Institute of Behavioral Science, Natural Hazards Center, University of Colorado-Boulder, 483 UCB, Boulder, CO, 80309-0483, USA.
Transcultural Psychosocial Organization - Nepal, GPO Box 8974/CPC Box 612, Baluwatar, Kathmandu, Nepal.
BMC Psychiatry. 2018 Sep 15;18(1):296. doi: 10.1186/s12888-018-1863-z.
On 25th April 2015, Nepal experienced a 7.8 magnitude earthquake, followed by countless aftershocks. Nearly 9000 people were killed and over 600,000 homes destroyed. Given the high frequency of earthquake and other natural hazards in Nepal, disaster preparedness is crucial. However, evidence suggests that some people exposed to prior disasters do not engage in risk reduction, even when they receive training and have adequate resources. Mental health symptoms, including those associated with prior disaster exposure, may influence engagement in preparedness. Perceived preparedness for future disasters may in turn influence mental health. Social cohesion may influence both mental health and preparedness.
We developed and tested a hybrid mental health and disaster preparedness intervention in two earthquake-affected communities in Nepal (N = 240), about 2.5 months after the April 25th, 2015 earthquake. The 3-day intervention was culturally adapted, facilitated by trained Nepalese clinicians and focused on enhancing disaster preparedness, mental health, and community cohesion. Communities were selected based on earthquake impacts and matched on demographic variables. The intervention was administered initially to one community, followed by the other receiving the intervention shortly thereafter. Survey data was collected across three time points. Focus groups were also conducted to examine intervention impact.
At pre-intervention baseline, greater depression symptoms and lower social cohesion were associated with less disaster preparedness. Depression and PTSD were associated with lower social cohesion. Participation in the intervention increased disaster preparedness, decreased depression- and PTSD-related symptoms, and increased social cohesion. Mediation models indicated that the effect of intervention on depression was partially explained by preparedness. The effect of the intervention on disaster preparedness was partially explained by social cohesion, and the effect of intervention on depression and on PTSD was also partially explained by social cohesion. Data from focus groups illuminate participant perspectives on components of the intervention associated with preparedness, mental health and social cohesion.
This mental health integrated disaster preparedness intervention is effective in enhancing resilience among earthquake-affected communities in Nepal. This brief, cost-effective group intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes and other natural hazards.
Clinical Trials Registry-India, National Institute of Medical Statistics. Registration number: CTRI/2018/02/011688. http://ctri.nic.in/Clinicaltrials/login.php Retrospectively registered February 5th, 2018. First participant enrolled July 2015.
2015 年 4 月 25 日，尼泊尔发生 7.8 级地震，随后发生无数余震。近 9000 人遇难，60 多万房屋被毁。鉴于尼泊尔地震和其他自然灾害的高发频率，做好灾害准备至关重要。然而，有证据表明，一些人在遭遇先前灾害后并未采取减少风险的措施，尽管他们接受了培训并有足够的资源。心理健康症状，包括与先前灾害暴露相关的症状，可能会影响他们参与准备工作。对未来灾害的准备感知可能反过来影响心理健康。社会凝聚力可能会影响心理健康和准备工作。
我们在尼泊尔受地震影响的两个社区（N=240）中开发并测试了一种心理健康和灾害准备综合干预措施，大约在 2015 年 4 月 25 日地震发生后 2.5 个月。该 3 天的干预措施经过文化适应性调整，由经过培训的尼泊尔临床医生进行，重点是增强灾害准备、心理健康和社区凝聚力。社区是根据地震影响选择的，并根据人口统计学变量进行匹配。干预措施首先在一个社区实施，然后不久后另一个社区接受干预。在三个时间点收集了调查数据。还进行了焦点小组讨论，以检查干预措施的影响。
在干预前的基线时，更多的抑郁症状和更低的社会凝聚力与较低的灾害准备度相关。抑郁和创伤后应激障碍与较低的社会凝聚力相关。参与干预措施提高了灾害准备度，降低了与抑郁和创伤后应激障碍相关的症状，并提高了社会凝聚力。中介模型表明，干预对抑郁的影响部分由准备程度解释。干预对灾害准备的影响部分由社会凝聚力解释，干预对抑郁和创伤后应激障碍的影响也部分由社会凝聚力解释。焦点小组的数据阐明了参与者对与准备度、心理健康和社会凝聚力相关的干预措施的看法。
这种心理健康综合灾害准备干预措施在增强尼泊尔受地震影响社区的韧性方面是有效的。这种简短、具有成本效益的小组干预措施有可能扩大规模，用于易受地震和其他自然灾害影响的其他社区。
印度临床试验注册处，国家医学统计研究所。注册号：CTRI/2018/02/011688。http://ctri.nic.in/Clinicaltrials/login.php 于 2018 年 2 月 5 日进行了回顾性注册。2015 年 7 月首次纳入参与者。
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