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Kuo SIC. Commentary on Tajima et al. (2024): Interplay between disaster-related experiences, stressors, and problem drinking. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1246-1249. [PMID: 38735881 PMCID: PMC11236521 DOI: 10.1111/acer.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
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Sanz J, Hernández-Martínez T, Castillo-Burgos P, Sanz-García A, García-Vera MP. Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: a systematic and meta-analytic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:705-722. [PMID: 38011685 DOI: 10.1080/00952990.2023.2275526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023]
Abstract
Background: Previous studies have reviewed the evidence on the increase in alcohol consumption after a terrorist attack. However, an increase does not necessarily imply the presence of an alcohol use disorder.Objectives: To conduct a systematic and meta-analytic review of the literature on the prevalence of increased alcohol consumption and alcohol use disorders in adult exposed to terrorism.Methods: A search of PsycINFO, MEDLINE and PTSDpubs identified 29 studies published up to March 2023 in which 38 adult samples totaling 282,753 persons exposed to terrorism were assessed. Using inverse variance heterogeneity models, pooled prevalence rates of increased alcohol use and alcohol use disorders were calculated.Results: 6% (95% CI [2.9, 9.5]) of the adults exposed to a terrorist attack increased their alcohol consumption. The prevalence of increased alcohol use varied depending on the degree of exposure (p = .006, R2 = .18) and the procedure for measuring increases (p = .043, R2 = .37). The prevalence of alcohol use disorders in adults exposed to a terrorist attack was 5.5% (95% CI [3.7, 7.5]), a rate that was not higher than that obtained in the general population and varied depending on the type of alcohol disorder (p = .015, R2 = .30).Conclusions: A relevant number of adults exposed to terrorist attacks will subsequently increase their alcohol consumption, but this increase is not associated with an increase in the prevalence of alcohol use disorders. Effects of terrorism on people's health are potentially widespread, but concerns of excessive alcohol use after terrorist attacks may be unwarranted.
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Affiliation(s)
- Jesús Sanz
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - Timanfaya Hernández-Martínez
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - Patricia Castillo-Burgos
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - Ana Sanz-García
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - María Paz García-Vera
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
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3
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North CS, Pfefferbaum B. Tobacco and Illicit Drug Use and Drug Use Disorders Among Employees of Businesses Affected by the 9/11 Attacks on the World Trade Center in New York City. J Dual Diagn 2023; 19:180-188. [PMID: 37796633 PMCID: PMC10624119 DOI: 10.1080/15504263.2023.2260328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders. METHODS A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders. RESULTS Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11. CONCLUSIONS The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.
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Affiliation(s)
- Carol S. North
- The Altshuler Center for Education and Research at Metrocare Services, Dallas, Texas, USA
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, The University of Oklahoma Health Sciences Center College of Medicine, Oklahoma City, Oklahoma, USA
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Patrick ME, Terry-McElrath YM, Miech RA, Keyes KM, Jager J, Schulenberg JE. Alcohol use and the COVID-19 pandemic: Historical trends in drinking, contexts, and reasons for use among U.S. adults. Soc Sci Med 2022; 301:114887. [PMID: 35316700 PMCID: PMC8924032 DOI: 10.1016/j.socscimed.2022.114887] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/16/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
Objective The current study used U.S. national data to examine drinking trends prior to and during the COVID-19 pandemic in 2020, focusing on changes in U.S. young- and middle-adult alcohol prevalence, frequency, and drinking contexts and reasons, and whether they differed by age and college status. Methods Data from 2015 to 2020 from 16,987 young adults (ages 19–30) and 23,584 middle adults (ages 35–55) in the national Monitoring the Future study were used to model historical trends and potential 2020 shifts (data collection April 1 to November 30, 2020) in prevalence (30-day, daily, binge drinking) and frequency (30-day, binge drinking). For young adults, data on drinking contexts and negative affect reasons for drinking were examined. Moderation by age and college status was also tested. Results 2020 was associated with (1) downward deviation in 30-day (young and middle adults) and binge drinking (young adults) prevalence; (2) upward deviation in daily drinking prevalence (middle adults); (3) among drinkers, upward deviation in frequency of 30-day (young and middle adults) and binge drinking (young adults); and (4) changes in drinking contexts and reasons among drinkers. Among college students, in particular, 2020 was associated with a downward deviation from expected historical trends in drinking prevalence. Upward deviations in daily prevalence and both binge and 30-day drinking frequency were stronger at ages 25–30 (vs. 19–24) and 35–45 (vs. 50–55). Conclusions Among U.S. young and middle adults, deviations from expected historical trends in population alcohol use that occurred during the pandemic included decreases in alcohol use prevalence, increases in alcohol use frequency, and increases in the use of alcohol to relax/relieve tension and because of boredom. These shifts were likely due, in part, to drinking while alone and at home—which increased during the pandemic.
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Affiliation(s)
- Megan E Patrick
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA.
| | | | - Richard A Miech
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
| | - Katherine M Keyes
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Justin Jager
- Arizona State University, T. Denny Sanford School of Social and Family Dynamics, Tempe, AZ, USA
| | - John E Schulenberg
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
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5
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Rosen R, Shao Y, Zhang Q, Bao J, Zhang Y, Masurkar A, Wisniewski T, Urban N, Reibman J. Cognitive Function among World Trade Center-Exposed Community Members with Mental Health Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3440. [PMID: 35329128 PMCID: PMC8948727 DOI: 10.3390/ijerph19063440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022]
Abstract
The World Trade Center Environmental Health Center (WTC EHC), is a federally designated clinical center of excellence for surveillance and treatment of WTC disaster exposed community members (WTC Survivors). Cognitive impairment (CI) has been extensively described in WTC responders and a concern for progressive impairment in all WTC disaster exposed groups has been raised. Cognitive status, however, has not been systematically characterized in the WTC Survivor population. We describe cognitive status in a subgroup of the Survivor population referred for mental health evaluation (N = 480) in the WTC EHC as measured by scores on the Montreal Cognitive Assessment (MoCA) instrument, and examine their association with WTC exposures and individual-level covariates including PTSD and depression screening inventory scores. In regression analyses, probable cognitive impairment (MoCA score < 26) was found in 59% of the study subjects and was significantly associated with age, race/ethnicity, education, income, depression and PTSD scores. Being caught in the dust cloud on 11 September 2011 was significantly associated with cognitive impairment even after controlling for the above. These data suggest an association with cognitive dysfunction in WTC Survivors with exposure to the toxic dust/fumes and psychological stress from the 9/11 terrorist attack and warrant further systematic study.
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Affiliation(s)
- Rebecca Rosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
| | - Yongzhao Shao
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
| | - Qiao Zhang
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Jia Bao
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yian Zhang
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Arjun Masurkar
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Thomas Wisniewski
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nina Urban
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
| | - Joan Reibman
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
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Xue J, Raitt J, Roaten K, North CS. A study of suicidal thoughts and behaviour in a sample of adults affected by the 9/11 attacks on New York City's World Trade Center. Int Rev Psychiatry 2022; 34:89-96. [PMID: 35584020 PMCID: PMC9992927 DOI: 10.1080/09540261.2021.2018996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Previous research on suicide risk in relation to disasters has yielded varying findings, likely resulting at least in part from inconsistencies in definitions of disaster exposure and assessment of psychiatric disorders. This study examined suicidal thoughts and behaviour in a sample of 379 adults affected by the 9/11 attacks on New York City, using carefully-defined disaster exposure variables and assessing psychopathology with full diagnostic criteria, nearly 3 years after the disaster. Only 7% of the sample reported any postdisaster suicidal thoughts or behaviour, only 1% of which were new (incident) after the disaster, amounting to very little evidence of incident suicidal risk. The occurrence of a postdisaster psychiatric disorder in nearly one-half of the sample (45%) was significantly associated with postdisaster suicide risk (15% vs 1%). Disaster trauma exposure was not associated with postdisaster suicide risk. The findings of this study are not consistent with the disaster experience itself giving rise to suicide risk. Nonetheless, the postdisaster setting provides opportunities for education about and surveillance for suicide risk and other mental health concerns.
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Affiliation(s)
- Judy Xue
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Josh Raitt
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Metrocare Services, Dallas, TX, USA
| | - Kimberly Roaten
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carol S North
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Metrocare Services, Dallas, TX, USA
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Eastman MR, Finlay JM, Kobayashi LC. Alcohol Use and Mental Health among Older American Adults during the Early Months of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4222. [PMID: 33923483 PMCID: PMC8073103 DOI: 10.3390/ijerph18084222] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
Poor mental health associated with the COVID-19 pandemic may prompt the utilization of various coping behaviors, including alcohol use. We aimed to investigate the relationships between mental health symptomatology and self-reported changes in alcohol consumption at the onset of the pandemic. Data were from the nationwide COVID-19 Coping Study of US adults aged ≥55 in April and May 2020 (n = 6548). We used population-weighted multivariable-adjusted multi-nomial logistic regression models to estimate odds ratios (ORs) for the associations between mental health (of depression, anxiety, and loneliness, each) and self-reported increased alcohol consumption (vs. no change in consumption). One in ten adults (717/6548; 11%) reported an increase in their alcohol consumption in the past week compared to their usual pre-COVID-19 drinking. Mental health symptomatology was associated with increased drinking since the pandemic onset (depression: OR = 2.66, 95% CI: 1.99-3.56; anxiety: OR = 1.80, 95% CI: 1.34-2.42; loneliness: OR = 2.45, 95% CI: 1.83-3.28). Participants who screened positive for all three mental health outcomes were substantially more likely to report increased alcohol consumption since the onset of the pandemic (OR = 3.87, 95% CI: 2.52-5.96, vs. no mental health outcomes). This study demonstrates potentially harmful changes in alcohol intake among middle-to-older aged adults experiencing mental health symptomatology during the early months of the COVID-19 pandemic.
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Affiliation(s)
- Marisa R. Eastman
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Jessica M. Finlay
- Survey Research Center, Institute for Social Research, University of Michigan School of Public Health, Ann Arbor, MI 48104, USA;
| | - Lindsay C. Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
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Outcomes and Correlates of Major Depression in 11 Disaster Studies Using Consistent Methods. Behav Sci (Basel) 2021; 11:bs11010004. [PMID: 33401379 PMCID: PMC7823870 DOI: 10.3390/bs11010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/17/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
This study investigated psychosocial functioning and employment status in association with postdisaster major depression and its course in survivors of 11 different disasters in a sample of 808 directly-exposed survivors of 10 disasters and 373 survivors of the 11 September 2001 (9/11), terrorist attacks on New York City’s World Trade Center (total n = 1181). Participants were assessed between 1987 and 2007 with structured diagnostic interviews in a prospective longitudinal design. Consistent research methods allowed merging of the disaster databases for analysis using multivariate modeling. Postdisaster major depression in the study cohort from the 9/11 disaster was more than twice as prevalent as in the other disasters, possibly reflecting the greater psychosocial/interpersonal loss and bereavement experienced by 9/11 disaster survivors. At follow up, employment was associated with remission of postdisaster major depression, non-development of PTSD, and coping via family or friends. Functioning problems were associated with disaster injuries, but not with persistent major depression. This study is unprecedented in its large sample of survivors across the full range of disaster typology studied using consistent methods and full structured interview diagnostic assessment. These findings may help guide future interventions to address postdisaster depression.
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Hong BA, Pollio DE, Pollio EW, Sims OT, Pedrazine A, North CS. Religious and Spiritual Aspects of Disaster Experience Among Survivors of the 9/11 Attacks on New York City's World Trade Center. JOURNAL OF RELIGION AND HEALTH 2019; 58:1619-1630. [PMID: 30825031 DOI: 10.1007/s10943-019-00785-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examined religious and spiritual aspects of disaster experience among 379 survivors of the 9/11 attacks on New York City's World Trade Center. Interviews conducted 35 months after the disaster provided structured diagnostic assessments of psychiatric disorders and specific detail of demographic characteristics, experience of the disaster, and variables related to religion and spirituality. The study participants overwhelmingly identified with a specific religion. The disaster appeared to have only modest effects on strength and importance of religion/spirituality, and changes were predominantly positive. Specific religions and faith groups differed in their disaster experience in important ways.
