1. Introduction
1.1 Background
Australia has long experienced significant natural disasters, and due to climate change is experiencing more frequent and more severe disasters, with rural Australia expected to be disproportionately impacted.Reference Maurice1 Natural disaster impacts can range from loss of life, property, or livelihood to physical and mental health impacts.2 Australian populations, in particular rural Australian populations, are at risk of acute and prolonged mental health issues post disasters.Reference Batterham, Brown and Trias3 At the same time, there is insufficient mental health workforce to support current needs, much less to support the likely increase in mental health issues as disaster frequency increases.4
Important research and policy work have been undertaken to examine and inform communities on how to prepare physically for disasters.2, 4 However, limited work has been done in psychological preparedness,Reference Boylan and Lawrence5 particularly within rural Australia.Reference Roudini, Khankeh and Witruk6 Evidence suggests that psychological preparedness, defined here as the capacity to anticipate, understand, and manage emotional and psychological response to a disasterReference Boylan7 is associated with better physical disaster preparation, lower mental health impacts, and improved recovery efforts following a disaster.Reference Every, McLennan and Reynolds8, Reference McLennan, Marques and Every9
A better understanding of psychological preparedness in rural Australia is required, as rural communities are likely to be disproportionally impacted by disasters and post-disaster mental health challenges but face long-standing shortages in mental health and other support services.
1.2 Objective
This article aims to provide preliminary insights into factors that may be associated with better psychological preparedness and explore the relationship between psychological preparedness and mental health among Australian rural residents.
2. Methods
2.1 Study Design
This study used quantitative data from a cross-sectional online survey design.
2.2 Setting
The study was conducted online and was open to participants nationally.
2.3 Recruitment
A link to the online survey was distributed via e-mail and social media posts by initially using personal and professional networks of the author’s, consenting participants from a previous study, and subsequent snowballing recruitment. Inclusion criteria comprised residing in Australia and being aged 18 years and over.
2.4 Data Collection
Study data were collected and managed using REDCap™ electronic data capture tools from November 2022 to March 2023.
2.5 Measures
Primary measure
The 8-item Awareness, Anticipation and Management (AAM) subscale from the short form of the Psychological Preparedness for Disaster Threat Scale (PPDTS) was used in this study.Reference McLennan, Marques and Every9 This measure was chosen based on McLennan et al., who concluded that the PPDTS was suitable for investigating psychological preparedness across a range of disaster types in English-speaking Australian contexts, following their rigorous comparison of eight self-report measures of psychological preparedness, confirmatory factor analysis, and validity testing.Reference McLennan, Marques and Every9 The subscale score for this study demonstrated high internal consistency (α = 0.93) comparable to the McLennan study (α = 0.96).Reference McLennan, Marques and Every9
Associated variables
Key demographic variables of interest included geographical location (MMM), sex, and age. Preparedness variables of interest were: Experienced a disaster other than COVID since 2018, number of disasters experienced, changed how you prepare for a disaster, and three specific physical preparedness items: household emergency plan, preparation of supply of food and water in the house, and emergency survival kit in the house, with all binary response options (yes/no).
Depression Anxiety Stress Scale-21 (DASS-21)
The DASS-21 is a 21-item non-diagnostic measure of the emotional states associated with depression, anxiety, and stress. It contains 3 self-report subscales of seven items each, relating to depression, anxiety, and stress. Respondents are asked to rate each item on a four-point scale reflecting the regularity of each concern over the preceding week. The DASS-21 possesses good internal consistency across the subscales and overall scale (α > 0.81), and convergent and discriminant validity has been established. The overall score for the study demonstrated high internal consistency (α = 0.94).
2.6 Data Analysis
Data analysis utilized SPSS version 29.
Descriptive analysis was used for all variables. Binomial regression was used to examine the relationship between geographical location and disaster experience. ANOVA was used to explore univariable relationships between PPDTS AAM scores and theorized variables of interest.
2.7 Ethics Approval and Consent
This study received ethical approval from the University of Melbourne Human Research Ethics Committee (Project ID: 14095).
