Longitudinal Impact of Hurricane Sandy Exposure on Mental Health Symptoms

Brain diseases in changing climate

Climate change is one of the biggest and most urgent challenges for the 21st century. Rising average temperatures and ocean levels, altered precipitation patterns and increased occurrence of extreme weather events affect not only the global landscape and ecosystem, but also human health. Multiple environmental factors influence the onset and severity of human diseases and changing climate may have a great impact on these factors. Climate shifts disrupt the quantity and quality of water, increase environmental pollution, change the distribution of pathogens and severely impacts food production - all of which are important regarding public health. This paper focuses on brain health and provides an overview of climate change impacts on risk factors specific to brain diseases and disorders. We also discuss emerging hazards in brain health due to mitigation and adaptation strategies in response to climate changes.

Mental Health Effects in Primary Care Patients 18 Months After a Major Wildfire in Fort McMurray: Risk Increased by Social Demographic Issues, Clinical Antecedents, and Degree of Fire Exposure

Objectives: To assess prevalence of likely posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in patients attending the only out-of-hours primary care clinic in Fort McMurray some 18 months following a major fire. Methods: A quantitative cross-sectional survey was used to collect data through self-administered paper-based questionnaires to determine likely PTSD, MDD, and GAD using the PTSD Checklists for Diagnostic and Statistical Manual (DSM) 5, Patient Health Questionnaire (PHQ) 9, and GAD-7, respectively, from residents of Fort McMurray who were impacted by the wildfires. This was carried out eighteen (18) months after a major wildfire, which required the rapid evacuation of the entire city population (approximately 90,000 individuals). Results: We achieved a response rate of 48% and results from the 290 respondents showed the 1 month prevalence rate for likely PTSD was 13.6%, likely MDD was 24.8%, and likely GAD was 18.0%. Compared to self-reported prevalence rates before the wildfire (0%, 15.2%, and 14.5% respectively), these were increased for all diagnoses. After controlling for other factors in a logistic regression model, there were statistically significant associations between individuals who had likely PTSD, MDD, and GAD diagnoses and multiple socio-demographic, clinical, and exposure-related variables as follows: PTSD: History of anxiety disorder and received counselling had odds ratios (ORs) of 5.80 and 7.14, respectively. MDD: Age, witnessed the burning of homes, history of depressive disorder, and receiving low level support from friends and family had ORs of 2.08, 2.29, 4.63, and 2.5, respectively. GAD: Fearful for their lives or the lives of friends/family, history of depressive disorder, and history of anxiety disorder had ORs of 3.52, 3.04, and 2.68, respectively. There were also associations between individuals with a likely psychiatric diagnosis and those who also had likely alcohol or drug abuse/dependence. Conclusion: Our study suggests there are high prevalence rates for mental health and addiction conditions in patients attending the out-of-hours clinic 18 months after the wildfires, with significant associations between multiple variables and likely PTSD, MDD, and GAD. Further studies are needed to explore the impact of population-based mental health interventions on the long-term mental health effects of the wildfires.

What the Puerto Rican hurricanes make visible: Chronicle of a public health disaster foretold

García Márquez's novel, "Chronicle of a Death Foretold", narrates the multiple strands of a story leading up to a murder in a small Caribbean village. The novel shows both the incredulity of those who do not believe it possible that this tragic death could occur, and the impotence of those who see it coming but can do nothing to prevent it. Something akin to this double incapacity seems to be occurring today in Puerto Rico. In September 2017, the passage of Hurricanes Irma and María caused a public health disaster with large-scale death and destruction. Paradoxically, this catastrophe has made visible the need to evaluate the critical socio-environmental situation of this country, and to analyse the underlying social factors contributing to the problems caused by the hurricanes. Why did neither the US nor the Puerto Rican government react as expected when faced with such a serious situation? For decades, this country has been suppressed by colonial domination, exploitation of the workforce, and health discrimination. It has been a "laboratory", where colonial practices have institutionalized social control, racism, and inequality, with profound negative effects on society, quality of life and health equality. Poverty and unemployment have always been very high, and thousands of families live in precarious housing situations. Additionally, current labour reforms imposed as part of a neoliberal agenda, are eroding the job security and protections of the working population, while education, health, housing, pensions, energy, and land are being progressively privatized. What are the root causes of this situation? What future does the country await? To answer these questions, critical and comprehensive scrutiny of history showing what the hurricanes have helped to make visible is required. This shows that neoliberal colonialism has shaped the social features behind the principle health and inequality problems of the Puerto-Rican population.

