Skip to main content Accessibility help

Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti

  • Leah Emily James (a1), Courtney Welton-Mitchell (a2), John Roger Noel (a3) and Alexander Scott James (a4)



Given the frequency of natural hazards in Haiti, disaster risk reduction is crucial. However, evidence suggests that many people exposed to prior disasters do not engage in disaster preparedness, even when they receive training and have adequate resources. This may be partially explained by a link between mental health symptoms and preparedness; however, these components are typically not integrated in intervention.


The current study assesses effectiveness of an integrated mental health and disaster preparedness intervention. This group-based model was tested in three earthquake-exposed and flood-prone communities (N = 480), across three time points, using a randomized controlled trial design. The 3-day community-based intervention was culturally-adapted, facilitated by trained Haitian lay mental health workers, and focused on enhancing disaster preparedness, reducing mental health symptoms, and fostering community cohesion.


Consistent with hypotheses, the intervention increased disaster preparedness, reduced symptoms associated with depression, post-traumatic stress disorder, anxiety, and functional impairment, and increased peer-based help-giving and help-seeking. Mediation models indicated support for the underlying theoretical model, such that the effect of the intervention on preparedness was mediated by mental health, and that effects on mental health were likewise mediated by preparedness.


The community-based mental health-integrated disaster preparedness intervention is effective in improving mental health and preparedness among community members in Haiti vulnerable to natural hazards. This brief intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes, seasonal flooding, and other natural hazards.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Leah Emily James, E-mail:


Hide All
Acharya, L, Upadhya, KD and Kortmann, F (2006) Mental health and psychosocial support aspects in disaster preparedness: Nepal. International Review of Psychiatry 18, 587592.
Adeola, FO and Picou, JS (2014) Social capital and the mental health impacts of Hurricane Katrina: assessing long-term patterns of psychosocial distress. International Journal of Mass Emergencies and Disasters 32, 121156.
Afifi, WA, Felix, ED and Afifi, TD (2012) The impact of uncertainty and communal coping on mental health following natural disasters. Anxiety, Stress & Coping 25, 329347.
Albrecht, F (2018) Natural hazard events and social capital: the social impact of natural disasters. Disasters 42, 336360.
Blanchet, K, Roberts, B, Sistenich, V, Ramesh, A, Frison, A, Warren, E, Hossain, M, Knight, A, Lewis, C and Smith, J (2013) An evidence review of research on health interventions in humanitarian crises. Final Report. Technical Report. London School of Hygiene and Tropical Medicine, London, UK.
Bodas, M, Siman-Tov, M, Kreitler, S and Peleg, K (2017) Psychological correlates of civilian preparedness for conflicts. Disaster Medicine and Public Health Preparedness 11, 451459.
Bubeck, P, Botzen, WJ and Aerts, JC (2012) A review of risk perceptions and other factors that influence flood mitigation behavior. Risk Analysis 32, 14811495.
Cerdá, M, Paczkowski, M, Galea, S, Nemethy, K, Péan, C and Desvarieux, M (2013) Psychopathology in the aftermath of the Haiti earthquake: a population-based study of posttraumatic stress disorder and major depression. Depression and Anxiety 30, 413424.
Donahue, AK, Eckel, CC and Wilson, RK (2014) Ready or not? How citizens and public officials perceive risk and preparedness. The American Review of Public Administration 44, 89S111S.
Eisenman, DP, Zhou, Q, Ong, M, Asch, S, Glik, D and Long, A (2009) Variations in disaster preparedness by mental health, perceived general health, and disability status. Disaster Medicine and Public Health Preparedness 3, 3341.
Ejeta, LT, Ardalan, A and Paton, D (2015) Application of behavioral theories to disaster and emergency health preparedness: a systematic review. PLoS Currents 7, 126.
Falsetti, SA, Resnick, HS, Resick, PA and Kilpatrick, DG (1993) The modified PTSD symptom scale: a brief self-report measure of posttraumatic stress disorder. The Behavior Therapist 16, 161162.
Ferrer-Wreder, L, Sundell, K and Mansoory, S (2012) Tinkering with perfection: theory development in the intervention cultural adaptation field. Child & Youth Care Forum 41, 149171.
Foa, E, Stein, D and McFarlane, A (2006) Symptomatology and psychopathology of mental health symptoms after disaster. Journal of Clinical Psychiatry 67, 1525.
Galappatti, A and Richardson, SM (2016) Linking mental health and psychosocial support and disaster risk reduction: applying a wellbeing lens to disaster risk reduction. Intervention 14, 223231.
Goldmann, E and Galea, S (2014) Mental health consequences of disasters. Annual Review of Public Health 35, 169183.
Gray, MJ, Litz, BT, Hsu, JL and Lombardo, TW (2004) Psychometric properties of the life events checklist. Assessment 11, 330341.
Guerda, N, Kahaema, B and Ho, K (2015) Implementing culturally sensitive and sustainable mental health training programs internationally: lessons from Haiti. International Journal of Culture and Mental Health 8, 446457.
Gupta, SK (2011) Intention-to-treat concept: a review. Perspectives in Clinical Research 2, 109112.
Hikichi, H, Aida, J, Tsuboya, T, Kondo, K and Kawachi, I (2016) Can community social cohesion prevent posttraumatic stress disorder in the aftermath of a disaster? A natural experiment from the 2011 Tohoku earthquake and tsunami. American Journal of Epidemiology 183, 902910.
Hogan, BE, Linden, W and Najarian, B (2002) Social support interventions: do they work? Clinical Psychology Review 22, 381440.
International Organization for Migration (2017, January) Humanitarian aid: 7 years after the 2010 earthquake, who remains displaced? Available at (Accessed January 2018).
James, LE (2013) A Pilot Assessment of Psychological Factors Associated with Hurricane Sandy Preparedness in Post-earthquake Haiti. Quick Response Grant Report series, Natural Hazards Center, Institute of Behavioral Sciences, University of Colorado, Boulder 246, 115.
James, LE, Noel, JR, Favorite, TK and Jean, JS (2012) Challenges of post-disaster intervention in cultural context: the implementation of a lay mental health worker project in post-earthquake Haiti. International Perspectives in Psychology: Research, Practice, Consultation 1, 110126.
James, LE, Welton-Mitchell, C and Soulaje Lespri, Moun (2016) Community-based disaster mental health intervention (CBDMI): Curriculum manual for use with communities affected by natural disasters in Haiti. Available at
James, LE, Welton-Mitchell, C and Khanal, SN (2018) Mental health integrated disaster preparedness (MHIDP) in Nepal and Haiti. Mental Health Innovation Network. Available at
Jones, S (2016) World heading for catastrophe over natural disasters, world experts warn. The Guardian. Available at (Accessed January 2018).
Kaiser, B, Kohrt, BA, Keys, H, Khoury, NM and Brewster, A (2013) Strategies for assessing mental health in Haiti: local instrument development and transcultural translation. Transcultural Psychiatry 50, 532558.
Khoury, NM, Kaiser, BM, Keys, HM, Brewster, AR and Kohrt, B (2012) Explanatory models and mental health treatment: is vodou an obstacle to psychiatric treatment in rural Haiti? Culture, Medicine, and Psychiatry 36, 514534.
Kohn, S, Eaton, J, Feroz, S, Bainbridge, A, Hoolachan, J and Barnett, D (2012) Personal disaster preparedness: an integrative review of the literature. Disaster Medicine and Public Health Preparedness 6, 217231.
