60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research

Developing a sustainable child and family service system after a community tragedy: Lessons from Sandy Hook

This paper describes a systematic approach to assessing community services post-Sandy Hook shooting. An evaluation team was invited to develop a sustainability plan for community services in Newtown. Service organizations, providers and families were interviewed. Descriptive statistics were used to characterize the range of services; respondent perspectives were coded using content analysis. We found that Newtown has a broad array of community services, but respondent groups varied in their perceptions of service adequacy. Consensus existed about core components of an ideal service system, including centralizing access; coordinating care; personalizing and tailoring services for families; and providing evidence-based care. The strategic community assessment approach developed here may inform how communities examine their service capacity and develop sustainability plans post-disaster.

Does depression moderate handwashing in children?

BACKGROUND

Although diarrheal diseases are preventable and treatable, they are the leading cause of child mortality and morbidity as a consequence of poor hygiene and contaminated water. Handwashing with soap is an effective method for preventing and decreasing the incidence of diarrhea. However, mental disorders such as depression can substantially moderate an individual's ability to cope with daily life and can exert a negative influence on daily hygiene activities such as handwashing with soap, especially in children. The aim of this study was to explain the influence of depression on pupils' hand-washing behavior in Zimbabwe.

METHODS

In a cross-sectional study, face-to-face interviews were carried out with primary school pupils in peri-urban Harare, Zimbabwe (n = 556) using a quantitative questionnaire to assess handwashing and its behavioral determinants in school settings. The Center for Epidemiological Studies Depression Scale for Children (CES-DC) was used to assess depression.

RESULTS

More than half of the assessed children were depressed. Self-reported handwashing with soap among depressed children was significantly lower than among non-depressed children. Almost all behavioral determinants of hand-washing behavior were significantly lower in depressed children. The behavioral determinants worked differently in the depressed children than in the non-depressed children's group. The effects of important behavioral determinants on handwashing were moderated by depression.

CONCLUSIONS

Depression exerts a negative influence on handwashing in children. These results suggest depression-relieving measures should be conducted together with any water, sanitation, and hygiene (WASH) interventions to make such interventions more effective.

Post-Traumatic Stress Disorder and other mental disorders in the general population after Lorca's earthquakes, 2011 (Murcia, Spain): A cross-sectional study

AIMS

To describe the prevalence and severity of mental disorders and to examine differences in risk among those with and without a lifetime history prior to a moderate magnitude earthquake that took place in Lorca (Murcia, Spain) at roughly the mid-point (on May 11, 2011) of the time interval in which a regional epidemiological survey was already being carried out (June 2010 -May 2012).

METHODS

The PEGASUS-Murcia project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia. Main outcome measures are prevalence and severity of anxiety, mood, impulse and substance disorders in the 12 months previous to the survey, assessed using the Composite International Diagnostic Interview (CIDI 3.0). Sociodemographic variables, prior history of any mental disorder and earthquake-related stressors were entered as independent variables in a logistic regression analysis.

FINDINGS

A total number of 412 participants (response rate: 71%) were interviewed. Significant differences in 12-month prevalence of mental disorders were found in Lorca compared to the rest of Murcia for any (12.8% vs 16.8%), PTSD (3.6% vs 0.5%) and other anxiety disorders (5.3% vs 9.2%) (p≤ 0.05 for all). No differences were found for 12-month prevalence of any mood or any substance disorder. The two major predictors for developing a 12-month post-earthquake mental disorder were a prior mental disorder and the level of exposure. Other risk factors included female sex and low-average income.

CONCLUSIONS

PTSD and other mental disorders are commonly associated with earthquake disasters. Prior mental disorders and the level of exposure to the earthquakes are the most important for the development of a consequent mental disorder and this recognition may help to identify those individuals that may most benefit from specific therapeutic intervention.

Mental Health Impact of Hosting Disaster Refugees: Analyses from a Random Sample Survey Among Haitians Living in Miami

OBJECTIVES

Studies on the mental health of families hosting disaster refugees are lacking. This study compares participants in households that hosted 2010 Haitian earthquake disaster refugees with their nonhost counterparts.

METHODS

A random sample survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants were assessed regarding their 2010 earthquake exposure and impact on family and friends and whether they hosted earthquake refugees. Using standardized scores and thresholds, they were evaluated for symptoms of three common mental disorders (CMDs): posttraumatic stress disorder, generalized anxiety disorder, and major depressive disorder (MDD).

RESULTS

Participants who hosted refugees (n = 51) had significantly higher percentages of scores beyond thresholds for MDD than those who did not host refugees (n = 365) and for at least one CMD, after adjusting for participants' earthquake exposures and effects on family and friends.

CONCLUSIONS

Hosting refugees from a natural disaster appears to elevate the risk for MDD and possibly other CMDs, independent of risks posed by exposure to the disaster itself. Families hosting refugees deserve special attention.

Association of posttraumatic stress disorder symptoms with migraine and headache after a natural disaster

OBJECTIVE

Previous research shows that migraine and general headache symptoms increase after traumatic events. Questions remain about whether posttraumatic stress disorder (PTSD) produces migraine/headache symptoms, or if individuals afflicted by migraine/headache are especially likely to develop PTSD. We test whether PTSD symptoms following a natural disaster are associated with higher odds of reporting frequent headaches/migraines postdisaster. We decompose PTSD into intrusion, avoidance, and hyperarousal symptom clusters to examine which, if any, are uniquely related to headache/migraine postdisaster.

METHOD

We use prospectively collected pre- and postdisaster data to explore whether overall PTSD symptoms and symptom clusters are associated with migraine/headache in a sample of Hurricane Katrina survivors. We account for severity of hurricane exposure and control for baseline migraine and headache problems to reduce the probability that heightened PTSD susceptibility among those who already suffered from the conditions could explain observed associations.

