Climate Change and Health Seminar: “Mental Health after Weather-Related Disasters: State of the Research and Future Directions”

March 12, 2021

Information

Dr. Sarah Lowe; Assistant Professor of Public Health (Social and Behavioral Sciences), Yale School of Public Health joined the Yale Center on Climate Change and Health's seminar series to discuss mental health issues after weather-related disasters.

February 8, 2021

ID6280

To CiteDCA Citation Guide

00:00- Hi all and welcome to the
00:03Yale Center on Climate Change and Health seminar series.
00:07So today is our first spring seminar series
00:11and we are very fortunate to have
00:14Dr. Sarah Lowe joining us today.
00:17So Dr. Sarah Lowe is assistant professor
00:20at the Yale School of Public Health
00:22the Department of Social and Behavioral Sciences.
00:26So her talk today will be mental health
00:28after natural disasters,
00:30state of the research and a future directions.
00:33So I was told that this seminar
00:36was one of the most popular seminar series we had.
00:41There were more than 80 participants registered
00:44and we have another roughly 10 students.
00:47So hopefully we can have a large audience today.
00:52And before handing over to Sarah,
00:56I want to mention that we will have our Q&A section
01:01at the end of this seminar.
01:04So if you have any questions please type
01:07in the chat box and I will raise the questions in the end.
01:12So without further ado, Sarah the stages is yours.
01:17- All right, thank you very much for that Kai
01:20for that nice introduction.
01:21I'm going to share my screen and get to it.
01:26Okay, so you can see my slides, yes?
01:29- [Kai] Yes, yes.
01:30- Okay, awesome.
01:32So as Kai said, I'm going to be talking about
01:35the research on mental health
01:36after weather related disasters,
01:39the state of the research and future directions.
01:41And you'll know what that I actually changed the name
01:43of my talk because the field is really moving away
01:46from referring to weather related
01:50or climate related disasters as natural disasters
01:53and acknowledgement of increasing findings showing that
01:59human beings are contributing to climate change
02:01and in turn increasing the frequency
02:03and severity of these types of events.
02:05And also that these disasters affects human-made structures
02:09and systems and people.
02:10So it's really an interaction
02:12between the environment and humanity.
02:16So I wanted to start off by giving...
02:19Hold on just a second.
02:20An overview of my talk today.
02:22I'm going to be first introducing myself
02:25and discussing my program of research.
02:27Then talking about the state of the literature
02:30on mental health after disasters,
02:32as well as some of the limitations they're in.
02:35And then give some examples of recent trends
02:37in the literature.
02:39I'm gonna end by discussing some of my current
02:41and hopefully future work.
02:45So starting off with my program of research.
02:47So I am a clinical psychologist by training.
02:51I received my doctorate
02:52at the University of Massachusetts Boston
02:55which has I think, unprecedented attention
02:58to social justice and multiculturalism.
03:02After getting my PhD, I did a post-doctoral fellowship
03:05in psych Epi at Columbia Mailman School of Public Health.
03:09And I stayed on there for a year
03:10as an associate research scientist.
03:12And that's where I really caught the public health bug
03:15and discovered that this would be a good home for me.
03:18I then actually spent four years
03:19in the department of psychology
03:20at Montclair State university in New Jersey
03:23before coming to Yale.
03:24This is my second year at the school of public health.
03:27And I've had a really great experience so far
03:30and I'm happy to be here today and to be affiliated
03:32with the center for climate change and health.
03:36My research program focuses on the long-term impacts
03:39of a range of potentially traumatic events.
03:42So much of it has focused on climate related
03:45and weather related disasters.
03:47But I've also been involved in research projects
03:49after the deep water horizon oil spill,
03:51projects focusing on the impact of gun violence,
03:53sexual assaults, child maltreatment, and community violence.
03:58Work-related potentially trauma exposures
04:01among first responders,
04:03the impact of discrimination
04:05on the mental health and Muslim youth.
04:07And most recently I've been involved in studies
04:10of the intergenerational impact of the 1994 genocide
04:14against the Tutsi in Rwanda
04:16and the impact of the COVID-19 pandemic on vulnerable groups
04:19including healthcare workers and persons with disabilities.
04:22And I'd be happy to talk
04:23about any of this research in the Q&A.
04:26So that is me in a nutshell, and I'm gonna move on
04:29to discussing some of the work on mental health
04:31after disasters and giving an overview of the literature.
04:36So in 2018, my colleagues and I were asked
04:40to do a review of a year of research
04:43on the mental health impact of environmental disasters.
04:46So climate related disasters,
04:47as well as disasters like oil spills and nuclear explosions.
04:52And when agreeing to do this I thought back
04:55to the Seminole Review by Fran Norris
04:57and colleagues in 2002, that reviewed all of the literature
05:00at the time on the psychosocial impacts of disaster.
05:04And that review had included a total of 160 papers
05:10on mental health and disaster.
05:12So I said to myself this is one year
05:14it's probably gonna be less than that,
05:16I can definitely handle that.
05:18But then when my colleagues and I looked at the literature
05:20in that single year, we found an enormous number.
05:23We actually ended up narrowing our inclusion criteria
05:26to those focused on PTSD and depression
05:29as our two key outcomes
05:30and only including quantitative research
05:32just to manage our workload.
05:35So I think this reflects the burgeoning interest
05:38in mental health after disasters, which is very exciting.
05:42Nonetheless, what we saw in the literature
05:44was consistent with prior research
05:48in that most studies were cross sectional
05:50and some included representative samples, and some did not.
05:57So I just wanted to review
05:58some of the mental health conditions that have been found
06:01across studies of mental health after disasters.
