Hacia un cambio de paradigma en la atención psicológica en grandes emergencias: de incidentes con múltiples víctimas a incidentes con múltiples afectados / Towards a paradigm shift in psychological care in major emergencies: from incidents with multiple victims to incidents with multiple victims

Las grandes emergencias o desastres plantean grandes retos a la sociedad y en especial a todos los servicios de emergencia. En las últimas décadas, se ha incorporado la perspectiva de la salud mental como una parte importante de la atención sanitaria integral a los afectados. Así, el cambio conceptual de «incidente de múltiples víctimas» (IMV) a «incidente de múltiples afectados» (IMA) se centra en la atención y bienestar de todas las personas afectadas por un incidente, no solo en aquellos que han sufrido lesiones físicas. El objetivo del presente artículo se centra en conocer las posibilidades de intervención con afectados etiquetados en un triaje como verdes psicológicos (sin afectación y/o lesiones físicas), a partir de la intervención psicológica avanzada en emergencias (IPA). La IPA, más allá de alejar a los afectados del peligro, persigue aumentar su sensación de control y eficacia, tanto para afrontar la situación como para aumentar su sentido de competencia en la vivencia de trauma posterior respecto a esa experiencia. En este sentido, las posibilidades recientes de evaluación, así como los enfoques de primeros auxilios psicológicos, permiten nuevas aplicaciones de intervención en emergencias como las que posibilitan los soportes aéreos remotos (drones). Se discute su aplicación y posibilidades como opciones de futuro. (AU)

Major emergencies or disasters pose great challenges to society and especially to all emergency services. In the last decades, the Mental Health perspective has been incorporated as an important part of comprehensive health care for those affected. Thus, the conceptual change from “multiple casualty incident” (MCI) to “multiple affected incident” (MAI) focuses on the care and well-being of all people affected by an incident, not only those who have suffered physical injuries. The objective of this article is focused on finding out the possibilities of intervention with patients labeled in triage as psychological green (without affectation and/or physical injuries), based on advanced psychological intervention in emergencies (IPA). The IPA, beyond removing those affected from danger, seeks to increase their sense of control and efficacy, both to face the situation and to increase their sense of competence in the experience of subsequent trauma with respect to that experience. In this sense, recent assessment possibilities, as well as psychological first aid approaches, allow new intervention applications in emergencies such as those made possible by remote air support (drones). Its application and possibilities as future options are discussed. (AU)

Characterization and Evolution of Mental Health Problems Attended to in a Telephone Helpline During the Lockdown and De-Escalation by COVID-19.

Objectives: To picture the psychological impact on the general population consulting the Emergency Medical System (EMS) of Catalonia for psychological assistance due to the COVID-19. Methods: Calls received to the 061 emergency phone number between the months of March and June 2020 (period of lockdown and de-escalation) were analyzed. The reason, most prevalent psychological symptoms, presence of psychological antecedents, and type of intervention that was carried out were analyzed. Results: A total of 2,516 calls were analyzed. Weeks 6, 7, 8 and 9 of lockdown saw the highest volume of calls (298, 314, 282 and 290 daily calls, respectively). The main profile of the affected person was women, under the age of 50 who are responsible for others. Psychologically, they present symptoms of depression (7.33%) and anxiety (39.44%). The greatest impacts on mental health throughout lockdown seem to be related to an increase of interpersonal conflict (8.8% < 11.2%), work-related problems (1.7% < 4.6%), and problems of psychological distress (6.5% < 17.0%). Conclusion: The information obtained enables us to better understand the possible evolution of the impacts on mental health derived from the lockdown.

A Web-Based App for Emotional Management During the COVID-19 Pandemic: Platform Development and Retrospective Analysis of its Use Throughout Two Waves of the Outbreak in Spain.

BACKGROUND: Quarantines and nationwide lockdowns implemented for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the nationwide lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a web-based app to promote emotional self-care in the general population and facilitate contact with health care professionals. OBJECTIVE: This study aimed to describe a web-based app and analyze its utilization pattern throughout 2 successive waves of the COVID-19 outbreak in Spain. METHODS: Our web-based app targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile app for adjuvant treatment of posttraumatic stress disorder (ie, the PTSD Coach app) to the general population and the pandemic or lockdown scenario. We retrospectively assessed the utilization pattern of the web-based app using data systematically retrieved from Google Analytics. Data were grouped into 3 time periods, defined using Joinpoint regression analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave. RESULTS: The resulting web-based app, named gesioemocional.cat, maintains the navigation structure of the PTSD Coach app, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 and the 7-item Generalized Anxiety Disorder scale and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized in accordance with a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (ie, positive or negative) of the information. Positive information pieces (eg, relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the web-based app. CONCLUSIONS: mHealth tools may help the general population cope with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population-including individuals without diagnosed mental illnesses-and strategies to reach as many people as possible.