Disaster Mental Health and Community-Based Psychological First Aid: Concepts and Education/Training.

Any community can experience a disaster, and many traumatic events occur without warning. Psychologists can be an important resource assisting in psychological support for individuals and communities, in preparation for and in response to traumatic events. Disaster mental health and the community-based model of psychological first aid are described. The National Preparedness and Response Science Board has recommended that all mental health professionals be trained in disaster mental health, and that first responders, civic officials, emergency managers, and the general public be trained in community-based psychological first aid. Education and training resources in these two fields are described to assist psychologists and others in preparing themselves to assist their communities in difficult times and to help their communities learn to support one another.

Helping the Helpers: Assisting Staff and Volunteer Workers Before, During, and After Disaster Relief Operations.

Self-care strategies and system supports employed in preparation for, during, and after disaster relief operations (DROs) are crucial to relief worker well-being and the overall effectiveness of relief efforts. Relief organizations and management must structure DROs in a manner that promotes self-care and workers must implement proper self-care strategies. Proper self-care before, during, and after a DRO can reduce negative reactions to stressful emergency work and promote growth, mastery, and self-efficacy after the experience. Therefore, the purpose of this article is to discuss the importance of organizational supports and self-care strategies in disaster relief settings. This article emphasizes the role of both individual and management participation and commitment to relief worker support and positive experience in DROs and provides suggestions for doing so. These suggestions are derived from the empirical and experiential literature and extensions from the theoretical background, and from our experience as managers in DROs.

The development and maturation of humanitarian psychology.

Humanitarian psychological support as an organized field is relatively young. Pioneers in the field were involved primarily in providing psychological support to refugees and internally displaced persons in conflict and nonconflict situations. This article describes basic principles for the design of psychological support programs and interventions. The International Federation of Red Cross and Red Crescent Societies (IFRC) began a psychological support program in 1991. The IFRC chose psychological first aid as its model for implementation in developing countries. Psychological first aid fits all the principles for psychological support program design and is adapted to individual communities. The first generation of psychological support programs differed dramatically depending on the countries in which they were developed. A second generation of psychological support programs evolved in response to the earthquake/tsunami of December 26, 2004. The Inter-Agency Standing Committee international guidelines consolidated the advances of second-generation programs and provided a clear indication of the wide acceptance of the importance of psychological support. A glimpse is provided of the third generation of psychological support programs, and an admonition is made for a more empirical evaluation of the effectiveness of interventions.

Psychological distress among American Red Cross disaster workers responding to the terrorist attacks of September 11, 2001.

This study investigated American Red Cross disaster workers' symptoms of distress and posttraumatic stress resulting from exposure to disaster stimuli during their response to the September 11, 2001 terrorist attacks. A sample of 3055 Red Cross disaster workers was surveyed 1 year after the terrorist attacks regarding demographic characteristics, function during the response, and exposure to disaster stimuli. Participants were grouped by function and self-reported exposure, with the hypothesis that workers in Direct Services and/or those reporting to be directly exposed to disaster stimuli would experience greater levels of posttraumatic stress symptoms and distress than workers in indirect services or reporting no exposure. Findings revealed that while there were significant differences between both Function and Exposure groups on dependent measures, the multivariate eta2 was very small for both and did not meet medium effect size criteria. The results indicated that workers directly exposed to disaster stimuli reported no more distress than those who were not directly exposed.

Mental health service use among American Red Cross disaster workers responding to the September 11, 2001 U.S. terrorist attacks.

In this article, we explored 1) the extent of mental health (MH) service use by American Red Cross disaster relief workers, both before (lifetime) and 1 year after the September 11, 2001 terrorist attacks, and 2) demographic, disaster and MH variables predicting (1-year) post-September 11 MH service use in this population. A sample of 3015 Red Cross disaster workers was surveyed 1 year after the attacks, regarding demographic characteristics, MH service use before and since the attacks, and posttraumatic stress disorder (PTSD) symptoms. Findings revealed that while 13.5% used MH services before the attacks, 10.7% used services after. Variables increasing the likelihood of MH service use after the attacks included the following: no previous MH treatment, younger age, being divorced/widowed, and higher PTSD intrusion or hyperarousal symptoms. Findings support other recent research on MH service use after the September 11 attacks.