06:04So our review specifically focused
06:06on post-traumatic stress disorder and major depression
06:09but we know that these events are associated
06:11with increases in a range of mental health conditions
06:14such as acute stress disorder
06:17which is sort of a precursor to PTSD,
06:20other conditions like generalized anxiety disorder
06:22and substance use and other clinical phenomenon.
06:25And these are symptoms that are concerning
06:28but don't necessarily map nearly
06:30on to psychiatric diagnoses.
06:32Such as non-specific psychological distress
06:34internalizing symptoms, such as mood
06:37and anxiety symptoms in children.
06:39Externalizing symptoms including attention
06:41and conduct symptoms in children and adolescents,
06:44suicidality and adverse health behaviors
06:47including disruptions in sleep, eating and exercise.
06:50And what I would say is that
06:52across all of the studies today,
06:53there's been considerable variation
06:56in the prevalence estimates of these conditions.
06:59And this is likely due to divergences across the studies
07:02for example, in the timing of assessment
07:04relative to the disaster, the exposure severity
07:08of the sample included as well as the disaster itself
07:11as well as other characteristics samples.
07:16However, across this literature
07:18something that has been consistent
07:20is that we've identified individual level risk factors
07:22at least at the cross-sectional level
07:24of adverse mental health outcomes.
07:26And here I've organized them by timing relative
07:29to the disaster, starting with a predict disaster factor.
07:33So what we know about people
07:34going into these types of events.
07:36So studies have pretty consistently showed that women,
07:39those of low socioeconomic status,
07:42those who have preexisting health conditions
07:44and in particular mental health conditions
07:47who are socially isolated,
07:49who have experienced previous exposure
07:51not only to disasters but other events
07:54are at increased risk for mental health adversity.
07:56Whereas findings regarding race and ethnicity
07:59and age have been mixed.
08:02Turning to the peri-disaster period.
08:04So this is the period of the disaster itself
08:07and its immediate aftermath,
08:08we know that a range of experiences
08:10are associated with adversity
08:12including the perception that one's life was in danger
08:15experiences of physical injuries and bereavement and so on.
08:19We also know increasingly that media exposure,
08:21so exposure to versus details and images of disasters
08:26in their aftermath are associated with increased severity
08:30of psychiatric symptoms.
08:32Reflecting the potentially broader impact
08:35of these types of events.
08:37And then post disaster we know that
08:40when the storm clouds have cleared
08:42and the earth has stopped shaking
08:44disaster related stressors tend to persist.
08:46And those who experienced financial strain, unemployment,
08:50continue disruptions in their work and school lives,
08:53stressors in their relationships
08:55tend to be at increased risk.
08:57And that other stressful and traumatic life events,
08:59whether or not they're related to the disaster
09:01tend to exacerbate
09:02disaster related mental health conditions.
09:05So that in a nutshell is the research to date.
09:08And I think what we've seen in the past five years or so
09:11are some exciting ways in which researchers
09:14are trying to push the boundaries
09:16of disaster mental health research.
09:19So I have here some examples of recent trends.
09:22I know for those of you who read the review
09:24as part of the seminar
09:26you've seen examples of these already.
09:28But I'm gonna be focusing on on four trends
09:31and how my colleagues, students and I
09:33have in our work tried to push the field.
09:38So first focusing on long-term responses
09:40both in the general population and among vulnerable groups.
09:44Pathways to adversity, characteristics of communities
09:47and their impacts on mental health and treatment.
09:52So first off long-term responses.
09:54So what happens in terms of effective populations
09:58mental health not just in the immediate aftermath
10:00of disasters but in the longer term.
10:04And in this work, my colleagues and I
10:06have been very much influenced
10:07by the work of clinical psychologists and other scholars
10:10such as George Bonanno at Columbia
10:13and their theories about resilience
10:15and other potential trajectories of mental health symptoms
10:19after exposure to a potentially traumatic event or PTE.
10:23And what Bonanno and colleagues have said
10:24is that most people when exposed to trauma
10:27will experience what has been termed resilience.
10:30And resilience here means a trajectory
10:32of chronically low symptoms of distress and well being.
10:38So across studies, more than 50%
10:40tend to fall into this trajectory.
10:42However, other trajectories are common.
10:45About 25% on average experience
10:47what has been termed recovery.
10:49So short term elevations and symptoms
10:51and then smaller percentages have exhibited directories
10:55of chronic elevations and distress
10:57as well as delayed onset distress.
11:00So my colleagues and I have worked within this area
11:03while also trying to push its boundaries
11:05and question some of the key tenants of this theory.
11:10So as a first example, I'm going to be presenting data
11:13from the Galveston Bay Recovery Study.
11:16This was a study of...
11:17And I would say it's probably the gold standard
11:21of disaster mental health studies that Sandra Golia
11:24and Fran Norris led where they were able to gather data
11:27from a representative sample of areas that were
11:31most severely affected by Hurricane Ike.
11:33And they collected three waves of data
11:36within the first two years.
11:38So it's a really fantastic dataset.
11:42So what we did is we ran a trajectory analysis
11:44not just of PTSD, but also of depression,
11:48functional impairment and days of poor health.
11:52So I have our trajectory results here
11:53but they're very small and with good reason,
11:55which is that I want to put across the takeaway message.
12:00Which is that when we looked
12:01within each of these four domains
12:03resilience was indeed the modal outcome
12:05ranging from 45.1% to around 75% for PTSD.
12:10However, when we looked across all of these domains,
12:12we found that only 25% of our participants
12:15thereabouts had resilience across all four.
