Hacia un cambio de paradigma en la atención psicológica en grandes emergencias: de incidentes con múltiples víctimas a incidentes con múltiples afectados / Towards a paradigm shift in psychological care in major emergencies: from incidents with multiple victims to incidents with multiple victims

Las grandes emergencias o desastres plantean grandes retos a la sociedad y en especial a todos los servicios de emergencia. En las últimas décadas, se ha incorporado la perspectiva de la salud mental como una parte importante de la atención sanitaria integral a los afectados. Así, el cambio conceptual de «incidente de múltiples víctimas» (IMV) a «incidente de múltiples afectados» (IMA) se centra en la atención y bienestar de todas las personas afectadas por un incidente, no solo en aquellos que han sufrido lesiones físicas. El objetivo del presente artículo se centra en conocer las posibilidades de intervención con afectados etiquetados en un triaje como verdes psicológicos (sin afectación y/o lesiones físicas), a partir de la intervención psicológica avanzada en emergencias (IPA). La IPA, más allá de alejar a los afectados del peligro, persigue aumentar su sensación de control y eficacia, tanto para afrontar la situación como para aumentar su sentido de competencia en la vivencia de trauma posterior respecto a esa experiencia. En este sentido, las posibilidades recientes de evaluación, así como los enfoques de primeros auxilios psicológicos, permiten nuevas aplicaciones de intervención en emergencias como las que posibilitan los soportes aéreos remotos (drones). Se discute su aplicación y posibilidades como opciones de futuro. (AU)

Major emergencies or disasters pose great challenges to society and especially to all emergency services. In the last decades, the Mental Health perspective has been incorporated as an important part of comprehensive health care for those affected. Thus, the conceptual change from “multiple casualty incident” (MCI) to “multiple affected incident” (MAI) focuses on the care and well-being of all people affected by an incident, not only those who have suffered physical injuries. The objective of this article is focused on finding out the possibilities of intervention with patients labeled in triage as psychological green (without affectation and/or physical injuries), based on advanced psychological intervention in emergencies (IPA). The IPA, beyond removing those affected from danger, seeks to increase their sense of control and efficacy, both to face the situation and to increase their sense of competence in the experience of subsequent trauma with respect to that experience. In this sense, recent assessment possibilities, as well as psychological first aid approaches, allow new intervention applications in emergencies such as those made possible by remote air support (drones). Its application and possibilities as future options are discussed. (AU)

Use of the HESPER Web to Assess Perceived Needs Immediately After Multiple Disaster Events in Fiji.

OBJECTIVE: In January 2022, Fiji was hit by multiple natural disasters, including a cyclone causing flooding, an underwater volcanic eruption, and a tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters. METHODS: A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data. RESULTS: In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD = 3). The top 3 most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public. CONCLUSIONS: The top 3 needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters and may require more attention from responding actors. The HESPER Web was considered a usable tool for needs assessment in a sudden onset disaster.

Exploring Pathways and Obstacles to Well-Being in Victims of Terrorism: A Qualitative Approach

On March 11, 2004, Madrid suffered one of the worst terrorist attacks in the history of Spain, leaving more than 190 dead and 2,000 injured. For years, the psychological consequences of the attacks have been studied; however, its long-term effects on symptomatology and especially on well-being remains unknown. This study aims to explore, through a qualitative approach, pathways and obstacles to the well-being of those affected directly or indirectly by the attacks of March 11 in Madrid. Two focus groups were held, one for indirect victims and one for direct victims. Subsequently, a thematic analysis of the materials obtained was carried out. More than 10 years after the attacks, most of the participants reported great difficulty in achieving well-being. Acceptance and victims’ associations seemed to act as key facilitators, while symptoms, political institutions and the media were the main obstacles. Direct and indirect victims presented similar data although aspects such as guilt and family relationships played a different role in their well-being. (AU)

The impact of prenatal maternal stress due to potentially traumatic events on child temperament: A systematic review.

