Understanding Resilience and Other Trajectories of Psychological Distress: a Mixed-Methods Study of Low-Income Mothers Who Survived Hurricane Katrina

Post-traumatic stress and depression following disaster: examining the mediating role of disaster resilience

The current study used structural equation modeling to examine the role of disaster resilience as a mediator between disaster exposure and post-traumatic stress and depressive symptoms among a sample of 625 U.S. adults who experienced a disaster event. Results found that disaster resilience mediated the relationship between disaster exposure as a predictor and depression and post-traumatic stress as dependent variables. These findings have important implications for understanding the mechanisms by which disaster resilience supports post-disaster mental health and can inform future disaster mental health interventions and practice models.

Random intercept cross-lagged relations among trauma coping self-Efficacy, trauma coping, and PTSD symptoms among rural hurricane survivors

BACKGROUND AND OBJECTIVES

The trajectories of recovery and non-recovery following a disaster are well-documented, but the mechanisms of post-disaster adaptation remain poorly understood. Rooted in social cognitive theory and the transactional model of stress and coping, this study longitudinally investigated the reciprocal relations among coping self-efficacy (CSE), coping behaviors (approach and avoidant), and posttraumatic stress symptoms (PTSS) among highly exposed hurricane survivors.

DESIGN

261 Hurricane Florence survivors completed measures of hurricane-related CSE, coping behaviors, and hurricane-related PTSS across three timepoints, beginning 5-8.5 months after Hurricane Florence.

METHOD

Random-intercept cross-lagged panel models investigated the relations among study variables.

RESULTS

Reciprocal, cross-lagged relations were identified between higher CSE and approach coping from T2 to T3. The lagged relations between approach coping at T1 and T2 were significant, as well as between avoidant coping at T2 and T3. Significant cross-sectional relations were also present for CSE, coping behaviors, and PTSS at T3.

CONCLUSIONS

Results provide partial support for the positive feedback loop involving CSE and approach coping, but not for the negative feedback loop involving avoidant coping. CSE may be an important mechanism in longer-term disaster recovery, in part by increasing use of approach coping.

Trajectories of parental posttraumatic stress disorder and children's mental health following Super Typhoon Lekima: The mediating role of feeling of safety

INTRODUCTION

Several studies have examined the impact of parents' posttraumatic stress disorder (PTSD) on their children's mental health, but few have evaluated the role of parents' specific PTSD trajectories. The aim of this study was to assess the mechanisms underlying distinct trajectories of parental PTSD that affect children's PTSD and depression through the feeling of safety.

METHODS

The final sample comprised 242 dyads of parents and their children who experienced Super Typhoon Lekima in 2019. All participants were surveyed at three time points after the typhoon: 3 months (T1), 15 months (T2), and 27 months (T3). Parental PTSD symptoms at three time points and children's PTSD, depression, and feeling of safety at T3 were analyzed.

RESULTS

Four parental PTSD trajectories were identified: recovery, resilience, delayed, and coping. Compared with the resilient group, children of parents with delayed PTSD trajectories reported higher levels of depression at T3, while children of parents in the coping group were more likely to experience severe PTSD at T3. Children of parents in the recovery group, with a reduced feeling of safety, exhibited more severe depression and PTSD at T3, whereas children of parents in the delayed group were at an increased risk of PTSD at T3.

CONCLUSIONS

These findings highlight the heterogeneity of parental PTSD trajectories following natural disasters and their distinct effects on children's PTSD and depression. Furthermore, feeling of safety emerges as a crucial mechanism in this process.

Coping With Disasters and Pandemics Through Experience and Community: How African American Older Adults Navigate Disaster Planning, Response, and Recovery

OBJECTIVE

Studies have reported that minorities are disproportionately impacted by the COVID-19 pandemic. Few studies have elucidated the lived experiences of African American older adults, and the resiliency displayed in combatting the COVID-19 pandemic and other disasters.

METHODS

This study used 4 recorded focus groups with 26 African American older adults who have spent most of their lives living in Houston, Texas to assess safety, economic, and health concerns related to the pandemic and similarities or differences with other types of disasters that are specific to Houston/ the Gulf Region of Texas, such as Hurricane Harvey.

