The Prevalence of Posttraumatic Stress Disorder Among Survivors After a Typhoon or Hurricane: A Systematic Review and Meta-Analysis

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.

Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies

BACKGROUND

More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones.

OBJECTIVES

We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research.

METHODS

We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies.

RESULTS

In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed.

CONCLUSIONS

There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.

Hurricane Florence and suicide mortality in North Carolina: a controlled interrupted time-series analysis

BACKGROUND

Natural disasters are associated with increased mental health disorders and suicidal ideation; however, associations with suicide deaths are not well understood. We explored how Hurricane Florence, which made landfall in September 2018, may have impacted suicide deaths in North Carolina (NC).

METHODS

We used publicly available NC death records data to estimate associations between Hurricane Florence and monthly suicide death rates using a controlled, interrupted time series analysis. Hurricane exposure was determined by using county-level support designations from the Federal Emergency Management Agency. We examined effect modification by sex, age group, and race/ethnicity.

RESULTS

8363 suicide deaths occurred between January 2014 and December 2019. The overall suicide death rate in NC between 2014 and 2019 was 15.53 per 100 000 person-years (95% CI 15.20 to 15.87). Post-Hurricane, there was a small, immediate increase in the suicide death rate among exposed counties (0.89/100 000 PY; 95% CI -2.69 to 4.48). Comparing exposed and unexposed counties, there was no sustained post-Hurricane Florence change in suicide death rate trends (0.02/100 000 PY per month; 95% CI -0.33 to 0.38). Relative to 2018, NC experienced a statewide decline in suicides in 2019. An immediate increase in suicide deaths in Hurricane-affected counties versus Hurricane-unaffected counties was observed among women, people under age 65 and non-Hispanic black individuals, but there was no sustained change in the months after Hurricane Florence.

CONCLUSIONS

Although results did not indicate a strong post-Hurricane Florence impact on suicide rates, subgroup analysis suggests differential impacts of Hurricane Florence on several groups, warranting future follow-up.

Physiotherapy and ecosystem services: improving the health of our patients, the population, and the environment

INTRODUCTION

The relevance of ecosystems to physiotherapy has traditionally been overlooked, despite its potential for health impacts relevant to conditions often managed by physiotherapists.

PURPOSE

The purpose of this article is to introduce the concept of ecosystem services to physiotherapists, and to discuss how understanding ecosystem services may improve patient care, and population and planetary health.

DISCUSSION AND CONCLUSION

Physiotherapists with an understanding of ecosystem services may improve patient care by value-adding to management through patient education, empathy, advocacy, and broader population health approaches. Physiotherapists are also well placed to promote the conservation and restoration of ecosystem through participation, advocacy, and the development of public health measures, to the benefit of global sustainability and population health. Further research is required into how physiotherapists currently use nature-based interventions, and the barriers and enablers to their use. To be adequately prepared to meet the challenges that climate change and environmental degradation pose to patient care, population health and health systems, both current and future physiotherapists need to take a broader view of their practice. By including consideration of the potential role of the environment and green space exposure in particular on their patient's health, physiotherapists can ultimately contribute more to population and planetary health.

Trajectories of Posttraumatic Stress Symptoms Among Young Adults Exposed to a Typhoon: A Three-Wave Longitudinal Study

Objective: We used a latent class growth model to identify distinct PTSS trajectories and correlates of these trajectories among young adults who experienced Typhoon Hato, the strongest storm to strike China in the last 50 years. Methods: A longitudinal survey (three-waves) was conducted to explore the mental health status and its correlates among young adults exposed to the typhoon. Data from 362 participants were analyzed via a latent class growth model and multinomial logistic regression. Results: Three distinct classes of PTSS trajectories were identified, including: "resilience" (86.46%), "recovery" (9.12%), and "deterioration" (4.42%). The higher levels of direct typhoon exposure, media use, and posttraumatic growth significantly predicted the higher likelihood of participants being in the "recovery'' class. In addition, more social support significantly predicted the higher possibility of being in the "resilience" class. Finally, more severe depressive and anxiety symptoms significantly predicted the higher likelihood of being in the "deterioration" class. Conclusion: Further research should develop interventions to enhance protective factors (e.g., posttraumatic growth, media use), decrease risk factors (e.g., depressive and anxiety symptoms), and thereby prevent PTSS.

Trends in Lifestyle-related Diseases and Their Risk Factors After the Fukushima Daiichi Nuclear Power Plant Accident: Results of the Comprehensive Health Check in the Fukushima Health Management Survey

Residents were forced to evacuate owing to the radiation released after the Fukushima Nuclear Power Plant (NPP) accident following the Great East Japan Earthquake on 11/03/2021; thus, their lifestyles drastically changed. The Comprehensive Health Check (CHC) of the Fukushima Health Management Survey (FHMS) was performed to evaluate health statuses and prevent lifestyle-related diseases in evacuation area residents. The first part of the CHC survey is a retrospective analysis of pre- and post-disaster data on health check-ups of evacuation area residents. The second part is a cross-sectional, prospective analysis of post-disaster (fiscal year (FY) 2011-2017) data on health check-ups. Subjects were men and women living in 13 municipalities in areas surrounding the NPP in Fukushima Prefecture. Post-disaster (FY 2011-2012) overweight, hypertension, dyslipidemia, diabetes mellitus, metabolic syndrome, liver dysfunction, hyperuricemia, polycythemia and atrial fibrillation cases increased from the pre-disaster (FY 2008-2010) levels. This tendency was strongest among residents who were forced to evacuate. Proportion of overweight people remained unchanged, the prevalence of liver dysfunction decreased and the proportion of people with treated hypertension and dyslipidemia increased during FY 2011-2017. Meanwhile, the prevalence of diabetes mellitus and mean levels of HbA1c increased. Furthermore, Evacuees showed higher risks of diabetes mellitus, dyslipidemia, chronic kidney diseases and liver dysfunction than non-evacuees. Therefore, residents in the evacuation area, especially evacuees, are at high risk of developing lifestyle-related diseases, especially cardiovascular diseases; therefore, it is necessary to observe health statuses and implement measures to prevent lifestyle-related diseases.

Mental Health Impacts of Tornadoes: A Systematic Review

Tornadoes are one of the most prevalent natural hazards in the United States, yet they have been underrepresented in the disaster mental health comprehensive literature. In the current study, we systematically reviewed available scientific evidence within published research journals on tornadoes and mental health from 1994 to 2021. The electronic search strategy identified 384 potentially relevant articles. Of the 384 articles, 29 articles met the inclusion criteria, representing 27,534 participants. Four broad areas were identified: (i) Mental health impacts of tornadoes; (ii) Risk factors; (iii) Protective factors; and (iv) Mental health interventions. Overall, results showed adverse mental health symptoms (e.g., post-traumatic stress disorder, depression, anxiety) in both adult and pediatric populations. A number of risk factors were found to contribute to negative mental health, including demographics, tornado exposure, post-tornado stressors, and prior exposure to trauma. Protective factors found to contribute to positive outcomes included having access to physical, social, and psychological resources. Together, these findings can serve as an important resource for future mental health services in communities experiencing tornadoes.

Association Between Repeated Exposure to Hurricanes and Mental Health in a Representative Sample of Florida Residents

IMPORTANCE

During the past century, more than 100 catastrophic hurricanes have impacted the Florida coast; climate change will likely be associated with increases in the intensity of future storms. Despite these annual threats to residents, to our knowledge, no longitudinal studies of representative samples at risk of hurricane exposure have examined psychological outcomes associated with repeated exposure.

OBJECTIVE

To assess psychosocial and mental health outcomes and functional impairment associated with repeated hurricane exposure.

DESIGN, SETTING, AND PARTICIPANTS

In this survey study, a demographically representative sample of Florida residents was assessed in the 60 hours prior to Hurricane Irma (wave 1: September 8-11, 2017). A second survey was administered 1 month after Hurricane Irma (wave 2: October 12-29, 2017), and a third survey was administered after Hurricane Michael (wave 3: October 22 to November 6, 2018). Data were analyzed from July 19 to 23, 2021.

EXPOSURE

Hurricanes Irma and Michael.

MAIN OUTCOMES AND MEASURES

The main outcomes were posttraumatic stress symptoms (PTSS), global distress, worry about future events (generalized worries), and functional impairment. Path models were used to assess associations of individual-level factors (prior mental health, recent adversity), prior storm exposures (loss and/or injury, evacuation), and direct, indirect, and media-based exposures to hurricanes Irma and Michael with those outcomes. Poststratification weights were applied to facilitate population-based inferences.

RESULTS

Of 2873 individuals administered the survey in wave 1, 1637 responded (57.0% completion rate) (894 [54.6%, weighted] women; mean [SD] age, 51.31 [17.50] years); 1478 in wave 2 (90.3% retention from wave 1) and 1113 in wave 3 (75.3% retention from wave 2) responded. Prior mental health ailments (b, 0.18; 95% CI, 0.07-0.28), prior hurricane-related loss and/or injury (b, 0.09; 95% CI, 0.02-0.17), hours of Hurricane Irma-related media exposure (b, 0.03; 95% CI, 0.02-0.04), being in an evacuation zone during Hurricane Irma and not evacuating (b, 0.14; 95% CI, 0.02-0.27), and loss and/or injury in Hurricane Irma (b, 0.35; 95% CI, 0.25-0.44) were positively associated with PTSS after Hurricane Irma; most associations persisted and were associated with responses to Hurricane Michael. Prior mental health ailments (b, 0.10; 95% CI, 0.03-0.17), hours of Hurricane Michael-related media exposure (b, 0.01; 95% CI, 0.003-0.02), hurricane Irma-related PTSS (b, 0.42; 95% CI, 0.34-0.50), recent individual-level adversity (b, 0.03; 95% CI, 0.005-0.05), being in an evacuation zone during Hurricane Irma and evacuating (b, 0.10; 95% CI, 0.002-0.19), and direct (b, 0.36; 95% CI, 0.16-0.55) and indirect (b, 0.12; 95% CI, 0.05-0.18) Hurricane Michael-related exposures were directly associated with Hurricane Michael-related PTSS. After Hurricane Michael, prior mental health ailments (b, 0.17; 95% CI, 0.06-0.28), and PTSS related to hurricanes Irma (b, 0.11; 95% CI, 0.001-0.22) and Michael (b, 0.58; 95% CI, 0.47-0.69) were associated with respondents' functional impairment. Analogous analyses using global distress and generalized worries as mediators of functional impairment yielded a similar pattern of results.

CONCLUSIONS AND RELEVANCE

In this survey study, repeated direct, indirect, and media-based exposures to hurricanes were associated with increased mental health symptoms among Florida residents who experienced hurricanes Irma and Michael, suggesting that people were sensitized to respond with more psychological symptoms over time. These results may inform targeted public health intervention efforts for natural disasters.

Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention

Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.

Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima

BACKGROUND

Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types.

OBJECTIVE

This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic.

METHODS

Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively.

RESULTS

COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network.

CONCLUSIONS

PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.

Full and partial posttraumatic stress disorders in adults exposed to super typhoon Lekima: a cross-sectional investigation

BACKGROUND

Super typhoon Lekima had a maximum wind force of 16 (52 m/s) and hit Wenling city, Zhejiang province in China on August 10, 2019. The typhoon left many victims showing symptoms of posttraumatic stress disorder (PTSD).

OBJECTIVE

This study aimed to assess the prevalence of full and partial PTSD to inform targeted interventions for adult victims.

METHOD

In total, four thousand seven hundred and forty-six adults who are parents of students in local primary and middle schools were recruited to participate in this study. Participants completed a trauma exposure scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition PTSD Checklist. Logistic regression analysis was used to examine the factors of full and partial PTSD.

RESULTS

Nine hundred and ten (19.2%) adults had full PTSD and 1775 (37.4%) had partial PTSD. Adults with a monthly income > 10,000 RMB (about 1530 dollars) and a high education level (bachelor's degree or above) were less likely to have full or partial PTSD than those with lower income and lower education levels. In addition, married adults were less likely to have full PTSD than divorced or widowed ones. Higher rates of PTSD were observed among those aged ≥40 years, who were injured/trapped, whose family members/friends were injured/trapped, and who lost property.

CONCLUSIONS

Partial and full PTSD were common among adults following super typhoon Lekima, and high income, high education level, and married status were protective factors, whereas trauma exposure was a risk factor of PTSD. Target psychological intervention should be provided to these victims who are in low income and education level, divorced and widowed, and experienced more serious trauma.

Infectious Disease Outbreak and Post-Traumatic Stress Symptoms: A Systematic Review and Meta-Analysis

Background: As one of the most widely researched consequence of traumatic events, the prevalence of post-traumatic stress symptoms (PTSS) among people exposed to the trauma resulting from infectious disease outbreak varies greatly across studies. This review aimed at examining the pooled prevalence of PTSS among people exposed to the trauma resulting from infectious disease outbreak, summarizing the possible causes of the inconsistencies in the current estimates. Methods: Systematic searches of databases were conducted for literature published on PubMed, EMBASE, Web of Science, the Cochrane Library, PsycArticles, and Chinese National Knowledge Infrastructure (CNKI) until 14 October 2020. Statistical analyses were performed using R software (registration number: CRD42020182366). Results: About 106 studies were included. The results showed that the pooled prevalence of PTSS among the general population exposed to the trauma resulting from infectious disease outbreak was 24.20% (95% CI: 18.54-30.53%), the pooled prevalence of PTSS among healthcare workers was 24.35% (95% CI: 18.38-1.51%), the pooled prevalence of PTSS among patients with infectious disease was 28.83% (95% CI: 18.53-44.86%), and the pooled prevalence of PTSS among suspected cases of infectious disease was 25.04% (95% CI: 18.05-34.73%). Mortality rate was a significant contributor to heterogeneity. Conclusions: Evidence suggests that PTSS were very common among people exposed to the trauma resulting from infectious disease outbreak. Health policymakers should consider both short-term and long-term preventive strategy of PTSS.

Prevalence of post-traumatic stress symptoms among people influenced by coronavirus disease 2019 outbreak: A meta-analysis

BACKGROUND

As one of the most widely researched consequence of traumatic events, the prevalence of post-traumatic stress symptoms among people exposed to the trauma resulting from coronavirus disease 2019 (COVID-19) outbreak varies greatly across studies. This review aimed at examining the pooled prevalence of post-traumatic stress symptoms among people exposed to the trauma resulting from COVID-19 outbreak.

METHODS

Systematic searches of databases were conducted for literature published on PubMed, EMBASE, Web of Science, the Cochrane Library, PsycArticle, and Chinese National Knowledge Infrastructure until October 14, 2020. Statistical analyses were performed using R software (PROSPERO registration number: CRD42020180309).

RESULTS

A total of 106,713 people exposed to the trauma resulting from the COVID-19 outbreak were identified in the 76 articles, of which 33,810 were reported with post-traumatic stress symptoms. The pooled prevalence of post-traumatic stress symptoms among people exposed to the trauma resulting from COVID-19 outbreak was 28.34%, with a 95% confidence interval of 23.03-34.32%. Subgroup analysis indicated that older age, male and bigger sample size were associated with higher prevalence of post-traumatic stress symptoms. After controlling for other factors, the results of meta-regression showed that the influence of gender and sample size on prevalence is no longer significant.

CONCLUSIONS

Symptoms of post-traumatic stress disorder (PTSD) were very common among people exposed to the trauma resulting from COVID-19 outbreak. Further research is needed to explore more possible risk factors for post-traumatic stress symptoms and identify effective strategies for preventing PTSD-related symptoms among people exposed to the trauma resulting from COVID-19 outbreak.

Anxiety, Depression, and Post-traumatic Stress a month after 2019 Cyclone Fani in Odisha, India

BACKGROUND

Early Identification of disaster victims with mental health problems may be useful, but information within a short period after a disaster is scarce in developing countries. This study examined anxiety, depression, and post-traumatic stress symptoms at 1 month following 2019 Cyclone Fani in Odisha, India.

METHOD

Post-traumatic stress symptoms (PTSS) were assessed by the Primary care PTSD screen for DSM 5 (PC-PTSD-5), anxiety symptoms by the Generalised Anxiety Disorder (GAD-7), and depression by the Patient Health Questionnaire (PHQ-9). The survey included participants' disaster experience e.g., evacuation, fear of death, injury, death in family, damage to house, difficulty for food, displacement, and effect on livelihood.

RESULTS

Proportion of sample (n = 80) with probable PTSD was 42.9%, with severe anxiety was 36.7%, moderately severe depression was 16.5%, and severe depression was 3.8%. Suicidal cognitions were reported to increase by 14%. Comorbidity was common; with significant (P < 0.01) correlation between PTSS and anxiety (r = 0.69), depression (r = 0.596), and between anxiety and depression (r = 0.63). Damage of house and displacement were associated significantly with PTSD; evacuation and displacement with moderate and severe depression; and displacement with severe anxiety. No specific demographic factors were significantly linked to the psychiatric morbidities.

CONCLUSION

A considerable proportion of victims had psychiatric morbidities at 1 month. Associated risk factors included housing damages, evacuation, and displacement, suggesting the need to improve the disaster-management process.

Long-Lasting Effects of the 2013 Yolanda Typhoon on Overall Health of Mothers and Children

OBJECTIVES

Three years after the 2013 Yolanda Typhoon, this study sought to determine the factors associated with the stress of the affected mothers and the health of the children on Leyte island, and the preparedness of the community to mitigate future potential disasters.

METHODS

Three hundred mothers with children from 0 to 7 years old were selected through convenience sampling, structured interviews conducted using the Hurricane-Related Traumatic Experiences questionnaire and the PTSD (post-traumatic stress disorder) Checklist 5 (PCL5), and the children's weights and heights were measured.

RESULTS

The provisional PTSD prevalence was found to be 53.3% 3 y after Yolanda. The multiple regression analysis with multiple imputation for the missing values found that housing and childcare attitudes were significantly associated with preparedness.

CONCLUSIONS

This study concluded that living in multistoried houses was useful for disaster mitigation and that the caregiving responsibility for their children could be a disaster preparedness motivation for mothers.