Health-care and social service providers affected by climate-related disasters play a pivotal role in response and recovery but yet are at a disproportionate risk for mental health symptoms such as posttraumatic stress disorder (PTSD), secondary traumatic stress, anxiety, and burnout. Factors such as social support and resilience may protect these providers from stress related symptoms. To explore providers' responses to recent disasters, this study examined mental health distress, work-related stress, and protective factors in Texas and Puerto Rico-both of which were struck by hurricanes in 2017. This study was conducted with N ϭ 1,101 health-care and social service providers 10 to 12 months after hurricanes Harvey and Maria. Providers completed measures of PTSD, anxiety, burnout, secondary traumatic stress, compassion satisfaction, social support, and resilience. Frequencies were calculated to determine percentages of those who scored above the clinical cutoff for mental health symptoms. One-way analyses of variance explored differences in mental health symptoms between Texas and Puerto Rico. Bivariate correlations examined the relationships between all measures. Puerto Rican participants scored significantly higher on measures of PTSD, anxiety, and compassion satisfaction. Participants in Texas reported significantly higher burnout and resilience. Measures of PTSD, anxiety, burnout, and secondary traumatic stress were positively correlated. Social support, resilience, and compassion satisfaction were inversely correlated with measures of distress. Findings confirm high rates of mental health distress among providers during the disaster recovery. Given our findings, it is critical for accessible, evidence-informed interventions be available for providers.

Background: In 2015, a 7.8 magnitude earthquake struck Nepal, causing unprecedented damage and loss in the mountain and hill regions of central Nepal. The aim of this study was to investigate the association between healthcare access and utilization, and post-disaster mental health symptoms. Methods: A cross-sectional study conducted with 750 disaster-affected individuals in six districts in central Nepal 15 months post-earthquake. Anxiety and depression were measured through the Depression, Anxiety and Stress Scale (DASS-21). Healthcare utilization questions examined types of healthcare in the communities, utilization, and approachability of care providers. Univariate analyses, ANOVAs and Tobit regression were used. Results: Depression and anxiety symptoms were significantly higher for females and individuals between 40–50 years old. Those who utilized a district hospital had the lowest anxiety and depression scores. Participants who indicated medical shops were the most important source of health-related information had more anxiety and depression than those who used other services. Higher quality of healthcare was significantly associated with fewer anxiety and depressive symptoms. Conclusions: Mental health symptoms can last long after a disaster occurs. Access to quality mental health care in the primary health care settings is critical to help individuals and communities recover immediately and during the long-term recovery.

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Objectives This study examined the mediating or moderating relationship of social health on physical health and post-traumatic stress symptoms among displaced Syrians and Jordanians at high risk for physical and mental health ailments. Frequency of mental health symptoms stratified by demographic factors was also explored. We hypothesized social health would mediate and/or moderate the relationship between physical and post-traumatic stress symptoms (PTSS). Methods This cross-sectional study includes 598 adults between 18 and 75 years old recruited from three health centers in the city of Irbid, Jordan, 20 km away from the Syrian border. Post-traumatic stress symptoms (PTSS) were measured through the primary care post-traumatic stress disorder checklist. Physical and social health were assessed through the Duke Health Profile. One-way ANOVA and independent samples T-tests examined mean scores of social health, PTSS, physical health stratified by age, gender, nationality, education level, and trauma exposure. Bivariate correlations explored the relationship between social health, PTSS, and physical health. PROCESS macro tested social health as a moderator and mediator on the association of the physical health and PTSS. Results Social health moderated and mediated the relationship between physical health and PTSS. Males reported ( t = 2.53, p < .05) better physical health scores than females. Those who had less than a high school education reported lower social health ( F = 13.83, p < .001); higher PTSS (F = 5.83, p < .001); and lower physical health (F = 5.76, p < .01) than more educated individuals. Syrians reported significantly higher PTSS (F = 4.13, p < .05) than Jordanians, however, there was no significant differences between nationality for physical or social health. Social health was positively associated with better physical health (r = 0.10, p < .01) and negatively with PTSS (r = -.293, p < .01). Conclusions Our results support our primary hypothesis suggesting social health mediates and moderates PTSS and physical health. Secondary findings illustrate gender, educational, and income differences in physical health and PTSS. Clinical trials registry NCT03721848

ObjectivesWe estimated war-related Iraqi mortality for the period 1980 through 1993.MethodTo test our hypothesis that deaths reported by siblings (even dating back several decades) would correspond with war events, we compared sibling mortality reports with the frequency of independent news reports about violent historic events. We used data from a survey of 4,287 adults in 2000 Iraqi households conducted in 2011. Interviewees reported on the status of their 24,759 siblings. Death rates were applied to population estimates, 1980 to 1993. News report data came from the ProQuest New York Times database.ResultsAbout half of sibling-reported deaths across the study period were attributed to direct war-related injuries. The Iran-Iraq war led to nearly 200,000 adult deaths, and the 1990–1991 First Gulf War generated another approximately 40,000 deaths. Deaths during peace intervals before and after each war were significantly lower. We found a relationship between total sibling-reported deaths and the tally of war events across the period, p = 0.02.ConclusionsWe report a novel method to verify the reliability of epidemiological (household survey) estimates of direct war-related injury mortality dating back several decades.