Resilience in children in the aftermath of disasters: A systematic review and a new perspective on individual, interpersonal, group, and intergroup level factors

The Communities Organizing for Power Through Empathy (COPE) Community-Based Intervention to Improve Adult Mental Health During Disasters and Crises: Protocol for a Stepped-Wedge Cluster Randomized Trial

BACKGROUND

Severe weather events, exacerbated by climate change, can lead to hardships such as displacement, resource scarcity, and social network disruptions. Such disasters impact mental health, triggering conditions such as anxiety, depression, and posttraumatic stress disorder. For communities in the Gulf South, the increasing frequency of disasters often further exacerbates already disastrous levels of inequality. In this context, there is an urgent need for evidence-based, multilevel, community-based interventions to support individual and community mental health and resilience.

OBJECTIVE

This protocol describes the design of a community-based participatory research (CBPR) study to improve individual and community mental health in Gulf South communities by examining the implementation and effects of the multilevel, community-based intervention, Communities Organizing for Power through Empathy (COPE). Specifically, this study aims to (1) examine factors affecting the implementation, effectiveness, and adoption of the COPE intervention and (2) test its effects on mental health and community resilience. We hypothesize that participants in the COPE intervention will experience greater reductions in psychological distress (eg, perceived stress, anxiety, and depression); improvements in protective factors (eg, social support and coping self-efficacy); and community participation as compared with an attention control group.

METHODS

The Consolidated Framework for Implementation Research guides our analysis of data collected from surveys, fidelity and field notes, interviews, and focus groups to examine aim 1. We examine aim 2 primarily via a 2-arm pragmatic stepped-wedge cluster randomized trial (SW-CRT) with individuals (approximately n=300) in clusters (faith-based and secular community-based organizations; approximately n=15) in a disaster-prone community in the US Gulf Coast. The cluster-based design implemented in steps supports the community-based nature of the study where timelines differ by organization. A total of 5 self-assessments will be conducted both in person and via email at later time points. We will integrate mixed methods in our analyses for aim 1 by combining themes from interviews and focus groups with implementation measures, and for aim 2 by constructing a data matrix to combine findings from the SW-CRT with thematic analyses of field notes and interviews.

RESULTS

The SW-CRT is being conducted from June 2022 to June 2025. Recruitment began in April 2023, to conclude in spring 2025, to assess mental health, social support, and community resilience at 5 time points. Data analysis and dissemination of results are expected by spring of 2026.

CONCLUSIONS

This protocol is among the first to use a CBPR approach to examine the implementation and effectiveness of a multilevel intervention on psychological distress and resilience. This study provides new insights into how CBPR can enhance intervention implementation research and expand the evidence on community-based mental health interventions during disasters. Policy makers should consider integrating CBPR approaches into disaster response frameworks to ensure culturally relevant and sustainable outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06093737; https://clinicaltrials.gov/study/NCT06093737.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63723.

'School-based screen-and-treat': An effective blueprint for expediating access to care in children experiencing PTSD following disasters

OBJECTIVES

While 5%-10% of children exposed to natural disasters develop PTSD, few children access support. This paper reports on the proactive 'screen-and-treat' approach deployed following devastating floods in Queensland, Australia, in 2011 and presents results for children in the Lockyer Valley (the most impacted community).

DESIGN

Open treatment study (2011-2012) within a government-funded post-disaster service response.

METHODS

One hundred and fifty children (7-12 years) completed pencil-and-paper screening (PTSD, anxiety and depression) at school. Eighty children endorsing either clinical levels of PTSD, or moderate levels of PTSD and clinical levels of either anxiety or depression, and their parents, completed a structured diagnostic interview. Forty-eight children were offered a free trauma-focused CBT intervention. The parents of 19 children accepted this offer. Most clinicians were clinical psychology trainees from local universities. All measures were repeated at post-treatment, 6- and 12-month follow-up. Note: The term 'parents' is used to refer to the wide variety of people serving as a child's primary caregiver.

RESULTS

Pre-treatment, all children met diagnostic criteria for full (N = 17) or sub-clinical PTSD. By post-treatment, 10.5% met criteria for PTSD, with 0% meeting criteria at the 12-month follow-up. The incidence of anxiety and depressive disorders also reduced significantly. There were no differences in outcomes for children seen by trainees compared to experienced clinicians.

CONCLUSIONS

A school-based screen-and-treat approach offers potential as a means of identifying and treating children following natural disaster exposure. However, engagement of families at the outset, and when offering intervention was challenging. Postgraduate trainees represent an effective potential workforce in a post-disaster environment.

