider sector stakeholders seeking to address suicide prevention issues at a local community level.

Ethical concerns in suicide research: thematic analysis of the views of human research ethics committees in Australia.

BACKGROUND: Suicide research aims to contribute to a better understanding of suicidal behaviour and its prevention. However, there are many ethical challenges in this research field, for example, regarding consent and potential risks to participants. While studies to-date have focused on the perspective of the researchers, this study aimed to investigate the views and experiences of members of Human Research Ethics Committees (HRECs) in dealing with suicide-related study applications. METHODS: This qualitative study entailed a thematic analysis using an inductive approach. We conducted semi-structured interviews with a purposive sample (N = 15) of HREC Chairs or their delegates from Australian research-intensive universities. The interview guide included questions regarding the ethical concerns and challenges in suicide-related research raised by HREC members, how they dealt with those challenges and what advice they could give to researchers. RESULTS: The analysis identified four main themes: (1) HREC members' experiences of reviewing suicide-related study applications, (2) HREC members' perceptions of suicide, suicide research, and study participants, (3) Complexity in HREC members' decision-making processes, and (4) HREC members' relationships with researchers. CONCLUSIONS: Reliance on ethical guidelines and dialogue with researchers are crucial in the assessment of suicide-related study applications. Both researchers and HREC members may benefit from guidance and resources on how to conduct ethically sound suicide-related studies. Developing working relationships will be likely to help HRECs to facilitate high quality, ethical suicide-related research and researchers to conduct such research.

Immediate and long-term health impact of exposure to gas-mining induced earthquakes and related environmental stressors.

BACKGROUND: Little is known about the public health impact of chronic exposure to physical and social stressors in the human environment. Objective of this study was to investigate the immediate and long-term health effects of living in an environment with gas-mining induced earthquakes and related stressors in the Netherlands. METHODS: Data on psychological, somatic and social problems recorded routinely in electronic health records by general practitioners during a 6-year period (2010-2015) were combined with socioeconomic status and seismicity data. To assess immediate health effects of exposure to ML≥1.5 earthquakes, relative risk ratios were calculated for patients in the week of an earthquake and the week afterwards, and compared to the week before the earthquake. To analyse long-term health effects, relative risks of different groups, adjusted for age, sex and socioeconomic status, were computed per year and compared. RESULTS: Apart from an increase in suicidality, few immediate health changes were found in an earthquake week or week afterwards. Generally, the prevalence of health problems was higher in the mining province in the first years, but dropped to levels equal to or even below the control group in subsequent years, with lower relative risks observed in more frequently exposed patients. CONCLUSIONS: From a public health perspective, the findings are fascinating. Contrary to our expectation, health problems presented in general practice in the earthquake province decreased during the study period. More frequently exposed populations reported fewer health issues to general practitioners, which might point at health adaptation to chronic exposure to stressors.

Lived experience peer support programs for suicide prevention: a systematic scoping review.

BACKGROUND: Peer-led support models have gained increasing popularity in suicide prevention. While previous reviews show positive effects of peer-led support for people with mental health problems and those bereaved by suicide, little is known about the types of lived experience peer support programs in suicide prevention and whether these are effective in improving the health and wellbeing of people at risk of suicide. The aim of this paper is to provide an overview of peer support programs that aim to reduce suicidality and are led by people with lived experience of suicide. METHOD: We conducted a systematic scoping review, involving a search of three academic (Medline, PsycINFO, Embase) and selected grey literature databases (Google Scholar, WHO Clinical Trials Registry) for publications between 2000 and 2019. We also contacted suicide prevention experts and relevant internet sites to identify peer support programs that exist but have not been evaluated. The screening of records followed a systematic two-stage process in alignment with PRISMA guidelines. RESULTS: We identified 8 records accounting for 7 programs focussed on peer-led support programs in suicide prevention. These programs employed a range of different designs and included a variety of settings (schools, communities, rural and online). Only 3 of the 7 programs contained data on effectiveness. With the small number of eligible programs the findings from this review are limited and must be interpreted with caution. CONCLUSIONS: Despite the increased focus of policymakers on the importance of peer support programs in suicide prevention, our scoping review confirms an evidence gap in research knowledge regarding program design, implementation, and effectiveness. More rigour is required in reporting peer-led support initiatives to clarify the underlying definition of peer support and lived experience and to enhance our understanding of the types of current peer support programs available to those experiencing suicidality. Further, we need formal and high-quality evaluations of peer support suicide prevention programs led by people with lived experience to better understand their effectiveness on participant health across different settings and delivery modalities and to allow for comprehensive systematic reviews and meta-analysis in future.

The Integration of Mental Health and Psychosocial Support and Disaster Risk Reduction: A mapping and Review.

The field of disaster and emergency management has shifted in focus towards the goal of Disaster Risk Reduction (DRR). However, the degree to which the Mental Health and Psychosocial Support (MHPSS) field has followed this trend is relatively unknown. Therefore, the objectives of this review were to identify relevant projects, materials, and publications relating to MHPSS and DRR integration and define current domains of action in this integration. A review was conducted using a two-pronged approach for data collection. This approach included 1) a mapping exercise eliciting relevant documentation and project descriptions from MHPSS actors, and 2) a database and internet literature search. The mapping exercise was conducted between January and November 2019, while the literature search was completed in March 2019. The majority of identified materials concerned actions of capacity and systems building; preparedness; policy development, consensus building, and awareness raising; school- and child-focused DRR; inclusive DRR; and resilience promotion. Results also suggested that relatively little consensus exists in terms of formal definitions of and frameworks or guidance for integrating MHPSS and DRR. Moreover, domains of action varied in terms of current implementation practices and empirical evidence. Materials and projects are reviewed and discussed in terms of implications for advancing the integration of DRR and MHPSS and expanding MHPSS approaches to include building better before emergencies.