H5N1

Post-traumatic stress disorder in patients after severe COVID-19 infection

Via JAMA Network, a February 18 report with alarming implications: Posttraumatic Stress Disorder in Patients After Severe COVID-19 Infection.

Posttraumatic stress disorder (PTSD) may occur in individuals who have experienced a traumatic event. Previous coronavirus epidemics were associated with PTSD diagnoses in postillness stages, with meta-analytic findings indicating a prevalence of 32.2% (95% CI, 23.7-42.0). However, information after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is piecemeal. 

We aimed at filling this gap by studying a group of patients with coronavirus disease 2019 (COVID-19) who sought treatment at the emergency department, most of whom required hospitalization, eventually recovered, and were subsequently referred to a postacute care service for multidisciplinary assessment. 

Methods A total of 381 consecutive patients who presented to the emergency department with SARS-CoV-2 and recovered from COVID-19 infection were referred for a postrecovery health check to a postacute care service established April 21, 2020, at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy. Patients were offered a comprehensive and interdisciplinary medical and psychiatric assessment, detailed elsewhere, which included data on demographic, clinical, psychopathological, and COVID-19 characteristics. 

Trained psychiatrists diagnosed PTSD using the criterion-standard Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), reaching a Cohen κ interrater reliability of 0.82. To meet PTSD criteria, in addition to traumatic event exposure (criterion A), patients must have had at least 1 DSM-5 criterion B and C symptom and at least 2 criterion D and E symptoms. Criteria F and G must have been met as well. Additional diagnoses were made through the Structured Clinical Interview for DSM-5. 

Participants provided written informed consent, and the study was approved by the Università Cattolica and Fondazione Policlinico Gemelli IRCCS Institutional Ethics Committee. 

Data for patients with and without PTSD were compared with the χ2 test for nominal variables and one-way analysis of variance for continuous variables. Factors significantly associated with PTSD were subjected to a binary logistic regression. P values were 2-tailed, and significance was set at a P value less than .05. Analyses were performed using R version 4 0.0 (The R Foundation). 

Results 

rom April 21 to October 15, 2020, the postacute care service assessed 381 White patients who had recovered from COVID-19 infection within 30 to 120 days, 166 (43.6%) of whom were women. The mean (SD; range) age was 55.26 (14.86; 18-89). During acute COVID-19 illness, most patients were hospitalized (309 of 381 [81.1%]), with a mean (SD) length of hospital stay of 18.41 (17.27) days. 

PTSD was found in 115 participants (30.2%). In the total sample, additional diagnoses were depressive episode (66 [17.3%]), hypomanic episode (3 [0.7%]), generalized anxiety disorder (27 [7.0%]), and psychotic disorders (1 [0.2%]). Patients with PTSD were more frequently women (64 [55.7%]), reported higher rates of history of psychiatric disorders (40 [34.8%]) and delirium or agitation during acute illness (19 [16.5%]), and presented with more persistent medical symptoms in the postillness stage (more than 3 symptoms, 72 [62.6%]). Logistic regression specifically identified sex (Wald1 = 4.79; P = .02), delirium or agitation (Wald1 = 5.14; P = .02), and persistent medical symptoms (Wald2 = 12.46; P = .002) as factors associated with PTSD.

Discussion

This cross-sectional study found a PTSD prevalence of 30.2% after acute COVID-19 infection, which is in line with findings in survivors of previous coronavirus illnesses1 compared with findings reported after other types of collective traumatic events (Figure).3-5 Associated characteristics were female sex, which has been extensively described as a risk factor for PTSD, history of psychiatric disorders, and delirium or agitation during acute illness. In the PTSD group, we also found more persistent medical symptoms, often reported by patients after recovery from severe COVID-19.

This study had limitations, including the relatively small sample size and cross-sectional design, as PTSD symptom rates may vary over time. Furthermore, this was a single-center study that lacked a control group of patients attending the emergency department for other reasons. Further longitudinal studies are needed to tailor therapeutic interventions and prevention strategies.

'Sheer fear': Mental health impacts of Covid-19 come to fore

Via The Guardian: 'Sheer fear': mental health impacts of Covid-19 come to fore. Excerpt:

Two months after falling ill with Covid-19, Julie had her first hallucination. “It started slowly. I was struggling to track the plot of a TV show, then I couldn’t read the words on my phone screen,” she said. 

