Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study

Summary: Background: Hurricanes and other natural disasters produce public health and economic consequences that last well beyond their immediate aftermath. Resource loss is a core driver of post-traumatic stress disorder (PTSD) after large-scale traumatic events. We examined the effect of restorat...

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Main Authors: Gregory H Cohen, MPhil, Shailesh Tamrakar, MS, Sarah Lowe, PhD, Laura Sampson, BA, Catherine Ettman, BA, Dean Kilpatrick, ProfPhD, Benjamin P Linas, MD, Kenneth Ruggiero, ProfPhD, Sandro Galea, ProfMD
Format: Article
Language:English
Published: Elsevier 2019-02-01
Series:The Lancet Planetary Health
Online Access:http://www.sciencedirect.com/science/article/pii/S2542519619300129
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spelling doaj-af8319af7548414da7afbb254ff7f7c52020-11-25T02:32:51ZengElsevierThe Lancet Planetary Health2542-51962019-02-0132e93e101Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling studyGregory H Cohen, MPhil0Shailesh Tamrakar, MS1Sarah Lowe, PhD2Laura Sampson, BA3Catherine Ettman, BA4Dean Kilpatrick, ProfPhD5Benjamin P Linas, MD6Kenneth Ruggiero, ProfPhD7Sandro Galea, ProfMD8School of Public Health, Boston University, Boston, MA, USA; Mailman School of Public Health, Columbia University, New York, NY, USA; Correspondence to: Mr Gregory H Cohen, School of Public Health, Boston University, Boston, MA 02118, USASchool of Public Health, Boston University, Boston, MA, USADepartment of Psychology, Montclair State University, Montclair, NJ, USASchool of Public Health, Boston University, Boston, MA, USASchool of Public Health, Boston University, Boston, MA, USADepartment of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USASchool of Public Health, Boston University, Boston, MA, USA; School of Medicine, Boston University, Boston, MA, USACollege of Nursing, Medical University of South Carolina, Charleston, SC, USASchool of Public Health, Boston University, Boston, MA, USA; Mailman School of Public Health, Columbia University, New York, NY, USASummary: Background: Hurricanes and other natural disasters produce public health and economic consequences that last well beyond their immediate aftermath. Resource loss is a core driver of post-traumatic stress disorder (PTSD) after large-scale traumatic events. We examined the effect of restoration of residential and housing-related financial resources on recovery from PTSD in post-disaster contexts. Methods: We built an agent-based model, empiricised with observational and experimental data, to test the effects of differing health service approaches on PTSD recovery, measured by prevalence and persistence. We tested a social services case management (SSCM) approach similar to Psychological First Aid, featuring shelter-based social service provision and linkage to mental health treatment for people who were displaced and had income loss, by comparing the treatment effectiveness of usual care alone, usual care with SSCM, stepped care alone, and stepped care with SSCM. Findings: An SSCM approach to restore housing and provide linkage to mental health services among people who were displaced and had income loss after a large-scale natural disaster resulted in between 1·56 (95% CI 1·55–1·57) and 5·73 (5·04–6·91) times as many remitted PTSD cases as non-SSCM conditions at the end of the first year, and between 1·16 (1·16–1·17) and 2·28 (2·25–2·32) times as many remitted cases at the end of the second year. Interpretation: Restoring economic and housing resources to populations affected by a natural disaster would significantly reduce the mental health burden in populations, particularly those with resource loss, after a disaster. Funding: US Department of Health and Human Services.http://www.sciencedirect.com/science/article/pii/S2542519619300129
collection DOAJ
language English
format Article
sources DOAJ
author Gregory H Cohen, MPhil
Shailesh Tamrakar, MS
Sarah Lowe, PhD
Laura Sampson, BA
Catherine Ettman, BA
Dean Kilpatrick, ProfPhD
Benjamin P Linas, MD
Kenneth Ruggiero, ProfPhD
Sandro Galea, ProfMD
spellingShingle Gregory H Cohen, MPhil
Shailesh Tamrakar, MS
Sarah Lowe, PhD
Laura Sampson, BA
Catherine Ettman, BA
Dean Kilpatrick, ProfPhD
Benjamin P Linas, MD
Kenneth Ruggiero, ProfPhD
Sandro Galea, ProfMD
Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
The Lancet Planetary Health
author_facet Gregory H Cohen, MPhil
Shailesh Tamrakar, MS
Sarah Lowe, PhD
Laura Sampson, BA
Catherine Ettman, BA
Dean Kilpatrick, ProfPhD
Benjamin P Linas, MD
Kenneth Ruggiero, ProfPhD
Sandro Galea, ProfMD
author_sort Gregory H Cohen, MPhil
title Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
title_short Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
title_full Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
title_fullStr Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
title_full_unstemmed Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
title_sort improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study
publisher Elsevier
series The Lancet Planetary Health
issn 2542-5196
publishDate 2019-02-01
description Summary: Background: Hurricanes and other natural disasters produce public health and economic consequences that last well beyond their immediate aftermath. Resource loss is a core driver of post-traumatic stress disorder (PTSD) after large-scale traumatic events. We examined the effect of restoration of residential and housing-related financial resources on recovery from PTSD in post-disaster contexts. Methods: We built an agent-based model, empiricised with observational and experimental data, to test the effects of differing health service approaches on PTSD recovery, measured by prevalence and persistence. We tested a social services case management (SSCM) approach similar to Psychological First Aid, featuring shelter-based social service provision and linkage to mental health treatment for people who were displaced and had income loss, by comparing the treatment effectiveness of usual care alone, usual care with SSCM, stepped care alone, and stepped care with SSCM. Findings: An SSCM approach to restore housing and provide linkage to mental health services among people who were displaced and had income loss after a large-scale natural disaster resulted in between 1·56 (95% CI 1·55–1·57) and 5·73 (5·04–6·91) times as many remitted PTSD cases as non-SSCM conditions at the end of the first year, and between 1·16 (1·16–1·17) and 2·28 (2·25–2·32) times as many remitted cases at the end of the second year. Interpretation: Restoring economic and housing resources to populations affected by a natural disaster would significantly reduce the mental health burden in populations, particularly those with resource loss, after a disaster. Funding: US Department of Health and Human Services.
url http://www.sciencedirect.com/science/article/pii/S2542519619300129
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