Adaptation and Evaluation of a Disaster Mental Health Intervention for Earthquake Survivors in Kathmandu Valley

Principal Investigators: Courtney Welton-Mitchell, University of Colorado & Leah James, University of Colorado

What was the purpose of the study?

In April 2015, Nepal experienced a 7.8 magnitude earthquake, followed by another of 7.3 magnitude two weeks’ later. In the immediate aftermath more than 8,000 people died, and over 480,000 houses were destroyed. This study sought to investigate the type of mental health interventions which are effective in the months following this type of disaster and in a context such as Nepal. The project focused on expanding an existing R2HC-funded study on mental health intervention activities in disaster-affected communities, which had been - implemented elsewhere in Nepal with flood-prone communities. The study sought to rapidly adapt an existing intervention and apply it to earthquake affected areas in Kathmandu Valley.

The project aimed to target two distinct populations in Kathmandu Valley: mental health service providers (themselves earthquake survivors) and displaced community members. The key objectives were to increase knowledge and skills of mental health service providers and increase their own self-care practices, whilst also decreasing earthquake-related mental health symptoms for vulnerable community members. By adapting the intervention for earthquake-affected communities, the research sought to determine the effectiveness of the intervention in an acute rapid onset disaster in addition to the previous research on chronic slow-onset disaster contexts (annual flooding).

What did the study achieve?

The intervention manual was successfully and rapidly tailored to survivors of the Nepal earthquake and translated to Nepali, along with a brief interview schedule shortened from the existing materials. A self-report assessment of service provider well-being was undertaken, followed by a 3-day disaster mental health intervention training for service providers. A post-training assessment was undertaken shortly afterwards. A pre and post intervention assessment was then undertaken with 240 vulnerable community members, half of whom received the 3-day disaster mental health intervention using the adapted materials immediately, and the second group at a later point. Focus group discussions with community members added qualitative information.

What were the key findings?

• The intervention led to a decrease in the symptoms of depression for mental health service providers, decreased their compassion fatigue and found increases in their job satisfaction.
• For vulnerable community members, the treatment resulted in a decrease in earthquake-related mental health symptoms of depression and Post Traumatic Stress Disorder (PTSD).
• An increase in people’s coping capacity (use of relaxation techniques) was found, and community members’ ability to provide peer mental health support to fellow community members increased following the intervention.
• There was also an increase in engagement with low cost disaster preparedness initiatives and behaviours amongst vulnerable community members.

What does this mean for policymakers and practitioners?

• Four dissemination workshops held for key stakeholders, community members in Bhaktapur and mental health/disaster response agencies
• Community-Based Disaster Mental Health intervention curriculum manuals published in English and Nepali languages. Over 2,000 manuals printed and disseminated to government, international and local NGOs and other stakeholders in Nepal, and shared with several disaster-affected districts. The manuals are publicly available for use in further settings.

Further work was planned by the study team to undertake additional statistical analysis and preparation of data sets for the public repository.