Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires.

BACKGROUND: The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the 'Black Summer' bushfires of 2019-20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. AIMS: To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. METHOD: We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. RESULTS: Six themes were produced: (a) 'Pulling together, pulling apart', describing experiences after bushfires and prior to impacts of the pandemic; (b) 'Disruption of the 'normal response', encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) 'Escalating tensions and division in the community', describing impacts on relationships; (d) 'Everywhere you turn you get a slap in the face', acknowledging impacts of bureaucratic 'red tape'; (e) 'There are layers of trauma', highlighting intersecting traumas and pre-existing vulnerabilities; and (f) 'Where does the help come from when we can't do it?', encompassing difficulties accessing services and impacts on the helping workforce. CONCLUSIONS: This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.

Improving mental health following multiple disasters in Australia: a randomized controlled trial of the Skills for Life Adjustment and Resilience (SOLAR) programme.

Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..

We tested the efficacy of a brief, skills-based psychosocial programme under randomised controlled conditions following compound disasters.The SOLAR programme was associated with improvements in anxiety, depression and posttraumatic stress symptoms across time.The SOLAR programme may benefit from booster sessions especially where there are ongoing impacts of disaster.

Prevalence and implications of gambling problems among firefighters.

Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational context. The sample consisted of n = 566 career and retained firefighters who participated in a cross-sectional survey of an Australian metropolitan fire service. The Problem Gambling Severity Index (PGSI) was used to operationalise both clinically significant levels of problem gambling (PGSI ≥ 5), and 'at-risk' gambling (PGSI 1-4); alongside measures of major depression (PHQ-9), anxiety (GAD-7), Posttraumatic Stress Disorder (PCL-5) and alcohol problems (AUDIT), as well as other addictive behaviours, wellbeing and psychosocial issues. Results indicated 12.3% of firefighters that reported any gambling problems across a continuum of severity (PGSI ≥ 1), including 2.3% that were problems gamblers, and 10.0% reporting at-risk gambling. The weighted prevalence of problem gambling was comparable to other significant mental health conditions including depression and PTSD, while the rate of any gambling problems was high relative to other addictive behaviours. Gambling problems were associated with poor mental health and wellbeing, but not psychosocial indicators (e.g., financial difficulties). The findings suggest that gambling problems across a spectrum of severity may be significant yet hidden issues among emergency service workers, and thus require increased recognition and responses at the organisational level.

Locating gambling problems across a continuum of severity: Rasch analysis of the Quinte Longitudinal Study (QLS).

Addressing gambling problems across a continuum requires understanding of low severity problems, as well as severe levels of problem gambling or disorder. The aims of this study were thus to derive a map of how problematic gambling behaviours and harms are situated across a continuum, and identify the best available indicators of low severity problems to inform assessment and secondary prevention. This involved the Rasch analyses of baseline data from the Quinte Longitudinal Study (QLS); a community-based survey involving random-digit dialling of numbers around Belleville, Canada. Participants were n = 1305 adults with non-zero scores across 26-items from: the Problem Gambling Severity Index (PGSI); the NORC DSM Screen for Gambling Problems (NODS); and the Problem and Pathological Gambling Measure (PPGM). Results indicated that item-level measures except chasing losses provided fit to the Rasch model, and most were clustered within a narrow region of the continuum which resembled addictive disorders. At the most severe end were mainly items about harms, while there were few items representing low severity levels (feeling guilty, betting more than one can afford, attempts to reduce gambling, gambling more than intended). There was Differential Item Functioning (DIF) for several indicators of low severity problems. The findings suggest that measures remain closely aligned with psychiatric models and are suited for discriminating across severe levels of problem gambling or addictive disorder. Although cognitive-affective and behavioural indicators comprise the best available indicators of low severity symptoms, there is an urgent need for improvements in conceptualisation and measurement.

Industry interests in gambling research: Lessons learned from other forms of hazardous consumption.

Research indicates that the evidential bases for many harm reduction policies targeting hazardous consumptions (including tobacco, alcohol and gambling) have been distorted by commercial industries that derive revenue from such commodities. These distortions are best illustrated by research on tobacco and alcohol, which indicates similar tactics used by industries to determine favourable policy environments through engineering of evidence, among other approaches. Although there is concern that gambling research is similarly vulnerable to commercial interests, the relevant literature lags far behind other fields and the aim of this paper is to increase familiarity with tactics used by industries for influencing research. It summarises the conceptual and empirical bases for expecting conflicts between goals of public health and companies that profit from hazardous consumptions. It also summarises evidence describing practices deployed by tobacco corporations, which include third-party techniques and the selective funding of research to manufacture doubt and deflect attention away from the consequences of smoking. It then reviews both early and emerging evidence indicating similar strategies used by alcohol industry, and uses this literature to view practices of the gambling industry. It argues that parallels regarding selective funding of research and third-party techniques provide grounds for strong concern about commercial influences on gambling research, and implementation of precautionary approaches to management of vested interests.

Episodic and Binge Gambling: An Exploration and Preliminary Quantitative Study.

The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.

Gambling problems in treatment for affective disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

BACKGROUND: Gambling problems co-occur frequently with other psychiatric difficulties and may complicate treatment for affective disorders. This study evaluated the prevalence and correlates of gambling problems in a U. S. representative sample reporting treatment for mood problems or anxiety. METHODS: n=3007 respondents indicating past-year treatment for affective disorders were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses examined correlates of gambling problems. RESULTS: Rates of lifetime and past-year problem gambling (3+DSM-IV symptoms) were 3.1% (95% CI=2.4-4.0%) and 1.4% (95% CI=0.9-2.1%), respectively, in treatment for any disorder. Rates of lifetime problem gambling ranged from 3.1% (95% CI=2.3-4.3%) for depression to 5.4% (95% CI=3.2-9.0%) for social phobia. Past-year conditions ranged from 0.9% (95% CI=0.4-2.1%) in dysthymia to 2.4% (95% CI=1.1-5.3%) in social phobia. Higher levels were observed when considering a spectrum of severity (including 'at-risk' gambling), with 8.9% (95% CI=7.7-10.2%) of respondents indicating a history of any gambling problems (1+ DSM-IV symptoms). Lifetime gambling problems predicted interpersonal problems and financial difficulties, and marijuana use, but not alcohol use, mental or physical health, and healthcare utilisation. LIMITATIONS: Data were collected in 2001-02 and were cross-sectional. CONCLUSIONS: Gambling problems occur at non-trivial rates in treatment for affective disorders and have mainly psychosocial implications. The findings indicate scope for initiatives to identify and respond to gambling problems across a continuum of severity in treatment for affective disorders.

The Prevalence of Comorbid Personality Disorders in Treatment-Seeking Problem Gamblers: A Systematic Review and Meta-Analysis.

The aim of this study was to systematically review and meta-analyze the prevalence of comorbid personality disorders among treatment-seeking problem gamblers. Almost one half (47.9%) of problem gamblers displayed comorbid personality disorders. They were most likely to display Cluster B disorders (17.6%), with smaller proportions reporting Cluster C disorders (12.6%) and Cluster A disorders (6.1%). The most prevalent personality disorders were narcissistic (16.6%), antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline (13.1%) personality disorders. Sensitivity analyses suggested that these prevalence estimates were robust to the inclusion of clinical trials and self-selected samples. Although there was significant variability in reported rates, subgroup analyses revealed no significant differences in estimates of antisocial personality disorder according to problem gambling severity, measure of comorbidity employed, and study jurisdiction. The findings highlight the need for gambling treatment services to conduct routine screening and assessment of co-occurring personality disorders and to provide treatment approaches that adequately address these comorbid conditions.