RESULTS

PTSD symptoms were associated with higher odds of experiencing frequent headaches or migraines with a standard deviation change in PTSD score corresponding to over twice the odds (95% confidence interval [1.64, 2.68]) of having trouble with frequent headaches or migraines in the post-Katrina period. Each additional point on the intrusion subscale (sample M [SD] = 1.6 [1.1]) was associated with 55% higher odds of reporting frequent headache/migraine (95% confidence interval [1.03, 2.33]), but we found no association with avoidance or hyperarousal symptoms.

CONCLUSIONS

Clinicians and disaster planners should be aware that disaster survivors might be at heightened risk of migraine/headache episodes, and those experiencing intrusive reminders may be most affected. (PsycINFO Database Record

Addressing the Needs of Children With Disabilities Experiencing Disaster or Terrorism

PURPOSE OF REVIEW

This paper reviews the empirical literature on psychosocial factors relating to children with disabilities in the context of disaster or terrorism.

RECENT FINDINGS

Research indicates adults with disabilities experience increased exposure to hazards due to existing social disparities and barriers associated with disability status. However, studies on the psychological effects of disaster/terrorism on children with pre-existing disabilities are exceedingly few and empirical evidence of the effectiveness of trauma-focused therapies for this population is limited. Secondary adversities, including social stigma and health concerns, also compromise the recovery of these children post-disaster/terrorism. Schools and teachers appear to be particularly important in the recovery of children with disabilities from disaster. Disasters, terrorism, and war all contribute to increased incidence of disability, as well as disproportionately affect children with pre-existing disabilities. Disaster preparedness interventions and societal changes are needed to decrease the disproportionate environmental and social vulnerability of children with disabilities to disaster and terrorism.

Emotional, physical, and social needs among 0-5-year-old children displaced by the 2010 Chilean earthquake: associated characteristics and exposures

An 8.8-magnitude earthquake occurred off the coast of Chile on 27 February 2010, displacing nearly 2,000 children aged less than five years to emergency housing camps. Nine months later, this study assessed the needs of 140 displaced 0-5-year-old children in six domains: caregiver stability and protection; health; housing; nutrition; psychosocial situation; and stimulation. Multivariate regression was applied to examine the degree to which emotional, physical, and social needs were associated with baseline characteristics and exposure to the earthquake, to stressful events, and to ongoing risks in the proximal post-earthquake context. In each domain, 20 per cent or fewer children had unmet needs. Of all children in the sample, 20 per cent had unmet needs in multiple domains. Children's emotional, physical, and social needs were associated with ongoing exposures amenable to intervention, more than with baseline characteristics or epicentre proximity. Relief efforts should address multiple interrelated domains of child well-being and ongoing risks in post-disaster settings.

Disaster complexity and the Santiago de Compostela train derailment

This disaster complexity case study examines Spain's deadliest train derailment that occurred on July 24, 2013 on the outskirts of Santiago de Compostela, Galicia, Spain. Train derailments are typically survivable. However, in this case, human error was a primary factor as the train driver powered the Alvia train into a left curve at more than twice the posted speed. All 13 cars came off the rails with many of the carriages careening into a concrete barrier lining the curve, leading to exceptional mortality and injury. Among the 224 train occupants, 80 (36%) were killed and all of the remaining 144 (4%) were injured. The official investigative report determined that this crash was completely preventable.

Effects of optimism on recovery and mental health after a tornado outbreak

OBJECTIVE

Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being.

DESIGN

Data for this study come from the Centers for Disease Control and Prevention's Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama.

MAIN OUTCOME MEASURES

This study assesses the effect of dispositional optimism on post-disaster recovery and mental health.

RESULTS

Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage.

CONCLUSIONS

The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events.

Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study

OBJECTIVE

The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery.

METHODS

The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis.

RESULTS

Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four "core cases" of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash.

CONCLUSION

The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery. Doohan I , Björnstig U , Östlund U , Saveman BI . Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study. Prehosp Disaster Med. 2017;32(2):165-174.

Who is going to rescue the rescuers? Post-traumatic stress disorder among rescue workers operating in Greece during the European refugee crisis

PURPOSE

During the European refugee crisis, numerous Greek and international rescue workers are operating in Lesvos, offering search, rescue, and first aid services. Exposure to stressful life events while engaging in this rescue work can result in developing Post-Traumatic Stress Disorder (PTSD). The study aimed to assess the prevalence of PTSD and explore potential differences between different categories of rescuers.

METHODS

A cross-sectional study was conducted among 217 rescue workers. Participants were grouped according to affiliation: "Greek Professionals Rescuers/GPR", "International Professionals Rescuers/IPR" and "Volunteer Rescuers/VR". The PTSD Checklist-Civilian Version (PCL-C) was utilized. All tests were two-tailed (a = 0.05). Mann-Whitney, Kruskal-Wallis, and multivariate logistic regression were performed.

RESULTS

Overall probable PTSD prevalence found was 17.1%. Rates varied significantly per rescuer's category; 23.1% in GPR, 11.8% in IPR, and 14.6% in VR (p = 0.02). GPR demonstrated the highest risk compared to IPR and VR (p < 0.001). Females had approximately two times higher risk. Other significant risk factors included marital status, age, and number of children. Lack of previous experience, longer operation period, longer shift hours, and handling dead refugees and dead children were also considered major risk factors.

CONCLUSIONS

Rescue workers providing substantial aid to the refugees and migrants at Lesvos experience significant psychological distress. The present findings indicate the urgent need for targeted interventions. Further studies are needed to address long-term effects of the refugee crisis on rescuers, and explore effective measures to prevent PTSD.

The 2004 tsunami and mental health in Thailand: a longitudinal analysis of one-and two-year post-disaster data

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36-item Short Form Health Survey (SF-36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long-lasting ramifications for mental health, and that diverse losses may influence mental health differently.

Storm Impact and Depression Among Older Adults Living in Hurricane Sandy–Affected Areas

Objective

Research on the impact of natural disasters on the mental health of older adults finds both vulnerabilities and resilience. We report on the rates of clinically significant depression among older adults (aged ≥60 years) living in areas affected by Hurricane Sandy in 2012 and the factors associated with mental health need.

Methods

The Sandy Mobilization, Assessment, Referral and Treatment for Mental Health (SMART-MH) program integrates community outreach and needs assessments to identify older adults with mental health and aging service needs. Older adults with significant anxiety or depressive symptoms were offered short-term psychotherapy. Social service referrals were made directly to community agencies. All SMART-MH activities were offered in Spanish, Russian, Mandarin/Cantonese, and English.

Results

Across the full sample, 14% of participants screened positive for depression. Hurricane Sandy stressors predicted increased odds of depression, including storm injury, post-storm crime, and the total count of stressors. Outcomes varied significantly by age group, such that all Sandy-related variables remained significant for younger-old adults (aged 60–74 years), whereas only the loss of access to medical care was significant for older-old adults (aged ≥75 years).

Conclusions

Storm-affected communities show higher rates of depressive symptoms than seen in the general population, with storm stressors affecting mental health needs differentially by age group. (Disaster Med Public Health Preparedness. 2017;11:97–109)

Individual and community-level determinants of mental and physical health after the deepwater horizon oil spill: findings from the gulf States population survey

The 2010 Deepwater Horizon oil spill had enormous consequences on the environment. Prevalence of mental and physical health conditions among Gulf residents after the disaster, however, are still being assessed. The Gulf State Population Survey (GSPS) was a representative survey of 38,361 residents in four Gulf States and was conducted from December 2010 to December 2011. Analysis of the GSPS data showed that differences in individual characteristics and direct or indirect exposure to the disaster drove the individual-level variation in health outcomes (mental distress, physical distress, and depression). Direct exposure to the disaster itself was the most important determinant of health after this event. Selected county-level characteristics were not found to be significantly associated with any of our health indicators of interest. This study suggests that in the context of an overwhelming event, persons who are most directly affected through direct exposure should be the primary focus of any public health intervention effort.

Posttraumatic Stress among Not-Exposed Traumatically Bereaved Relatives after the MS Estonia Disaster

Background

Little is known about posttraumatic stress (PTS) reactions in bereaved individuals following loss in disaster who were not directly exposed to disaster. The aim of the present study was to examine the course of PTS up to three years after losing relatives in the MS Estonia ferry disaster, one of the worst maritime disasters in modern times.

Methods

Seven postal surveys were sent out over three years post-disaster. The respondents were invited and added consecutively during the three years and 938 relatives participated in one or more of the surveys, representing 89% of the MS Estonia’s Swedish victims. The survey included the Impact of Event Scale (IES) to measure PTS. Latent growth curve modeling was used to analyze PTS over time.

Results

The majority of bereaved individuals had high levels of PTS. At three years post-loss, 62% of the respondents scored above the recommended cut-off value on the IES. Over time, PTS symptoms declined, but initially high symptoms of PTS were associated with a slower recovery rate.

Conclusion

The present finding suggests that being an indirectly-exposed disaster-bereaved close-relative can lead to very high levels of PTS which are sustained for several years.

The trauma signature of 2016 Hurricane Matthew and the psychosocial impact on Haiti

Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin season, bringing severe impacts to multiple nations including direct landfalls in Cuba, Haiti, Bahamas, and the United States. However, Haiti experienced the greatest loss of life and population disruption. Methods. An established trauma signature (TSIG) methodology was used to examine the psychological consequences of Hurricane Matthew in relation to the distinguishing features of this event. TSIG analyses described the exposures of Haitian citizens to the unique constellation of hazards associated with this tropical cyclone. A hazard profile, a matrix of psychological stressors, and a "trauma signature" summary for the affected population of Haiti - in terms of exposures to hazard, loss, and change - were created specifically for this natural ecological disaster. Results. Hazard characteristics of this event included: deluging rains that triggered mudslides along steep, deforested terrain; battering hurricane winds (Category 4 winds in the "eye-wall" at landfall) that dismantled the built environment and launched projectile debris; flooding "storm surge" that moved ashore and submerged villages on the Tiburon peninsula; and pummeling wave action that destroyed infrastructure along the coastline. Many coastal residents were left defenseless to face the ravages of the storm. Hurricane Matthew's slow forward progress as it remained over super-heated ocean waters added to the duration and degree of the devastation. Added to the havoc of the storm itself, the risks for infectious disease spread, particularly in relation to ongoing epidemics of cholera and Zika, were exacerbated. Conclusions. Hurricane Matthew was a ferocious tropical cyclone whose meteorological characteristics amplified the system's destructive force during the storm's encounter with Haiti, leading to significant mortality, injury, and psychological trauma.

Changes in coping behavior in a randomized controlled trial of concurrent treatment for PTSD and alcohol dependence

OBJECTIVE

The current study examines changes in coping among 165 adults meeting DSM-IV criteria for co-morbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD).

METHOD

Participants were randomized to receive naltrexone or placebo, with or without prolonged exposure (PE). All participants received supportive counseling focused on alcohol use (BRENDA). Assessments of coping, PTSD, and AD were conducted at pre-treatment, mid-treatment, post-treatment, 3-month follow-up, and 6-month follow-up.

RESULTS

Participants exhibited significant decreases in both avoidant coping and adaptive coping from pre-treatment to 6-month follow-up across all groups. Participants who received PE showed faster decreases in avoidant coping during this period than participants who did not receive PE. PTSD symptom reduction was associated with changes in both avoidant and adaptive coping across groups. Improvement in PTSD symptoms was related to a faster rate of reduction in avoidant coping in the PE groups compared to those receiving BRENDA alone.

CONCLUSIONS

The current results suggest that concurrent treatment for co-morbid PTSD-AD decreases avoidant and adaptive coping, and participants who show greater reductions in PTSD symptoms also show greater changes in coping style. Consistent with theorized mechanisms of change in PE, the addition of PE to supportive counseling for AD was associated with a greater reduction of avoidant coping than supportive counseling alone.

The Benefit of Conserving and Gaining Resources after Trauma: A Systematic Review

BACKGROUND

Traumatic events involve loss of resources, which has consistently been found to be associated with developing stress-related illness such as posttraumatic stress disorder (PTSD).

OBJECTIVE

The purpose of this systematic literature review was to determine if there is evidence for the salutatory effect of resource gain on PTSD, and if there are intervention models that utilize and assess gain in PTSD.

DATA SOURCES

All relevant online databases were systematically searched using key terms and a method, detailed in Figure 1.

RESULTS

Of 22 relevant articles, there were three intervention studies, one longitudinal naturalistic study, eleven non-intervention association studies focusing on PTSD, and eight non-intervention association studies not focusing on PTSD. The intervention and naturalistic studies showed a significant positive effect on PTSD by specifically targeting the gain of resources during an intervention. Other non-intervention research supports the notion that resource loss is pathogenic and resource gain is beneficial after traumatic exposure.

CONCLUSIONS

Interventions that develop and assess effects of gain of various types of resources on stress-related illness should be encouraged. Interventions that already have proven efficacy for PTSD might include standardized assessment of resource loss and gain to further understand mechanisms of action.

Spatio-temporal variation of mood and anxiety symptom treatments in Christchurch in the context of the 2010/11 Canterbury earthquake sequence

This article explores the spatio-temporal variation of mood and anxiety treatments in the context of a severe earthquake sequence. The aim was to examine a possible earthquake exposure effect, identify populations at risk and areas with particularly large mood and anxiety treatment rate increases or decreases in the affected Christchurch urban area. A significantly stronger increase of mood and anxiety treatments among residents in Christchurch compared to others in New Zealand have been found, as well as children and elderly identified as especially vulnerable. Spatio-temporal cluster analysis and Bayesian spatio-temporal modelling revealed little changes in mood and anxiety treatment patterns for most parts of the city, whereas areas in the less affected north and northwest showed the strongest increases in risk. This effect may be linked to inner-city mobility activity as a consequence of the earthquakes, but also different levels of community cohesion after the disaster, which merit further research.

Long-term psychological consequences among adolescent survivors of the Wenchuan earthquake in China: A cross-sectional survey six years after the disaster

BACKGROUND

Most epidemiological studies on adolescent survivors' mental health have been conducted within 2 years after the disaster. Longer-term psychological consequences remain unclear. This study explored psychological symptoms in secondary school students who were living in Sichuan province 6 years after the Wenchuan earthquake.

METHODS

A secondary data analysis was performed on data from a final survey of survivors conducted 6 years after the Wenchuan earthquake as part of the five-year mental health and psychosocial support project. A total of 2641 participants were divided into three groups, according to the level of traumatic experience exposure during the earthquake (0, 1, and 2 or more). ANCOVA was used to compare the mean scores of the Symptom Checklist-90 (SCL-90) among the three groups, adjusting for covariates such as age, gender, ethnicity, having a sibling, parents' divorce, and socio-economic status. Logistic regression analysis was used to identify relationships between the traumatic experiences and suicidality after the disaster.

RESULTS

Having two or more kinds of traumatic experiences was associated with higher psychological symptom scores on the SCL-90 (Cohen's d=0.23-0.33) and suicidal ideation (OR 1.98, 95% CIs:1.35-2.89) and attempts (OR 3.32, 95% CIs:1.65-6.68), as compared with having no traumatic experience.

LIMITATIONS

Causality cannot be inferred from this cross-sectional survey, and results may not generalize to other populations due to convenience sampling.

CONCLUSIONS

Severely traumatized adolescent survivors of the earthquake may suffer from psychological symptoms even 6 years after the disaster. Long-term psychological support will be needed for these individuals.

Extreme weather events in developing countries and related injuries and mental health disorders - a systematic review

BACKGROUND

Due to climate change, extreme weather events have an incremental impact on human health. Injuries and mental health disorders are a particular burden of disease, which is broadly investigated in high income countries. Most distressed populations are, however, those in developing countries. Therefore, this study investigates mental and physical health impacts arising from extreme weather events in these populations.

METHOD

Post-traumatic Stress Disorder (PTSD), injury [primary outcomes], anxiety and depressive disorders [secondary outcomes], caused by weather extremes were systematically analyzed in people of developing countries. A systematic review of observational studies was conducted searching six databases, complemented by hand search, and utilizing two search engines. Review processing was done independently by two reviewers. Prevalence rates were analyzed in a pre/post design; an additional semi-structured search was conducted, to provide reference data for studies not incorporating reference values.

RESULTS

All 17 identified studies (70,842 individuals) indicate a disease increase, compared to the reference data. Increase ranges from 0.7-52.6 % for PTSD, and from 0.3-37.3 % for injury. No studies on droughts and heatwaves were identified. All studies were conducted in South America and Asia.

CONCLUSION

There is an increased burden of psychological diseases and injury. This finding needs to be incorporated into activities of prevention, preparedness and general health care of those developing countries increasingly experiencing extreme weather events. There is also a gap in research in Africa (in quantity and quality) of studies in this field and a predominant heterogeneity of health assessment tools. PROSPERO registration no.: CRD42014009109.

Employing a community based participatory research approach to bear witness: psycho-social impact of the 2010 earthquake on Haitians in Somerville, MA

We employed a community-based participatory research approach to assess mental health among the Haitian community in the Somerville, MA area. The development of the survey coincided with the 2010 earthquake in Haiti, and so several questions related to the natural disaster were included in the analysis to increase understanding of the impact locally. We surveyed a convenience sample of 64 Haitians recruited with the assistance of the Somerville Haitian Coalition. The survey assessed demographic data, reasons for migrating to the area, response to the 2010 earthquake, and mental health. Mental health measures included the short versions of the Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale. Participants reported high rates of stress and depression post-earthquake. On the CES-D, men reported higher average depression and stress scores than women (13.8 vs. 11 and 20.6 vs. 17.6). Our results suggest that social and family support resources may be beneficial to Haitians in our sample.

Women's Mental Health and Intimate Partner Violence Following Natural Disaster: A Scoping Review

Introduction Survivors of natural disasters in the United States experience significant health ramifications. Women particularly are vulnerable to both post-disaster posttraumatic stress disorder (PTSD) and depression, and research has documented that these psychopathological sequelae often are correlated with increased incidence of intimate partner violence (IPV). Understanding the link between these health concerns is crucial to informing adequate disaster response and relief efforts for victims of natural disaster. Purpose The purpose of this review was to report the results of a scoping review on the specific mental health effects that commonly impact women following natural disasters, and to develop a conceptual framework with which to guide future research.

METHODS

A scoping review of mental and physical health effects experienced by women following natural disasters in the United States was conducted. Articles from 2000-2015 were included. Databases examined were PubMed, PsycInfo, Cochrane, JSTOR, Web of Science, and databases available through ProQuest, including ProQuest Research Library.

RESULTS

A total of 58 articles were selected for inclusion, out of an original 149 that were selected for full-text review. Forty-eight articles, or 82.8%, focused on mental health outcomes. Ten articles, or 17.2%, focused on IPV. Discussion Certain mental health outcomes, including PTSD, depression, and other significant mental health concerns, were recurrent issues for women post-disaster. Despite the strong correlation between experience of mental health consequences after disaster and increased risk of domestic violence, studies on the risk and mediating factors are rare. The specific challenges faced by women and the interrelation between negative mental health outcomes and heightened exposure to IPV following disasters require a solid evidence base in order to facilitate the development of effective interventions. Additional research informed by theory on probable health impacts is necessary to improve development/implementation of emergency relief policy. Bell SA , Folkerth LA . Women's mental health and intimate partner violence following natural disaster: a scoping review. Prehosp Disaster Med. 2016;31(6):648-657.

Outdoor activities and depressive symptoms in displaced older adults following natural disaster: community cohesion as mediator and moderator

OBJECTIVES

This investigation examined whether community cohesion mediates or moderates the relationship between outdoor activities and depressive symptoms in older adults displaced by Typhoon Morakot in Taiwan.

METHOD

This cross-sectional study included 292 adults aged 65 years or older who were relocated to permanent houses after Typhoon Morakot damaged their homes on 8th August 2009. Multiple regression analysis was applied to test the role of community cohesion on the association between outdoor activities and depressive symptoms.

RESULTS

The sample of displaced older adults displayed higher prevalence of depressive symptoms than the average for community dwelling older people in Taiwan. Community cohesion fully mediated the relationship between outdoor activities and depressive symptoms. Community cohesion also moderated the relationship between outdoor activities and depressive symptoms.

CONCLUSION

Community cohesion occupies a key role on the link between outdoor activities and depressive symptoms. Participation in outdoor activities was associated positively with community cohesion, while high community cohesion was related negatively to depressive symptoms. Additionally, the benefit of outdoor activities to fewer depressive symptoms only manifested in older adults with high community cohesion. Programs and services should be designed to enhance community cohesion in order to maximize the benefit of outdoor activities to the mental health of displaced older adults after natural disasters.

Psychometric Properties of Disaster Event Reaction Items From the Crisis Counseling Individual/Family Encounter Log

OBJECTIVE

The purpose of this article was to examine the psychometric properties of the Crisis Counseling Assistance and Training Program (CCP) data collection instrument, the Individual/Family Encounter Log (IFEL). Data collected from disaster survivors included how they reacted to events in emotional, behavioral, physical, and cognitive domains. These domains are based on conceptual categorization of event reactions and allow CCP staff to provide survivors with referrals to appropriate behavioral health support resources, if warranted.

METHODS

This study explored the factor structure of these survey items to determine how best to use the available information as a screen of disaster-related behavioral health indicators. Specifically, our first research question explored and confirmed the optimal factor structure of the event reaction items, and our second question examined whether the new factor structure was similar across disaster types: hurricanes, tornadoes, floods, and wildfires. Using a factor analytic technique, we tested whether our event reaction outcomes achieved consistent and reliable measurement across different disaster situations. Finally, we assessed how the new subscales were correlated with the type of risk to which CCP disaster survivors were exposed.

RESULTS

Our analyses revealed 3 factors: (1) depressive-like, (2) anxiety-like, and (3) somatic. In addition, we found that these factors were coherent for hurricanes, floods, and wildfires, although the basic factor structure was not equivalent for tornadoes.

CONCLUSION

Implications for use of the IFEL in disaster preparedness, response, and recovery are discussed. (Disaster Med Public Health Preparedness. 2016;10:822-831).

Contextual Positive Coping as a Factor Contributing to Resilience After Disasters

OBJECTIVE

Strategy-situation fit, or contextual coping, posits that the physical and psychological demands associated with stressors are determined in part by the characteristics of each stress situation and may therefore require the use of different coping strategies. In this review, we discuss strategy-situation fit in the context of both natural and manmade disasters as it pertains to positivity and, ultimately, resilience after disasters.

METHOD

We reviewed the relevant literature on positivity and coping with disasters using a contextual approach.

RESULTS

We identified several disaster-related characteristics (i.e., cause of disaster, temporal characteristics of disasters, and degree of resource loss) that might influence the efficacy of positive coping strategies. We then discussed strategies that could be useful for promoting resilience with regard to these different characteristics.

CONCLUSION

This work represents an initial step in conceptualizing disaster resiliency within the framework of contextual positive coping. Recommendations for future avenues of research are discussed.

Gulf Coast Resilience Coalition: An Evolved Collaborative Built on Shared Disaster Experiences, Response, and Future Preparedness

OBJECTIVE

For close to a decade, the Gulf Coast of the United States has been in almost constant disaster recovery mode, and a number of lessons have been learned concerning disaster recovery and behavioral health. The purpose of this report was to describe the natural development of a Gulf Coast Resilience Coalition (GCRC).

