An integrated approach to mental health and disaster preparedness: a cluster comparison with earthquake affected communities in Nepal

Abstract

Background: On 25th April 2015, Nepal experienced a 7.8 magnitude earthquake, followed by countless aftershocks. Nearly 9000 people were killed and over 600,000 homes destroyed. Given the high frequency of earthquake and other natural hazards in Nepal, disaster preparedness is crucial. However, evidence suggests that some people exposed to prior disasters do not engage in risk reduction, even when they receive training and have adequate resources. Mental health symptoms, including those associated with prior disaster exposure, may influence engagement in preparedness. Perceived preparedness for future disasters may in turn influence mental health. Social cohesion may influence both mental health and preparedness.

Methods: We developed and tested a hybrid mental health and disaster preparedness intervention in two earthquake-affected communities in Nepal (N = 240), about 2.5 months after the April 25th, 2015 earthquake. The 3-day intervention was culturally adapted, facilitated by trained Nepalese clinicians and focused on enhancing disaster preparedness, mental health, and community cohesion. Communities were selected based on earthquake impacts and matched on demographic variables. The intervention was administered initially to one community, followed by the other receiving the intervention shortly thereafter. Survey data was collected across three time points. Focus groups were also conducted to examine intervention impact.

Results: At pre-intervention baseline, greater depression symptoms and lower social cohesion were associated with less disaster preparedness. Depression and PTSD were associated with lower social cohesion. Participation in the intervention increased disaster preparedness, decreased depression- and PTSD-related symptoms, and increased social cohesion. Mediation models indicated that the effect of intervention on depression was partially explained by preparedness. The effect of the intervention on disaster preparedness was partially explained by social cohesion, and the effect of intervention on depression and on PTSD was also partially explained by social cohesion. Data from focus groups illuminate participant perspectives on components of the intervention associated with preparedness, mental health and social cohesion.

Conclusions: This mental health integrated disaster preparedness intervention is effective in enhancing resilience among earthquake-affected communities in Nepal. This brief, cost-effective group intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes and other natural hazards.

Trial registration: Clinical Trials Registry-India, National Institute of Medical Statistics. Registration number: CTRI/2018/02/011688. http://ctri.nic.in/Clinicaltrials/login.php Retrospectively registered February 5th, 2018. First participant enrolled July 2015.

Keywords: Aftershocks; Disaster; Earthquake; Intervention; Mental health; Nepal; Preparedness.

Fig. 1

Participant flow diagram. Analyses conducted based on as-treated, with outcomes examined for those who completed the intervention as allocated. Results and corresponding conclusions were similar when analyzed as intent-to-treat [53]

Fig. 2

Mediation diagrams. a effect of intervention on depression is partially explained by preparedness; (b) effect of intervention on disaster preparedness is partially explained by social cohesion; (c) effect of intervention on depression is partially explained by social cohesion; (d) effect of intervention on PTSD is partially explained by social cohesion. In each model, two equations were used: 1) the effect of the intervention on the mediator (a path), and 2) the effects of the mediator on the outcome variable (b path) and the intervention on the outcome variable (c’ path). The direct effect of the intervention on outcomes is given by c’ and the mediated or indirect effect of the intervention is given by the product ab