Regardless of its nature, a major disaster such as an earthquake, flooding, an ice storm, a nuclear transport accident or an attack can engender a broad range of impacts on individual health and well-being and on the economy and the environment. The authorities usually properly document the immediate effects, especially as regards physical health and economic aspects. However, mental health impacts can be perceived as harder to document.
Individuals who have experienced a disaster can develop or exacerbate mental health problems that may appear several months after a disaster. It is necessary and crucial that mental health resources and services be available to help a community recover from a disaster. To ensure continued support for the community by offering sufficient, appropriate services, monitoring of the mental health impacts in the population affected becomes important. It should continue several years after an event in certain cases.
In Québec, epidemiological surveillance has existed for a long time but only a few epidemiological and surveillance studies have been conducted after major disasters. Since then, with the increase in certain climate-related disasters, interest appears to be growing in carrying out surveillance of mental health impacts in respect of disasters of all scales. However, the means used to conduct such surveillance differ considerably from one study to the next and make comparisons difficult.
Accordingly, this toolkit has been developed to make available tools that facilitate appropriate, reproducible surveillance of post-disaster mental health impacts. Experts in the realm of mental health and surveillance from various Québec institutions have elaborated it. It is aimed mainly at public health professionals and epidemiologists, researchers and other interveners who wish to document post-disaster mental health impacts using standardized, evaluated tools that are available free of charge.
Potential impacts on mental health
The toolkit does not cover all mental health impacts. It is mainly mental health problems that have been documented along with certain aspects of well-being and positive mental health. Furthermore, tools related to other indicators of interest in post-disaster surveillance are presented concerning the following effects:
- anxiety symptoms;
- depressive symptoms;
- post-traumatic stress disorder symptoms;
- psychological distress;
- immediate impact of the trauma (peritraumatic reactions);
- functioning and disability;
- quality of life;
- social support;
- alcohol use;
- drug use;
- medication use;
- use of mental health services.
Existing surveillance data
There are already several surveillance systems in Québec that disseminate health indicators and determinants from an array of sources. The toolkit describes several of the surveillance systems. Another section of the toolkit presents population-based surveys conducted by Statistics Canada and the Institut de la statistique du Québec (ISQ). The surveillance and survey systems selected in the toolkit present indicators related to mental health or other indicators of interest to conduct post-disaster surveillance.
Indicators drawn from such surveillance systems and large-scale population-based surveys are a good starting point to obtain statistics related to mental health. What is more, depending how frequently they are updated, they can provide worthwhile measurements to conduct follow-up over time. However, it is difficult to predict the place and time that a disaster occurs. Such surveillance systems and major surveys might not properly target the population affected by the disaster (insufficient geographic resolution) or might not have been conducted at the appropriate time. Such data can then be used to estimate prevalences related to the pre-disaster state of mental health. A survey specific to the disaster must be conducted subsequently to obtain post-disaster prevalences.
Accordingly, the toolkit presents in the form of information sheets a list of the surveys conducted in the wake of a disaster in Québec or in France that includes at least one section on mental health impacts. Each sheet contains information on the study, i.e. the objectives, the target population, the type of survey, the year of data collection, the contents of the survey, and the standardized instruments used. While the prevalences estimated in the studies are probably not comparable from one disaster to the next, the information in the sheets can help interveners to elaborate their research protocols. However, it should be noted that certain instruments used in the studies are no longer topical while others are protected by copyright and sometimes subject to payment.
New data obtained through surveys
To help interveners navigate in all the instruments available, the last section of the toolkit presents recommendations from the committee of experts established to produce the toolkit, concerning the standardized instruments that should be used to measure certain post-disaster impacts in epidemiological studies. A standardized measurement instrument is a rigorously developed tool that measures a concept (or an indicator) in an objective, standardized manner. The instruments must undergo rigorous validation processes.
The committee of experts’ recommendations take into account the interveners’ current context in the health network, i.e. the sometimes limited financial and human resources and the wide range of topics to be included in such surveys. Among those, the instruments recommended must be available free of charge with a succinct number of items and include a guide to interpret the findings.
An information sheet specifying the conditions of use and the interpretation of the scores is available for each instrument recommended. The items used to elaborate the instruments recommended are reproduced at the end of the toolkit when they are in the public domain.
This toolkit presents two main options to conduct surveillance of post-disaster mental health impacts. First, it compiles a list of existing sources that yield statistics drawn from surveillance systems, population-based surveys or other databases of interest for the surveillance of mental health impacts. It then recommends standardized instruments to be used during post-disaster surveys.
The information sheets on the instruments have been designed to facilitate their use and the judicious choice of certain tools will provide a better picture of the situation in the wake of a disaster. Such a picture will afford a sound way to verify the needs of the population affected with respect to the resources and mental health services that are often crucial to help a community recover from a major disaster. In this context, surveillance could be conducted over several years. It is the authors’ hope that this toolkit can become a reference in the realm of post-disaster surveillance in Québec. The objective is to facilitate surveillance activities and to standardize surveillance indicators between different studies to ensure better spatial and temporal comparability of the population’s mental health status.