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Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
The aim of this chapter is to provide a conceptual overview for emergency planners and responders of the different patterns of emergencies, incidents, disasters, and disease outbreaks (EIDD) and the challenges that they pose for mounting a mental health response. Issues covered include anticipating who is affected, where they are located, and how they can be identified and contacted, as well as other implications for public health and clinical services.
The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in this context is not well documented.
Aims
To evaluate a stepped-care psychological support pathway for HSCWs from Homerton Healthcare Foundation Trust in London, which offered psychological first aid, evidence-based psychological therapies and group-based well-being workshops.
Method
The service evaluation used a pre–post approach to assess depression, anxiety, functional impairment and post-traumatic stress disorder symptom change for those who attended sessions of psychological first aid, low- or high-intensity cognitive–behavioural therapy or a combination of these. In addition, the acceptability of the psychological first aid sessions and well-being workshops was explored via feedback data.
Results
Across all interventions, statistically significant reductions of depression (d = 1.33), anxiety (d = 1.37) and functional impairment (d = 0.93) were observed, and these reductions were equivalent between the interventions, as well as the demographic and occupational differences between the HSCWs (ethnicity, staff group and redeployment status). HSCWs were highly satisfied with the psychological first aid and well-being workshops.
Conclusions
The evaluation supports the utility of evidence-based interventions delivered as part of a stepped-care pathway for HSCWs with common mental health problems in the context of the COVID-19 pandemic. Given the novel integration of psychological first aid within the stepped-care model as a step one intervention, replication and further testing in larger-scale studies is warranted.
The coronavirus disease 2019 (COVID-19) pandemic is having a well-documented impact on the mental health of front-line health and social care workers (HSCWs). However, little attention has been paid to the experiences of, and impact on, the mental health professionals who were rapidly tasked with supporting them.
Aims
We set out to redress this gap by qualitatively exploring UK mental health professionals’ experiences, views and needs while working to support the well-being of front-line HSCWs during the COVID-19 pandemic.
Method
Mental health professionals working in roles supporting front-line HSCWs were recruited purposively and interviewed remotely. Transcripts of the interviews were analysed by the research team following the principles of reflexive thematic analysis.
Results
We completed interviews with 28 mental health professionals from varied professional backgrounds, career stages and settings across the UK. Mental health professionals were motivated and driven to develop new clinical pathways to support HSCWs they perceived as colleagues and many experienced professional growth. However, this also came at some costs, as they took on additional responsibilities and increased workloads, were anxious and uncertain about how best to support this workforce and tended to neglect their own health and well-being. Many were professionally isolated and were affected vicariously by the traumas and moral injuries that healthcare workers talked about in sessions.
Conclusions
This research highlights the urgent need to consider the mental well-being, training and support of mental health professionals who are supporting front-line workers.
Social media provides an opportunity to engage in social contact and to give and receive help by means of online social networks. Social support following trauma exposure, even in a virtual community, may reduce feelings of helplessness and isolation, and, therefore, reduce posttraumatic stress symptoms (PTS), and increase posttraumatic growth (PTG). The current study aimed to assess whether giving and/or receiving offers of help by means of social media following large community fires predicted PTS and/or PTG.
Methods:
A convenience sample of 212 adults living in communities that were affected by large-scale community fires in Israel (November 2016) completed questionnaires on giving and receiving offers of help by means of social media within 1 mo of the fire (W1), and the PTSD checklist for DSM-5 (PCL-5) and PTG questionnaire (PTGI-SF), 4 mo after the fire (W2).
Results:
Regression analyses showed that, after controlling for age, gender, and distance from fire, offering help by means of social media predicted higher PTG (β = 0.22; t = 3.18; P < 0.01), as did receiving offers of help by means of social media (β = 0.18; t = 2.64; P < 0.01). There were no significant associations between giving and/or receiving offers of help and PTS.
Conclusions:
Connecting people to social media networks may help in promoting posttraumatic growth, although might not impact on posttraumatic symptoms. This is one of the first studies to highlight empirically the advantages of social media in the aftermath of trauma exposure.
Conceptualizing posttraumatic stress disorder (PTSD) symptoms as a dynamic system of causal elements could provide valuable insights into the way that PTSD develops and is maintained in traumatized individuals. We present the first study to apply a multilevel network model to produce an exploratory empirical conceptualization of dynamic networks of PTSD symptoms, using data collected during a period of conflict.
Methods
Intensive longitudinal assessment data were collected during the Israel–Gaza War in July–August 2014. The final sample (n = 96) comprised a general population sample of Israeli adult civilians exposed to rocket fire. Participants completed twice-daily reports of PTSD symptoms via smartphone for 30 days. We used a multilevel vector auto-regression model to produce contemporaneous and temporal networks, and a partial correlation network model to obtain a between-subjects network.
Results
Multilevel network analysis found strong positive contemporaneous associations between hypervigilance and startle response, avoidance of thoughts and avoidance of reminders, and between flashbacks and emotional reactivity. The temporal network indicated the central role of startle response as a predictor of future PTSD symptomatology, together with restricted affect, blame, negative emotions, and avoidance of thoughts. There were some notable differences between the temporal and contemporaneous networks, including the presence of a number of negative associations, particularly from blame. The between-person network indicated flashbacks and emotional reactivity to be the most central symptoms.
Conclusions
This study suggests various symptoms that could potentially be driving the development of PTSD. We discuss clinical implications such as identifying particular symptoms as targets for interventions.
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