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Complementary Mental Health Interventions for Disaster Recovery: A Review and Critical
Appraisal of the Literature

Adrienne Connick
Justice Institute of British Columbia
BESMS 4900 - Capstone
Instructor: Beth Larcombe
Academic Advisor: Daniella Sieukaran
April 10, 2022

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Abstract
The aim of this study was to investigate the impact of using non-clinical interventions for mental
health recovery in a natural disaster context. The mental health interventions investigated were
those that offered an alternative or complementary approach which differ from the more
traditional clinical or psychiatric settings. A literature review and critical appraisal of secondary
data was conducted on studies that investigated complementary mental health interventions
(CMHIs) in natural disaster impacted communities. The interventions that presented from the
literature search were focused on mind-body connections including: yoga, meditation, breathing
techniques, and art-based programs. The literature review uncovered several themes including:
an overall reduction in perceived mental health symptoms as a result of the interventions, better
accessibility of CMHIs compared to clinical-based therapies, the need for collaborations to
integrate CMHIs into disaster recovery and research, and the challenges in conducting research
in disaster-impacted communities. Findings from the critical appraisal showed inconsistencies in
the data collection approaches, limitations in data focusing on demographic characteristics, and
limitations in data focusing on intervention effectiveness in different contexts. More research
and more standardized measurement methods would be beneficial to the field and to assist in
supporting the findings. Overall, the data from the reviewed studies found that CMHIs had a
positive impact on mental health symptoms and showed advantages for use in post-disaster
situations. The use of CMHIs has the potential to be an effective treatment method that can be
integrated into community disaster recovery planning.
Keywords: Disaster recovery, mental health, complementary interventions

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Table of Contents
Background.....................................................................................................................................4
Research Problem, Question, and Rationale...................................................................................5
Research Design and Methodology................................................................................................6
Literature Review...........................................................................................................................7
Search Methodology..........................................................................................................7
Selecting Articles and Descriptions...................................................................................7
Analysis of the Literature..................................................................................................8
Positive Impact on Mental Health Symptoms.......................................................8
Collaborations in Treatment and Research..........................................................9
Challenges in Conducting Research....................................................................10
CMHIs an Adaptable Option in Disasters...........................................................10
Critical Appraisal.........................................................................................................................11
Measurement Tools..........................................................................................................12
The Participants................................................................................................................15
Methods............................................................................................................................18
Limitations.......................................................................................................................18
Implications for Disaster Recovery Field........................................................................19
Discussion....................................................................................................................................20
Evaluation and Recommendations...............................................................................................21
Conclusion...................................................................................................................................23
References....................................................................................................................................24

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Background
Research has consistently shown that disaster events increase mental health issues in the
communities effected. With traditional healthcare resources often inundated in emergency
events, a move towards sustainable, community-led disaster mental health initiatives is needed.
Post-disaster mental health outcomes can manifest as distress reactions, health risk behaviours,
and psychiatric disorders and can be experienced in the short or long-term (Morganstein &
Ursano, 2020). Common mental health symptoms that present in larger emergencies include
grief, acute stress reactions, substance abuse, depression, anxiety and post traumatic stress
disorder (PTSD; World Health Organization [WHO], 2022). The majority of people impacted
by emergencies will experience some form of psychological distress (WHO, 2022) and thus will
benefit from psychosocial supports (Health Emergency Management BC [HEMBC], 2021).
There are three common issues that arise during emergencies in the context of mental health
including: “increased rates of mental health problems, weakened mental health infrastructure,
and difficulties coordinating agencies and actors providing mental health and psychosocial
support” (WHO, 2013, p. 10). The immediate mental health needs of community members and
the array of challenges that present during disaster events points to the need for additional mental
health program opportunities that can assist in meeting post-disaster recovery demands.
Traditional forms of mental health supports cannot meet the demand of disaster impacted
communities. Mental Health and Psychosocial Supports (MHPSS) are those supports that
“protect and promote psychosocial wellbeing, prevent mental health disorders and treat such
disorders when they occur” (International Committee of the Red Cross [ICRC], 2016, p. 1).
Clinical referral, diagnoses and treatment are an important component of disaster mental health
recovery, but resources are often overwhelmed in disaster situations where public health services