RESULTS

Key themes emerged from the thematic analysis: 1) previous disasters provided important coping and preparation skills, although each occurrence was still a major stressor, 2) while telehealth was a significant benefit, regular health maintenance and chronic disease management were not completed during the COVID-19 pandemic, 3) information from the federal and state authorities were inconsistent and spurred fear and anxiety, 4) participants experienced few to no disruptions to their income but were heavily called on to support family members, and 5) participants experienced anxiety and isolation, but many used existing social connections to cope.

CONCLUSIONS

These findings demonstrate how African American older adults navigate disaster response and recovery through experience and community. Providing unambiguous information to older adults could prove useful in preparing for future disaster events and coping with disasters.

Psychosocial resources underlying disaster survivors' posttraumatic stress symptom trajectories: insight from in-depth interviews with mothers who survived Hurricane Katrina

Background: Weather-related disasters, including hurricanes, are becoming more frequent and severe due to climate change. Vulnerable populations, such as people with low income and racial and ethnic minorities, are particularly prone to increased levels of physical harm and psychiatric adversity from weather-related events.Objectives: We aimed to explore psychosocial resources and coping of survivors with three different posttraumatic stress symptom (PTSS) trajectories (High-Decreasing, Moderate-Decreasing, and High-Stable), after Hurricane Katrina across two different time points: F1 (1-year post-disaster) and F3 (12 years post-disaster).Method: Participants in this multi-method study were part of a larger cohort of the Resilience in Survivors of Katrina (RISK) project. Transcripts of interviews completed at the two time points were analysed using two qualitative methods, combining thematic analysis and narrative analysis, and providing both breadth of perspectives with the depth of specific case studies.Results: Sixteen survivors completed interviews at both F1 and F3. From our in-depth analysis of the data, we derived five inductive themes: 'Hope,' 'Adaptive vs maladaptive avoidance,' 'Emotional delay,' 'Acceptance, Finding Meaning and Being in the Moment,' and 'Coping strategies.' Survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories experienced hope for future, accepted the hurricane and its results, and found efficient ways to cope with their situation. Survivors with High-Stable PTSS trajectories tended to express a lack of hope for future and struggled to be mindful and accept the hurricane and its harm. Unlike survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories, survivors with High-Stable PTSS trajectories also reported less social and family support and faced more discrimination and racism.Conclusion: There are factors beyond individual-level psychosocial resources that may shape post-disaster resilience. When supporting survivors after a weather-related disaster, it is essential to provide ongoing psychological, financial, and physical assistance to bolster these resources.

Experiences of pregnant women exposed to Hurricanes Irma and Maria in the US Virgin Islands: a qualitative study

INTRODUCTION

Hurricanes Irma and Maria made landfall in the US Virgin Islands (USVI) in 2017. To date, there is no published literature available on the experiences of pregnant women in the USVI exposed to these hurricanes. Understanding how hurricanes affect pregnant women is key to developing and executing targeted hurricane preparedness and response policies. The purpose of this study was to explore the experiences of pregnancy and birth among women in the USVI exposed to Hurricanes Irma and Maria.

METHODS

We employed a qualitative descriptive methodology to guide sampling, data collection, and analysis. Semi-structured interviews of 30-60 min in length were conducted with a purposive sample of women (N = 18) in the USVI who were pregnant during or became pregnant within two months after the hurricanes. Interviews were transcribed verbatim and data managed in MAXQDA. Team members developed a codebook, applied codes for content, and reconciled discrepancies. We thematically categorized text according to a socioecological conceptual framework of risk and resilience for maternal-neonatal health following hurricane exposure.

RESULTS

Women's experiences were organized into two main categories (risk and resilience). We identified the following themes related to risk at 3 socioecological levels including: (1) individual: changes in food access (We had to go without) and stress (I was supposed to be relaxing); (2) household/community: diminished psychosocial support (Everyone was dealing with their own things) and the presence of physical/environmental hazards (I was really scared); and (3) maternity system: compromised care capacity (The hospital was condemned). The themes related to resilience included: (1) individual: personal coping strategies (Being calm); (2) household/community: mutual psychosocial and tangible support (We shared our resources); and (3) the maternity system: continuity of high-quality care (On top of their game).

CONCLUSIONS

A socioecological approach provides a useful framework to understand how risk and resilience influence the experience of maternal hurricane exposure. As the frequency of the most intense hurricanes is expected to increase, clinicians, governments, and health systems should work collaboratively to implement hurricane preparedness and response plans that address pregnant women's unique needs and promote optimal maternal-infant health.