A data-driven approach for estimating the change-points and impact of major events on disease risk

Considering the impact of events on disease risk is important. Here, a Bayesian spatio-temporal accelerated failure time model furnished an ideal situation for modeling events that could impact survival experience via spatial and temporal frailty estimates. Through a hierarchical structure, this model allowed the data to detect the change-point(s) in addition to generating the event-related estimates. Both a real data case study and a simulation study were employed for testing these methods. The results suggested that meaningful and accurate change-points could be detected. Further, accurate event-related estimates for individuals in relation to those change-points could be obtained. By allowing the data to drive the change-point choices, the models were better fitting and the inference was more accurate.

Engagement in linkage to mental health care program in the Rockaways after Hurricane Sandy

The Rockaways area of New York City was especially devastated by Hurricane Sandy. This study examined participant characteristics associated with acceptance of a linkage to and attendance at appointments for mental health difficulties (MHD). Participants (N = 1,011) completed questionnaires to assess mental health symptoms. Participants who met screening criteria (n = 442) were offered linkage to care. Individuals who had a higher mental health symptom burden (MHSB; i.e., those who screened in on more than one criteria vs. only one criterion) had 2.68 greater odds of accepting services (95% confidence interval [1.68, 4.26]). MHSB was not associated with attending a first appointment (p = 0.80). Female gender and Hispanic ethnicity were also associated with acceptance of linkage to care, though not attendance. Reducing stigma around MHD associated with natural disasters and increasing knowledge about the mental health care system could promote help-seeking behavior among survivors.

Stress exposures, neurodevelopment and health measures in the ABCD study

The Adolescent Brain Cognitive Development (ABCD) Study, a large, longitudinal study of brain development and child health, is uniquely positioned to explore relationships among stress, neurodevelopment, and psychiatric symptomatology, including substance use and addiction. There is much we do not know about how adverse experiences affect the developing brain and cognitive, social, emotional, and academic outcomes. The data collected by the ABCD Study will allow the examination of the relationships among these variables in adolescence, including the effects of stressors (e.g., abuse, neglect, household challenges, parental substance use) on psychological adjustment and other stress responses. A comprehensive protocol that includes physical and mental health, substance use, culture and environment, neurocognitive assessments, biospecimen analyses, and structural and functional neuroimaging will provide opportunities for learning about the impacts of stressors on health and other outcomes in the context of adolescent development. This knowledge could lead to the development of interventions that reduce or even reverse the impacts of stressors.

Long-term effects of disaster on depressive symptoms: Type of exposure matters

RATIONALE

Natural disasters have the potential to change the lives of older people, yet most studies rely on small convenience samples, few include assessments of people prior to the disaster, and only a handful examine the effects of different types of exposure.

OBJECTIVE

Our analyses add new knowledge to the literature by examining the ways in which four types of exposure (i.e., geographic, peri-traumatic stress, personal and property loss, and post-storm hardship) affect depressive symptoms experienced by older people over a five-year period.

METHOD

We analyzed four waves of data from the ORANJ BOWL panel using multilevel mixed effects models.

RESULTS

We found that although each type of exposure had an independent effect on depressive symptoms, the effects of peri-traumatic stress were dominant.

CONCLUSIONS

As nearly 20% of people in the United States will experience a natural disaster during the course of their lives, it is critical to understand how disaster exposure can influence mental health because each type of exposure demands a different response. Finding that an individual's emotional response during the disaster plays an important role in the development of depressive symptoms suggests that reduction of exposure to traumatic stress during a storm (i.e., evacuation from a storm area) is important for older people. Likewise, immediate interventions following a disaster that target people experiencing high levels of peri-traumatic distress may be particularly effective and that failing to attend to these people may miss a critical opportunity and result in years of suffering.

Public Health Emergency Response Lessons Learned by Rapid Deployment Force 3, 2006-2016

Following Hurricane Katrina, the uniformed US Public Health Service created an updated system through which its officers participated in emergency responses. The Rapid Deployment Force (RDF) concept, begun in 2006, involved five teams of officers with diverse clinical and public health skill sets organized into an incident command system led by a team commander. Each team can deploy within 12 hours, according to a defined but flexible schedule. The core RDF mission is to set up and provide care for up to 250 patients, primarily persons with chronic diseases or disabilities, in a temporary federal medical station. Between 2006 and 2016, the RDF 3 team deployed multiple times in response to natural disasters and public health emergencies. Notable responses included Hurricane Sandy in 2012, the unaccompanied children mission in 2014, and the Louisiana floods in 2016. Lessons learned from the RDF 3 experience include the need for both clinical and public health capacity, the value of having special mental health resources, the benefits of collaboration with other federal medical responders, and recognition of the large burden of chronic disease management issues following natural disasters.

Community Resilience Learning Collaborative and Research Network (C-LEARN): Study Protocol with Participatory Planning for a Randomized, Comparative Effectiveness Trial

This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.