12:20Suggesting that a focus exclusively on PTSD
12:23or one other symptom domain might outscore
12:26the suffering and impacts of disasters
12:29on affected populations.
12:31Now, something I would know here is that all the data
12:35for the study were collected prior to Hurricane Ike.
12:38So we don't know how the participants were doing beforehand.
12:42And it's fairly likely
12:43that those who were experiencing elevated symptoms
12:46that this had something to do with their wellbeing
12:49and health beforehand.
12:51So in another study, I've been a part of
12:54the Resilience in Survivors of Katrina Project,
12:57we've been able to address this limitation.
12:59And so what the RISK project is,
13:01is a longitudinal study of about 1000 women.
13:04Most of them are single low-income African-American mothers
13:08who all experienced Hurricane Katrina.
13:11What's very interesting about this study
13:12was that all of the participants
13:14were part of a study that was already going on
13:18prior to the hurricane called the Opening Door Study.
13:21But the Opening Door Study was a multi-site RCT
13:24of a community college intervention
13:27that sought to increase retention and graduation rates
13:30from community colleges throughout the country.
13:32And two of those colleges happened to be in New Orleans.
13:36So the hurricane hit in August of 2005
13:40and both of those colleges were closed
13:41for the fall 2005 semester.
13:44But my colleagues, Jean Rhodes and Mary Waters
13:47were able to secure funding to launch a new study
13:50of resilience among those participants.
13:53And we've not collected data three times after the hurricane
13:56at approximately one, four and 12 years after Katrina.
13:59And we just got back in the field last week
14:02to do an additional assessment
14:03of how they're fairing amidst the pandemic.
14:07So I'm gonna be talking about two analysis
14:09we did with these data, looking at trajectories over time.
14:14The first was actually my dissertation.
14:16And for this project, we looked at patterns
14:20of non-specific psychological distress
14:23from prior to the hurricane
14:25to four years after the hurricane.
14:27So at the time, and actually I would say probably still
14:31it's one of the few trajectory studies that had access
14:33to pre trauma data.
14:35So we were really able to look at how the patterns
14:38of symptoms over time might have been influenced
14:41by how people were doing before.
14:44And in a nutshell, we found a six trajectory solution
14:47and I know that this is a lot to look at.
14:49So I'm gonna try to break it down a little bit.
14:53So consistent with prior research,
14:55the modal trajectory was what we called resilience
14:59exhibited by over 60% of our participants.
15:02But what we can see is that those participants
15:03actually were doing well in terms of having low distress
15:07prior to the hurricane.
15:09Similarly, other common trajectories in our sample
15:13were marked by consistency from pre to post disaster.
15:17So we had a coping trajectory
15:19which may have looked like recovery
15:21and an increased trajectory
15:22which may have looked like chronically elevated symptoms.
15:25But again, here we see that prior to the hurricane
15:27they had significantly higher psychological distress
15:30than those who were resilient.
15:32Despite this consistency, we saw evidence
15:35for meaningful changes in distress.
15:40So we actually had two trajectories that were marked
15:43by decreasing symptoms.
15:45The first which we turned simply decreased
15:47had severe distress prior to the storm
15:49that decreased pretty consistently thereafter.
15:52Another trajectory that we termed improved
15:54also had a severe distress prior to the storm.
15:58And post disaster distress that was indistinguishable
16:01from those in the resilience trajectory.
16:03So had we only had post-disaster data
16:05we would have assumed resilience.
16:07And then we had a delayed trajectory
16:09consistent with prior research.
16:13In a more recent analysis, we used our latest data
16:17to run a trajectory analysis
16:19this time specifically of PTSD symptoms.
16:22So because their PTSD symptoms had ties to the disaster,
16:25we only have them after the disaster.
16:27And here we did a trajectory analysis
16:29and examined pre trauma predictors of our trajectories.
16:34What was notable here is that we did not find
16:37what would typically be termed a resilience trajectory.
16:40That is a trajectory of consistently low symptoms.
16:43The healthiest trajectory in the sample
16:45had actually moderate PTSD symptoms
16:47that consistently decreased over time.
16:50So in my more recent work,
16:52I have been trying actually not to use the term resilience
16:56although I hate to muddy the waters.
16:58I think that resilience as a trajectory
17:02of consistently low symptoms maybe does not capture
17:06what it means to be resilience
17:08in terms of people's lived experiences.
17:13So that's one thing.
17:14The other thing we found in this analysis
17:17that I think is notable is that the most robust predictor
17:21of trajectory membership
17:23was having probable pre disaster mental illness.
17:29Disaster related exposures, including bereavement,
17:32lack of vital resources like food, water and medical care
17:35and property damage were also predictive.
17:38Whereas other pre trauma factors seem to be mediated
17:43by either pre trauma mental illness or disaster exposure.
17:47So for example, we looked at pre disaster social support
17:52and at the university level
17:53this was associated with trajectory membership
17:55but not when we controlled for pre trauma mental illness.
18:00Similarly, we had access to data
18:02on pre disaster physical health conditions.
18:06And we found that its association with trajectory membership
18:09reduced to non-significant
18:11once we control for disaster exposure.
18:13Suggesting that there might be some mediational pathways
18:16from these risk factors to outcomes.
18:19Which brings me to the second area
18:23that I'm gonna be talking about today
18:24that I've observed in the disaster mental health literature
18:27which is an increasing focus on pathways.
18:30So pathways to both disaster exposure
18:33and even more so to post disaster mental health problems.
18:39Here my colleagues and I used what's called
18:42a pre peri post disaster framework
18:45thinking about how risk factors
18:48at these different time periods
18:49work together to shape disaster mental health.
18:53So for example, we would think that pre disaster factors
18:56not only increase post disaster mental health directly
18:59but they also increase adversity
19:01by influencing the extent to which people are exposed
19:05as well as the stressors they experience
19:07in the aftermath of disasters.
19:09Similarly, we think disaster related experiences
19:12are important for post disaster mental health
19:14both directly and in so far
19:16as they increase risk for further stressors downstream.
19:20And then finally we see the relationship
19:23between post-disaster stressors
19:25and mental health as being bi-directional
19:28in that post disaster stressors likely increased risk
19:31for mental health symptoms, but mental health symptoms
19:34in turn, make it more difficult to cope
19:36with post disaster stressors and actually can lead
19:39to more stressors in the post disaster environment.
19:44My colleagues and I recently published a paper
19:47testing such a model using data from the risk project.
19:50And we were specifically interested
19:51in the pathway from pre disaster trauma.
19:54So we assessed trauma exposures separate from disasters
19:58including assaulted violence,
20:00bereavements, physical assaults, that sort of thing.
20:05And then we looked at both PTSD symptoms
20:07and generalized psychological distress symptoms.
20:10And today I'm just gonna be presenting
20:12the results from PTSD.
20:15So what we hypothesized was a bit of a complex model
20:18at least to look at.
20:19But we essentially thought that pre disaster trauma exposure
20:24would be directly associated
20:25with long-term post-disaster PTSD symptoms.
20:29So PTSD symptoms directly tied to one's experience
20:32of Hurricane Katrina assessed at around 12 years
20:36after the hurricane.
20:37But we thought even more so there would be indirect pathways
20:40to variables downstream.
20:42Among them pre disaster psychological distress
20:46that these would work together and the likelihood
20:48of exposure to disaster related trauma,
20:51to short term post disaster PTSD symptoms
20:54and then also to post disaster trauma experiences.
20:59- And in a nutshell,
21:00we found support for this type of model.
21:03The model had good fit with the data
21:05and most of our pathways were significant
21:07and they expect a direction.
21:09Although notably in this model
21:11the path from pre disaster trauma
21:13to long-term symptoms was non-significant.
21:17- However, it had a significant indirect effect
21:20on long-term PTSD through other variables downstream
21:24and in particular by increasing risk for disaster related
21:27and post disaster trauma.
21:29Suggesting that people might have factors that increase
21:32their vulnerability to trauma across the board
21:36disaster related trauma and other types of trauma.
21:40Which brings me to the third area of research
21:42that my colleagues and I have been focusing on,
21:44which is attention to community level factors
21:47and characteristics and exposures of communities
21:50that could increase or mitigate the impact of disasters
21:55on mental health.
21:58So much of this research has been using data
22:01from the community resilience after hurricane Sandy study.
22:04Which is a study we launched in New York city
22:07after the hurricane in 2012.
22:11And what we did is a serial cross-sectional approach
22:13where we sampled two representative sub samples of survivors
22:18from highly effective neighborhoods within New York City.
22:22We gathered data from around 500 participants
22:25a year after the storm and 500 participants
22:28two years after the storm.
22:30We would have loved for the study to have been longitudinal
22:32but we did not have the funding to run that type of study
22:34so we took this approach instead.
22:38And we also gathered data on where our participants
22:41were living and community characteristics
22:44including property damage within the communities
22:47as well as demographic data
22:50from the American Community Survey.
22:53We were fortunate to have a health geographer on the team
22:56Oliver Grooner who did geospatial analysis
23:00including spatial autocorrelation analysis.
23:03In which we were able to identify clusters
23:05of low and high PTSD that were related to exposure
23:09but not entirely so.
23:11Suggesting that there might be unique characteristics
23:14of these different neighborhoods that could have increased
23:17or mitigate risk.
23:20In another study, we looked at the interaction
23:23between exposures experience at the individual level.
23:25These included stressors like financial losses,
23:28displacement, and bereavement.
23:31Participants in communities that either experienced
23:34high or low levels of damages.
23:37And what we found was perhaps not surprisingly
23:39that individual and community level exposure
23:42had a synergistic effect on the likelihood
23:46of perceived need for mental health services.
23:49And that it was those who experienced both stressors
23:51themselves and who lived in communities
23:53that were highly damaged
23:55who had the greatest mental health needs.
23:58We've also using the serial cross-sectional data
24:02been able to look at interactions
24:03between individual and community level factors
24:06in shaping mental health risks over time.
24:09So there's one example we looked at the interaction
24:12between again individual level disaster related stressors
24:17in participants who are living in communities
24:19with either high or low unemployment.
24:22And what we found was that a year after the hurricane
24:25it didn't matter whether our participants lived
24:27in higher or low unemployment areas
24:30at least for their PTSD symptoms.
24:32Across the board, hurricane related stressors
24:34were associated with elevated risk for PTSD symptoms.
24:40However, two years after the storm,
24:41the picture dramatically changed.
24:43And at this point, a disaster related stressors
24:46experienced at the individual level,
24:48their impact on post-traumatic stress disorder symptom
24:51severity was grossly exacerbated among our participants
24:54who were living in a high unemployment neighborhoods.
24:57And what this suggests is that the impact
25:00of community vulnerability might not manifest
25:03until the longer aftermath of disasters.
25:07And this is problematic because oftentimes the resources
25:10that are funneled to vulnerable communities
25:13are cut off at about the one-year anniversary.
25:14So this suggests greater needs over time.
25:19Which brings me to my fourth area
25:21that I've been seeing Burgeon in the research,
25:25which is a focus on treatment approaches.
25:28And I should say, I have not been involved
25:30in this research as much as I would like.
