By DarrenRD - File:Landscape view of wildfire near Highway 63 in south Fort McMurray.jpg, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=48561288
FORT MCMURRAY — As wildfire season and the 10th anniversary year of the Fort McMurray wildfire move toward their close, published research led by psychologist Dr. Geneviève Belleville offers a detailed look at the disaster’s psychological effects and the challenge of treating them.
Belleville, a professor at Université Laval, has been part of a research team studying the mental-health needs of people evacuated during the May 2016 wildfire since the disaster. The work has ranged from documenting post-traumatic stress and sleep problems in the months after the evacuation to a large population-based survey a year later and a randomized trial of an online treatment program.
One of the team’s largest studies surveyed 1,510 adult evacuees approximately one year after the wildfire and found 37.7 per cent had symptoms consistent with at least one probable mental-health disorder. About one in five screened positive for more than one.
Insomnia was the most common condition, affecting an estimated 28.5 per cent of respondents. Probable post-traumatic stress disorder was found in 15.4 per cent, major depression in 15 per cent and generalized anxiety disorder in 14.2 per cent. Another 7.9 per cent screened positive for substance-use disorder.
The numbers were drawn from a random-digit telephone survey conducted between May and July 2017. Researchers interviewed 1,510 adult evacuees using validated screening tools for PTSD, insomnia, depression, anxiety and substance use. The response rate was 40.2 per cent.
The findings suggested the psychological effects of the wildfire extended well beyond the evacuation itself.
Researchers found people who had experienced mental-health problems before the fire were at greater risk across all five categories studied. Financial stress tied to Fort McMurray’s economic downturn before the wildfire was also associated with poorer psychological outcomes.
What happened after the evacuation also mattered.
Decreased work and social activity, poorer health, increased alcohol or drug use and higher levels of continuing stress were associated with more severe symptoms across four of the five mental-health conditions studied.
The researchers wrote that the findings point to the importance of the burden people experience during the year following a disaster, including stress, physical-health problems and withdrawal from work, recreation and social activities.
The study also found significant overlap between conditions.
Among respondents who screened positive for probable PTSD, 87.1 per cent also screened positive for at least one other disorder. More than 94 per cent of those with probable major depression or generalized anxiety also had at least one additional probable diagnosis.
Earlier research led by Belleville captured the psychological impact much closer to the evacuation.
That study involved 379 evacuees who completed an online questionnaire between July and September 2016, while a smaller group of 55 underwent standardized clinical interviews.
Nearly 63 per cent of the online respondents met criteria for a provisional PTSD diagnosis on a self-report questionnaire. Among those who received the more rigorous clinical assessment, 29.1 per cent met DSM-5 criteria for PTSD, 25.5 per cent for major depression and 43.6 per cent for insomnia.
The authors cautioned that the study relied on volunteers and could not be considered representative of the entire Fort McMurray population. People experiencing greater distress may have been more likely to participate.
The later population survey addressed some of that limitation through a much larger randomly selected sample.
Its estimated PTSD prevalence of 15.4 per cent one year after the fire cannot be directly compared with the earlier 29.1-per-cent clinical figure because the studies used different samples and methods. But the larger survey still found more than one-third of evacuees experiencing clinically significant symptoms associated with at least one of the mental-health conditions examined.
Sleep problems emerged prominently throughout the research.
In the early study, trouble falling or staying asleep was reported by 72.5 per cent of respondents and was among the most commonly reported post-traumatic symptoms.
One year later, insomnia remained the most prevalent probable disorder identified in the population survey.
Belleville and her co-authors noted disaster research has traditionally focused heavily on PTSD and depression while sleep has received comparatively little attention, despite growing evidence that persistent sleep problems are among the most common responses following traumatic events.
The research later moved beyond documenting the problem to testing a possible treatment.
Belleville was lead author of a randomized controlled trial examining RESILIENT, a 12-session online cognitive behavioural therapy program developed for Fort McMurray evacuees experiencing symptoms of PTSD, depression or insomnia.
The program combined approaches including psychoeducation, exposure therapy, behavioural activation, problem solving, cognitive restructuring, relaxation and mindfulness, as well as sleep hygiene and other cognitive behavioural techniques for insomnia. Participants also had access to limited contact with therapists.
A total of 136 Fort McMurray residents were randomized between the treatment and wait-list groups. Researchers found access to the program produced significant reductions in PTSD, depression, insomnia and anxiety symptoms, along with reduced disability.
More than half of those included in the treatment group’s intent-to-treat analysis showed a minimally clinically important improvement in at least one of the three primary outcomes. Among participants who completed at least half of the treatment, 82.4 per cent reached that threshold in at least one area.
The researchers found moderate treatment effects when all participants assigned to receive the intervention were included in the analysis, with larger effects among those who completed at least half of the program. Most improvements were maintained three months later.
Participation itself remained a challenge. Of the 69 people assigned to the treatment group, 32 accessed the platform and 17 completed at least half of its content. The researchers noted online treatment may not suit everyone and said improving participation and adherence remains important when considering internet-based mental-health programs after disasters.
Taken together, the research traces a broader arc through Fort McMurray’s experience: from measuring the acute psychological symptoms appearing after the evacuation, to examining their prevalence and predictors a year later, and ultimately testing whether specialized care could be delivered remotely to people continuing to experience those symptoms.
The population-based study cautioned that its screening instruments identified probable disorders rather than providing formal psychiatric diagnoses and could not establish that the wildfire directly caused the conditions observed.
Still, researchers concluded that more than a third of evacuees were experiencing clinically significant psychological symptoms a year after the disaster and said post-disaster planning should consider a person’s psychiatric history, financial circumstances and the continuing consequences of the event when identifying those most at risk.
Comments