Preliminary Assessment of Hurricane Harvey Exposures and Mental Health Impact

Hurricane Harvey made landfall in Houston, Texas on 25 August 2017, the psychological and physical effects of which are still unknown. We assessed hurricane exposure and the immediate mental health needs of the population to define public health priorities for a larger epidemiological study. Convenience sampling was used to recruit participants (n = 41) from the greater Houston area aged ≥18 years. Participants completed a questionnaire about demographics, hurricane exposures, and physical/mental health. Post-Traumatic Stress Disorder (PTSD) was measured with the Post-Traumatic Stress Disorder Checklist-S (PCL-S; a score ≥30 indicated probable PTSD symptoms). The Patient Health Questionnaire-4 (PHQ-4) was used to assess symptoms of depression and generalized anxiety disorder. The average PTSD score was 32.9 (SD = 17.1); a total of 46% of participants met the threshold for probable PTSD. Increased overall hurricane exposure (adjusted odds ratio (OR_adj) 1.42; 95% confidence interval (CI): 1.06⁻2.05) and property-related exposure (OR_adj 1.53; 95% CI: 1.07⁻2.18) were both statistically significantly associated with increased odds of probable PTSD symptoms. A perception of chemical/toxin exposure due to Hurricane Harvey was reported by 44% of participants. A higher number of personal or property exposures were associated with greater mental health symptoms three weeks post-hurricane. This work has implications for the ongoing response to Hurricane Harvey and for assessing the immediate needs of the population.

When Natural Disaster Follows Economic Downturn: The Incremental Impact of Multiple Stressor Events on Trajectories of Depression and Posttraumatic Stress Disorder

OBJECTIVE

To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy.

METHOD

Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy.

RESULTS

We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy.

CONCLUSION

We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2019;13:173-182).

Mental health challenges and experiences in displaced populations following Hurricane Sandy and Hurricane Harvey: the need for more comprehensive interventions in temporary shelters

Hurricane exposure can have a profound impact on mental health, leading to increased symptoms of stress, anxiety, depression and post-traumatic stress disorder that are still present years after the storm. Those displaced following a hurricane are particularly vulnerable to adverse mental health outcomes, especially if displaced to temporary shelters. The current work highlights the experiences and mental health challenges of displaced populations following Hurricane Sandy and Hurricane Harvey, as well as describing barriers to conducting research in the immediate aftermath of Hurricane Harvey and the need for more comprehensive interventions in these vulnerable populations.

Lack of access to medical care during Hurricane Sandy and mental health symptoms

Destruction caused by natural disasters compromises medical providers' and hospitals' abilities to administer care. Hurricane Sandy was particularly devastating, resulting in massive disruptions of medical care in the region. This study aimed to determine whether a lack of access to medical care during Hurricane Sandy was associated with posttraumatic stress disorder (PTSD) symptoms and other mental health/substance abuse outcomes. A secondary aim was to examine whether having a chronic illness moderates those associations. Self-reported medical access and mental health symptomatology were obtained from New York City and Long Island residents (n = 1669) following Hurricane Sandy under the Leaders in Gathering Hope Together project (10/23/2013–2/25/2015) and Project Restoration (6/5/2014–8/9/2016). Multivariable logistic regressions were utilized to determine the relationship between lack of access to medical care and mental health outcomes. Of the 1669 participants, 994 (59.57%) were female, 866 (51.89%) were white, and the mean age was 46.22 (SD = 19.2) years old. Those without access to medical care had significantly higher odds of showing symptoms of PTSD (AOR = 2.71, CI = [1.77–4.16]), as well as depression (AOR = 1.94, CI = [1.29–2.92]) and anxiety (AOR = 1.61, CI = [1.08–2.39]) compared to those with access. Lack of access to care was associated with a 2.12 point increase in perceived stress scale score (SE = 0.63). The interaction between having a chronic illness and lack of access to medical care was not significantly associated with any outcomes. The findings emphasize the importance of making medical care more accessible to patients, both chronically and acutely ill, during natural disasters to benefit their physical as well as their mental health.

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Individuals without access to medical care had asignificantly higher odds of showing symptoms of mental health difficulties.

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Chronic illness did not moderate the relationship between a lack of access to care and mental health outcomes.

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Access to medical care during natural disasters may benefit the mental health of survivors with and without chronic illness.</span>

Hurricane Season Public Health Preparedness, Response, and Recovery Guidance for Health Care Providers, Response and Recovery Workers, and Affected Communities - CDC, 2017

CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) have guidance and technical materials available in both English and Spanish to help communities prepare for hurricanes and floods (Table 1). To help protect the health and safety of the public, responders, and clean-up workers during response and recovery operations from hurricanes and floods, CDC and ATSDR have developed public health guidance and other resources; many are available in both English and Spanish (Table 2).