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and access to medical facilities can be seriously disrupted because of damage to electrical grids,
communication networks, and transportation infrastructure (Sledge & Thomas, 2019). There is a
need for addressing the large scale, short-term mental health symptoms that will impact many
survivors at the onset of a disaster.
One opportunity to improve disaster mental health recovery is to integrate
Complementary Mental Health Interventions (CMHIs) into community disaster planning. These
interventions focus on reducing the stressors and physiological arousal that occurs post-disaster.
CMHIs can be described as behavioural health strategies that are alternative to psychiatric or
clinical interventions. Morganstein and Ursano (2020) note that complementary and alternative
interventions have “an increasing body of knowledge support in their use in the treatment of
traumatic stress,” and found that “many individuals will prefer social and community support
over formal intervention” (p. 9). Interventions include those corresponding to mind-body and
mindfulness practices, yoga, breathing techniques, meditation, arts-based, and other nontraditional interventions which can assist in reducing mental health symptoms in participants
who have experienced trauma. These alternative or complementary intervention strategies have
the potential to improve disaster mental health response in communities.
Research Problem, Question and Rationale
Mental health in the context of disasters is an important topic and it is “crucial to the
overall well-being, functioning, and resilience of individuals, societies, and countries recovering
from natural disaster” (WHO, 2013, p. 9). The intent of this study was to explore opportunities
for alternative, complementary interventions that have the potential to assist in addressing the
mental health problems presented post-disaster. Interventions that are outside of the traditional
clinical settings may present additional opportunities for reducing post-disaster stress reactions,

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providing choices that are less stigmatized, and providing options that are more readily
accessible.
The study presents a review and critical appraisal of the existing literature to determine
the potential impact of using CMHIs for disaster recovery planning and answer the following
questions: Are CMHIs effective in reducing post-disaster mental health symptoms? What are the
advantages and disadvantages of these types of interventions? And what are the considerations
for integrating CMHIs into community disaster recovery planning?
Research Design and Methodology
The goal of the research was to analyze existing data to determine the impact, advantages
and integration of CMHIs into community disaster recovery. Utilizing secondary data from
existing studies was determined to be the most effective method for the purposes of this research
paper. It is advantageous because it does not require ethical approval, there are many outlets to
access secondary data, and it provides the opportunity to assess global studies. Data was
collected from scientific databases and a critical appraisal of the literature was conducted to
determine the validity and reliability of the data as it pertained to the proposed research
questions. The challenges that presented during the research process included determining what
search terms to include as there were many possible keywords that could be used to describe
mental health interventions and disaster recovery. As such, there was a possibility that the
literature search did not encompass all relevant studies related to the research topic. The use of
secondary data also limits the ability of the researcher to collect first hand information and thus
the data is reliant on research that is previously available.

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Literature Review
An analysis of existing literature was conducted on studies that investigated the
implications of CMHIs on disaster impacted communities. The aim of the analysis was to
identify trends in the research and to assist in answering the proposed research questions.
Search Methodology
The literature search was conducted using the following databases: JIBC Ebscohost and
Google Scholar. Several combinations of keywords were used for the search describing natural
disasters, disaster recovery, post-disaster, interventions, wellness, wellbeing, holistic, mind-body,
non-clinical, mental health, and community healing. The search was confined to English
language sources and to publications related to alternative interventions for natural disaster
recovery. Further revision to the search included filtering to include journal titles related to
emergency management, psychosocial, psychiatric, social work, and public health.
The initial search yielded 344 results of which 34 articles were selected for abstract
review. The other 310 articles were excluded based on title reviews. The Abstracts of the 34
articles were examined and 13 articles were excluded for not meeting the inclusion criteria. The
remaining 21 articles were read in full. As research in this field was limited, studies with any
age range and international studies were included. Research was limited to a publication date of
2010 or later to further narrow the results and focus on the most recent data. Six additional
articles were found using backwards citation chaining. Of these 27 articles read in full, 9 were
determined to meet the inclusion criteria for the study.
Selecting Articles and Descriptions
The articles selected for review presented academic studies that investigated a variety of
CMHIs for disaster mental health recovery. Eight of the nine articles presented data that