Coping motives and trait negative affect: testing mediation and moderation models of alcohol problems among American Red Cross disaster workers who responded to the September 11,2001 terrorist attacks.

This study explored the mechanism by which trait negative affect and alcohol coping motives are associated with alcohol-related problems in a sample of American Red Cross workers who participated in the relief operation following the attacks in New York City, the Pentagon, and the Pennsylvania crash site on Sept. 11th 2001. The results supported the mediation but not moderation model of coping motives. The support for the mediation model was fairly strong, including small to moderate associations between negative affect and alcohol problems, moderate to strong associations between negative affect and coping motives, and evidence of coping motives mediating the negative affect to alcohol problems relationships. The association between negative affect and coping motives was stronger among younger participants.

Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors.

The Indonesian population has faced political violence, victimization, and torture throughout the last 70 years. Due to the scarcity of mental health professionals in many low and middle-income countries, counseling programs are increasingly utilizing paraprofessionals to provide support to the affected population as a strategy of task shifting. In this article, we would like to examine the effectiveness of counseling services provided by such trained paraprofessionals. This study was part of program evaluation to determine whether the participants (torture survivors) improved after counseling services provided by trained paraprofessionals in Indonesia. Local communities were invited to join the psychosocial program created and implemented by an NGO in 2005. The 178 participants were recruited from Jakarta, Papua, and Aceh, Indonesia for the program, which aimed to help survivors of violence suffering from "heavy hearts." The intervention lasted three months, and the follow-up intake was conducted after four months. The results indicated the participants' anxiety symptoms, depressive symptoms, somatic symptoms, and functioning improved from the intake to the follow-up. The program appeared to have been effective in reducing the participants' symptoms and impairment in functioning. This indicates that in countries where there is a scarcity of mental health professionals, working with paraprofessionals has the potential to help survivors of torture and violence.

The integration of mental and behavioral health into disaster preparedness, response, and recovery.

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises.

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

Assessing posttraumatic stress disorder with or without reference to a single, worst traumatic event: examining differences in factor structure.

The authors examined the effects of a methodological manipulation on the Posttraumatic Stress Disorder (PTSD) Checklist's factor structure: specifically, whether respondents were instructed to reference a single worst traumatic event when rating PTSD symptoms. Nonclinical, trauma-exposed participants were randomly assigned to 1 of 2 PTSD assessment conditions: referencing PTSD symptoms to their worst trauma (trauma-specific group, n = 218) or to their overall trauma history in general (trauma-general group, n = 234). A 3rd group of non-trauma-exposed participants (n = 464) rated PTSD symptoms globally from any stressful event. Using confirmatory factor analysis, the authors show that the 4-factor PTSD model proposed by D. W. King, G. A. Leskin, L. A. King, and F. W. Weathers (1998; separating effortful avoidance and emotional numbing) demonstrated the best model fit for trauma-general and non-trauma-exposed participants. The 4-factor PTSD model proposed by L. J. Simms, D. Watson, and B. N. Doebbeling (2002; emphasizing a general dysphoria factor) demonstrated the best model fit for trauma-specific participants. Measurement invariance testing revealed that non-trauma-exposed participants were different from both trauma-exposed groups on factor structure parameters, but trauma groups were not substantially different from each other.

Varying cautionary instructions, monetary incentives, and comorbid diagnostic training in malingered psychopathology research.