25:33But there are many different treatment approaches
25:35that I have received empirical support,
25:37including Psychological First Aid,
25:40Skills for Psychological Recovery,
25:42Project Hope in New York City,
25:44Bounce Back Now which is a smartphone-based app
25:49that focuses on a variety of mental health symptoms
25:51that could be experienced after disasters.
25:54And TF-CBT and cognitive behavioral interventions
25:57in schools have also been investigated in literature.
26:02So I've been involved, not in these treatment studies,
26:05but in studies using a system science approach
26:09to simulate populations
26:13or communities exposed to disasters
26:16and the potential impact of different ways of providing care
26:20on levels of PTSD, DK, Snus.
26:23So in this first study, we use data from
26:26our Hurricane Sandy study as well as studies
26:30of the effectiveness of different treatment approaches
26:33to create an agent-based model of New York City
26:35after Hurricane Sandy.
26:38And we tested two different approaches to providing care.
26:42First was termed care, which was skills
26:45for psychological recovery applied broadly
26:48irrespective of our agent's PTSD symptoms.
26:53We also then tried a step care approach
26:56where our agents were screened for their levels of PTSD.
27:00And those with lower moderate symptoms were given
27:03the skills for psychological recovery intervention.
27:05And those who had like the PTSD were given
27:08a more intensive treatment of cognitive behavioral therapy.
27:12And through the simulation study,
27:14we found that the step care approach
27:17had benefits in decreasing the prevalence of PTSD over time
27:22as well as lead to cost savings.
27:26We did a follow-up using the same data
27:28and adding on a social service case management approach.
27:32And what we found here was that this approach
27:34had even greater benefits and reducing PTSD
27:37and across our population of agents in our simulation.
27:41And in particular for those who experienced greater exposure
27:45to the hurricane characterizes having been displaced
27:48or losing income.
27:50So while this is not a direct test
27:52of these types of interventions
27:54it represents an approach to system science to simulate
27:58and test different possibilities in effected populations.
28:03So now I'm gonna turn to some of my current
28:06and hopefully future directions.
28:07And for these, I have three.
28:11The first is considering cumulative exposure
28:14which we think is important given that
28:16we know that there are some areas within the United States
28:19and beyond that are disaster prone
28:21and have unfortunately experienced
28:23more than one environmental disaster
28:26as well as other stressors.
28:29So one example of this is an analysis
28:31my colleagues and I did using data
28:33from the Gulf long-term follow-up study.
28:36And what we did is we looked at exposure
28:38amongst the sample to hurricane Katrina
28:41to clean up work after the deep water horizon oil spill.
28:45And then the combination of these two different exposures.
28:48And what we found was that participants who were exposed
28:51to both disasters, both oil spill cleanup
28:54and to hurricane Katrina tended to have
28:56higher mental health symptoms, including PTSD, depression
29:00and anxiety symptoms, as well as physical health symptoms,
29:03including headaches, back pain and digestive problems.
29:09In a future project, I mentioned that we're collecting data
29:12on the COVID-19 experiences of our risk sample.
29:16And what we're hoping here is to investigate
29:19the impact of the pandemic on this group
29:22that has already been exposed to a major disaster
29:25and their perceptions of whether having experienced
29:27hurricane Katrina exacerbated the impact of the pandemic
29:31or help them cope.
29:36Another future direction is that
29:37I've been increasingly interested
29:40in the broader impacts of climate change
29:45both on people living in areas that are affected
29:48by disasters and other climate change indicators,
29:51but more generally in the population
29:55even in less affected areas.
29:58So for this work, I have had the honor
30:01of working with Susan Clayton,
30:04who is an environmental psychologist
30:06at the college of Wooster.
30:07And she, this past year developed and validated
30:11a measure of climate change anxiety.
30:13So the two of us are working
30:15with a former classmate of mine, Sarah Schwartz,
30:17who's a psychologist at Suffolk University
30:20on a study looking at college and graduate students
30:23climate change anxiety, its relationship
30:26with mental health indicators
30:27such as depression and generalized anxiety disorder.
30:31And the protective role of constructs such as climate hope
30:35and climate activism, and mitigating this relationship.
30:39And some of you in the climate change and health seminar
30:41may have been invited to participate
30:44in this study last semester.
30:48And then finally, I've been increasingly interested
30:51in other climate change indicators beyond disasters
30:55including some of those that are more chronic and persistent
30:58as well as other environmental exposures
31:00that are likely to affect mental health.
31:04An example of this work I have had the honor
31:08of working with Kai Chen
31:09from the Yale Center for Climate Change and Health
31:13on a study looking at particulate matter, air pollution
31:16and its association with outpatient visits
31:19for mental health problems in Nanjing China.
31:22And what we found that was on days
31:24where there was greater levels of particulate matter
31:29the use of outpatient services increased.
31:32Suggesting that this environmental indicator
31:34could increase the demand for mental health services
31:37and also impact the likelihood of mental health symptoms.
31:42And then I've been collaborating on a systematic review
31:45trying to conceptualize climate change indicators
31:49and look at their impact on mental health.
31:51This has been sort of slow going.
31:53I think in our initial screening
31:55we looked at around 12,000 abstracts
31:59and in doing so recognize the challenges
32:02of measuring chronic climate change impacts
32:07and their potential influence on mental health.
32:09So, hopefully that will come out in the next few years.
32:13So that is actually all I've got for today.
32:16I think that was faster than I expected.
32:18But I have my email here and I would be happy
32:22to answer questions about this work both today and offline.
32:27So feel free to email me and reach out.
32:30I love connecting with people, hearing from students
32:33and so on.
32:35So, thank you very much.
32:38- Great, thank you Sarah for this wonderful presentation,
32:41giving the state or the knowledge regarding
32:44the mental health after all these weather related disasters.
32:48And thank you very much for sharing your future
32:52and the current directions in this field.
32:54It's all, it's very fantastic.
32:56And I'm sure the audience will have a lot of questions.
32:59So while the audience is preparing the question
33:02and typing in the chat box,
33:03we do have already clacking a question from the students.
33:07So there are a lot of student questions.
33:10But the first question the student is wondering is
33:15you have shown different types of disasters
33:20especially in your review paper.
33:22Several students are kind of wondering
33:25is there a way to compare the mental health matters
33:29across different types of disasters?
33:32Like when you compare the different types of disasters,
33:35does this matter?
33:37Is a particular type of disaster has a strong effect
33:41on a particular mental health outcome?
33:45- That is a really good question.
33:47So I know that it used to be said
33:50that disasters that were clearly human made
33:54such as oil spills and terrorism
33:58we're likely to trigger more severe impacts on mental health
34:02because there was someone to blame
34:04and they seemed less fateful.
34:08However, I don't think that has been shown empirically
34:11although perhaps someone else in this seminar
34:14knows more than I do.
34:18And I do think that it is again worth emphasizing that
34:21what we've typically seen as natural disasters
34:24do have a clear tie to climate change and human impacts
34:29and affects human made systems.
34:31And I think that that can lead to feelings of anger
34:36and blame and neglect that can exacerbate risks
34:39sort of in the same way that would happen
34:42after a technological disaster or terrorism.
34:46So I think it's difficult to really make the comparison.
34:50But my sense is that both have the potential
34:53to trigger symptoms across the board.
34:58- Thanks, so another type of question follows
35:01the interventions you mentioned.
35:04So the students are wondering,
35:06you mentioned give some examples
35:09more from the clinical science clinical based interventions.
35:13And you have also mentioned your own research
35:17and other papers has shown some individual level
35:22or community level characteristics
35:25such as the employment rate
35:28that it can kind of modify the risk.
35:31So is there wave, can you talk about
35:34more this nonclinical intervention strategies?
35:38And are there community-based programs are happening
35:42or are there any further readings for the students?
35:47- Yeah, so that is a really good question.
35:49So yeah, so as a clinical psychologist, I'm most well-versed
35:54in trauma-focused CBT and those types of treatments
35:59for people who have moderate or severe symptoms.
36:03But I think that there are public health approaches
36:06to treating mental health across the board
36:08including psychological first aid.
36:11And I think a key here is that psychological first aid
36:14acknowledges that most people are going to be resilient
36:18in terms of their mental health.
36:20And so aren't going to benefit from more intensive services.
36:25And in fact, you know, therapeutic approaches
36:28might actually impede their coping processes
36:30and increase their risk.
36:32So psychological first aid as I understand,
36:34I have not been trained in it
36:36and I would love to at some point,
36:38focuses on assessing how people are doing,
36:41providing them information and then referring them
36:45to resources that help them
36:46either with their mental health problems
36:48or other social service needs.
36:52I think a social service approach that integrates
36:54both psychological first aid and that assesses
36:58the broader range of post disaster needs
37:00and provides some case management
37:02in navigating the various systems
37:04that disaster survivors come into contact with
37:07is very important.
37:09And I know that in our Katrina study
37:12so that was a mixed methods project
37:15a lot of our, not a lot, some of our survivors
37:18talked about how their encounters with social services
37:22after Katrina was actually their first touch point
37:26to getting mental health services for preexisting problems.
37:30So I think the post disaster period
37:32could actually be in some cases, an opportunity
37:35for people to get help that they needed all along.
37:38And it's unfortunate that it takes a disaster to do that
37:40but could actually facilitate not just psychological growth
37:45but access to social and economic resources
37:48that foster their wellbeing across the board.
37:52- Oh, thanks, Sarah.
37:53I think there's a question from the audience relate to this
37:56from Pat Haney.
37:58Just thank you, Sarah, can you give an explanation
38:01of the step heard care you discuss in your model?
38:05- Yeah, so that was a really interesting project
38:08to be a part of.
38:09So we use what's called agent-based modeling
38:12which you actually put in, you create a population
38:16within a computer programming software.
38:19We use Python and then you put in various inputs.
38:23So you distribute disaster exposure,
38:26you distribute risk factors for psychopathology
38:31and then you can apply an intervention to that population.
38:34So intercept care approach, what I believe we did
38:37is we screened our participants
38:39meaning that we assign them different levels of PTSD.
38:44And then those who met a certain level
38:45I think we said seven PTSD symptoms
38:48who likely had the disorder were then given
38:51in the simulation cognitive behavioral therapy for PTSD.
38:56And that others who had non-zero
38:58but less than seven symptoms of PTSD were given
39:02quote unquote skills for psychological recovery.
39:06And based on the findings of prior research
39:10on the effectiveness
39:12of these two different intervention approaches
39:15our agents within the model, their symptoms declined
39:18in a way we would expect
39:19based on their socioeconomic demographics.
39:22So again, it was a simulation, it was not a test
39:25of an approach, but more of a demonstration
39:28that screening participants and providing services
39:30that meet their mental health needs
39:33could more effectively lead to decreases in PTSD over time.
39:39- Oh, great, I think another, it's not maybe a question
39:43but a comment from Massey asking
39:46as a clinician and a public health practitioner
39:49how best to translate this information
39:52to first advocate clinician to be aware now of these issues.
39:57So I think it's first within the interaction question.
40:02There has been other questions from students as well.
40:07So while the students is asking
40:10like we study the association between disaster
40:13and the mental health, is that a case that is
40:16some solution, will there be some underestimation
40:21of their mental health status due to the stigma
40:25of the mental illness
40:26especially in a lot of surveys you have performed?
40:31- Yeah, so the question is whether
40:35mental consequences will be exacerbated
40:37if there's stigma experienced?
40:39- Or maybe underestimated in the service.
40:42Some people would maybe reclined
40:46to answer these questions, so.
40:49- That is a good question.
40:52I don't think I have a good answer for you.
40:54I think it's certainly possible
40:56that people who experienced mental health stigma
41:00might be less likely to report symptoms.
41:04That being said in these studies
41:06we use validated scales that ask about specific behaviors
41:11and experiences, not disorders.
41:14So for example someone who experienced mental health stigma
41:17might be more likely to say I haven't had good sleep
41:21over the past two weeks, or I've been feeling
41:23like a lack of pleasure.
41:26Than saying that they experienced depression per se.
41:31So they are sort of behaviorally anchored questions.
41:35And it's interesting 'cause I think people are more likely
41:40to report symptoms if they're doing so anonymously,
41:44such as via an online survey or something like that.
41:47But a lot of, especially the epidemiologic studies
41:49are done over the phone, at least historically.
41:52And that having that personal contact could potentially
41:55be a barrier to reporting.
41:58And then absolutely stigma is a barrier to service seeking
42:02but you know, there are other barriers too.
42:05So in one study we looked at the frequency
42:07of different barriers
42:08and a major one was a lack of resources.
42:12So not knowing where services were,
42:14not having time, needing childcare,
42:18not having transportation.
42:19And I think those can get in the way as well.
42:23- Yes, another question kind of related
42:27to the respondents characteristics is,
42:29there's one question from Peter asking,
42:31has any of the current research considered the difference
42:35in PTSD among first responders and long-term
42:39community responders versus those who are impacted
42:44but did not assist them with the response?
42:48- Yeah, that is a really good question.
42:49So from the research that I've seen,
42:54epidemiologic studies have shown that people
42:56who are involved in the response
42:58tend to be at increased risk for mental health problems
43:01relative to the general population.
43:03However, there is substantial variability
43:06amongst first responders.
43:08So those who are exposed to atrocities, such as,
43:14dead bodies, people who are harmed
43:16really severe property damage,
43:18who are exposed to environmental toxins,
43:20like mold and things of that nature
43:23and who have not received adequate training.
43:27So I know for example, I think there was a study
43:30after the Deepwater horizon oil spill, or maybe not,
43:33I'm trying to think.
43:34This may have been a disaster in one of the ones in Japan
43:37that was conducted that showed that people who were
43:41police officers or who had previously been involved
43:44in response work tended to have fewer
43:48adverse mental health impacts
43:49relative to those who volunteered.
43:52Which suggests the benefits and importance
43:55of resilience training prior to these exposures,
43:59which is really hard to do, right?
44:00Because these events by their very nature are unexpected
44:03and people are going to volunteer
44:05which is great to help out.
44:07There might not be adequate time to really prepare them,
44:10but probably at least some.
44:15- Great, so there's a couple of other questions
44:19relating to the study.
44:23Actually to the review paper you presented.
44:25One of them is actually asking
44:28about not weather related disaster, but
44:32a question from the audience asking,
44:34have you worked or research interests such as
44:38with manmade disaster, such as armed conflict?
44:42And looking into the displacement
44:44and how these may impacted them in the house?
44:48- Absolutely, that's a very good question.
44:51So I have been involved in studies of human made disasters,
44:55namely the study, I mentioned with the workers
44:57after the deep water horizon oil spill
44:59but that seems very different
45:00than what the student is asking about
45:02which is armed conflict and displacement.
45:05I would love to get involved in this type of work.
45:07I haven't yet had the opportunities.
45:10But what I can say is that there are some clear parallels
45:16to weather related disasters
45:19as well as some clear distinctions.
45:22So a parallel is that being displaced from your community
45:26not by choice can be really stressful
45:29and potentially traumatic.
45:31And that we found in our Katrina study,
45:34that those who relocated which was a good percentage
45:37of our sample tended to be at increased risk
45:39for mental health problems.
45:41Both those who like stably relocated
45:44who found a new place to live
45:45in a different state and settled there
45:46and those who had unstable housing trajectories.
45:50I think another commonality is that
45:55both types of community level trauma
45:59involve exposure to death and destruction.
46:02But I think the particulars of it are very distinctive
46:08and the level of violence who is perpetrating it,
46:15the extent of displacement could be very different
46:18in ways that could exacerbate mental health risks.
46:22So I think that there are some ways are similar
46:23and some ways they're very different.
46:26- Yeah, I wanted a follow up
46:28on the like displacement request.
46:30And we know what you also mentioned
46:32the kind of anxiety conscience is your future direction.
46:36So we know there's issue on the counter refugees
46:41especially considering even the whiteflies in the West.
46:45A lot of people just were displaced due to the whiteflies.
46:48So when talking about to the mental health burden
46:52of these kind of refugees,
46:56can you give more like an explanation
46:58on the state of the science on that?
47:00And are there any new directions that you want to ask?
47:06- Yeah, that is a really good question.
47:09In terms of the state of the science,
47:10I don't know a lot of good literature
47:13on climate refugees and displacement aside from
47:17like domestic displacement after hurricane Katrina.
47:21That doesn't mean that there's not good research going on,
47:22I just might not know about it.
47:25But my overall sense is there's probably not a lot of it
47:28going on and that this is to be a major issue
47:31'cause being displaced from one's home community
47:34either because your community has been destroyed
47:36or that it's at great risk is incredibly stressful.
47:41And not only can impact mental health
47:42but it can impact the things that foster mental health.
47:46Such as social connections, employment,
47:49community attachment, things of that nature.
47:54So, you know, what I would say is that we need to be mindful
47:57that this is going to happen
48:00and trying to create communities that are accepting
48:05and supportive of people who are displaced.
48:08You know, I know for our Katrina sample
48:10one of the things qualitatively that was very difficult
48:12for them was moving to places where they were not welcome,
48:16where they were stigmatized,
48:17where they had difficulty getting jobs,
48:19because they were from New Orleans.
48:22Or heard people say things about people
48:25from New Orleans and the culture of New Orleans
48:27and this is within the same country.
48:29So I could only imagine, you know, when we're talking about
48:31people crossing international borders
48:32that these types of issues within communities
48:35are gonna be heightened.
48:40- Yeah, another question kind of related
48:43to the culture inference, one of the students is asking
48:46among these community level characteristics,
48:50do you expect these different characteristics
48:54such as the culture inference can be a factor
48:58influencing the substantial variability
49:01you observed in the review paper
49:04on the premise of the PTSD and the depression?
49:07- Yeah, that is a really good question.
49:08And I don't know, offhand I'd have to actually look closely
49:11at the review paper that you all read
49:13to see what literature was came out at that particular year.
49:16What I would say having been involved in this research
49:19you know, we try to get community level data
49:21from the Census Bureau and the American Community Survey.
49:26And oftentimes when you run these analysis
49:29they explained very little variability in outcomes.
49:33And I think part of the reason is because
49:36census tracks and census blocks don't necessarily
49:39map onto what people perceive as their communities.
49:43Like I know in after Hurricane Sandy
49:45like I technically I was eligible for the study that we did.
49:48I have no idea what my census track was.
49:52And it would be hard to imagine
49:54that it really mapped onto what I saw as my community
49:57given that the people that I interacted with
50:00on a day-to-day basis didn't necessarily even live
50:02in that particular census track.
50:04So I think it's tricky.
50:06And then an alternative source that people sometimes use
50:09is they ask people about their perceptions
50:11of their own community and that's going to be biased
50:13by their mental health and functioning.
50:16So I think, you know, there are advantages
50:17and drawbacks to different approaches
50:20and very likely community level characteristics
50:23do shape mental health after disasters.
50:26But I don't think we've been able to
50:28very precisely estimate that.
50:32- Great, so due to the time limitation
50:35we will have the last two questions.
50:36So the one is from Diane,
50:41excuse me, if I pronounce it wrong
50:45from the audience, what might the considerations be
50:48for substance misuse services pre and post disaster?
50:53And what has to be ensured to help these populations most?
50:58- That is a really good question.
51:01So I am not super well versed in substance abuse services.
51:08I can say that there have been studies
51:09that have shown increases in alcohol use
51:13and use of other substances including non-medical use
51:18of prescription drugs after disasters
51:20and often they're endorsed as a means of coping with stress.
51:24And I think certainly we've seen that
51:25with the COVID-19 pandemic as well.
51:28So I think in general a population-based approach
51:30could be to acknowledge that that is something
51:33that people do to cope
51:34as well as the potential negative consequences of that
51:37and alternative ways of coping if people feel like using.
51:41I do know anecdotally I have
51:46colleagues, not super close colleagues
51:48but contacts who have done some work
51:50with opioid and methadone maintenance after hurricanes.
51:54And I think it's really challenging
51:56because the people who run these clinics are also impacted.
52:00And when people are displaced, they have disruptions in care
52:04that can be really devastating for their recovery.
52:08So I think it is a major issue
52:10both in terms of people using substances to cope
52:12and then people in recovery not only experiencing
52:16an additional stressor
52:17that can exacerbate their risk of abusing
52:20but also major disruptions in their care.
52:26- Okay, so last question is actually from the student
52:30is asking one of your future director
52:32is the community disaster exploring.
52:35So the students are wondering, do you know any study
52:39exploring the potential interaction facts
52:42from these individual characteristics you observed
52:45and also the community characteristics
52:47including some of the pre disaster finding?
52:51- Yeah, so I'm trying to think if there are good examples
52:54other than the one that I presented today
52:56which looked at individual and community level exposures.
53:01I don't know of any offhand
53:05that have looked at community level factors,
53:08such as indicators of socioeconomic status
53:12and individual level impacts.
53:14There is some work that has been done
53:16by Elizabeth Frankenberg and colleagues
53:18after the Nepal earthquake and tsunami
53:22that I believe found something in that effect.
53:26But I can't remember offhand what exactly they found.
53:30And then there's another study that was conducted
53:32after flooding in England by Compro,
53:35is the author Winden and Compro,
53:36I know are their last names
53:38that found interactions I believe between exposure
53:41and social cohesion.
53:43But social cohesion in that case was measured
53:46based on the participant's own perceptions
53:50of social cohesion across the area.
53:52So, yeah, those are two examples
53:55but I don't know a ton of literature in that area.
53:58And I think that is an open area
53:59for further explanation or examination.
54:03- Great, thank you Sarah.
54:05And I think there's a lot of excitement to conduct research
54:09in this field and thank you all for listening today.
54:12And just a reminder that this seminar is recorded
54:15and will be posted online
54:18on the Yale Center for Climate Change and Health
54:20so check out later.
54:22With that, thank you Sarah.
54:24- Yeah, feel free to be in touch.
54:26- Thanks Sarah.
54:28- [Sarah] Thanks Rob.
54:29- Bye everyone.
54:30- [Sarah] Bye everyone.