The objective of the current study was to complete a systematic review of the relationship between prenatal maternal stress due to potentially traumatic events (PTEs) and child temperament. Eligible studies through June 2020 were identified utilizing a search strategy in PubMed and PsycInfo. Included studies examined associations between prenatal maternal stress due to PTE and child temperament. Two independent coders extracted study characteristics and three coders assessed study quality. Of the 1969 identified studies, 20 met full inclusion criteria. Studies were classified on two dimensions: (1) disaster-related stress and (2) intimate partner violence during pregnancy. For disaster-related prenatal maternal stress, 75% (nine out of 12) of published reports found associations with increased child negative affectivity, 50% (five out of 10) also noted associations with lower effortful control/regulation, and 38% (three out of eight) found associations with lower positive affectivity. When considering prenatal intimate partner violence stress, 80% (four out of five) of published reports found associations with higher child negative affectivity, 67% (four out of six) found associations with lower effortful control/regulation, and 33% (one out of three) found associations with lower positive affectivity. Prenatal maternal stress due to PTEs may impact the offspring's temperament, especially negative affectivity. Mitigating the effects of maternal stress in pregnancy is needed in order to prevent adverse outcomes on the infant's socioemotional development.

Piloting a scalable, post-trauma psychosocial intervention in Tuvalu: the Skills for Life Adjustment and Resilience (SOLAR) program.

Background: The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster. Objectives: We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu. Method: This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group (n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group (n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up. Results: Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive. Conclusions: Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted.

Antecedentes: El programa de Destrezas para la Adaptación a la Vida y Resiliencia (SOLAR en sus siglas en inglés) es un programa breve, escalable y de desarrollo de destrezas psicosociales diseñado para reducir el malestar y las dificultades de adaptación después de un desastre.Objetivos: Probamos la viabilidad, aceptabilidad, eficacia y seguridad de una versión de SOLAR culturalmente adaptada en dos comunidades remotas afectadas por ciclones en la nación Insular de Tuvalu en el Pacífico.Método: Este piloto adoptó un diseño de control cuasiexperimental, involucrando n = 99 participantes. Se administró SOLAR al grupo de tratamiento (n = 49) por facilitadores locales no especialistas (es decir 'Entrenadores') en un formato de grupo masivo durante cinco días consecutivos. El grupo control (n = 50) tuvo acceso a la Atención Habitual (AH). Comparamos las diferencias entre los grupos (post-intervención versus post-control) siendo el resultado primario el malestar psicológico. Examinamos también si los cambios se mantuvieron a los 6 meses de seguimiento.Resultados: Se observaron diferencias grandes estadísticamente significativas entre los grupos en el malestar psicológico después de controlar los puntajes basales a favor del grupo SOLAR. Los resultados promedio del grupo fueron consistentemente más bajos a los 6 meses de seguimiento que al inicio. Se encontró que SOLAR era aceptable y seguro, y la retroalimentación del programa por los participantes y entrenadores fue extremadamente positiva.Conclusiones: Los hallazgos contribuyen a la evidencia emergente que SOLAR es una intervención flexible, culturalmente adaptable y escalable que puede apoyar la recuperación individual y la adaptación después de un desastre. Se justifica la realización de ECAs para fortalecer la evidencia de la eficacia de SOLAR.

The Lived Experience of Victims of Catastrophic Coastal Erosion: A cycle of impact, consequence and recovery.

OBJECTIVES: Environmental hazards are part of the Earth's natural cycle and are ongoing within human history. When vulnerable situations meet environmental hazards, disasters occur where human and natural costs could be enormous. This study aimed to explore the experiences of the victims of coastal erosion during the monsoon season. METHODS: Seven victims of catastrophic coastal erosion in the Kollam District of Kerala, India, were interviewed from December 2013 to February 2014. The study followed Edmond Husserl's descriptive phenomenological method. RESULT: These interviews constituted the primary data source. Three main themes with eleven subthemes emerged from these data. The main themes were impact, consequences and recovery. The subthemes were living in constant fear, escaping from the catastrophe; cataclysmic sea waves and their tumultuous behaviour, instant damage and destruction, the epoch of losses; agony and suffering; homelessness-helplessness-sleeplessness mixed with fear; government aid only in dreams; haunting memories; never-ending daily needs; first home and native land; and the desire to go back to the site of the disaster. CONCLUSION: From the derived themes, a phenomenon associated with coastal erosion evolved. The phenomenon is termed "Catastrophic coastal erosion: A cycle of impact, consequences, and recovery."