Things deteriorated, with an overwhelming sense of her mind and body being consumed. “I know it sounds crazy, and I don’t know how to properly articulate it, but in the moment it really felt like something was taking over my brain and my body. 

“I was so convinced that was happening that I made my sister promise to remember a code word so she’d know if I was still in my body.”  

Amid these delusions, Julie, 36, from Minnesota, was eventually taken to hospital by her family. “My mom told the ER doctor that I was recovering from Covid and that they were concerned this was a strange side-effect. He agreed it was possible, but didn’t seem to have any treatment to suggest.” 

Julie is not alone. As the long and lingering effects of Covid on physical health are emerging, so too are its impacts on mental health.  

NHS England has announced that more staff are being trained to treat people with post-traumatic stress disorder (PTSD) in preparation for a potential increase in demand for mental health services as a result of the coronavirus crisis.  

Almost 3,000 trainees are expected to start courses in psychological therapies and former staff are being asked to consider returning to frontline roles in preparation for growing numbers of people suffering from anxiety, depression and related conditions. 

NHS England said it hoped to boost the number of advanced clinical practitioners, psychiatrists and mental health nurses over the next few months.  

Research from Italy found that more than half of those admitted to hospital with Covid-19 had a psychiatric disorder a month later, with 28% showing signs of post-traumatic stress disorder (PTSD), 31% depression and 42% anxiety. Insomnia and obsessive-compulsive symptoms were also common. 

A study by researchers at University College London (UCL) also flagged psychiatric and neurological problems following Covid infections. The husband of one woman discharged from hospital found her behaving oddly, taking her coat on and off repeatedly and saying she saw lions and monkeys in the house.  

It is not only those ill enough to be admitted to hospital who are affected, as members of a Covid-19 group on the social media platform Slack, who include Julie, attest. 

Before Covid struck, Dawn, 48, also a member of the Slack group, was an organ transplant coordinator in Philadelphia. Now she is unemployed, and on a recent visit to friends took half an hour to feel comfortable getting out of the car.  

After Dawn was diagnosed with Covid, her anxieties about the disease grew. She experienced chest pains and panic attacks. “I would walk around the house [at night] and make sure everyone was breathing,” she said. In June, as her younger daughter became increasingly concerned and physical causes were ruled out, Dawn sought mental health services. 

She has since been diagnosed with PTSD, generalised anxiety disorder and major depression, and is undergoing an intensive outpatient therapy programme. “I am two months into my therapy and … still having quite a difficult time getting out of my house,” she said.

COVID-19 is causing a historic rise in mental health problems, experts warn

Via The Washington Post: Coronavirus is causing a historic rise in mental health problems, experts warn. Both the problem, and the lack of response to it, are sadly predictable. Excerpt:

Three months into the coronavirus pandemic, America is on the verge of another health crisis, with daily doses of death, isolation and fear generating widespread psychological trauma.  

Federal agencies and experts warn that a historic wave of mental health problems is approaching: depression, substance abuse, post-traumatic stress disorder and suicide.

 Just as the initial coronavirus outbreak caught hospitals unprepared, the country’s mental health system — vastly underfunded, fragmented and difficult to access before the pandemic — is even less prepared to handle this coming surge.  

“That’s what is keeping me up at night,” said Susan Borja, who leads the traumatic stress research program at the National Institute of Mental Health. “I worry about the people the system just won’t absorb or won’t reach. I worry about the suffering that’s going to go untreated on such a large scale.”  

Data show depression and anxiety are already roiling the nation.  

Nearly half of Americans report the coronavirus crisis is harming their mental health, according to a Kaiser Family Foundation poll. A federal emergency hotline for people in emotional distress registered an 891 percent increase in March compared with the same time last year. Calls and messages to the Substance Abuse and Mental Health Services Administration’s hotline grew 338 percent in March from a month earlier, before state lockdowns began.  

Online therapy company Talkspace reported a 65 percent jump in clients since mid-February. Text messages and transcribed therapy sessions collected anonymously by the company show coronavirus-related anxiety dominating patients’ concerns. 

“People are really afraid,” Talkspace co-founder and CEO Oren Frank said. The increasing demand for services, he said, follows almost exactly the geographic march of the virus across the United States. “What’s shocking to me is how little leaders are talking about this. There are no White House briefings about it. There is no plan.”  