Effectiveness of internet-delivered psychological treatments for children and adolescents with anxiety and/or depressive disorders: Systematic review and network meta-analysis

Background

Anxiety and depression symptomatology has increased in the child and adolescent population. Internet-delivered psychological treatments (IDPT) can help to reduce this symptomatology, attending to the largest possible population.

Aim

To conduct a systematic review and network meta-analysis of IDPT to reduce anxiety and depression symptoms in children and adolescents.

Methods

The search for studies was conducted in SCOPUS, PsycINFO, PSICODOC, PsycARTICLES and Medline, between 2000 and 2022, in December 2022. Studies were selected if they were conducted with a sample of children and/or adolescents with previous symptoms of anxiety and depression, had applied IDPT, and included at least two comparative groups with pretest-posttest measures. Network meta-analyses were separately performed for anxiety and depression outcomes. Publication bias was analyzed using Egger's test and funnel plots, and mixed-effects meta-regression models were applied to account for heterogeneity.

Results

37 studies were included in the meta-analysis, providing a total of 74 comparative groups. IDPT exhibited low-to-moderate, statistically significant average effect sizes when compared to both inactive and active controls. No statistical significance was found when IDPT was compared with other types of interventions.

Discussion

IDPT is recommended to reduce anxiety and depression symptomatology in children and adolescents, but more studies are needed which compare treatments with other types of interventions, such as face-to-face therapy.

Parental Support during the COVID-19 Pandemic: Friend or Foe? A Moderation Analysis of the Association between Maternal Anxiety and Children's Stress in Italian Dyads

There is evidence that parental psychological disorders in stressful situations increase the risk of disturbance in child development. This has been investigated in disasters but not in pandemics, which are sensibly different from other types of traumatic events. We investigated the relationship between mothers' anxiety and their children's (self-reported) stress and the boundary conditions of this association during the first full COVID-19 lockdown in Italy. During the COVID-19 pandemic, mothers might have increased their protective attitudes to secure and support their children; we tested whether the relationship between mothers' anxiety and children's stress was weaker (buffer effect) or stronger (over-protection effect) when perceived parental support was high. We measured mothers' anxiety, children's perceived parental support, and children's stress in a sample of 414 8- to 11-year-old primary school children (229 females, Mage = 9.44) and 395 mothers (Mage = 42.84). Results supported the over-protection scenario and provided the first evidence for the "helicopter-parent effect" during the COVID-19 pandemic: mothers' anxiety was positively associated with children's stress only when perceived support was high. Our finding highlights the importance of educating parents (for example, via emotional training) to prevent the worst consequences of adverse events in children and promote their mental health.

Alone in the disaster? The independent nature of behavioural instructions for evacuation

In disaster evacuation, the most reasonable reaction is seen as to evacuate through independence. On the contrary, people often stay and behave socially interdependent, hence stressing the gap between evacuation instructions and actual people's behaviour. The present research analyses the content of a set of behavioural instructions and provides an overview of common framing of evacuation communication. That is informed by psychological models that explain behaviour based distinguish between the independent self (i.e., everyone for themselves) and interdependent self (i.e., all together). Results of this article highlight that, despite the prevalence of interdependent behaviour, most of the instructions focuses on the independent behaviours rather than on interdependent instructions that do not reflect actual people's behaviour in case of evacuation. The objective of this article is to increase authorities' awareness on the relation between existing instructions (independent) and actual behaviour (interdependent); the final aim is to help authorities to design and create better instructional communication campaign for disaster evacuation.

Maternal depressive symptoms and early childhood temperament before and during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic is an unexpected and major global event, with the potential to have many and varied impacts on child development. However, the implications of the pandemic for maternal depressive symptoms, early childhood temperament dimensions, and their associations, remain largely unknown. To investigate this, questionnaires were completed by mothers (N = 175) before and during the pandemic when their child was 10- and 16-months old (Study 1), and by an extended group of mothers with young children (6-48 months; 66 additional mothers) during the first and second national lockdowns in the United Kingdom in 2020 (Study 2). Results indicated that while maternal pandemic-related stress decreased over the first 6 months of the pandemic, there was an increase in mothers who reported feeling some level of pandemic-specific depression. Despite this, we did not observe an increase in the severity of global maternal depressive symptoms, or any negative impact of the pandemic on the development of temperament in infancy and early childhood.