[Daily information-gathering behavior of natural disaster victims: Focusing on residents who experienced the Great East Japan Earthquake and the Kanto-Tohoku Heavy Rainfall Disaster].

Objectives　To obtain suggestions for improving disaster-prevention literacy, this study elucidated the daily information-gathering behavior of residents living in areas affected by two Japanese natural disasters (the Great East Japan Earthquake of 2011 and the Kanto-Tohoku Heavy Rainfall Disaster in September 2015) and examined factors affecting life backgrounds and disaster experiences.Methods　In June 2017, we administered a cross-sectional survey using a self-administered questionnaire to 1,065 households in areas affected by the Great East Japan Earthquake and the Kanto-Tohoku Heavy Rainfall. One person in each household responded to the questionnaire. Of 362 respondents (response rate 34.0%), 336 with definite attributes were analyzed. After ascertaining their daily information-gathering behavior, we applied binary logistic regression analysis, incorporating-as dependent variables-three variables previously used in times of disaster.Results　Of the respondents, 179 were men (53.3%); the average age (standard deviation) was 65.5 (10.6) years. Information-gathering modes used by more than half the subjects were "television," "newspaper," "conversation/word of mouth," "radio," and "community magazine" in descending order of use.　Examination of the factors of the three variables revealed the following. (1) Four variables were significantly and positively correlated with "conversation/word of mouth": "woman" (1.82 odds ratio [OR]; 1.05-3.15 95% confidence interval [CI]); "I have" a co-resident family member (OR, 2.46; 95% CI, 1.06-5.72); "I can expect" mutual aid from community residents (OR, 2.31; 95% CI, 1.27-4.21); and "I feel more" fear of typhoons and heavy rains now than before (OR, 1.82; 95% CI, 1.04-3.18). (2) "Radio" has two variables with significant and positive correlations: "I have" a co-resident family member (OR, 3.22; 95% CI, 1.35-7.67) and "I was affected" by the Great East Japan Earthquake and the Kanto-Tohoku Heavy Rainfall Disaster (OR, 1.73; 95% CI, 1.01.2.97). (3) Two variables are significantly correlated with "Internet service": "Age" has a negative correlation (OR, 0.91; 95% CI, 0.88-0.94); "I can expect" mutual aid from community residents has a positive correlation (OR, 2.66; 95% CI, 1.19-5.93).Conclusion　Damage and fear instilled by natural disasters influence subsequent information-gathering behavior. Disaster prevention literacy in ordinary times can be improved because of the correlation between awareness of mutual aid in local communities and information-gathering behavior.

Gone with the Wind.

OBJECTIVE: If the narrative of "coronavirus" has an underlying theme, it may perhaps for some be one of survival, whilst for others, the theme might be suffering. The recurring motif of survival has continued throughout history, yet for the first time the sum of all fears has amounted to a run on the bare essentials. This paper seeks to offer an alternative formulation of "panic buying," with references to literature, philosophy, and contemporary neurobiology. CONCLUSION: The bare essentials disappeared perhaps as part of some self-fulfilling prophecy: the supermarkets became bare because others inadvertently lead us to believe they would become bare. The contagion model of emotional propagation provides a psychological model of how "panic buying" by an individual might lead to the replication of panic in an observer. The Polyvagal Theory further informs us of how the threat posed by the pandemic primes our limbic system to perceive danger, and explains how witnessing others engaging in fight-flight responses might evoke a fearful affect in an observer. In the end, it is perhaps through Nietzsche's study of classical tragedy that we may find some meaning to the pandemic, allowing our collective lived experience to serve as a template for growth.