The suicides of two New York health-care workers highlight the risks, especially to those combating the pandemic. Lorna Breen, a top New York emergency room doctor, had spent weeks contending with coronavirus patients flooding her hospital and sometimes dying before they could be removed from ambulances. She had no history of mental illness, her relatives have said in interviews, but struggled increasingly with the emotional weight of the outbreak before she died. Days later, reports emerged that a Bronx EMT also killed himself. 

Researchers have created models — based on data collected after natural disasters, terrorist attacks and economic downturns — that show a likely increase in suicides, overdose deaths and substance use disorders. 

And yet, out of the trillions of dollars Congress passed in emergency coronavirus funding, only a tiny portion is allocated for mental health. At the same time, therapists have struggled to bring their practices online and to reach vulnerable groups because of restrictions on licensing and reimbursement. Community behavioral health centers — which treat populations most at risk — are struggling to stay financially solvent and have begun closing programs.

Wuhan’s Covid-19 crisis is easing. Its mental health disaster is just beginning

Via Caixin Global: Wuhan’s Covid-19 Crisis Is Easing. Its Mental Health Disaster Is Just Beginning. Excerpt:

After Covid-19 ripped through Wuhan, killing thousands and sparking an unprecedented months-long lockdown, the central Chinese city is now cautiously navigating a path back toward normality. But although the risk of catching the pneumonia-causing virus seems to be receding, the epidemic’s mental health impacts will likely linger for a long time to come.  

As officials gradually dismantle a strict citywide quarantine ahead of a planned reduction of interprovincial transport restrictions on April 8, many Wuhan residents, as well as the city’s former Covid-19 patients and medical workers, are reeling from psychological wounds inflicted by the virus, which had infected more than 50,000 people in the city and killed at least 2,553 as of Tuesday, according to the Wuhan Municipal Health Commission. 

The experiences of people in the city that recorded the world’s first Covid-19 cases late last year carry lessons for the more than 170 other countries and regions afflicted by what has become a global pandemic. They also raise questions about the capacity of China’s nascent mental health sector, which has long been blighted by a lack of qualified personnel, restrictive laws and a cultural tendency to ignore or minimize psychological distress. 

Disasters like life-threatening epidemics, which can overwhelm the capacity of communities to respond, are frequently associated with lasting mental health issues. Research conducted after an outbreak of SARS (severe acute respiratory syndrome) sickened thousands and killed 774 people worldwide almost 20 years ago indicates that the disease caused enduring post-traumatic stress, anxiety, and depression among frontline medical workers and recovered patients. 

Those two groups are now similarly vulnerable as the threat of Covid-19 abates. As the disease rapidly accelerated in January and February, Wuhan’s overwhelmed hospitals were forced to ration beds, tests and medical supplies. Overstretched doctors described wards crammed with sick patients, exhausted colleagues helpless to save the dying, and bodies lying around for hours before undertakers could remove them.  

Early research suggests those experiences have impacted medical workers’ mental wellbeing. In an unpublished online survey conducted by Peking University medical psychology professor Guan Ruiyuan, around one-third of 311 respondents who served as frontline medical workers in Wuhan’s Covid-19 epidemic — a group of mostly female doctors, nurses and support staff — said they had experienced some kind of psychological issue. Another third said they thought they would benefit from some kind of online or telephone-based mental health counseling.  

Using World Health Organization evaluation criteria, Guan estimated that between 33% and 39% of respondents were experiencing anxiety, depression, and/or somatic symptom disorder, which is when psychological distress manifests as physical symptoms such as pain. The most common complaints included exhaustion, sleeping poorly, and feelings of tension or unease.  

Research into the psychological impacts of Covid-19 remains at an early stage, complicating efforts to draw clear conclusions. But some initial signs suggest that large numbers of Chinese medical personnel may be dealing with epidemic-related mental health issues. Last month, a preprint paper co-written by Liu Zhaorui of Peking University’s NHC Key Laboratory of Mental Health and posted for review on the website of medical journal The Lancet said that one-sixth of medical workers in China may have experienced some kind of psychological distress during the country’s Covid-19 epidemic.

Mitigate the effects of home confinement on children during the COVID-19 outbreak

Via The Lancet: Mitigate the effects of home confinement on children during the COVID-19 outbreak. Excerpt:

In response to the coronavirus disease 2019 (COVID-19) outbreak, the Chinese Government has ordered a nationwide school closure as an emergency measure to prevent spreading of the infection. Public activities are discouraged. The Ministry of Education estimates that more than 220 million children and adolescents are confined to their homes; this includes 180 million primary and secondary students and 47 million preschool children). 

