Mental health and sleep routines: Uttarkashi, India tunnel collapse workers' experience

Among the mental health outcomes and disaster types (determined by damage to life, property, long-term consequences, displacement, and unpredictability), floods are associated with anxiety and sleep problems, mudslides with anxiety and mood disturbance, volcanic eruptions with acute stress reactions, and earthquakes with anxiety, depression, and physical complaints. Disasters such as tunnel collapse are unique as it involves the healthy, without loss of personal property or displacement; hence, they can have very different health-related outcomes. In this study, we explore mental health and sleep-related issues in workers rescued from an under-construction collapsed tunnel trapped for 17 days. After the initial triage and stabilization and a detailed evaluation of their physical and mental health status, the participants responded to self-administered scales for assessing anxiety [Generalized Anxiety Disorder-7], depression [Patient Health Questionnaire-9], and insomnia [Insomnia Severity Index] in the local language (Hindi). A separate research team conducted open-ended interviews to explore daily routines and concerns, circadian rhythm, orientation to time and day of tunnel collapse to day of rescue events, and sleep routine (and other nuances such as sleep quality and daytime napping) during the 17 days of entrapment. Thirty-three workers consented and hailed from the northern and eastern states of India. They report a mix of hope and worry in the initial days. On the assessment of anxiety, depression, and sleep, only 2-5 scored above the cut-off value, and scales correlated with each other, though clinically it had no bearing. One-third were disoriented to the passage of time, which was related to difficulty falling asleep and more napping. Daytime napping was associated with delayed waketime. Those depressed had more difficulty in the onset, maintinance, and termination of sleep, and reduced total sleep time. Victims of tunnel collapse experience a different set of mental health and sleep problems compared to those reported in other disasters. The findings can partly be attributed to the disruption of light-dark cycles. As only a fraction develops these problems, there is a need for triaging while providing mental health and sleep-related interventions in such circumstances. Lastly, there is a need to establish a light-dark cycle to prevent disorientation among victims.