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investigated an intervention related to mind-body, holistic, yoga, meditation, breathe, or artbased strategies implemented on participants impacted by a natural disaster. The final article
presented a review of existing CMHIs and their outcomes. These articles provided important
information on the implications of CMHIs for disaster recovery and assisted in answering the
proposed research questions.
Analysis of the Literature
Several themes emerged from the literature review including: the overall positive impact
that these interventions had on post-disaster recovery; the use of collaborations to both
implement these programs and conduct research; the various challenges that come with
conducting research post-disaster; and the overall adaptability of these strategies compared to
that of clinical, psychiatric approaches.
Positive Impact on Mental Health Symptoms
The literature showed that participants receiving holistic, mind-body, or arts expression
interventions post-disaster presented with reductions in mental health symptoms mostly reflected
through participant self-rating scales and self-reporting (Baumann et al., 2021; Descilo et al.,
2010; Heinz et al, 2021; Ho et al., 2014; Mathew, 2021; Telles et al., 2010; Thordardottir et al.,
2014). Physiological measures were also measured in two of the studies, where one result
showed reductions in hyperarousal symptoms (Zhu et al., 2014) after a calligraphy therapy
program and one showed no changes in heart rate variability or breath rate after a yoga program
(Telles et al., 2010).
Of the literature reviewed, the researchers generally found that program participants
showed significant improvements in anxiety and depression, lowered PTSD symptoms, and
reduced self-reported ratings of many mental health symptoms (Heinz et al, 2021; Mathew,

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2021; Thordardottir et al., 2014; Telles et al., 2010; Descilo et al., 2010; Baumann et al., 2021;
Ho et al., 2014; Zhu et al., 2014). The literature suggests that there are opportunities for different
forms of wellness interventions to be implemented post-disaster and that can have a positive
effect on mental health symptoms. More research is needed on different forms of interventions
as yoga-based interventions seemed to be most prominent.
Collaborations in Treatment and Research
A commonality amongst the literature was the collaborations and partnerships that were
involved in both conducting the research and administering the intervention techniques. This is
important to consider for future research and is important to consider for successfully
incorporating these wellness interventions into community disaster recovery planning.
Heinz at al. (2021) described the Sonoma wildfire mental health collaborative which was
formed by a large group of community stakeholders and was overseen by the Healthcare
Foundation Northern Sonoma County. The vast resources of this collaborative allowed for not
only expert involvement, but also funding opportunities for both research and implementation of
programs. The collaborative provided tools and training to local yoga instructors that enabled
them to provide the intervention to disaster recovery participants. This type of structure may be
an important consideration for integrating disaster recovery programs into communities.
The study by Ho et al. (2014) found the involvement “of a team composed of social
workers, art therapists, dance/movement therapists and behavioral health specialists” (p. 9)
beneficial for training teachers in expressive arts and integrative body-mind-spirit interventions
at a disaster-impacted school in China. The teachers were supported by this team for two years
while they learned to integrate these practices both for self-care and building student
relationships. Much like the collaborative described by Heinz et al. (2021), a supportive network