Thanks to the strong administrative system in China, the emergency home schooling plan has been rigorously implemented. Massive efforts are being made by schools and teachers at all levels to create online courses and deliver them through TV broadcasts and the internet in record time. The new virtual semester has just started in many parts of the country, and various courses are offered online in a well organised manner. These actions are helping to alleviate many parents' concerns about their children's educational attainment by ensuring that school learning is largely undisrupted. 

Although these measures and efforts are highly commendable and necessary, there are reasons to be concerned because prolonged school closure and home confinement during a disease outbreak might have negative effects on children's physical and mental health. Evidence suggests that when children are out of school (eg, weekends and summer holidays), they are physically less active, have much longer screen time, irregular sleep patterns, and less favourable diets, resulting in weight gain and a loss of cardiorespiratory fitness. Such negative effects on health are likely to be much worse when children are confined to their homes without outdoor activities and interaction with same aged friends during the outbreak. 

Perhaps a more important but easily neglected issue is the psychological impact on children and adolescents. Stressors such as prolonged duration, fears of infection, frustration and boredom, inadequate information, lack of in-person contact with classmates, friends, and teachers, lack of personal space at home, and family financial loss can have even more problematic and enduring effects on children and adolescents. 

For example, Sprang and Silman showed that the mean posttraumatic stress scores were four times higher in children who had been quarantined than in those who were not quarantined. Furthermore, the interaction between lifestyle changes and psychosocial stress caused by home confinement could further aggravate the detrimental effects on child physical and mental health, which could cause a vicious circle. 

To mitigate the consequences of home confinement, the government, non-governmental organisations (NGOs), the community, school, and parents need to be aware of the downside of the situation and do more to effectively address these issues immediately. Experiences learned from previous outbreaks can be valuable for designing a new programme to tackle these issues in China. 

The Chinese Government needs to raise the awareness of potential physical and mental health impacts of home confinement during this unusual period. The government should also provide guidelines and principles in effective online learning and ensure that the contents of the courses meet the educational requirements. 

Yet it is also important not to overburden the students. The government might mobilise existing resources, perhaps involving NGOs, and create a platform for gathering the best online education courses about healthy lifestyle and psychosocial support programmes available for schools to choose from. For example, in addition to innovative courses for a better learning experience, promotional videos can be useful to motivate children to have a healthy lifestyle at home by increasing physical activities, having a balanced diet, regular sleep pattern, and good personal hygiene. 

To make these educational materials truly effective, they must be age-appropriate and attractive. They require professional expertise and real resources to create.

Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study

Via The Lancet: Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study. The summary:

Background 

Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs. 

Methods 

In a population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist—Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required. 

Findings 

After the two baseline surveys, we followed up random subsets of 1213–1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8–12·7) of participants in 2019, compared with 1·9% (1·6–2·1) during 2009–14 and 6·5% (5·3–7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2–14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent. 

Interpretation 

We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally.

See also this comment in The Lancet on the Hong Kong study.

An Ebola patient treated in the U.S. chose to remain anonymous. Now he’s telling his story.

Via The Washington Post: An Ebola patient treated in the U.S. chose to remain anonymous. Now he’s telling his story. What happened to this American presumably happens also to African Ebola survivors, but their experience somehow doesn't deserve mention. Excerpt:

When they wheeled Preston Gorman into a light spring breeze outside the National Institutes of Health nearly five years ago, he was, medically speaking, among the most fortunate people on the planet.  

Gorman’s doctors had just defeated advanced Ebola virus disease, one of the most fearsome infections known to medicine. There were smiles and hugs and handshakes in the NIH Clinical Center in Bethesda, Md., where Gorman had spent the previous month in isolation, attended every moment by a medical SWAT team in moon suits.  

Doctors, nurses and other caregivers gathered for a short prayer with Gorman and his family before sending him home to Texas in the same private jet that had raced him to NIH from Sierra Leone. At his parents’ home outside Dallas, siblings, aunts and cousins turned out to celebrate the emaciated young man who had returned from the dead. 

 And then Gorman’s life fell apart.  

At a time when another Ebola outbreak is spreading, Gorman is a reminder of how easily trauma can be overlooked after severe illness. Gorman’s family and friends, and the medical system that so skillfully battled his disease, all missed the gravity of his condition. 

“No one said, ‘You’ve just been selected for a really hard journey, and by the way none of your family is gonna understand, none of your friends are going to understand and you’re not going to understand,’ ” Gorman recalled. “They’re thinking it’s all over, and I walk into this group of people, and I don’t even know what’s happening.” 

A prolonged battle with severe post-traumatic stress disorder cost Gorman his family, the woman he intended to marry, his friends and his job. One of the luckiest men alive, he considered suicide.  

Gorman, 38, who chose to remain anonymous until now, was one of 11 people treated for Ebola infections in the United States during the West Africa outbreak of 2014-2016. The others have been previously identified. 

Today Gorman is climbing back. He has a job, roommates and new friends in Austin. He maintains his faith, though his views on religion have changed. He still struggles at times, but he also feels joy again. And hope.  

“It forced me to dig deep, find out who I really was, and rely on God’s direction in the healing process that is still ongoing to this day,” Gorman said in one of many emails and conversations over the past few months. “There were many mistakes and dark moments. But a journey that, I hope, in the end will be worth it.” 

Research has revealed extensive post-traumatic stress disorder among Ebola survivors, their caregivers and witnesses to the widespread death in West Africa. During his brief stay in Sierra Leone, Gorman was all three.  

“He wasn’t just there to witness it, but rather became a victim himself,” said Lorenzo Paladino of SUNY Downstate Health Sciences University, who has studied post-traumatic stress. Fear, survivor’s guilt, deferred grieving and helplessness, as well as Gorman’s history of depression, all can play a role in post-traumatic stress.  

Medical experts are also learning that surviving a life-threatening illness that requires intensive care can leave cognitive and emotional scars, a condition called post-intensive care syndrome. 

“We’re not very good, even in this country, at figuring that all out and giving people that support,” said Natasha Tobias-White, an intensive care nurse who worked with Gorman in Sierra Leone.

MSF: Remain in Mexico policy leaves more than 1,500 asylum seekers stranded in border camp

Via Doctors Without Borders USA: Remain in Mexico policy leaves more than 1,500 asylum seekers stranded in border camp.

The Remain in Mexico policy, officially known as the US Migrant Protection Protocols (MPP), has left more than 1,500 vulnerable asylum seekers waiting in an informal camp at the international bridge between the violent border city of Matamoros, in Mexico’s Tamaulipas state, and Brownsville, Texas. 

Though latrines and showers have been installed in the camp, Doctors Without Borders/Médecins Sans Frontières (MSF) teams have witnessed the unsanitary conditions in which people are being held and are increasing medical humanitarian activities accordingly. The MPP, initially implemented in January 2019, requires people applying for asylum in the US to wait out their legal proceedings in Mexico. 

“We have a team with a doctor, psychologists and social workers who treat issues such as anxiety and post-traumatic stress disorder—consequences of the hopelessness produced by the uncertainty of not knowing what is going to happen with their future or their family,” said Anneli Droste, project coordinator for MSF Mexico's northern border project. 

In the last three weeks, MSF has also conducted 178 medical consultations for ailments including diarrhea, hypertension, diabetes, psychiatric conditions, and asthma. Most of the patients exhibited respiratory and skin and soft tissue conditions related to the overcrowded and unsanitary living conditions in the camp. Of these consultations, 48 percent were for women and 52 percent were for men. More than half were under 15 years old (58 percent).  

Droste said that she recently spoke with a 15-year-old boy living in the camp with his family while waiting for a decision on their asylum claim. “He told me that they don’t want to be separated from the asylum seekers’ group, because they fear assault or kidnapping,” Droste said. “Staying together is one of the measures they have taken to feel, in some way, protected.” 

MSF remains gravely concerned about the humanitarian needs of asylum seekers along Mexico’s northern border and demands, once again, that the Mexican and US governments protect their lives and well-being.

PAHO: Bahamas health officials respond to Hurricane Dorian

PAHO has published Bahamas Health Officials Respond to Hurricane Dorian with PAHO’s support. Excerpt:

Nassau, Bahamas, Sept. 3, 2019— A Pan American Health Organization (PAHO) team is working closely with health authorities in the Bahamas to support their response to Hurricane Dorian, which has damaged health facilities and flooded hospitals on Abaco islands and Grand Bahama island. 

 Prior to the hurricane, the PAHO/WHO country office contributed to the Ministry of Health’s preparedness and response planning. PAHO also pre-positioned experts from its sub-regional office in Barbados to assist the country in on-site assessments of Water Sanitation and Hygiene (WASH) and health infrastructure and facilities needs. 

Additional support on logistics, civil and military coordination, information management, surveillance, and coordination are expected to arrive in the next 24 hours to work with counterparts in the country.  

A Rapid Assessment is crucial to assist the health ministry in the implementation of urgent life-saving interventions, said Dr. Ciro Ugarte, director of PAHO’s Health Emergencies Department. 

Hurricane Dorian struck the Abaco islands most severely, and significant damage to health infrastructure is likely, although communications are currently cut, and the island cannot be reached. 

Some 400 persons sought shelter at the clinic in Marsh Harbour on Abaco, and initial reports of deaths and injuries have not yet been confirmed. In Grand Bahama, Dorian stalled over the island with intense rainfall, 165 mph winds and 15-20 feet of storm surges. Reports indicate people are stranded in flooded buildings. 

The Ministry of Health (MoH) informed that at least 20 critical patients were evacuated from Abaco to the Princess Margaret Hospital by the Royal Bahamas Defense Forces. 

Health personnel from New Providence and other unaffected Family Islands are on stand-by to be deployed to Abaco and Grand Bahamas to replace exhausted health care professionals. The MoH is determining what additional medical teams need to be deployed to the affected islands and will decide on deployments according to the needs on the affected islands. 

On Grand Bahama Island, Rand Memorial Hospital has 70 nurses, 3 emergency physicians and senior health officers on standby for medical needs on other islands, and the Ministry of Health is setting up a rotating system for physicians and nurses to provide support to Marsh Harbour Clinic, once Abaco is deemed safe.   

Extensive flooding in both affected islands, damage to the Rand Memorial Hospital in Freeport, Grand Bahama, displacement of persons as a result of property damage or loss and psychological trauma of the population could bring additional public health challenges.

Significant PTSD and other mental health effects 18 months after the Fort McMurray wildfire

Via Frontiers in Psychiatry: Significant PTSD and Other Mental Health Effects Present 18 Months After the Fort Mcmurray Wildfire: Findings From 3,070 Grades 7–12 Students. This study has implications for a whole range of climate disasters, including Hurricane Dorian, and not just for students. Governments and educators are going to have to deal with repercussions for a long time. The abstract:

Background: The May 2016 wildfire in Fort McMurray, Alberta, Canada forced evacuation of the population of 88,000 individuals and destroyed 10% of the homes. Youth are particularly impacted by disaster. 

Methods: Eighteen months after the wildfire, Fort McMurray Public and Catholic Schools surveyed 3,252 of the 4,407 students in Grades 7–12 to determine possible long-term psychological impacts. The survey included validated measurement scales for post-traumatic stress disorder (PTSD), depression, anxiety, use of drugs, alcohol, and tobacco, quality of life, self-esteem, and resilience. Data analysis was possible for only 3,070 students, i.e., 70% of the total student population. Anonymized data were analyzed to compare students who directly experienced lesser or greater impact from the wildfire, with greater impact defined as personally seeing the fire or having one’s home destroyed. Also, students with greater or lesser scores on the Child and Youth Resilience Measure (CYRM-12) were compared. 

Results: Of the 3,070 students, 37% met criteria for probable PTSD; 31% met criteria for probable depression, and 17% for probable depression of at least moderate severity; 27% of students met criteria for probable anxiety, and 15% for probable alcohol or substance use disorder; 46% of all students met criteria for one or more probable diagnosis of PTSD, depression, anxiety, or alcohol/substance abuse, and this included students who were both present and not present in Fort McMurray at the time of the wildfire. Students with greater impact from the wildfire exhibited significantly higher scores on measures of PTSD, depression, anxiety, and alcohol/substance use. They also had lower self-esteem and quality of life scores. Students with lower resilience scores exhibited a similar pattern. 

Conclusions: These findings highlight first the negative impact of disasters on youth mental health, particularly for those who directly experience wildfire, and second the role of resilience on youth mental health, with lower resilience associated with substantially lower mental health outcomes. These results emphasize the need for long-term mental health supports for youth post-disaster, with specific focus on increasing youth resilience, which may serve as a protective factor against effects of disaster on mental health.