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

Abstract

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

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

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

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

Keywords: Disaster; Haiti; earthquake; flood; intervention; mental health; preparedness.

Fig. 1.

Participant flow diagram. ¹All willing participants over age 18 were interviewed. An estimated 5% of those approached were not at home (n = 24) (note: as there are no accurate public records of dwellings in the area, it is not clear if some of these dwellings were occupied). An estimated 1% of those who were home declined to participate in the study/first interview (n = 5). Participants who were not home or declined to participate were replaced with other participants at Time 1. ²Some of those who did not attend the intervention were re-contacted for Time 2 interviews (n = 23) and gave the following explanations for non-attendance: traveled out of area (26%), had work (22%), childcare responsibilities (13%), unaware of invitation/issues contacting (9%). ³Main analyses conducted as intent-to-treat (ITT): all participants analyzed as belonging to the group to which they were initially randomized, regardless of compliance (see Gupta, 2011). In as-treated analyses, only compliant subjects with at least T1 and T2 data were analyzed.

Fig. 2.

Mediation model diagram: disaster exposure, anxiety, and disaster preparedness. ***p < 0.001, **p < 0.01, *p < 0.05. Note 1. Figure 2 depicts an example of a mediation model (mediating effects of anxiety on the relationship between disaster exposure and preparedness) as visual guide to aid the reader's interpretation of mediation results; data for all other models described in the manuscript can be found in Table 4. In each model, two equations were used: (1) the effect of the independent variable (disaster exposure or the intervention) on the mediator (a path), and (2) the effects of the mediator on the outcome variable (b path) and the independent variable on the outcome variable (c’ path). The direct effect of the independent variable on outcomes is given by c’ and the mediated or indirect effect of the independent variable is given by the product ab. The total effect on the outcome is given by c (not shown).