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of people appeared to be an effective approach for implementing mental health interventions and
provides insight into the integration of these programs for community disaster recovery planning.
Challenges in Conducting Research
It is commonly noted in the literature that post-disaster mental health research is limited
and challenging to conduct. Because of this, little is known about how to provide effective
mental health interventions during and after disasters (Gerbarg et al., 2011).
Descilo et al. (2010) note from their research that there are challenges to conducting a
controlled study during the chaos and conditions that can transpire post-disaster. The study by
Descilo et al. (2010) experienced participant drop-outs due to “conflicts with childcare,
household duties and return to work” (p. 296). In the study by Telles et al. (2010), participant
retention was made difficult by relocation of displaced disaster survivors. Sample size for the
study was determined in part by “whether the participants would be re-located to another camp
during the study” (Telles et al., 2010, p. 2). Other issues that were noted were the challenge of
utilizing local community members to teach or implement the intervention as local leaders were
also experiencing negative health implications from the disaster. Research during disaster
recovery is challenging and places limitations on studies conducted in the field. This
information is important for future research strategies and disaster recovery planning.
CMHIs an Adaptable Option in Disasters
There is the potential for CMHIs to be more adaptable in disaster settings than those
offered in a clinical setting. Adaptability is important in a disaster context because critical
infrastructure is often damaged and resources are limited. Alternative programs present several
advantages including their adaptability to local needs, cultures, religions, languages, their costeffectiveness, their limited needs in terms of equipment, electricity or specific spaces, their

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minimal involvement of healthcare professionals and their ability to rapidly serve large numbers
of survivors (Gerbarg et al. 2011). The literature demonstrates that CMHIs can present wellness
opportunities in the chaos of disaster that might not otherwise be available to community
members.
The intervention conducted by Heinz et al. (2021) had the ability to be adaptable to a
variety of settings, local instructors could be trained to lead the class, and a large number of
participants could attend the class. Gerbarg at al. (2011) found that CMHI programs can be
adaptable to local needs, cultures, religions, languages, can be low-cost, and have the ability to
serve large numbers of participants at a time. Descilo et al. (2010) emphasized that “one-on-one
interventions become impractical as the number of victims overwhelms healthcare providers” (p.
296) and so alternative approaches provide a more attainable option for post-disaster recovery.
In a school-aged setting as studied by Ho et al. (2014) and Zhu et al. (2014), interventions have
the potential to be implemented by instructors and can be provided to large groups of students at
a time. Finally the study conducted by Baumann et al. (2021) looked at art as an intervention
method and this tool has the ability to be taught by local artists in various settings and can be
scalable to individuals or large groups.
The literature review demonstrated the positive impact that mind-body and arts-based
interventions can have and the common themes that may assist with future advancement of this
field.
Critical Appraisal
In order to better interpret and utilize the findings for the proposed research questions, the
study methods were assessed for their validity and reliability. The critical appraisal will assist in
identifying limitations, gaps, and present opportunities for future considerations in the field.

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Measurement Tools
Qualitative data collection in the form of self-report questionnaires were the most
common format throughout the studies. These tools varied in their type: some provided baseline
health information, and some provided perceived health effects related to mental health
symptoms. The variety of qualitative tools used across the studies makes it difficult to compare
findings. Additionally, some studies neglected to provide enough detail about the measurement
tool used and therefore limited the ability to validate the results and use the findings for disaster
recovery planning.
Several of the studies utilized validated and tested methods of qualitative data collection.
Zhu et al. (2014) used the Children’s Revised Impact of Event Scale (CRIES-13) to assess
behavioural effects of the participants and is a measure designed to screen children eight years
and older who are at risk for Post-Traumatic Stress Disorder (PTSD). CRIES-13 is a selfcompleted questionnaire where internal consistency was found to be good, test-retest reliability
was found to be good, and the tool was found to be positively correlated with measures of
anxiety and depression (Child Outcomes Research Consortium [CORC], n.d.). The results from
this study could provide important and reliable information for school-based and arts-based
interventions in a disaster context.
The study conducted by Descilo et al. (2010) used various questionnaires to measure the
outcomes of the intervention including: the PTSD Check list, The Beck Depression Inventory,
and the general health questionnaire. The Beck Depression Inventory (BDI) is a 21-item selfreport rating inventory that measures characteristic attitudes and symptoms of depression
(American Psychological Association [APA], 2020). The BDI demonstrated high internal
consistency for psychiatric and non-psychiatric populations (APA, 2020). The general health

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questionnaire is designed as an instrument for screening not as an instrument to be used over
time and has demonstrated good test-retest reliability (McDermott, 2015). The combination of
validated and reliable measurement tools means that the data collected from this study is
meaningful for disaster recovery planning and mental health intervention strategies.
Five questionnaires covering different aspects of psychological and physiological wellbeing were administered at pre and post intervention for the study conducted by Thordardottir et
al. (2014). The researchers used the Perceived Stress Scale which is a widely used and well
validated 10 item self-report questionnaire; the Post-traumatic Stress Diagnostic Scale which is a
49 item self-report questionnaire designed to measure the severity of PTSD symptoms; the Beck
Depression Inventory Second Edition; the Beck Anxiety Inventory which is designed to
discriminate anxiety from depression and has been recommended for clinical and research
settings in order to obtain the highest accuracy; and the Icelandic Quality of Life Scale which is a
generic Icelandic instrument with 32 questions evaluating how the individual considers his/her
health and how diseases interfere with well-being (Thordardottir et al., 2014). The use of a
variety of questionnaires in this study allows for verification of the results and adds to the
research on disaster mental health and disaster recovery planning.
The studies conducted in Bihar and Kerala, India utilized Visual Analogue Scales (VAS)
which measure symptoms of fear, anxiety, disturbed sleep and sadness (Mathew, 2021; Telles et
al, 2010). The VAS, while highly subjective, “is widely used due to its simplicity and
adaptability to a broad range of populations and settings,” and “are of most value when looking
at change within individuals” (Physiopedia, 2022, para 7). There is a “significant amount of
empirical evidence to demonstrate the reliability of VAS methods in terms of inter-rater
reliability and test-retest reliability” (Brazier & Radcliffe, 2017, p. 586). The VAS tool, while

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widely used, is subjective so it may be beneficial to compare the data to other similar studies to
determine its validity before generalizing to broader populations.
Additional studies utilized qualitative data collection methods that were not tested or
validated or not clearly defined in the paper. The study conducted by Baumann et al. (2021)
collected qualitative data through semi-structured interviews, photography and audio recordings.
The researchers did use template analysis to analyze the data which is a qualitative data analysis
technique that thematically analyzes data and is widely used in qualitative research (Baumann et
al., 2021). The study by Ho et al. (2014) did not detail data collection or analysis methods. It
appears that qualitative data was collected through participant interviews, however the lack of
detailed information is problematic for assessing the data’s validity and reliability. The
questionnaire and surveys provided in the study conducted by Heinz et al. (2021) were not tested
methods or did not have enough details to validate the data and so results should be compared
against other studies to determine their value. Where data collection methods are not tested or
validated it is difficult to draw conclusions or generalize the results to broader populations.
Two of the studies reviewed measured physiological changes of participants. Salivary
cortisol levels of the participants were measured during the arts-based intervention in Sichuan,
China (Zhu et al., 2014). Salivary biomarkers have been widely used to help diagnose stress,
anxiety, and/or depression and analysis of salivary cortisol has shown to be a reliable method of
measuring physiological stress (Ivković et al., 2015). The other study that measured
physiological changes was conducted by Telles et al. (2010) and assessed the autonomic and
respiratory variables in participants, however did not detail the methods used to measure these
variables. Limited data is available on the physiological outcomes of CMHIs post-disaster, so
more research would be needed in this area before drawing conclusions.

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Qualitative data collection in the form of questionnaires and surveys was the prominent
technique presented in the reviewed studies. The information collected provided important
insight into the use of CMHIs for disaster recovery and its perceived effects on participants.
Further research to validate these findings would be beneficial as well as the use of more
standardized measurement tools across the studies to allow for better comparison. The data
collected is in line with other research that investigates alternative mental health interventions for
those who have experienced trauma (Hwang et al., 2018; Poudel-Tandukar et al., 2021; Thorpe,
2021). The findings are important to the field of disaster recovery as there is potential for
community-led intervention strategies to assist in relieving post-disaster mental health
symptoms.
The Participants
There was limited research that looked specifically at CMHIs post-disaster. As a result
demographic information was not restricted during the literature search. Consequently, the study
participants ranged in age, gender and other demographic criteria. Similarly, the studies selected
were not limited to a specific geographic location, so study participants were international and
varied in culture and beliefs. While the research evaluated provides a broad perspective on the
topic, it does not provide enough data on how participant demographics may impact intervention
effectiveness and mental health outcomes.
The study conducted in Sichuan, China involved 210 children, 105 female and 105 male,
randomly selected from schools in the disaster area one year after the 2008 earthquakes (Zhu et
al., 2014). In this particular study the authors noted an interaction between test and gender
where boys showed a quicker recovery trajectory from PTSD symptoms compared to girls (Zhu
et al., 2014) which could have implications for intervention planning strategies. No other studies

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reviewed noted a correlation between intervention and gender, so this could be an area for further
investigation. This data has the potential to be generalized to similar age groups and schools in
China and potentially could be applied on a more global scale for school-based disaster recovery
interventions. More research would be needed to generalize these results and more investigation
into cultural context and intervention strategy is needed.
The sample size in the Nepal study was small, 19 participants, non-random, no control
group, and specific to artists and art-related professionals in the disaster effected area (Baumann
et al., 2021). The study does not mention participant demographics which makes it difficult to
transfer the results to other populations. Additionally, the small sample size and very specific
group would make it difficult to generalize to larger populations, but this data may provide
important information for community art groups and art-based interventions. The study results
are in line with other research that investigated art interventions as an effective tool for trauma
and disaster response (Sanders et al., 2022; Ballestas et al., 2022). Fancourt and Finn (2019)
note from their scoping review that arts have been shown to be effective in engaging
marginalized or hard-to-reach groups, in building social cohesion, in enhancing subjective wellbeing, in reducing the risk of developing mental illness, and in reducing stress and anxiety
amongst many other positive benefits that were highlighted. The findings may have implications
for community arts groups and may help to inform community-led programs post-disaster.
The study that investigated school-based interventions in Wenchuan, China did not detail
the demographic information of the teachers, only that 157 teachers were selected from primary
and secondary schools in the disaster affected region (Ho et al., 2014). More information about
the subjects would be beneficial for better understanding demographic characteristics and their
interactions with CMHIs. The study does add to the research on school-based interventions, but

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the limited details make it difficult to draw conclusions about the participants or generalize to
broader populations.
The intervention that was implemented in Iceland involved 66 participants between the
ages of 23 and 66 (Thordardottir et al., 2014). The study also collected various demographic
information including gender, age, occupation, education, marital and family status, any history
of smoking or substance abuse, financial status, and past participation of counselling or
alternative therapies. It was the only study reviewed that collected a large amount of
demographic information which could provide valuable information for better understanding
how intervention strategy, demographic characteristics, and mental health outcomes may have an
effect on each other.
The yoga intervention implemented in Bihar, India involved 22 participants all of whom
were male. The researchers restricted the sample to males as heart rate variability was known to
differ between genders and that was one outcome that was being measured (Telles et al., 2010).
The small sample size was a result of the challenges that occurred in the post-disaster context.
The intervention took place in a temporary camp and so participants who were originally in the
study were relocated and could not continue with the intervention (Telles et al., 2010). Gender
and sample size are limiting factors of this study. This research does provide important insight
into the challenges faced when conducting research in disaster areas.
Participant information for several studies involved minimal collection of demographic
information. The 2000 participants that took part in the intervention implemented after the
Sonoma county wildfires were self selected, but no demographic information was collected
(Heinz et al., 2021). The yoga and exposure therapy intervention implemented in the south-east
coast of Asia after a tsunami occurred involved 23 men and 160 women ranging from 18 to 65

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years (Descilo et al., 2010). Finally, 15 females and 17 males participated in a post-disaster
intervention who were impacted by the floods in Kerala, India (Mathew, 2021). Demographic
information in these studies was limited to gender and age range or no information at all. It
would be beneficial in future research to collect a larger range of demographic information to
determine if there is any connection between intervention strategy, mental health outcomes, and
demographic characteristics.
Methods
Methods of selecting participants included self-selection where participants voluntarily
joined the intervention. Self-selection took place in several studies (Heinz et al., 2021; Mathew,
2021; Ho et al, 2014; Thordardottir et al., 2014) and has implications for the outcome as
participants may already by motivated to make changes to their well-being. Randomized control
studies (Telles et al., 2010; Zhu et al., 2014 ) are the gold standard for academic studies as they
allow for reduced bias and a control group that assists in verifying the results. A randomized
sample selection is the best method for being able to generalize to broader populations. Nonrandom studies (Baumann et al., 2021; Thordardottir et al., 2014; Descilo, et al., 2010) are
beneficial for a specific group or the specific group being investigated and can provide valuable
information about the specific population studied. Control groups (Descilo et al., 2010; Telles et
al., 2010) are important as they allow for a comparison with the intervention group.
Limitations
The methods used in the studies predominantly used self-report questionnaires which are
subject to respondents honesty and interpretation of questions. Some studies did not provide
detail of the questionnaire or interview process, so it would be hard to assess the validity of the
data collected in those cases. Those studies that used previously validated questionnaires, scales,

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or surveys produced more valid, reliable results. Two studies utilized a mixed methods approach
where both quantitative and qualitative data was collected. The mixed approach might be an
important consideration going forward as it allows for increased verification of the results.
Experimental design varied in the reviewed studies. Randomized studies reduce selection
bias and control studies allow examination of the cause-effect relationship between an
intervention and outcome (Hariton & Locascio, 2018). The randomized-control studies present
data that has reduced selection bias and can be compared to control groups in order to better
determine the effect of the intervention on participants. Experiment design was challenged by
post-disaster conditions in several of the studies where emergency conditions and cultural
context effected sampling methods and retention.
Demographic information collected was limited in most of the studies, so it would be
difficult to draw conclusions or connections between demographic characteristics of participants
and intervention strategies.
Implications for Disaster Recovery Field
Based on the overall findings, participants reported a positive effect on mental health
symptoms after the intervention. The positive response in school-aged children has implications
for incorporating school-based intervention strategies post disaster. The differing interventions
used in the studies means that there is a potential for a variety of intervention strategies that
could be implemented post-disaster. There is potential for these interventions to be communityled and sustained. Overall, findings from the studies add to research in the field and provide
opportunities for further investigation on the topic.

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Discussion
The studies took place in the disaster impacted areas from several months to a year postdisaster. Two took place in temporary camp shelters as a result of the participants being
displaced from the disaster. Others took place in the communities impacted. This has important
implications for applying the findings to disaster recovery initiatives in communities. By
conducting the research directly in a disaster impacted area, the findings present a real
perspective on not only the participant mental health state, but also the challenges of
implementing interventions during an adverse event.
Interventions for the studies were derived from a common foundation focused on holistic,
mind-body approaches that have been previously connected to reductions in mental health
symptoms for people experiencing trauma. Interventions consisted of breathing techniques,
various yoga practices and arts-based programs. Yoga was a common intervention and this may
be because it is rooted in a mind-body connection. The advantages of these types of
interventions are their practicality in the community where community leaders have the potential
to be trained and lead these interventions locally. Additionally, the interventions have the
opportunity to be scalable where large groups to individuals can take part in the intervention.
The interventions do not have to be location-specific adding to their value in disaster conditions.
Additionally, they have the potential to be conducted in temporary camps, in participant homes,
and in various locations in the community. Lastly, an advantage of the complementary
intervention strategy is that it removes the mental health or psychiatric label that can be a
limiting factor when people are seeking care (Math et al., 2015).
The findings from the review and critical appraisal show overall participant reductions in
self-reported mental health symptoms as a result of a CMHI conducted post-disaster. Data

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collection methods across the studies varied and so drawing conclusions and comparisons is
challenging. More research is needed to validate these results and better understand the impact
of CMHIs on disaster effected participants and communities. Another challenge presented is
conducting research in a disaster context where participants may be living in temporary facilities
and dealing with other socioeconomic issues as a result of the disaster. There are many
directions that the research could take including: looking more specifically at types of
interventions, looking at interventions and cultural context, looking at demographic
characteristics and interventions, and how these interventions can be better integrated with
clinical services. Better standardization of measurement methods would help to bring
consistency to the research and allow for comparisons across studies.
The findings also present some considerations needed for integrating into community
disaster recovery planning. Not all interventions may be successful in all contexts. It is worth
considering a community’s culture, values and beliefs when determining what complementary
interventions to implement. Post-disaster programs require planning and collaboration. In order
for interventions to be community-led, community leaders need to integrate training pre-disaster.
Additionally, as complementary interventions are meant to be offered in conjunction with
interventions offered by healthcare providers, there should be partnering ahead of time to ensure
a consistent, holistic approach to community disaster recovery planning.
Evaluation and Recommendations
The information presented is important to the field of Disaster Management. The studies
findings overall have positive implications for the use of CMHIs in disaster recovery planning.
While more research is needed, there is potential that CMHIs could be considered an effective
tool within the scope of post-disaster recovery. The more tools available, the more opportunities

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to build capacity and resilience in communities. An additional advantage is that these
intervention strategies have the potential to be managed and sustained at a community level.
Based on the review and critical appraisal, the overall positive outcomes shown in
disaster survivors post-intervention is encouraging. This presents the opportunity for
communities to consider CMHIs for post-disaster recovery. CMHIs present advantages because
they are less stigmatized, more accepted and accessible, promote community engagement, and
have the potential to meet the needs of a wide range of people. Integration of CMHIs into
community planning should consider a collaborative effort that involves multi-agencies from
government to local leaders. Opportunities for research should also be considered in planning
phases as this may reduce some of the obstacles encountered when conducting research postdisaster. Based on the findings from the research, the following recommendations should be
considered when looking at CMHIs as a disaster recovery tool:
1. More research is needed in the field
a. Pre-planning for post-disaster research opportunities to reduce obstacles
b. Expanding the research to look more specifically at intervention type, cultural
impacts and demographic impacts
2. Standardizing measurement tools
a. More consistency across studies when measuring mental health outcomes
3. Advantages of CMHIs for community disaster recovery planning
a. Adaptable and scalable to a variety of situations
b. Can be led by community leaders
c. Less stigmatized than other mental health services

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4. Successful integration into community disaster recovery planning requires a collaborative
effort through all phases of emergency management
a. Multi-agency partnerships are needed
b. Pre-planning is needed for training local leaders in intervention strategies
Conclusion
This research study demonstrated consistent findings on the positive impact of CMHIs on
disaster effected community members. Self-report measures of participants showed overall
reductions in negative mental health symptoms after participating in the intervention. CMHIs
demonstrated a variety of advantages compared to that of clinical-based approaches including
adaptability, scalability, and sustainability at a local level.
The critical appraisal of the literature, however, showed the limitations of the data
collected. Methods and design were inconsistent across the studies, limited demographic
information was collected, and some studies failed to provide adequate details regarding their
research methods. Continued research is needed to support the findings and future research
should consider exploring demographic impacts, cultural impacts, and intervention type.

24
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