Kolbe, AR, Hutson, RA, Shannon, H, Trzcinski, E, Miles, B, Levitz, N, Puccio, M, James, L, Noel, JR and Muggah, R (2010) Mortality, crime and access to basic needs before and after the Haiti earthquake: a random survey of Port-au-Prince households. Medicine, Conflict and Survival 26, 281297.
Layne, CM, Pynoos, RS, Saltzman, WR, Arslanagić, B, Black, M, Savjak, N, Popović, T, Duraković, E, Mušić, M, Ćampara, N and Djapo, N (2001) Trauma/grief-focused group psychotherapy: school-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice 5, 277.
Lin, S, Shaw, D and Ho, M (2008) Why are flood and landslide victims less willing to take mitigation measures than the public? Natural Hazards 44, 305314.
McFarlane, AC, Van Hooff, M and Goodhew, F (2009) Anxiety disorders and PTSD. In Neria, Y, Galea, S and Norris, FH (ed.) Mental Health and Disasters. New York: Cambridge University, pp. 4766.
Miller, C (2012) Most Americans Unprepared for Disasters According to February Persuadable Research Survey. PRWEB. Available at (Accessed January 2018).
Mishra, S and Suar, D (2012) Effects of anxiety, disaster education, and resources on disaster preparedness behavior. Journal of Applied Social Psychology 42, 10691087.
Morrissey, S and Reser, J (2003) Evaluating the effectiveness of psychological preparedness advice in community cyclone preparedness materials. Australian Journal of Emergency Management 18, 4661.
Nakagawa, Y and Shaw, R (2004) Social capital: a missing link to disaster recovery. International Journal of Mass Emergencies and Disasters 22, 534.
Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E and Kaniasty, K (2002) 60000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry: Interpersonal and Biological Processes 65, 207239.
Oyama, M, Nakamura, K, Suda, Y and Someya, T (2012) Social network disruption as a major factor associated with psychological distress 3 years after the 2004 Niigata–Chuetsu earthquake in Japan. Environmental Health and Preventive Medicine 17, 118.
Paton, D, Houghton, BF, Gregg, CE, McIvor, D, Johnston, DM, Bürgelt, P, Larin, P, Gill, DA, Ritchie, LA, Meinhold, S and Horan, J (2009) Managing tsunami risk: social context influences on preparedness. Journal of Pacific Rim Psychology 3, 2737.
Petkova, E, Schlegelmilch, J, Sury, J, Chandler, T, Herrera, C, Bhaskar, S, Sehnert, E, Martinez, S, Marx, S and Redlener, I (2016) The American preparedness project: Where the US public stands in 2015. National Center for Disaster Preparedness at Columbia University's Earth Institute, Research Brief 2.
Rasmussen, A, Eustache, E, Raviola, G, Kaiser, B, Grelotti, DJ and Belkin, GS (2015) Development and validation of a Haitian creole screening instrument for depression. Transcultural Psychiatry 52, 3357.
Rodriguez, H, Trainor, J and Quarantelli, EL (2006) Rising to the challenges of a catastrophe: the emergent and prosocial behavior following hurricane Katrina. The Annals of the American Academy of Political and Social Science 604, 82101.
Sampson, RJ, Raudenbush, SW and Earls, F (1997) Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 277, 918924.
Shukla, J (2013) Extreme weather events and mental health: tackling the psychosocial challenge. International Scholarly Research Notices: Public Health 2013, 17.
Siedlecki, K, Salthouse, T, Oishi, S and Jeswani, S (2014) The relationship between social support and subjective well-being across age. Social Indicators Research 117, 561576.
Solberg, C, Rossetto, T and Joffe, H (2010) The social psychology of seismic hazard adjustment: re-evaluating the international literature. Natural Hazards and Earth System Sciences 10, 16631677.
Takahashi, K and Kitamura, Y (2016) Disaster anxiety and self-assistance behaviours among persons with cervical cord injury in Japan: a qualitative study. BMJ Open 6, 4.
Tang, B, Liu, X, Liu, Y, Xue, C and Zhang, L (2014) A meta-analysis of risk factors for depression in adults and children after natural disasters. BMC Public Health 14, 623.
Toya, H and Skidmore, M (2014) Do natural disasters enhance societal trust? Kyklos 67, 255279.
Transparency International (2017) Corruptions Perception Index 2017. Available at (Accessed April 2018).
United States Agency for International Development (USAID) (2013) Haiti – Hurricane Sandy. Fact Sheet #1 Fiscal Year 2013, February 15, 2013. Available at (Accessed January 2018).
Welton-Mitchell, C and James, L (2018) Evidence-based mental health integrated disaster preparedness in Nepal and Haiti. Special Edition of the Humanitarian Exchange on Mental Health and Psychosocial Support in Humanitarian Response. Guest editors: Wendy Fenton and Anne Harmer.
Welton-Mitchell, C, James, L and Awale, R (2016) Nepal 2015 earthquake: a rapid assessment of cultural, psychological and social factors with implications for recovery and disaster preparedness. International Journal of Mass Emergencies and Disasters 34, 5574.
Welton-Mitchell, C, James, L, Khanal, SN and James, A (2018) An integrated approach to mental health and disaster preparedness: a cluster comparison with earthquake affected communities in Nepal. BMC Psychiatry 18, 296. Available at
Wirtz, PW, Rohrbeck, CA and Burns, KM (2017) Anxiety effects on disaster precautionary behaviors: a multi-path cognitive model. Journal of Health Psychology 1, 111.
World Bank (2017) Rapidly assessing the impact of Hurricane Matthew in Haiti. Result Briefs. Available at (Accessed January 2018).
World Health Organization (WHO), King's College (2011) The Humanitarian Emergency Settings Perceived Needs Scale (HESPER): Manual with Scale. Geneva: World Health Organization.
World Health Organization (WHO), Pan American Health Organization (PAHO) (2010) Culture and Mental Health in Haiti: A Literature Review. Geneva: World Health Organization.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

James et al. supplementary material
Online Appendices

 Word (34 KB)
34 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed