ABSTRACT
Background: Disasters are broadly defined as “encounters between forces of harm (hazards), and a vulnerable human population in harm's way, that create demands exceeding the coping capacity of the affected community,” (Shultz, 2014). Disasters predictably produce behavioral and psychosocial consequences;in fact, more survivors are affected psychologically than are harmed physically. Type of disaster event, severity and duration of exposure, geographic scope, and extremity of resource losses contribute to distress and diagnosable psychopathology. For persons currently undergoing treatment for disease, injury, or life-changing medical condition, exposure to a disaster may complicate their care, exacerbate their condition, threaten their survival, and trigger psychological reactions. The ongoing COVID-19 pandemic has increased baseline population prevalence rates of common mental disorders worldwide, thereby compounding risks for psychopathology among persons whose communities are affected by disaster. The current era, marked by layered stressors, creates a compelling impetus to train upcoming psychiatrists on skills to support disaster survivors, including those with special needs. We are designing and implementing a curriculum to teach the principles of disaster behavioral health to our psychiatry residents based aligned with national guidelines (Flynn and Morganstein, 2020). Method: An electronic survey was distributed to psychiatry residents to assess their current knowledge and skill levels for performing key actions when dealing with disaster survivors, post-impact. Residents were asked to rate their current knowledge regarding disaster behavioral health principles, their confidence for providing psychological support to disaster survivors, and their interest in evidence-based disaster behavioral health training, grounded on national recommendations. Interested residents will participate in an expert-led lecture series that will include pre- and post-training assessment of disaster behavioral health knowledge and skills. Results: The initial interest survey garnered a 40% resident response rate. Apart from rating their ability to “gather information in a disaster situation” at 4-of-5, most residents rated their current knowledge levels and confidence in their skills to provide support to disaster survivors at 2-of-5 or below. Regarding interest in a disaster behavioral health lecture series, 86% indicated they would be interested. Pre- and post-training assessment are pending the delivery and completion of the lecture series. Discussion: Initial resident survey results demonstrate limited knowledge of disaster behavioral health principles, low levels of confidence in skills to support the psychological needs of survivors, and strong interest in receiving training. Conclusion: We will proceed to develop a robust disaster behavioral health training curriculum for our residents, starting with a lecture series featuring experts in the field and rapidly expanding to skills training and real-world disaster deployment/response opportunities. References: 1. Flynn BW, Morganstein JC. Curriculum Recommendations for Disaster Health Professionals: Disaster Behavioral Health, Second Edition, 2020. 2. https://www.usuhs.edu/sites/default/files/media/ncdmph/pdf/ncdmph_csts_revised.pdf 3. Shultz JM. Perspectives on disaster public health and disaster behavioral health integration. Disaster Health. 2014;2(2):69-74.
ABSTRACT
Background/Purpose: We present a case study demonstrating how cancer support services assisted a patient diagnosed with diffuse large B-cell lymphoma (DLBCL) to cope throughout the COVID-19 pandemic. Perceived social isolation and loneliness were exacerbated for this patient due to the interaction of 1) cancer diagnosis, 2) COVID- 19 social distancing, 3) inability of vaccination to produce immunity to COVID-19, and 4) diminution of her social network due to aging. Methods: We summarize clinical encounters and chart review for an 88-year-old female patient (divorced, living with son) with DLBCL evaluated at a large urban university hospital to illustrate the impact of cancer support service interventions on social isolation and loneliness. Results: Systematic review revealed that interventions such as exercise, mindfulness-based practice, Tai Chi Qigong meditation, and art therapies decrease loneliness and increase perceived social support. The patient consistently observed COVID-19 social distancing precautions throughout the pandemic, receiving Pfizer vaccine immediately once available, and Moderna vaccine thereafter. However, she did not develop antibodies, reinforcing her need to strictly isolate. The patient has participated in a regimen of online cancer support activities: twice-weekly group exercise physiology sessions and gentle chair yoga sessions, twice-monthly individual exercise physiology, weekly music therapy, weekly chaplain meetings, and daily treadmill walking. She recognizes distress and anxiety as temporary feelings and understands how these support activities enhance her repertoire of coping strategies. Despite being restricted to home;she states that regular interaction with her support services team-and attentive care from her son-have decreased feelings of loneliness. Conclusions and Implications: Our patient has demonstrated resilience, overcoming the combined challenges that amplify loneliness and social isolation: DLBCL diagnosis, lack of COVID-19 antibody response, and aging. Although she is unable to socialize in person, her interactions with cancer support services staff and engagement in a suite of activities have mitigated loneliness and isolation.