Use of the toolkit
This toolkit presents different options to conduct surveillance of post-disaster mental health impacts. First, it presents options to estimate impacts based on existing data. It then recommends the standardized instruments to be use in epidemiological studies, which engenders new data. Figure 1 summarizes the options that the toolkit proposes.
Figure 1 - How to use the toolkit
One of the first steps to conduct post-disaster surveillance is to ascertain whether data are already available to initially provide a portrait of the situation.
The surveillance systems, presented in section 2, and the major population-based surveys, presented in section 3, can contain post-disaster surveillance indicators of interest. The systems and major surveys can contain data on certain potential post-disaster impacts, especially in the realm of mental health and, depending on how frequently they are updated, it may be possible to obtain worthwhile measurements to conduct follow-up over time. However, access to certain systems or databases may be restricted. Accordingly, various portals enable surveillance interveners to quickly access statistics through a user-friendly interface. Certain indicators drawn from major surveys or surveillance systems are disseminated on the portals (see section 4).
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.
When the data available do not satisfy surveillance needs, it is possible to conduct a population-based survey to more accurately measure certain impacts on a clearly defined population. Section 5 of the toolkit presents in the form of information sheets regional post-disaster studies in Québec or in France and again presents certain major population-based surveys. The studies should include at least one section (or one indicator) on mental health impacts. While the prevalences estimated in the studies are probably not comparable from one disaster to the next, the information in the information sheets, especially the references, could 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.
To help interveners navigate in all the instruments available, section 6 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. The committee of experts’ recommendations take into account the interveners’ current context in the health network, i.e. sometimes limited financial and human resources and the wide range of topics to be included in such surveys. Among those, the instruments 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 for the instruments recommended follows the recommendations (section 6.2). The items used to elaborate the instruments recommended, i.e. the questionnaire, are found in the last section of the toolkit when they are in the public domain (section 6.3).