METHODS

The GCRC methods began with state-specific recovery goals following Hurricane Katrina in 2005 and transitioned to a shared multistate and multidiscipline coalition. The coalition's effectiveness is demonstrated through continuation, procurement of funding to provide response services, and increased membership to ensure sustainability.

RESULTS

The coalition has enhanced response, recovery, and resilience by providing strategic plans for dissemination of knowledge; post-disaster surveillance and services; effective relationships and communication with local, state, and regional partners; disaster response informed by past experience; a network of professionals and community residents; and the ability to improve access to and efficiency of future behavioral health coordination through an organized response.

CONCLUSIONS

The GCRC can not only improve readiness and response, but work toward a shared vision of improved overall mental and behavioral health and thus resilience, with beneficial implications for the Gulf South and other communities as well.

Sick Leave and Disability Across Three Decades After a Major Disaster

Extended functional impairment characterized by sick leave and disability after a single disaster has not been documented before. This prospective, longitudinal, case-control study applied growth mixture modeling to predict trajectories of functional impairment in oil rig workers, survivors (n = 68) and a matched comparison group (n = 84), over 27 years after the 1980 North Sea oil rig disaster. In the initial 12 years post-disaster, survivors displayed higher rates of functional impairment than the comparison group. A minor group of survivors (n = 8, 11.8%) demonstrated persistent functional impairment from the start and remained unable to work during the subsequent three decades. Long-term sick leave and disability were related to perceived peritraumatic death threat and a propensity towards social withdrawal. Most survivors (n = 60) revealed no major functional impairment. The study indicates that functional impairment should be counteracted in the early support after a single disaster.

Racism and Psychological and Emotional Injury

The purpose of this article is to discuss the psychological and emotional effects of racism on people of Color. Psychological models and research on racism, discrimination, stress, and trauma will be integrated to promote a model to be used to understand, recognize, and assess race-based traumatic stress to aid counseling and psychological assessment, research, and training.

Children and Natural Disasters

Worldwide children are impacted by natural disasters, including hurricanes, floods, tornadoes, earthquakes, wildfires, landslides and sandstorms, winter and severe storms, heat waves, volcanoes and tsunamis. School psychologists should understand natural disaster effects, such as economic loss, relocation and health concerns and mental health issues. While most children are able to cope, a significant minority develops severe symptoms and Post Traumatic Stress Disorder (PTSD). School psychologists should gain trauma mental health training through the American Psychological Association, the National Association of School Psychologists, and the International School Psychology Association. They can also be involved in school and community prevention, mitigation and educational programming. This article presents an overview for school psychologists of the literature on children in natural disasters.

Organizing the health sector for response to disasters

Each year millions of people around the world are affected by natural and manmade disasters. The consequences of natural disasters in terms of health are complex. Disasters directly impact the health of the population resulting in physical trauma, acute disease, and emotional trauma. Furthermore, disasters may increase the morbidity and mortality associated with chronic and infectious diseases due to the impact on the health system. The health sector must be organized for adequate preparedness, mitigation, response and recuperation from a plethora of potential disasters. This paper examines the various potential impacts of disasters on health, the components of the health sector and their roles in emergency medical care and disaster situations, as well as the coordination and organization necessary within the system to best meet the health needs of a population in the aftermath of a disaster.

Approaches to the Assessment of Children in the Context of Disasters

Children exposed to disasters are a vulnerable population, making the assessment of children post-disaster an important issue. Utilizing a Multiple Gating Stepped Care framework, we highlight recent literature related to post-disaster assessment and intervention for children. In particular, we focus on screening, clinical evaluation, and feedback-informed service delivery. Screening allows large populations of children to be assessed at a relatively low cost. Children identified by screening as being at risk may then be assessed through more in-depth clinical evaluations, in order to assess clinical symptoms, strengths, and stressors, and to make determinations about appropriate interventions. Continued assessment during therapy provides important feedback for the delivery of appropriate care. New formats for assessment, as well as issues related to identifying sources for assessment, are discussed. Recommendations for future directions are provided.

General self-efficacy and posttraumatic stress after a natural disaster: a longitudinal study

Background

Self-efficacy may be an important factor in individuals’ recovery from posttraumatic stress reactions after a natural disaster. However, few longitudinal studies have investigated whether self-efficacy predicts the course of posttraumatic recovery beyond lower initial levels of distress. The purpose of the present study was to investigate whether general self-efficacy is related to recovery from posttraumatic stress reactions from a longitudinal perspective.

Methods

A total of 617 Norwegians exposed to the 2004 Southeast Asian tsunami completed self-report questionnaires measuring their level of disaster exposure and general self-efficacy at 6 months and posttraumatic stress reactions 6 months and 2 years post-disaster. Predictors of changes in posttraumatic stress reactions were analyzed with multivariate mixed effects models.

Results

Self-efficacy at 6 months post-disaster was unrelated to trauma exposure and inversely related to posttraumatic stress reactions at 6 months and 2 years post-disaster. However, self-efficacy was not related to recovery from posttraumatic stress reactions between 6 months and 2 years post-disaster.

Conclusions

In conclusion, general self-efficacy is related to lower levels of posttraumatic stress reactions in the first months after a disaster but does not appear to be related to improved recovery rates over the longer term.

Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis

BACKGROUND

Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression.

AIMS

To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment.

METHOD

A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs).

RESULTS

The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30-3.98), technological disaster OR = 1.44 (95% CI 1.21-1.70), terrorist acts OR = 1.80 (95% CI 1.38-2.34) and military combat OR = 1.60 (95% CI 1.09-2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06-1.87).

CONCLUSIONS

Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.

Uttarakhand Disaster 2013: A Report on Psychosocial Adversities Experienced by Children and Adolescents

OBJECTIVE

To report the psychosocial adversities faced by children and adolescents in the Uttarkashi, district of Uttarakhand, experienced immediately after the Himalayan Tsunami in June 2013. Also to discuss issues pertinent to the disaster management including the needs of the disaster affected areas and future challenges.

METHODS

This is a cross sectional observational report from the community assessment and interventions that were carried out as part of the disaster relief work by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore within 1 mo of the disaster. Assessments and interventions were done by a team consisting of psychiatry resident, clinical psychologist, psychiatric social worker and a nurse. All diagnosis were made using International Classification of Diseases 10 (ICD 10) and the data was analysed using descriptive statistics and chi-square tests.

RESULTS

A total of 300 children were screened; the mean age of the sample was 11.5 y and 65(32.5%) were boys. Two hundred (66.7%) children/adolescents reported one or the other psychosocial adversities attributable to the disaster. Psychological distress was present in 54/300 (18%) of the individuals. Loss of shelter and loss of playing space were the social issues having a statistically significant association with psychological distress signals such as feelings of anxiety, helplessness, insecurity, grief and uncertainty. Stress induced diagnosable psychiatric disorder was not present in any child or adolescent, however stress related psychiatric symptoms were present in around 13%.

CONCLUSIONS

Himalayan tsunami of Uttarakhand in 2013 was associated with considerable psychosocial adversities among the resident children and adolescents. As children are a vulnerable population, a public health approach towards assessment and management of the psychosocial adversities in this population is urgently required at the state and national levels.

Posttraumatic stress symptoms, co-morbid psychiatric symptoms and distorted cognitions among flood victims of different ages

BACKGROUND

In literature, the effect of age on posttraumatic stress disorder (PTSD) is inconclusive; the effect on flood-related PTSD is particularly unclear. Little is known on distorted cognitions among flood victims, although cognition distortions and PTSD have been linked among victims of other traumas.

AIMS

To investigate: (1) whether flood-related PTSD, psychiatric co-morbidity and cognitive distortions would differ according to age and (2) distinctive patterns of association between the preceding variables for different age groups.

METHODS

One hundred and fifty-four flood victims of different ages completed standardized questionnaires measuring PTSD, psychiatric co-morbidity and cognitive distortions.

RESULTS

Adolescents and young adults reported significantly fewer PTSD, psychiatric co-morbidity and distorted cognition symptoms than people who were older. Preoccupation with danger and hopelessness were associated with both outcomes for adolescents, people in their thirties and middle-aged/older people. For young adults, helplessness was associated with PTSD; hopelessness and preoccupation with danger with psychiatric co-morbidity.

CONCLUSIONS

Adolescents and young adults buffered against flood-related psychological distress better than older people. Distorted cognitions related to distress outcomes differently depending on age.

Near-Death and Other Transpersonal Experiences Occurring During Catastrophic Events

The purpose of this article is to describe examples of near-death and other transpersonal experiences occurring during catastrophic events like floods, wars, bombings, and death camps. To date, researchers have limited their investigations of these transpersonal events to those occurring to seriously ill patients in hospitals, those dying from terminal illnesses, or to individuals experiencing a period of grief after the death of a loved one. Missing is awareness by first responders and emergency healthcare professionals about these transpersonal experiences and what to say to the individuals who have them. Some responders experience not only deaths of the victims they assist, but also deaths of their colleagues. Information about these transpersonal experiences can also be of comfort to them. The examples in this article include a near-death experience during the Vietnam War, an out-of-body experience after a bomb explosion during the Iraq War, a near-death visit to a woman imprisoned at Auschwitz, and two after-death communications, one from a person killed in Auschwitz and another from a soldier during World War I. Also included are interviews with two New York City policemen who were September 11, 2001 responders. It is hoped the information will provide knowledge of these experiences to those who care for those near death, or dying, or grieving because of catastrophic events, and encourage researchers to further investigate these experiences during disasters.

Personality diatheses and Hurricane Sandy: effects on post-disaster depression

BACKGROUND

According to diathesis-stress models, personality traits, such as negative emotionality (NE) and positive emotionality (PE), may moderate the effects of stressors on the development of depression. However, relatively little empirical research has directly examined whether NE and PE act as diatheses in the presence of stressful life events, and no research has examined whether they moderate the effect of disaster exposure on depressive symptoms. Hurricane Sandy, the second costliest hurricane in US history, offers a unique opportunity to address these gaps.

METHOD

A total of 318 women completed measures of NE and PE 5 years prior to Hurricane Sandy. They were also assessed for lifetime depressive disorders on two occasions, the latter occurring an average of 1 year before the hurricane. Approximately 8 weeks after the disaster (mean = 8.40, s.d. = 1.48 weeks), participants completed a hurricane stress exposure questionnaire and a measure of current depressive symptoms.

RESULTS

Adjusting for lifetime history of depressive disorders, higher levels of stress from Hurricane Sandy predicted elevated levels of depressive symptoms, but only in participants with high levels of NE or low levels of PE.

CONCLUSIONS

These findings support the role of personality in the development of depression and suggest that personality traits can be useful in identifying those most vulnerable to major stressors, including natural disasters.

Vile vigilance: An integrated theoretical framework for understanding the state of Black surveillance

The family is the principal source of socialization and protection against racism for many Blacks. Transmitting values, norms, morals, and beliefs (i.e., racial socialization) to successive generations is done to promote racial awareness and to prepare an individual to survive in racist environments. Further, developing a sense of security, resiliency, and cultural pride provides psychological protection against racial prejudice and discrimination. Protective socialization is even more critical when it becomes the difference between life and death at the hands of law enforcement-a fate faced by too many Black males as a result of racist policing practices, including the over-patrolling of Black communities. Because discriminatory surveillance and over-patrolling can incite a number of social, physical, and mental health issues, a holistic approach to understanding the interaction between Blacks and law enforcement is critical. This article reviews the Mundane Extreme Environmental Stress (MEES) model, racial socialization theory, and Family Stress Model in the development of a theoretical framework for understanding the patterns of interactions between Blacks and law enforcement, the immediate and long-term effects of unjustified shootings on Black families and communities, and the response of sociopolitical systems. The new theoretical framework will be used to inform the work of human service providers and practitioners by identifying targets for interventions to improve relations and trust between Black communities and law enforcement institutions.