Experiences of rural women with damages resulting from an earthquake in Iran: a qualitative study.

BACKGROUND: Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran. METHODS: In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba's Evaluative Criteria were used. RESULTS: There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions. CONCLUSIONS: Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.

Long-term displacement associated with health and stress among survivors of Typhoon Haiyan.

Displacement from one's home after a natural disaster results not only in physical separation from significant others but also in profound disruptions of psychological and social resources such as community support and sense of belonging. Frequent displacement can exacerbate health and mental health problems brought by the disaster, especially among lower-income families in resource-scarce regions. OBJECTIVE: The present study examined the association among frequency of displacement after the disaster, health status, and psychological adjustments among survivors four years after the 2013 Super Typhoon Haiyan in the Philippines. METHOD: The study surveyed 345 typhoon survivors using randomized cluster samples in 13 towns in Eastern Philippines and assessed their physical and mental health status. RESULT: Path analysis revealed that, after controlling for age, gender, and traumatic exposure severity, frequency of displacement was a significant predictor for subjective health ratings and stress but not for posttraumatic stress symptoms, depression, and anxiety. CONCLUSION: These findings underscore the detrimental impact of long-term displacement on health outcomes following a disaster, especially in countries where public health resources are largely unavailable. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Multidimensional Scale of Perceived Social Support in Indonesian adolescent disaster survivors: A psychometric evaluation.

BACKGROUND: Social support plays an important role in adolescents' mental health and well-being, and even more so for disaster survivors. To measure the level of social support, one needs an appropriate tool to produce valid and reliable results; therefore, we aimed to measure the invariance across gender groups, and analyze the construct validity and reliability of the Indonesian version of the Multidimensional Scale of Perceived Social Support (MSPSS), a social support measurement tool which was theoretically constructed and has been well validated in many countries with various cultures and backgrounds. METHODS: A school-based assessment was conducted in junior and senior high schools in a post-disaster setting in Yogyakarta Province, Indonesia. We analyzed 299 adolescent survivors of a volcanic eruption, aged 12~18 years who completed a 12-item Indonesian version of the MSPSS. RESULTS: The factorial validity confirmed the three-factor structure of the scale (Family, Friends, and Significant Others) which met all of the criteria of parameter indices and provided evidence of high internal consistency reliability. The three-level measurement of invariance, which consisted of configural, metric, and scalar invariance, also performed very well across gender groups with our data and corresponded to the recommended parameters. Our composite reliability values were all fine (>0.7) and indicated that the items in the same construct were strongly correlated and reliable. CONCLUSIONS: The Indonesian version of the MSPSS was shown to be a valid, reliable, theoretically constructed, and applicable instrument for adolescent disaster survivors.

Nuclear disaster as chronic crisis: Accounts of radiation embodiment by survivors of the Chernobyl nuclear disaster from Belarus born before, in and after 1986.

This article looks at chronic crisis on an empirical example of radiation embodiment by survivors of a nuclear disaster. Developing further the work of Henrik Vigh, this article argues that chronic crisis is conflictual in nature, where some individuals fully embrace it, while others reject it. A total of 16 in-depth interviews were conducted with survivors of the Chernobyl nuclear disaster from Belarus who were below 18 years in 1986 and born in or after 1986. It is shown that survivors do not consider themselves affected, when they argue against social stigma imposed by others and when development discourse in relation to post-communist health care is used as a background against which nuclear victimhood can be argued. It is also demonstrated that survivors do consider themselves affected, when they embrace disaster temporality and victimhood and argue against narrow scientific definitions of victimhood which downplay a variety of health conditions attributed to the disaster. This article concludes that chronic crisis may not always be transformative, but reproduce the existing inequalities. It contributes to the anthropology of disaster and the anthropology of suffering by bringing together scholarship in feminist theory of disability and critical perspectives on development.