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Affiliation(s)
- Barry A Hong
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8134, St. Louis, MO, 63110, USA.
| | - David E Pollio
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Whitney Pollio
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony Pedrazine
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carol S North
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Asana OO, Ayvaci ER, Pollio DE, Hong BA, North CS. Associations of alcohol use disorder, alcohol use, housing, and service use in a homeless sample of 255 individuals followed over 2 years. Subst Abus 2018; 39:497-504. [PMID: 29595364 DOI: 10.1080/08897077.2018.1449169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Homeless individuals with alcohol use disorders have multiple comorbidities and therefore various service needs. Despite need for services, homeless individuals face numerous barriers to treatment. Little is known about the associations of specific services in relation to homelessness in the context of alcohol problems. The current study analyzed 2-year prospective longitudinal data on a homeless sample, examining relationships between alcohol use disorder, alcohol use, housing status, and service use over time. METHODS Two hundred fifty-five of 400 individuals recruited systematically from shelters and street locations completed 3 annual assessments (69% completion). Data on lifetime and current psychiatric disorders, housing status, and past-year service use were obtained and merged with service use data gathered from local agencies. Generalized estimating equation (GEE) models were created to predict dependent outcome variables of stable housing, alcohol use, and service use in both follow-up years. RESULTS Lifetime alcohol use disorder was positively associated with substance and medical service use. Alcohol problems did not hinder attainment of stable housing, and placement in housing did not necessarily increase risk for alcohol use. Stable housing was negatively associated with psychiatric and substance service use. In the second year, when alcohol use was finally associated with receiving substance services, it appears that these services provided a gateway to psychiatric services. The psychiatric services in turn appeared to provide a gateway to medical services. CONCLUSIONS Alcohol use behaved differently compared with lifetime alcohol use disorder in relation to service use. Lack of association between alcohol use and housing supports Housing First policy. Obtaining housing may have ameliorative effects on mental health, diminishing perceived need for psychiatric services. Services may also be more accessible during homelessness. Obtaining substance treatment may provide a gateway for those who use alcohol after becoming homeless to connect with psychiatric and medical services, informing policy and practice.
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Affiliation(s)
- Olubunmi O Asana
- a Department of Psychiatry , New York University Langone Health , New York , New York , USA
| | - Emine R Ayvaci
- b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - David E Pollio
- c Department of Social Work , The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Barry A Hong
- d Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Carol S North
- b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA.,e The Altshuler Center for Education & Research , Metrocare Services , Dallas , Texas , USA
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11
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North CS. Disaster Mental Health Epidemiology: Methodological Review and Interpretation of Research Findings. Psychiatry 2016; 79:130-146. [PMID: 27724836 DOI: 10.1080/00332747.2016.1155926] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Carol S North
- a Altshuler Center for Education and Research , Metrocare Services , Dallas , Texas.,b Nancy and Ray L. Hunt chair in crisis psychiatry and professor of psychiatry at the University of Texas Southwestern Medical Center , Dallas
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12
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Abstract
A large existing academic disaster mental health literature provides a foundation to help guide disaster mental health response. Recent studies, however, have indicated that reconceptualization of certain mental health aspects of disasters may be indicated to guide further research to inform the planning and implementation of disaster mental health interventions. In particular, there is need to more carefully measure specific postdisaster disorders and syndromes using full diagnostic assessments, differentiate pre-existing from incident (new) postdisaster psychopathology, appropriately consider disaster trauma exposure groups in assessing psychopathology, and conduct prospective follow-up assessments over time from the acute postdisaster period to the long term. Further descriptive and longitudinal research is needed to better characterize the occurrence and course of fully-assessed psychiatric disorders after different disasters, clarify the role of disaster trauma exposures in the development of postdisaster psychopathology, and deconstruct confounding effects in determination of causalities in mental health consequences of disasters.
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