Photovoice: Assessing the Long-Term Impact of a Disaster on a Community's Quality of Life

Photovoice is a qualitative method of inquiry whereby individuals can document their lived experiences, particularly individuals whose voices are not typically heard in regard to promoting social change and policy development. We used photovoice to elicit major themes regarding community members' perceptions of the long-term impact on their quality of life as a deadly technological disaster hit a small, rural town in South Carolina. Overall, participants photographed more negative images than positive. Overarching themes included residential and business vacancies, economic decline, the need for clean-up and modernization, attention to wellness or rehabilitation, and concerns for safety. Emergency response agencies should consider the themes elicited from these community residents to help identify where to focus disaster response efforts both in the immediate aftermath and during the long-term recovery period of technological disasters, particularly in underserved, rural communities.

Burnout and Psychiatric Distress in Local Caregivers Two Years After the 2011 Great East Japan Earthquake and Fukushima Nuclear Radiation Disaster

The 2011 Great East Japan Earthquake precipitated a triple disaster of earthquake, tsunami and nuclear radiation disaster. To quantify the prevalence of burnout and psychiatric distress in local healthcare providers (caregivers) more than 2 years after the disaster, this study surveyed caregivers from affected areas through interviews about topics of concerns and two questionnaires: Maslach Burnout Inventory and General Health Questionnaire. Concerns listed by respondents were primarily radiation related: additional stress, concern for children, concern for local food, and sleep difficulties. We found significant number of caregivers to have signs of emotional exhaustion, low personal accomplishment, and psychological distress. Our findings suggest that local caregivers are experiencing substantial mental health burdens, which have unfortunately remained static from the year prior, even 2 years after the fact. Therefore, long term psychological support and improvement in caregiver work conditions are essential to maintain sustainable care in rebuilding disaster stricken areas.

Broadening perspectives on trauma and recovery: a socio-interpersonal view of PTSD

Posttraumatic stress disorder (PTSD) is one of the very few mental disorders that requires by definition an environmental context-a traumatic event or events-as a precondition for diagnosis. Both trauma sequelae and recovery always occur in the context of social-interpersonal contexts, for example, in interaction with a partner, family, the community, and the society. The present paper elaborates and extends the social-interpersonal framework model of PTSD. This was developed to complement other intrapersonally focused models of PTSD, which emphasize alterations in an individual's memory, cognitions, or neurobiology. Four primary reasons for broadening the perspective from the individual to the interpersonal-societal contexts are discussed. The three layers of the model (social affects, close relationships, and culture and society) are outlined. We further discuss additional insights and benefits of the social-interpersonal perspective for the growing field of research regarding resilience after traumatic experiences. The paper closes with an outlook on therapy approaches and interventions considering this broader social-interpersonal perspective on PTSD.

Disaster Mental Health Epidemiology: Methodological Review and Interpretation of Research Findings

Worldwide, disasters are increasing in frequency and severity. Mental health consequences of disasters are extensive, and knowledge of anticipated mental health effects is needed for effective disaster response. Difficulties inherent in conducting disaster research have limited the understanding of research findings. This article presents and interprets disaster mental health research findings in the context of research methods. A brief history of the disaster mental health research field is provided, and the presentation of findings is ordered into topical areas of disaster mental health consequences and timing and prediction of mental health outcomes. Results of different studies varied greatly by several main characteristics of research methods, especially methods of psychiatric assessment, sampling and exposure group determination, and consideration of confounding variables. In conclusion, many complexities in conducting disaster mental health research have limited the understanding and interpretation of available knowledge needed to inform efforts to plan and carry out effective mental health responses to disasters. Thoughtful interpretation of findings in the context of research design and methods is vital to accurate understanding of the types, prevalence, and predictors of anticipated mental health effects of disasters. A wealth of knowledge from disaster mental health research has accumulated in recent decades, but more research is still needed to resolve inconsistent findings through methodological refinements.

Immediate behavioural responses to earthquakes in Christchurch, New Zealand, and Hitachi, Japan

This study examines people's immediate responses to earthquakes in Christchurch, New Zealand, and Hitachi, Japan. Data collected from 257 respondents in Christchurch and 332 respondents in Hitachi revealed notable similarities between the two cities in people's emotional reactions, risk perceptions, and immediate protective actions during the events. Respondents' physical, household, and social contexts were quite similar, but Hitachi residents reported somewhat higher levels of emotional reaction and risk perception than did Christchurch residents. Contrary to the recommendations of emergency officials, the most frequent response of residents in both cities was to freeze. Christchurch residents were more likely than Hitachi residents to drop to the ground and take cover, whereas Hitachi residents were more likely than Christchurch residents to evacuate immediately the building in which they were situated. There were relatively small correlations between immediate behavioural responses and demographic characteristics, earthquake experience, and physical, social, or household context.

Cross-Sectional Data Within 1 Year of the Fukushima Meltdown: Effect-Size of Predictors for Depression

This cross-sectional study investigates effect sizes of depression predictors in a community close to the Fukushima, Japan nuclear reactor damaged by the 11 March, 2011 earthquake and tsunami. Subjects volunteered for assessment between December, 2011 and March, 2012. Of 466 individuals (351 female, mean age 60.4 year, SD = 14.0), 23 % of the female participants and 17 % of the male participants could be diagnosed with depression. The strongest predictors were house damage, age, income reduction, home water incursion, and casualty acquaintance. Education level, location during disaster, and workplace damage proved non-significant. The high number of retired/unemployed in the sample may have influenced outcome. Results suggest sampling influences the applicability of Conservation of Resources model to a disaster event.