3. Results
3.1. Characteristics of the Participants
A total of 388 people responded to the survey. Characteristics of the participants are detailed in Table 1.
Characteristics of the participants
* Participants could tick all responses that apply
3.2. Experience of Disaster
Of the cohort, 45% of the rural participants had experienced a disaster other than COVID-19 since 2018, compared to only 6% of metropolitan participants. A univariable binary logistic regression indicated that those individuals who live in a rural location were aOR: 11.59 times more likely to have experienced a disaster since 2018 (excluding COVID-19), compared to those who live in a metropolitan area (X2 = 58.75 (1), n = 355, P <0.001).
Of those who had experienced a disaster other than COVID-19 since 2018 (n = 124), 68% had experienced one disaster, 25% had experienced two disasters, and 5% had experienced three or more disasters, with most of these multiple disasters being experienced by those in rural areas (95%).
3.3. Factors Associated with Psychological Preparedness
ANOVA results indicated that male sex, older age, rural location, having experienced a disaster, and specific physical preparedness items (having a household plan and emergency survival kit in the house) were statistically significantly associated with higher PPDTS scores (see Table 2).
Association between PPDTS AAM scores and other factors
* Statistically significant at 0.05.
** Statistically significant at 0.01.
*** Statistically significant at 0.001.
ANOVA results indicated that those individuals with DASS scores indicative of elevated levels of depression, anxiety, and stress had statistically significantly lower PPDTS AAM scores compared to those who had normal DASS scores (see Table 2).
4. Discussion
This preliminary study is the first to the author’s knowledge to have explicitly examined the use of the PPDTS AAM psychological preparedness scale with a rural Australian population. PPDTS AAM scores for this study (μ = 23.1, SD: 5.02) were comparable to those from another Australian study (μ = 24.5, SD: 5.38); however, the residential location of the participants in the study is not reported.Reference Every, McLennan and Reynolds8, Reference McLennan, Marques and Every9
Rural people in this study have significantly higher risk of experiencing disasters, including multiple disasters. This finding is consistent with other literature where rural people are more likely to experience natural disasters,Reference Morrissey and Reser10 and have been shown to be at higher risk of experiencing multiple disasters.Reference Morrissey and Reser10 However, rural people in this study had better psychological preparedness scores compared to metropolitan people. This may be due to rural communities being confronted with the risk of disasters, including cumulative disasters,Reference Morrissey and Reser10 and needing to develop skills in personal resilience, or self-efficacy,Reference Morrissey and Reser10, Reference Hamann, Mello and Wu11 in part by drawing upon the high levels of social capital that exist in rural communities in the context of poorer access to services, which has been associated with community disaster resilience.Reference Zhao, Hui and Zhao12
Being male, older, and more physically prepared for disasters was positively associated with psychological preparedness, which is consistent with other literature.Reference Every, McLennan and Reynolds8, Reference McLennan, Marques and Every9 It has been reported that older age may be associated with greater knowledge and a better ability to cope due to a longer period of life experience,Reference Boylan7 or age as proxy for experiencing more life events. Similarly, Boylan demonstrated a relationship between owning a property and higher levels of psychological preparedness, with older people more likely to own their own property.Reference Boylan7 Female sex has been identified in the literature as having lower levels of both physical and psychological preparedness in relation to bushfire,Reference Every, McLennan and Reynolds8 reported to be due to lower confidence in bushfire situations,Reference Every, McLennan and Reynolds8 or lower knowledge of how to respond in an emergency,Reference Boylan7, Reference Every, McLennan and Reynolds8 rather than a limited coping capacity.Reference Boylan7
Those who were physically prepared by having a household plan and an emergency survival kit in the house were found to have higher psychological preparedness scores than those who didn’t. This is consistent with previous literatureReference Levac, Toal-Sullivan and O’Sullivan13 and may be reflective of personal attributes underlying these associations such as coping style, resilience, self-efficacy, optimism, and internal locus of control, as these personal attributes have been associated with psychological preparedness.Reference Every, McLennan and Reynolds8, Reference Gandhi, Sahu and Govindan14