Trajectories of Postpartum Recovery: What is Known and Not Known

Women's postpartum health is a public health issue that has lifelong consequences. Timely recognition and treatment of physical and mental health issues can have positive health consequences while lack of access to effective treatments or health care services can lead to long-term health problems. To advance knowledge of priority health symptoms and trajectories of postpartum recovery from women's health perspectives, we share findings from the Maternal health And Maternal Morbidity in Ireland (MAMMI) study. Data from 3047 first-time mothers recruited to a longitudinal maternal health study in Ireland from 2012 to 2017 reveal the trajectories of maternal health and health problems experienced up to 12 months postpartum. Morbidities explored include urinary incontinence, pelvic girdle pain, and sexual and mental health issues. Viewed together, and over time, the scale and persistent nature of many physical and mental health problems become apparent, yet considerable proportions of women were not asked directly about health problems by health care professionals. When women do not know what is and is not normal postpartum, they may suffer in silence and the consequence is that health problems/issues that are preventable, and treatable, are likely to become chronic. To make positive contributions to women's health, maternity care systems must be truly woman-centered and structured in ways that place emphasis on women's own health needs. In systems where women's voices and concerns are acknowledged and central, women are likely to thrive and flourish in motherhood.

"Showing Everybody's True Colors": Informal networks of low-income single mothers and their young children during the COVID-19 pandemic

Extensive evidence suggests low-income mothers depend upon their families and friends for emotional, practical, and economic support in times of need. This is the first study to examine the operation of low-income mothers' informal support networks and the impact of such networks on maternal well-being during the COVID-19 pandemic. We interviewed low-income, single mothers of young children (<12 years; N = 34) twice over Summer 2020 to consider mothers' decisions around network engagement and how their interactions contributed to their well-being. Consistent with the social capital framework and previous studies, most mothers turned to their networks and exchanged support. Thematic analysis uncovered 4 inter-related themes of mothers' experiences: (1) discovering emotionally-available networks, (2) navigating resource-limited networks, (3) reassessing network member relationships, and (4) establishing boundaries for in-person contact. Although emotionally valuable, networks could not meet increased economic and child care needs. The COVID-19 pandemic's economic impact and its impact on time use tested network relationships with some relationships strengthening and others dissolving. Widely-available emotional support was essential to mothers adapting to the pandemic. Safe, affordable child care options coupled with accessible, economic supplements can promote well-being among single mothers and their children.

Long-Term Impact of Hurricane Sandy Exposure on Positive and Negative Affect: The Role of Perceived Social Support

OBJECTIVES

Natural disasters can have devastating, long-lasting effects on the mental health of older adults. However, few studies have examined associations among disaster exposure and positive and negative affect, and no longitudinal studies have investigated the extent to which pre-disaster perceived social support affects these associations. These analyses examine the associations among pre-disaster perceived social support, disaster exposure, and positive and negative affect experienced by community-dwelling older adults four years after Hurricane Sandy, controlling for pre-disaster affect.

METHODS

Self-reported data collected before and after Hurricane Sandy from participants (aged 50-74 years) in the ORANJ BOWL panel (N=2442) were analyzed using linear regression models.

RESULTS

Higher levels of peri-traumatic stress experienced during Hurricane Sandy and greater hardship experienced after the storm were associated with more negative affect four years following the disaster. Higher perceived social support at baseline was related to more positive affect and less negative affect both before and after the hurricane. Social support did not moderate the effect of hurricane exposure on either positive or negative affect.

DISCUSSION

Findings suggest that psychological effects may persist years after natural disasters and that more effective interventions may be needed during and after a disaster. While social support is critical to positive and negative affect in general, its buffering effects when disaster strikes may be limited.

The Disaster Adaptation and Resilience Scale: development and validation of an individual-level protection measure

Given the increasing threat of disasters in the United States and elsewhere around the world, well-tested assessment tools that operationalise specific protective factors associated with adaptation and resilience to such events are needed. Consequently, the authors proposed, developed, and validated the Disaster Adaptation and Resilience Scale (DARS) to measure five domains found to support adaptive responses in individuals exposed to disasters: physical resources; social resources; problem-solving; distress regulation; and optimism. The development and validation processes of DARS occurred across two studies: the first comprised construct development, item generation, and expert review, whereas the second involved a full validation evaluation of the psychometric properties of the scale in a sample of adults exposed to a disaster in the US (N=625). The results revealed that DARS had psychometric properties that support its use among adults experiencing a disaster. A discussion is presented on how the scale can be employed in both research and practice.

Fear vs. hope in India: Finding the silver lining amid the dark clouds of COVID-19

COVID-19 has been declared a global pandemic, and the associated high rates of morbidity and mortality have made individuals susceptible to mental health problems that affect their psychological well-being. Although individual strengths can shield the negative impact of adverse conditions, their protective role in the context of COVID-19 has not received much attention. This study examines the relationship between fear of COVID-19 and mental health via rumination through the lens of hope as a personal psychological strength. This study employed a two-wave longitudinal design. Data was collected from 412 Indian participants with a time interval of three months and analyzed using a two-step approach to structural equation modelling. Fear of COVID-19 was found to a have negative effect on mental health through rumination. However, results from moderation analysis support the role of hope as a buffer against the indirect negative impact of fear of COVID-19 on mental health outcomes. As one of the first studies to demonstrate the role of psychological strengths of individuals in coping with the direct and indirect psychological ramifications of COVID-19 over a period of time, it contains important implications for the development of mental health interventions in the face of this global crisis.

Association between psychological resilience and changes in mental distress during the COVID-19 pandemic

BACKGROUND

Psychological responses to potentially traumatic events tend to be heterogeneous, with some individuals displaying resilience. Longitudinal associations between resilience and mental distress during the COVID-19 pandemic, however, are poorly understood. The objective of this study was to examine the association between resilience and trajectories of mental distress during the COVID-19 pandemic.

METHODS

Participants were 6,008 adults from the Understanding America Study, a probability-based Internet-panel representative of the US adult population. Baseline data were collected between March 10 and March 31, 2020, with nine follow-up waves conducted between April 1 and August 4. Mixed-effects logistic regression was used to examine the association between date and mental distress, stratified by resilience level (low, normal, or high).

RESULTS

In contrast to the high resilience group, participants in the low and normal resilience groups experienced increases in mental distress in the early months of the pandemic (low: OR=2.94, 95% CI=1.93-4.46; normal: OR=1.91, 95% CI=1.55-2.35). Men, middle-aged and older adults, Black adults, and adults with a graduate degree were more likely to report high resilience, whereas adults living below the poverty line were less likely to report high resilience.

LIMITATIONS

These associations should not be interpreted as causal, and resilience was measured at only one time-point.

CONCLUSIONS

Trajectories of mental distress varied markedly by resilience level during the early months of the COVID-19 pandemic, with low-resilience adults reporting the largest increases in mental distress during this crisis. Activities that foster resilience should be included in broader strategies to support mental health throughout the pandemic.

Mitigating Health Disparities After Natural Disasters: Lessons From The RISK Project

Climate change exacerbates the severity of natural disasters, which disproportionately affect vulnerable populations. Mitigating disasters' health consequences is critical to promoting health equity, but few studies have isolated the short- and long-term effects of disasters on vulnerable groups. We filled this gap by conducting a fifteen-year (2003-2018) prospective study of low-income, predominantly Black parents who experienced Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Here we describe this project and synthesize lessons from work that has resulted from it. Our findings can guide policy makers, service providers, and health officials in disaster planning and response. We synthesize them into an organizational schema of five priorities: Primary efforts should be aimed at preventing exposure to trauma through investments in climate resilience and by eliminating impediments to evacuation, health care policies should promote uninterrupted and expanded access to care, social services should integrate and strive to reduce the administrative burden on survivors, programs should aid survivors in forging or strengthening connections to their communities, and policy makers should fund targeted long-term services for highly affected survivors.

