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

Heterogeneous trajectories of depression and resilience following limb amputation

OBJECTIVE

To identify longitudinal trajectories of depression in the first 6 months following limb loss and to explore baseline predictors of trajectories, including pain and demographic factors. A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6 months.

DESIGN

Secondary longitudinal data analysis of an inception cohort study of persons with new-onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months).

SETTING

Hospitalized care, acute rehabilitation, ambulatory care, and community.

PARTICIPANTS

Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4 years (2002-2007). The final sample (n = 203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4 years (standard deviation [SD] = 14.6).

MAIN OUTCOME MEASURE(S)

Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9); posttraumatic stress symptoms were measured via the PTSD checklist- Civilian Version (PCL-C).

RESULTS

Four trajectories of depression were identified via Latent Growth Mixture Modeling: Resilience (73.2%), Chronic Depression (11.2%), Emerging Depression (8.9%), and Recovery (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the Chronic Depression class predicted elevated 6-month PTS compared to all other classes; membership in the Resilience class predicted lower PTS than in the Chronic and Emerging Depression classes but did not differentiate from the Recovery trajectory.

CONCLUSIONS

Findings reveal that the course of depression post-amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as Resilient, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (Emerging Depression), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.

Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat

Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.

Prevention of suicides associated with global warming: perspectives from early career psychiatrists

Climate change poses significant challenges to global mental health, with potential consequences including increased rates of suicide and mental health disorders. Early Career Psychiatrists (ECPs) play a crucial role in addressing these challenges. The Climate Psychiatry Alliance, a group of psychiatrists dedicated to improving mental health amidst climate change, recognizes the importance of cultivating climate-aware ECPs. Training ECPs to become confident climate-aware clinicians enables them to effectively treat patients experiencing anxiety, depression, and PTSD in the context of climate-related distress. Together with other mental health professionals, ECPs can contribute to efforts by implementing strategies for monitoring and treating mental health problems arising from climate events. Additionally, they can raise awareness about the psychological consequences and risks of suicide associated with climate change. Collaboration among ECPs from various regions is essential in developing community-based approaches and reducing vulnerabilities. ECPs must prioritize supporting vulnerable populations by advocating for increased funding for mental health support and research in affected areas. Long-term solutions to address the mental health impacts of climate change and global warming should be pursued to mitigate future suicidality. Integrating climate considerations into local mental health programs and expanding psychological support services is crucial. By promoting emotional resilience and self-awareness, ECPs can contribute to building a more climate-resilient and mentally healthy society.

Depressive and anxiety symptom trajectories in Polish adolescents during the COVID-19 pandemic and the outbreak of war in Ukraine: uncovering the role of family relations

INTRODUCTION

The aim of the study was to investigate longitudinal trajectories of change in anxiety and depression symptoms in Polish adolescents during the second year of the COVID-19 pandemic and after the outbreak of the war in Ukraine. Additionally, we aimed to identify risk/protective factors and outcomes associated with these trajectories.

METHOD

We collected data in three waves between November 2021 and May 2022. Adolescents (N = 281 in the first wave) completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Filial Responsibility Scale for Youth, and questions related to the COVID-19 pandemic and war in Ukraine.

RESULTS

We identified three trajectories of depressive symptoms: resilient with low, stable symptoms (71% of participants), chronically elevated symptoms (11%), and acute symptoms followed by recovery (18%). We distinguished two trajectories of anxiety symptoms: resilient (75%) and chronic (25%). Non-resilient trajectories were predicted by higher levels of familial unfairness (perceived lack of equality and reciprocity in the family), relationship difficulties at school and at home, older age, and poor socioeconomic status. Chronic depressive and anxiety symptoms were associated with higher war-related concerns.

DISCUSSION

These findings can inform preventive and therapeutic interventions for at-risk adolescents to reduce negative long-term outcomes of social crises.

The Wither or Thrive Model of Resilience: an Integrative Framework of Dynamic Vulnerability and Resilience in the Face of Repeated Stressors During the COVID-19 Pandemic

During the first 2 years of the COVID-19 pandemic, empirical efforts in the psychological sciences have been unequivocally focused on understanding the psychosocial impact on resilience and vulnerability. While current empirical work is guided by different existing theoretical models of resilience and vulnerability, the emerging datasets have also pointed to a necessity for an update of these models. Due to the unique features and developments specific to the current pandemic such as the occurrence of repeated collective stressors of varying durations, in the current position paper, we introduce the Wither or Thrive model of Resilience (With:Resilience). It integrates key aspects of prevailing psychological resilience frameworks within the context of the COVID-19 pandemic, and extends them by (1) moving away from single scale approaches towards a higher-order latent expression of resilience and vulnerability incorporating also non-clinical mental health markers, (2) proposing different trajectories of resilience-vulnerability emerging across repeated stressors over long periods of time, and (3) by incorporating multiple influencing factors including aspects of the socio-economic concept of social cohesion as well as separate mediating processing mechanisms. We propose that With:Resilience will enable a more nuanced approach and appropriate analytical investigation of the vast incoming data on mental health and resilience during the COVID-19 pandemic, and we suggest some concrete methodological approaches. This framework will assist in the development of actionable public health guidelines for society in the present and future pandemic contexts as well as aid policy making and the interventional sciences aimed at protecting the most vulnerable amongst us.

Long-Term Trajectories of Depressive Symptoms Among Children Affected by Parental HIV: A 12-Year Follow-Up Study

The present study explored the trajectories of depressive symptoms over 12 years spanning from childhood to emerging adulthood and the between-trajectory differences in psychosocial adjustment among Chinese children (N = 492, 52.8% boys, aged 6 to 18 years at baseline) affected by parental HIV. Rebounding (12.6%), resilient (64.8%), and improving  (22.6%) trajectories were identified. Individuals in the rebounding trajectory reported the highest levels of psychological distress and the lowest levels of subjective well-being, positive self-regard, and personal strengths in adulthood. Individuals in the resilient trajectory reported lower levels of psychological distress and negative affect than those in the improving trajectory. The findings support the development of programs by policymakers and practitioners to improve the psychosocial adjustment of children who have been affected by parental HIV while considering individual differences in the trajectories of depressive symptoms.

Natural disasters and mental health

Natural disasters are large-scale adverse events resulting from natural processes of the earth, often associated with death, trauma, and destruction of property. They threaten harm or death to a large group of people; cause disruption of services and social networks and a communal loss of resources; and involve identifiable mental and physical health outcomes, among those affected. While majority of individuals who experience a traumatic event due to natural disasters do not develop psychopathology, natural disasters can threaten our psychological well-being in many ways and they can result in both short and long-term psychological distress and thus create a significant burden of mental health conditions on individuals and the community affected by them. In this paper we provide a narrative review that focuses on the mental health effects of natural disasters. We discuss effective, evidence-based interventions that can help enhance the sense of safety, hope, and optimism, as well as serve to promote social connectedness for those who are impacted. We describe how these interventions, developed by keeping in mind the cultural context and the needs of the community, can be provided pre, peri and post-disaster period to improve the adverse mental health effects of the disaster.

Cumulative trauma from multiple natural disasters increases mental health burden on residents of Fort McMurray

BACKGROUND

Fort McMurray, a city in northern Alberta, Canada, has experienced multiple traumatic events in the last five years, including the 2016 wildfire, the 2020 floods, and the COVID-19 pandemic. Traumatic events often lead to increased mental health burdens in affected communities.

OBJECTIVE

To assess if the number of traumatic events experienced by residents of Fort McMurray correlates with the prevalence and severity of mental health issues experienced.

METHODOLOGY

A cross-sectional study using an online survey questionnaire was used to gather demographic, trauma (wildfire, flooding, and COVID-19), and clinical information from the resident of Fort McMurray between April 24 to June 2 2021. Likely Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD) and low resilience were measured using standardised rating scales. Data were analyzed with SPSS version 26 using Chi-Square tests and multivariate regression analysis.

RESULTS

Respondents who experienced COVID-19 and either flood or wildfire traumas (N = 101) were eleven times more likely to have GAD symptoms (OR: 11.39; 95% CI: 1.43-91.04), four times more likely to have likely MDD, (OR: 3.85; 95% CI: .995-14.90), ten times more likely to have likely PTSD (OR: 10.47; 95% CI: 1.28-85.67), and low resilience (OR: 10.56; 95% CI: 1.21-92.17). Respondents who experienced COVID-19, flooding, and wildfire traumas (N = 47) were eighteen times more likely to express GAD symptoms (OR: 18.30; 95% CI: 2.20-152.45) and more than eleven times likely to have likely PTSD (OR: 11.41; 95% CI: 1.34-97.37) in comparison to the respondents who experienced COVID-19 only trauma (N = 19).

CONCLUSION

Measures to reduce climate change and associated natural disasters could reduce the impact of cumulative trauma and associated mental health burden in vulnerable populations. It is essential that more mental health resources are mobilised to support communities impacted by multiple natural disasters.

HIGHLIGHTS

The number of traumatic disasters experienced in residents of Fort McMurray five years after the 2016 wildfires, a year after the 2020 flooding, and during the COVID-19 pandemic correlates with the prevalence and severity of the mental health conditions reported in this study.

Perceived Stress in Older Dementia Caregivers: Mediation by Loneliness and Depression

Coupled with aging, chronic stress experienced by dementia caregivers often leads to deteriorating health. Comparing caregivers and non-caregivers, we tested whether depression and loneliness mediate the relationship between caregiver status and a measure of chronic stress, the Perceived Stress Scale. Seventy-six cognitively normal older adults (mean age 72.7) were identified as caregivers or non-caregivers based on the functional independence of a paired family member. Caregivers reported more perceived stress, depression, and loneliness than non-caregivers. Using multiple mediation analyses, we found that loneliness and depression mediated the relationship of caregiver status with perceived stress. The loneliness effect on perceived stress was both direct and via its relationship with depressive symptoms. The findings suggest loneliness as a likely point of intervention to reduce caregiver stress. Initiatives to enable caregivers to maintain or develop social relationships apart from caregiver responsibilities may mitigate stress and its negative impact on mental and physical health.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession

OBJECTIVES

To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession.

METHODS

We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression.

RESULTS

We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy.

DISCUSSION

Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

To Be or Not to Be Flexible: Selective impairments as a means to differentiate between depression and PTSD symptoms

During the course of their lives, most individuals experience at least one potentially traumatic event. For some individuals this experience may result in them developing depression and/or post-traumatic stress disorder (PTSD) symptoms. The aim of the present study was to test the interactive effect of traumatic exposure and impaired cognitive flexibility on the tendency to develop either depression or PTSD symptoms. Eighty-two college students (M age = 25.32, SD age = 4.09) were assessed for exposure to traumatic events, depressive and PTSD symptoms. In addition, they completed a performance-based learning paradigm to evaluate the unique patterns of cognitive flexibility, defined as reduced and enhanced updating of prior knowledge in the face of new information. We predicted and found that for individuals with reduced updating, greater exposure to trauma was associated with elevated depressive symptoms. Contrary to our prediction, for individuals with enhanced updating, greater exposure was associated with elevated PTSD symptoms. While cognitive flexibility is traditionally associated with adaptive outcomes, our results illuminate the important role of a delicate updating balance to adaptively cope with aversive life events. The findings highlight the possible different roles of cognitive flexibility in the development of psychopathology and may serve as a first step toward developing tailored prevention and treatment methods.

Social Sharing of Emotions and Communal Appraisal as Mediators Between the Intensity of Trauma and Social Well-Being in People Affected by the 27F, 2010 Earthquake in the Biobío Region, Chile

The psychosocial impacts of natural disasters are associated with the triggering of negative and positive responses in the affected population; also, such effects are expressed in an individual and collective sphere. This can be seen in several reactions and behaviors that can vary from the development of individual disorders to impacts on interpersonal relationships, cohesion, communication, and participation of the affected communities, among others. The present work addressed the psychosocial impacts of the consequences of natural disasters considering individual effects via the impact of trauma and community effects, through the perception of social well-being, the valuation of the community and the social exchange of emotions. The aim of this study was to assess the relationship between individual reactions (i.e., intensity of trauma) and the evaluation of social and collective circumstances (i.e., social well-being) after the earthquake of 27F 2010 in Chile, through collective-type intervention variables not used in previous studies (i.e., social sharing of emotions and community appraisal). For this purpose, a descriptive, ex post facto correlational and cross-sectional methodology was carried on, with the participation of 487 people affected by the 2010 earthquake, 331 women (68%) and 156 men (32%), between 18 and 58 years old (M = 21.09; SD = 5.45), from the provinces of Ñuble and Biobío, VIII region, Chile. The measurement was carried out 4 years after the earthquake and the results show that greater individual than collective involvements were found, mainly in the coastal zone of the region. The mediation analysis showed that the relationship between the intensity of the trauma and social well-being occurs through a route that considers social sharing of emotions and community appraisal. These results indicate that the overcoming of individual affectations to achieve social well-being occurs when in the immediate post-disaster phases the affected communities activate shared emotional and cognitive processes, which allow them to jointly face subsequent threats and abrupt changes.

Anxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique

In the past two decades, climate change-related natural disasters, such as hurricanes, floods, and droughts have become increasingly frequent and severe, impacting the emotional and psychological well-being of those who are directly or indirectly exposed to them. Despite great interest in understanding differences in anxiety and resilience in response to natural disasters, enthusiasm appears to outstrip empirical clarity, as there remains considerable ambiguity as to determinants of resilient or pathological outcomes following exposure to natural disasters. In addition, there are several major methodological limitations in climate change and related natural disaster research, including the use of univariate analyses, cross-sectional design, and retrospective measures. Keeping these limitations in mind, we first review literature examining the mental health outcomes of natural disasters. Findings suggest that, overall, resilience is more common than pathological outcomes. Second, we use a multi-dimensional framework of resilience to selectively review factors at the event, individual, as well as family and community levels that could help inform resilient or pathological outcomes. Finally, we consider key limitations and future directions for research and practice in the field of anxiety and resilience in response to climate disasters.

Predisaster predictors of posttraumatic stress symptom trajectories: An analysis of low-income women in the aftermath of Hurricane Katrina

Exposure to disasters is associated with a range of posttraumatic stress symptom (PTSS) trajectories. However, few studies have tracked PTSS for more than a decade postdisaster, and none to our knowledge has explored the role of predisaster resources and vulnerabilities in shaping the likelihood of trajectory membership. The current study included participants from the Resilience in Survivors of Katrina Study (N = 885). Participants were originally part of a community college intervention study and were assessed prior to the hurricane (6–21 months predisaster), and approximately 1 year, 4 years, and 12 years postdisaster. Latent class growth analysis identified PTSS trajectories. Perceived social support, probable mental illness, and physical health conditions or problems–all assessed predisaster–were examined as predictors of trajectory membership at the univariate level and in multivariable models without and with adjustment for disaster exposure. Three PTSS trajectories were detected: Moderate-Decreasing (69.3%), High-Decreasing (23.1%), and High-Stable (7.6%). In the multivariable predictive model without adjustment for disaster exposure, probable predisaster mental illness was significantly associated with greater odds of the High-Decreasing and High-Stable trajectories, and physical health conditions or problems with greater odds of the High-Decreasing trajectory, relative to the Moderate-Decreasing trajectory. However, when disaster exposure was adjusted, only the association between predisaster mental illness and the odds of the High-Stable trajectory remained statistically significant. Lower predisaster perceived social support was significantly associated with membership in the High-Decreasing trajectory, relative to the Moderate-Decreasing, at the univariate level, but not in either multivariable model. Whereas predisaster mental illness confers risk for chronic postdisaster PTSS, other impacts of predisaster resources and vulnerabilities on elevated PTSS trajectories do not go beyond those of disaster exposure. The results support disaster preparedness efforts targeting those with mental and physical health conditions, and postdisaster mental health services addressing preexisting vulnerabilities in addition to disaster-related PTSS.

Collective Trauma and Mental Health Hospitalization Rates Among Children in New York State, 1999-2013: Age, Period, and Cohort Effects

Mental health hospitalization rates among U.S. children have been increasing locally and nationally in recent decades. Children in New York State (NYS) have also witnessed several collective traumatic events during the last two decades including the September 11, 2001, terrorist attacks (9/11), the Great Recession, and Hurricane Sandy (2012) and its aftermath. Decomposition of these rates into age, period, and cohort effects may help elucidate how large-scale collective traumatic events may be driving time trends. This study examined age-period-cohort effects in children and youth mental health hospitalizations in NYS from 1999-2013. Age effects followed a linear trend from age 5 years, B = -2.76, 95% CI [-3.48, -2.03)] up to age 15 years, B = 1.62, 95% CI [1.52, 1.73]. The largest period effects were noted in 2004, B = 0.36, 95% CI [0.28, 0.45], and in 2013, B = 0.31, 95% CI [0.15, 0.47], approximately 3 years after 9/11 and the Great Recession, respectively. The largest birth cohort effect was noted for children born in 1992-1995 (range: 0.29 for children born in 1992-0.27 for children born in 1995), suggesting that the birth cohorts who experienced the 9/11 attacks during middle childhood and the Great Recession during puberty are at increased risk of mental health hospitalizations compared to other birth cohorts.

Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018

PURPOSE OF REVIEW

As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events.

RECENT FINDINGS

Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.

How Does Paired Assistance to Disaster-Affected Areas (PADAA) Contribute to Economic Sustainability? A Qualitative Analysis of Wenchuan County

There is a high risk of an economic downturn after the end of reconstruction efforts following natural hazards. High levels of external assistance can sometimes weaken local autonomy and self-sufficiency, creating the pre-conditions for a “forgotten phase”. However, through the three-year Paired Assistance to Disaster-Affected Areas project (PADAA), the economy of Wenchuan County in China recovered to its pre-earthquake levels within two years and has shown clear signs of economic sustainability. Through a qualitative research approach based on the analysis of expert interviews, secondary data, and relevant documentation, this study discusses the phases of the reconstruction process following the Wenchuan earthquake, and the factors behind the success of the PADAA process in enabling economic sustainability. Some of the identified factors include: (1) the reshaping of local livelihoods and economic structure through a large number of investments in public infrastructure; (2) knowledge acquisition, self-adjustment, and the ability to meet the needs of a new economy and social development through institutional reform and openness; (3) increasing amounts of attracted investments and the development of sustainable industrial structures through the improvement of the local government’s economic governance.