Respondents with higher scores for depression, anxiety, and stress had lower psychological preparedness scores, also consistent with other literature.Reference Roudini, Khankeh and Witruk6, Reference McLennan, Marques and Every9 Together these results suggest that while some groups of people are psychologically prepared for natural disasters and can therefore be expected to fare relatively well after disaster, other groups, including people with pre-existing mental health symptoms may need greater support to psychologically prepare and reduce the risk of poor mental health outcomes post disaster. The majority of those with mental health conditions in this study were seeing their doctor or general practitioner for mental health treatment rather than specialized mental health practitioners,Reference Podubinski, Glennister and McNeil15 likely due to access to specialized mental healthcare being more limited in rural areas.Reference Kavanagh, Corney and Beks16 Thus, investment in psychological preparedness for natural disasters, by the development of locally informed and co-designed programs and initiatives that build the emotional capacity of communities to manage disaster, including those initiatives locally informed and co-designed with Australian rural communities,Reference Gunn, Skaczkowski and Dollman17 would be beneficial. This investment may assist with preventing mental health exacerbations post disasters and help to alleviate the burden on mental health support providers in rural communities particularly important in areas where access to mental health support is severely limited.
The findings from this study indicate that the use of psychological preparedness interventions may be beneficial to mitigate disaster impacts. Currently there is limited evidence available regarding the impact of psychological preparedness interventionsReference Roudini, Khankeh and Witruk6, Reference Gunn, Skaczkowski and Dollman17-Reference Karanci, Aksit and Dirik21; however, those that have been trialed and evaluated, including those in rural Australia, such as the Australian Red Cross Psychological Approach to Disaster PreparednessReference Richardson, Kelly and Mackay18 and Morrissey and Reser’s public education and communication intervention related to cyclone preparednessReference Morrissey and Reser20 among others,Reference Roudini, Khankeh and Witruk6, Reference Gunn, Skaczkowski and Dollman17, Reference Raphiphatthana, Sweet and Dingwall19, Reference Gibbs, Ireton and Block22 have demonstrated promising results.
5. Limitations
Data in this study is from a cross-sectional survey. Future research should consider multiple time points to ensure adequate comparison to baseline data as well as examine comparisons to general population norms. This study population is also drawn from a convenience sample; therefore, the results are unlikely to be generalizable to the broader Australian population.
5.1 Implications
An opportunity exists to invest in the development, implementation, and evaluation of evidence-informed interventions for rural communities vulnerable to disasters to build psychological preparedness. These interventions should capitalize on existing work and build on often-cited rural community strengths, such as social capital, informal support, and resilience, shown to have been associated with community disaster preparedness and recovery. This could leverage off the considerable work already being undertaken regarding physical preparedness, to include psychological preparedness activities.
The introduction of psychological preparedness interventions would be especially useful in rural areas that have lower access to mental health and other support services, as they might assist in mitigating mental health symptoms following a disaster.
6. Conclusion
Investment in psychological preparedness for natural disasters may assist in preventing mental health exacerbation following a disaster. This is particularly important in rural areas, as these areas are more likely to experience a disaster yet have limited access to mental health support.
Acknowledgments
Nil.
Author contribution
Robyn McNeil: Conceptualization (lead); writing—original draft (lead); formal analysis (lead); and writing—review and editing (equal).
Kristen Glenister: Conceptualization (equal); methodology (equal); and writing—review and editing (equal).
Tegan Podubinski: Conceptualization (equal); project administration (lead); methodology (equal); and writing—review and editing (equal).
Competing interests
No conflicts of interest.
Funding statement
No specific funding was received for this project. Researchers are supported by the Australian Government Rural Health Multidisciplinary program. This work has not been published in part or in full elsewhere.
Ethical approval
Research was conducted in accordance with National Ethics Guidelines and received ethical approval from the University of Melbourne’s Human Research Ethics Committee (HREC).
Participants completed written informed consent before completing the questionnaire.
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