Impact of the Great East Japan Earthquake on the Employment Status and Mental Health Conditions of Affected Coastal Communities

The Great East Japan Earthquake devasted the old community in coastal areas characterized by primary industry. The number of unemployed people increased from 150,000 to 190,000 after the earthquake. All of the adult residents of Shichigahama (18 years old or older), located in the coastal area of the Miyagi prefecture, whose houses were totally or majorly damaged, were recruited for a survey conducted in October 2011. All of the residents who responded with written informed consent were included in this study. Among 904 individuals who had a job before the Great East Japan Earthquake, 19% became unemployed. Concerning gender and age, 9% of young men, 34% of elderly men, 21% of young women, and 49% of elderly women became unemployed. Concerning the type of industry, 38%, 15%, and 16% of people who had belonged to the primary, secondary, and tertiary industries, respectively, before the disaster became unemployed. Those who became unemployed exhibited a significantly higher risk of insomnia compared to those who maintained jobs. The study pointed out the severe impact of the Great East Japan Earthquake on populations who had belonged to the primary industry, especially among elderly women, and its effect on sleep conditions.

A hybrid inductive-abductive analysis of health workers' experiences and wellbeing during the COVID-19 pandemic in the United States

The COVID-19 pandemic puts health workers at increased risk of adverse mental health outcomes. However, no studies have assessed health workers' experiences using qualitative methods during the COVID-19 outbreak in the United States to identify novel factors that could relate to their mental health. In May 2020, we distributed an online survey to health workers across 25 medical centers throughout the United States. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Primary Care-Post-Traumatic Stress Disorder, and Alcohol Use Disorders Identification Test-Concise and associated cutoff values were used to assess rates of probable major depression, generalized anxiety disorder, post-traumatic stress disorder, and alcohol use disorder, respectively. To provide insight into the factors shaping these and other mental health conditions, we included two open-ended questions asking respondents to recount their most upsetting and hopeful experiences during the COVID-19 pandemic and how it made them feel. Using a hybrid inductive-abductive approach and thematic content analysis, we created a Social Ecological Model to represent themes among health workers' experiences within five ecological levels: individual, interpersonal, organization, community, and public policy. Of the 1,132 participants who completed the survey, 14.0% had probable major depression, 15.8% probable generalized anxiety disorder, 23.1% probable post-traumatic stress disorder, and 42.6% probable alcohol use disorder. Individual level themes included participants' personal health and self-care behaviors. Interpersonal level themes included the health of their social circle, family functioning, and social support. Organization level themes included their hospital's management, resources, patient care, routine, and teams. Themes in the community level included the media, scientific knowledge about COVID-19, morale, behavior, and support of health workers. Lastly, government and health system leadership and shelter-in-place policy were themes within the public policy level. Our findings provide insights into novel factors that have impacted health workers' wellbeing during the COVID-19 pandemic. These factors should be further explored to inform interventions and public policy that mitigate mental health morbidities among health workers during this and future outbreaks.

Extremes in Context: A Life-Course Approach to Disaster Mental Health

Exposure to disasters has a range of adverse mental-health consequences. This Commentary argues that to understand variation in post-disaster mental health, we must look beyond the disaster itself to other sources of vulnerability throughout the life course, as well as the developmental stage at which the disaster was experienced.

Effects of gentrification on health status after Hurricane Katrina

Despite substantial debate about the impacts of gentrification on cities, neighborhoods, and their residents, there is limited evidence to demonstrate the implications of gentrification for health. We examine the impacts of gentrification on several health measures using a unique individual-level longitudinal data set. We employ data from the Resilience in Survivors of Hurricane Katrina (RISK) project, a study of low-income parents, predominantly non-Hispanic Black single mothers, who participated in a New Orleans-based study before and after Hurricane Katrina. After Katrina, all participants were displaced, at least temporarily, from New Orleans, and had little or no control over neighborhood placement immediately following the storm. This near-random displacement after Katrina created a natural experiment. We employ a quasi-experimental intent to treat design to assess the causal effects of gentrification on health in the RISK population. We do not find evidence of significant main effects of being displaced to a gentrified neighborhood on BMI, self-rated health, or psychological distress. The analysis employs a quasi-experimental design and has several additional unique features--homogeneous population, limited selection bias, and longitudinal data collection-- that improve our ability to draw causal conclusions about the relationship between gentrification and health. However, the unique context of displacement by natural disaster may limit the generalizability of our findings to other circumstances or residents experiencing gentrification.

Resilient, recovering, distressed: A longitudinal qualitative study of parent psychosocial trajectories following child critical injury

INTRODUCTION

The psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury.

METHODS

Semi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time.

FINDINGS

Three parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child's injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time; recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months; and distressed trajectory where parents experienced significant psychosocial disruption due to their child's injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented.

CONCLUSIONS

This is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families' psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child's admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.