In this article, we combine two analogue experiments in which we empirically examined three malingering methodological issues in individuals trained and instructed to simulate posttraumatic stress disorder (PTSD) on the Trauma Symptom Inventory (TSI; Briere, 1995). In Experiment 1, we examined TSI scale effects of the following manipulations using a 2 x 2 design with 330 college students: (a) inclusion or exclusion of cautionary instructions regarding believability of participants' simulation and (b) different financial incentive levels. In Experiment 2, we examined comorbid psychiatric diagnostic training with 180 college students who were either trained to simulate PTSD and comorbid major depressive disorder or trained to simulate only PTSD. Caution main effects were significant for all but two TSI Clinical Scales, incentive main effects and interactions were only significant for one Clinical scale each, and the comorbidity manipulation did not yield any scale differences. We discuss malingering research design implications regarding the use of cautionary instructions, financial incentive levels, and comorbid training.

Associations between alcohol use and PTSD symptoms among American Red Cross disaster relief workers responding to the 9/11/2001 attacks.

OBJECTIVE: This study examined associations between alcohol use and PTSD symptoms among Red Cross workers who responded to the 9/11/2001 attacks. METHOD: Participants were 779 Red Cross paid and volunteer staff that responded during the first three months to the September 11, 2001, attacks against the United States. Women made up 64% of the sample. The American Red Cross provided a mailing list of all paid and volunteer staff (N = 6055 with valid addresses) that participated in the disaster relief operations in response to the September 11, 2001, attacks. Participants were randomly assigned to receive one of four questionnaire packets. The present study is based on the fourth group, which received the alcohol questionnaires. RESULTS: Overall, traumatic stress symptoms and alcohol use were low. Hyperarousal and intrusion symptoms on the Impact of Events Scale-Revised (IES-R) were associated with alcohol consumption, hazardous alcohol consumption, and change in alcohol consumption when controlling for age, gender, and worksite. Positive associations between Intrusion and Avoidance scores and hazardous consumption were stronger for younger participants. Individuals who reported increasing or decreasing alcohol use had higher IES-R scores than did those who maintained their normal rate of alcohol consumption, though effects were stronger for increasing alcohol use. Associations between alcohol variables and avoidance symptoms were minimal. CONCLUSIONS: The results suggest that there is a functional relation between posttraumatic stress symptoms and alcohol consumption. The study indicates that efforts to cope with traumatic stress symptoms may manifest in either increases or decreases in alcohol consumption.

Clinical presentations in combat veterans diagnosed with posttraumatic stress disorder.

This article investigated subtypes of symptom patterns among male combat veterans diagnosed with posttraumatic stress disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Graham, Ben-Porath, Tellegen, Dahlstrom, & Kaemmer, 2001) clinical and validity scales. Participants were 126 veterans seeking outpatient treatment for combat-related PTSD at a Veterans Affairs Medical Center. Two well-fitting MMPI-2 cluster solutions (a four-cluster solution and a three-cluster solution) were evaluated with several statistical methods. A four-cluster solution was determined to best fit the data. Follow-up analyses demonstrated between-cluster differences on MMPI-2 "fake bad" scales and content scales, the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986), Mississippi Combat PTSD scale (M-PTSD; Keane, Caddall, & Taylor, 1988), and Clinician-Administered PTSD Scale (CAPS-1; Blake et al., 1990). Clusters also were different in disability-seeking status, employment status, and income. Implications for research and clinical practice using the MMPI-2 with combat veterans presenting with PTSD are briefly addressed.

Lessons from the aftermath of flight 232 : Practical considerations for the mental health profession's response to air disasters

The fiery crash of a DC-10 at Sioux City, Iowa, on July 19, 1989, caused a crisis of major proportions, with attendant mental health needs. Various articles have described the need for psychological response teams in such crises. The present article provides practical guidelines for the preparation of a mental health disaster plan and for the coordination of a mental health team responding to a major air disaster. Such disasters can occur in any part of the country at any time. It is hoped that the suggestions in the present article will help teams that respond to future air disasters provide more rapid effective, and efficient delivery of services to the survivors and their families, and to the families of those who are killed