Title: Protecting wellbeing during and after a major incident
Funder: Department of Health and Social Care

Abstract: Work will occur in two strands. In the first, we will develop ways of protecting the mental well-being of people affected by a major incident, focusing on the needs of direct victims within trauma-affected organisations, emergency responders and primary care practitioners. We will assess the issues and opportunities which result from organisational management practices in trauma-affected and responder groups (including staff of accident and emergency departments and primary care staff) and examine the impact of accessing social networks such as pre-existing occupational groups or a trauma-specific support group. In our second strand of work, we will develop techniques for reducing the impact of physical symptoms that develop following a disaster but which are unrelated to any chemical, biological or radiological (CBR) exposure. First, we will explore why patients with these symptoms seek healthcare following a major incident and identify how best to address their real healthcare needs. These patients were previously and unhelpfully described as ‘the worried well,’ but are better characterised as patients at ‘low risk’ of having been exposed to CBR. Second, we will explore the needs of patients and healthcare practitioners involved in an incident of probable mass psychogenic illness (MPI) and develop guidance to assist them. Third, we will develop interventions to reduce the incidence of psychologically-mediated symptoms (‘nocebo effects’) that occur when patients are asked to take emergency prophylactic medication following potential exposure to a CBR agent. Objectives for the distress and psychological health disorders strand Short-term: 1) Identify factors associated with distress and psychological health disorders among non- healthcare related occupational groups, emergency responders and primary care staff affected by disaster. 2) Evaluate the evidence base for existing interventions to reduce distress and psychological health disorders following disaster among occupational groups, emergency responders and primary care practitioners. 3) Develop interventions to reduce the psychological impact of a major incident among occupational groups and emergency responders, and assess its applicability to primary care staff. Medium-term: 1) Assess the acceptability of our interventions among occupational groups at risk of trauma and emergency responders, and refine these where necessary. 2) Develop protocols to allow the testing of these interventions both proactively (before an incident) in emergency responders and reactively (after an incident) in major commercial organisations at risk of trauma exposure. Long-term: 1) Evaluate the impact of our interventions for emergency service organisations given that such organisations predictably have to deal with significant incidents as part of their routine duties. 2) Evaluate the impact of our interventions aimed at supporting trauma-exposed personnel within commercial organisations after an incident. Objectives for the medically unexplained symptoms strand Short term: 1) Identify the likely proportion of people who will seek medical care following a CBR incident who are at low risk of having been exposed to a CBR agent and identify the factors that increase the likelihood of them seeking care. 2) Assess whether specific post-incident actions such as being placed on a register or being asked to record symptoms online are perceived as reassuring or worrying by low risk patients. 3) Identify factors that help or hinder the ability of patients and public health practitioners to cope with events initially suspected of being chemical incidents but where the cause of symptoms remains unclear despite appropriate investigation. 4) Develop a brief psychoeducational intervention to reduce the likelihood of people experiencing nocebo effects following administration of emergency prophylaxis. Medium term: 1) Develop a brief web-based questionnaire that can be provided to members of the public following a major incident to assess their physical symptoms and psychological wellbeing. 2) Obtain pilot data on the likely acceptability and effectiveness of the online questionnaire among members of the lay public. 3) Develop evidence-based guidance and educational material to support patients, emergency responders and public health practitioners involved in possible incidents of MPI. 4) Pilot test the effectiveness of our brief psychoeducational intervention in affecting the key psychological mechanisms believed to underlie nocebo effects. Long term: 1) Evaluate the acceptability of our online symptoms and well-being questionnaire among patients seeking healthcare following future public health incidents. 2) Evaluate the ability of our brief psychological intervention to reduce the nocebo effect.


Research activity codes: 7.4 RESOURCES AND INFRASTRUCTURE (DISEASE MANAGEMENT)
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE