Age and emotional response to the Northridge earthquake: a longitudinal analysis

Longitudinal assessment of mental health after a flood: roles of social support, hope, recovery stressors, and prior lifetime trauma

OBJECTIVES

Severe weather events have mental health consequences for survivors that may change over time. We assessed post-flood mental health longitudinally in three groups of mostly middle-aged and older adults who varied in current and prior severe weather experiences.

METHOD

Predictors of central interest were age, perceived social support, state hope (including agency and pathways), recovery stressors, and prior lifetime trauma. Criterion variables included symptoms of depression, post-traumatic stress disorder (PTSD), and worry.

RESULTS

Analyses of variance yielded significant Disaster Exposure Group x Wave interactions for depression and PTSD symptoms. Those with flooded homes and properties had elevated symptoms at Wave 1 which were reduced at Wave 2. Older age was associated with fewer symptoms of depression, PTSD, and worry. Recovery stressors and lifetime trauma predicted more PTSD symptoms. Greater agency predicted less PTSD and depression symptoms, whereas pathways predicted less worry.

CONCLUSION

These data show that mental health symptoms may decrease over time for those directly impacted by severe flooding. State hope appears to contribute to better mental health after exposure to a devastating flood. Implications for understanding the dynamic relationships among risk variables and positive factors that promote post-disaster mental health in the years after a flood are considered.

Religiosity and Social Support Predict Resilience in Older Adults After a Flood

In this study, we examined religiosity and social support as predictors of resilience after a devastating flood. Three flood exposure groups of primarily middle-aged and older adults were compared: (1) non-flooded adults as controls, (2) once-flooded adults with structural damage to homes and property in the 2016 flood, and (3) twice-flooded adults who had relocated inland because of prior catastrophic losses in the 2005 Hurricanes Katrina and Rita and then flooded again in 2016. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC). Correlation analyses confirmed that older age was correlated with higher religiosity, charitable work done for others, and resilience. Regression analyses indicated that religious beliefs and coping, social support, and charitable work done for others were associated with higher levels of resilience, whereas flood damage was unrelated to resilience. Implications for current views on post-disaster adversity and resilience in later life are discussed.

Ecological validity of social defeat stressors in mouse models of vulnerability and resilience

Laboratory mouse models offer opportunities to bridge the gap between basic neuroscience and applied stress research. Here we consider the ecological validity of social defeat stressors in mouse models of emotional vulnerability and resilience. Reports identified in PubMed from 1980 to 2020 are reviewed for the ecological validity of social defeat stressors, sex of subjects, and whether results are discussed in terms of vulnerability alone, resilience alone, or both vulnerability and resilience. Most of the 318 reviewed reports (95%) focus on males, and many reports (71%) discuss vulnerability and resilience. Limited ecological validity is associated with increased vulnerability and decreased resilience. Elements of limited ecological validity include frequent and repeated exposure to defeat stressors without opportunities to avoid or escape from unfamiliar conspecifics that are pre-screened and selected for aggressive behavior. These elements ensure defeat and may be required to induce vulnerability, but they are not representative of naturalistic conditions. Research aimed at establishing causality is needed to determine whether ecologically valid stressors build resilience in both sexes of mice.

College, Interrupted: Profiles in First-Year College Students Responses to the COVID-19 Pandemic Across One Year

First-year college students in the 2019-2020 academic year are at risk of having their mental health, identity work, and college careers derailed as a result of the COVID-19 pandemic. To assess emerging and evolving impacts of the pandemic on mental health/well-being, identity development, and academic resilience, we collected data from a racially, ethnically, geographically, and economically diverse group of 629 students at four universities across the US within weeks of lockdown, and then followed up on these students' self-reported mental health, identity, and academic resilience three times over the following year. Our findings suggest that: 1) students' mental health, identity development, and academic resilience were largely negatively impacted compared to pre-pandemic samples; 2) these alterations persisted and, in some cases, worsened as the pandemic wore on; and 3) patterns of change were often worse for students indicating more baseline COVID-related stressors.

Depressive and Anxiety Symptoms in Severe COVID-19 Survivors: A Prospective Cohort Study

The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients' neuropsychiatric consequences. This study aims to describe the presence of depressive and anxiety symptoms in severe COVID-19 survivors and to identify associated baseline, in-hospital and post-discharge factors. This study is part of the MAPA longitudinal project conducted with severe COVID-19 patients admitted in Intensive Care Medicine Department (ICMD) of a University Hospital (CHUSJ) in Porto, Portugal. Patients with ICMD length of stay ≤ 24 h, terminal illness, major auditory loss or inability to communicate at follow-up assessment were excluded. All participants were assessed by telephone post-discharge (median = 101 days), with a comprehensive protocol assessing depressive and anxiety symptoms, cognition, Intensive Care Unit (ICU) memories recall and health-related quality of life. Out of a sample of 56 survivors (median age = 65; 68% males), 29% and 23% had depressive and anxiety symptoms, respectively. Depressive and anxiety symptoms were significantly more prevalent among younger survivors and were associated with cognitive complaints, emotional and delusions ICU memories and fear of having COVID-19 sequelae, sleep problems and pain after discharge (all p < 0.05). An important proportion of these survivors suffers from depression and anxiety symptoms post-discharge, namely younger ones and those who reported more cognitive complaints, ICU memories, fear of having COVID-19 sequelae, sleep problems and pain. These findings highlight the importance of psychological consequences assessment and planning of appropriate and multidisciplinary follow-up care after hospitalization due to COVID-19.

Frail Older People Ageing in Place in Italy: Use of Health Services and Relationship with General Practitioner

Functional limitations, chronic diseases and frailty often occur in later life. These aspects become very challenging when older people age alone in place, thus needing support in the activities of daily living, and in this context, it is important they can access and use health services. The present study aimed to explore these issues in Italy. In 2019, 120 qualitative interviews were carried out within the “Inclusive Ageing in Place” (IN-AGE) project, involving frail older people living at home in three Italian regions (Lombardy, Marche, and Calabria). A content analysis and some quantifications of main statements are presented. Results showed that the majority of seniors report poor self-rated health (SRH), suffer from many chronic diseases, and mainly use the General Practitioner (GP) and Medical Specialists (MSs), even though long waiting list in the public sector and high costs in the private one act as barriers to access health services. Complaints regarding GPs mainly refer to the almost exclusive provision of prescriptions and the lack of home visits. Some regional peculiarities highlighted a better overall context in the north than in the south, especially with regards to the public health sector. These results can provide useful insights for policy makers, in order to deliver health services assuring frail, older people the continuity of assistance needed at home.

COVID-Related Perceptions of the Future and Purpose in Life Among Older Canadian Women

Global events that prime thoughts of proximity to death (e.g., the COVID-19 pandemic) can compress individuals' perceptions of future time horizons, and previous studies have found that compressed time horizons can be beneficial for older adults' well-being. However, findings from recent studies are mixed, and studies of well-being during the early months of COVID-19 show that older adults have fared comparatively well. The current study examines relationships between Future Time Perspective (FTP), COVID-19 impact, and purpose in life (PIL) among older Canadian women (N = 190; ages 59+). We expected that total FTP would be positively associated with PIL but that FTP subscales would be associated with PIL in different ways; COVID-19 impact would not be associated with PIL, but COVID-19 impact would moderate the FTP-PIL relationship. We found partial support for these hypotheses, as well as prevalence of social connection themes in open-ended question responses regarding COVID-19 impact.

Childhood adversity patterns differentially cluster with mental disorders and socioeconomic indicators in a large Swiss community sample

BACKGROUND

Exposure to childhood adversities (CHAD) has been found to be strongly associated with individuals' mental health and social development. Recently, it has been suggested that certain CHAD patterns exist in the population, which are more closely related to individuals' later mental health than the simple summation of adversities. The current study aims 1) to establish CHAD patterns based on self-reported child abuse and family dysfunction and 2) to assess their associations with mental disorders and sociodemographic indicators reported in adulthood.

METHODS

Data used in this cross-sectional study were derived from the representative CoLaus/PsyCoLaus population-based cohort (N = 5111, 35 to 88 years). Latent class analysis was conducted for the identification of CHAD patterns, while their associations with mental disorders and socioeconomic achievements (e. g. education and income) were investigated using correspondence analysis.

RESULTS

Four CHAD patterns emerged. While the majority (70.7%) of the sample showed an overall low adversity pattern (c1), 13.6% had not been raised by both of their biological parents due to divorce or being placed in foster home (c2), 11.0% had been raised by conflictive / dysfunctional / abusive parents (c3), and 4.7% showed high overall adversities (c4). Patterns c3 and c4 were most strongly associated with various mental disorders, especially c3 with internalizing anxiety disorders, while c2 was closely related to lower educational achievement.

CONCLUSIONS

Four CHAD patterns characterised by varying levels of child abuse and family dysfunction existed in this community sample. They yielded distinct associations with mental disorders and socioeconomic indicators.

COVID-19 negatively impacts on psychological and somatic status in frontline nurses

BACKGROUND

COVID-19 has become a public health emergency based on its clinical characteristics. Previous studies demonstrated that the onset of a sudden and immediately life-threatening illness could lead to extraordinary amounts of psychological pressure on nurses who play an important role in the illness. Whether COVID-19 pandemic has greater impacts on the psychological status and somatic symptoms from nurses who stand in the frontline of this crisis remain unclear.

METHODS

We evaluated post-traumatic stress disorder (PTSD), anxiety and somatic symptoms in the frontline nurses (n = 438) who served in Wuhan, China, during COVID-19 crisis. Nurses who did not worked in the frontline of COVID-19 served as controls (n = 452). The investigation was processed by online questionnaires including: impact of event scale-revised (IES-R) , self-rating anxiety scale (SAS), and somatic symptoms.

RESULTS

Prevalence of moderate and severe PTSD was significantly increased in the frontline nurses compared to non-frontline nurses. Prevalence of mild anxiety was significantly increased in frontline nurses compared to non-frontline nurses. There were more frontline nurses suffering from severe insomnia and losing weight compared to non-frontline nurses. Severity of PTSD (IES-R score), but not severity of anxiety (SAS score) was similarly positively correlated to incidence of insomnia and weight loss in both frontline and non-frontline nurses to a similar extent.

LIMITATIONS

The results only represented psychological statues and somatic symptom on one time point thus the development of psychological stress and somatic symptom during pandemic of COVID-19 in the frontline nurses were missing.

CONCLUSIONS

COVID-19 negatively impacted on psychological and somatic status in frontline nurses. PTSD may be the most reliability and validity criteria for evaluating psychological and somatic status for frontline nurses of COVID-19.

Psychological impairment and extreme weather event (EWE) exposure, 1980-2020: A global pooled analysis integrating mental health and well-being metrics

Extreme Weather Events (EWEs) impose a substantial health and socio-economic burden on exposed populations. Projected impacts on public health, based on increasing EWE frequencies since the 1950s, alongside evidence of human-mediated climatic change represents a growing concern. To date, the impacts of EWEs on mental health remain ambiguous, largely due to the inherent complexities in linking extreme weather phenomena with psychological status. This exploratory investigation provides a new empirical and global perspective on the psychological toll of EWEs by exclusively focusing on psychological morbidity among individuals exposed to such events. Morbidity data collated from a range of existing psychological and well-being measures have been integrated to develop a single ("holistic") metric, namely, psychological impairment. Morbidity, and impairment, were subsequently pooled for key disorders-, specifically PTSD, anxiety and depression. A "composite" (any impairment) post-exposure pooled-prevalence rate of 23% was estimated, with values of 24% calculated for depression and ⁓17% for both PTSD and anxiety. Notably, calculated pooled odds ratios (pOR = 1.9) indicate a high likelihood of any negative psychological outcome (+90%) following EWE exposure. Pooled analyses of reported risk factors (p < 0.05) highlight the pronounced impacts of EWEs among individuals with higher levels of event exposure or experienced stressors (14.5%) and socio-demographic traits traditionally linked to vulnerable sub-populations, including female gender (10%), previous history (i.e., pre-event) of psychological impairment (5.5%), lower socio-economic status (5.5%), and a lower education level (5.2%). Inherent limitations associated with collating mental health data from populations exposed to EWEs, and key knowledge gaps in the field are highlighted. Study findings provide a robust evidence base for developing and implementing public health intervention strategies aimed at ameliorating the psychological impacts of extreme weather among exposed populations.

Psychiatric symptoms during the COVID-19 outbreak in older adults with bipolar disorder

OBJECTIVES

Older adults with bipolar disorder (OABD) are vulnerable for a COVID-19 infection via multiple pathways. It is essential for OABD to adhere to the COVID-19 measures, with potential consequences for the psychiatric symptoms. This situation offers the unique opportunity to investigate factors of vulnerability and resilience that are associated with psychiatric symptoms in OABD.

METHODS

This study included 81 OABD patients aged over 50 years. Factors measured at baseline in patients that participated in 2017/2018 were compared with factors measured during the COVID-19 outbreak.

RESULTS

Participants experienced less psychiatric symptoms during COVID-19 than (67.9% euthymic) than at baseline (40.7% euthymic). There was no difference in loneliness between COVID-19 and baseline. Not having children, more feelings of loneliness, lower mastery, passive coping style and neuroticism were associated with more psychiatric symptoms during COVID-19 measures.

CONCLUSIONS

Participants experienced less psychiatric symptoms during COVID-19 measures when compared to baseline. Our results indicate promising targets for psychological interventions aimed at curing and preventing recurrence in OABD and improving quality of life in this growing vulnerable group.

Age Differences in Stress, Life Changes, and Social Ties During the COVID-19 Pandemic: Implications for Psychological Well-Being

BACKGROUND AND OBJECTIVES

Experiences of the coronavirus disease 2019 (COVID-19) pandemic and its implications for psychological well-being may vary widely across the adult life span. The present study examined age differences in pandemic-related stress and social ties, and links with psychological well-being.

RESEARCH DESIGN AND METHODS

Participants included 645 adults (43% women) aged 18-97 (M = 50.8; SD = 17.7) from the May 2020 nationally representative Survey of Consumers. Participants reported the extent to which they felt stress related to the pandemic in the last month, the extent to which their lives had changed due to the pandemic, as well as social isolation, negative relationship quality, positive relationship quality, and frequency of depression, anxiety, and rumination in the past week.

RESULTS

Results showed that older people reported less pandemic-related stress, less life change, less social isolation, and lower negative relationship quality than younger people. Greater pandemic-related stress, life change, social isolation, and negative relationship quality were associated with poorer psychological well-being. Poorer social ties (i.e., greater social isolation and negative quality) exacerbated the effects of the COVID-19 pandemic (stress, life change) on psychological well-being.

DISCUSSION AND IMPLICATIONS

Researchers have indicated that older adults may be more vulnerable to COVID-19 pandemic-related stress and social isolation, but this study indicates that young adults may be relatively more vulnerable. Because isolation and negative relationship quality appear to exacerbate the deleterious effects of the COVID-19 pandemic on psychological well-being, reducing social isolation and negative relations are potential targets for intervention.

Model of Post-traumatic Growth in Newly Traumatized vs. Retraumatized Adolescents

Background: In our analysis of adolescents affected by the 2016 Fort McMurray wildfire, we observed many negative mental health effects in individuals with a prior history of psychological trauma. Elevated rates of depression and markers of post-traumatic stress disorder (PTSD) were observed, consistent with the hypothesis that prior trauma may reduce sensitivity thresholds for later psychopathology (stress sensitization). Surprisingly, levels of anxiety did not differ based on prior trauma history, nor were retraumatized individuals at increased risk for recent (past month) suicidal ideation. These results are more suggestive of inoculation by prior trauma than stress sensitization. This led us to consider whether individuals with a prior trauma history showed evidence of Post-Traumatic Growth (PTG), a condition in which the experience of a previous trauma leads to areas of sparing or even improvement. Method: To investigate this issue, we generated a structural equation model (SEM) exploring the role of anxiety in previously traumatized (n = 295) and wildfire trauma alone (n = 740) groups. Specifically, models were estimated to explore the relationship between hopelessness, anxiety, PTSD symptoms, self-efficacy and potential protective factors such as friend and family support in both groups. The model was tested using a cross-sectional sample of affected youth, comparing effects between the two groups. Results: While both models produced relatively good fit, differences in the effects and chi-squared values led us to conclude that the groups are subject to different causal specifications in a number of areas, although details warrant caution pending additional investigation. Discussion: We found that adolescents with a prior trauma history appear to have a more realistic appraisal of potential difficulties associated with traumatic events, and seem less reactive to potentially unsettling PTSD symptoms. They also seemed less prone to overconfidence as they got older, an effect seen in the adolescents without a history of trauma. Our findings provide preliminary evidence that the construct of anxiety may work differently in newly traumatized and retraumatized individuals, particularly in the context of mass trauma events.

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.

Association Between Different Forms of Elder Mistreatment and Cognitive Change

Objectives: Elder mistreatment (EM) is associated with worse physical health and psychological well-being, but little is known regarding its cognitive consequences. Methods: Data were derived from the T1-T2 PINE (n = 2713). EM was measured by psychological, physical, and sexual mistreatment; financial exploitation; and caregiver neglect. Cognitive function was evaluated by global cognition, episodic memory, working memory, processing speed, and Mini-Mental State Examination. Linear regression was used. Results: At baseline, physical mistreatment and caregiver neglect were associated with lower global cognition and cognitive domains, while psychological mistreatment was associated with higher cognitive function. Older adults with incident psychological mistreatment, physical mistreatment, and caregiver neglect had a faster decrease in global cognition and cognitive domains over 2 years. Discussion: This study is among the first to examine the association between different forms of EM and cognitive change. These findings provide a basis for engaging ethnic minorities with EM to maintain cognitive health.

The factors associated with distress following exposure to smoke from an extended coal mine fire

In February 2014, the coalmine adjacent to the Hazelwood Power Station in the Latrobe Valley of Victoria, Australia, caught fire, with residents from the nearby town of Morwell and the wider area exposed to smoke for six weeks. Although there was evidence linking the mine-fire event with psychological distress, no studies have evaluated the degree of distress in relation to the level of smoke exposure. We aimed to investigate the exposure-response relationship between particulate matter 2.5 μm or less in diameter (PM_2.5) released during the Hazelwood mine fire event and long-term symptoms of posttraumatic distress in the affected community, including the consideration of other key factors. A total of 3096 Morwell residents, and 960 residents from the largely unexposed comparison community of Sale, were assessed for symptoms of posttraumatic distress 2.5 years after the Hazelwood incident using the Impact of Events Scale-Revised (IES-R). Individual-level PM_2.5 exposure was estimated by mapping participants' self-reported location data on modelled PM_2.5 concentrations related to the mine fire. Multivariate linear regression was used to evaluate the exposure-response relationship. Both mean and peak exposure to mine fire-related PM_2.5 were found to be associated with participant IES-R scores with an interaction effect between age and mean PM_2.5 exposure also identified. Each 10 μg/m³ increase in mean PM_2.5 exposure corresponded to a 0.98 increase in IES-R score (95% CI: 0.36 to 1.61), and each 100 μg/m³ increase in peak PM_2.5 exposure corresponded to a 0.36 increase (95% CI: 0.06 to 0.67). An age-effect was observed, with the exposure-response association found to be stronger for younger adults. The results suggest that increased exposure to PM_2.5 emissions from the Hazelwood mine fire event was associated with higher levels of psychological distress associated with the mine fire and the most pronounced effect was on younger adults living in the affected community.

The psychological burden experienced by Chinese citizens during the COVID-19 outbreak: prevalence and determinants

BACKGROUND

The present study is aims to investigate the prevalence and determinants of depression and anxiety among the general population in the context of coronavirus disease 2019 (COVID-19) outbreak in China.

METHODS

A cross-sectional self-report survey methodology was used to gather the following data from Chinese citizens: sociodemographic information, physical and mental health disorder history, daily online time, social media exposure, feeling toward social media exposure, perception of the disease, infection cases in the local area, and previous experiences with stressful life incidents. Levels of anxiety and depression were self-reported employing the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively.

RESULTS

Among the 6130 participants, the prevalence of anxiety and depression was 7.1 and 12%, respectively. Multiple logistic regression analysis revealed that psychological disturbances were associated with gender, people with religious background, being a medical professional, having physical or mental health disease, difficulty accessing medical aids, experience with traumatic incidents, the perceived possibility of sequelae after being cured of COVID-19, daily online time, the source of the information relevant to COVID-19, frequency of receiving information regarding COVID-19, and negative feelings triggered by social media.

CONCLUSIONS

There needs to be a consistent message from authorities to reduce the panic and confusion of the public, and to decrease public exposure to persistently negative information. It is necessary to help people transform their negative experiences into positive changes especially for individuals with physical illness, individuals with mental health disorders, and medical professionals.

Psychological Distress and Its Correlates Among COVID-19 Survivors During Early Convalescence Across Age Groups

OBJECTIVE

To examine the psychological distress and the associated predictor factors of the 2019 corona-virus disease (COVID-19) on survivors in the early convalescence in Shenzhen.

METHOD

A survey questionnaire consisting of post-traumatic stress disorder self-rating scale (PTSD-SS), self-rating depression scale (SDS), and self-rating anxiety scale (SAS) was presented to COVID-19 survivors still in quarantine. Scores of each scale and subscale were dependent variables in the Mann-Whitney test and stepwise regression analysis.

RESULTS

A total of 126 subjects were included in the study, the mean scores of PTSD-SS, SDS, and SAS were 45.5 ± 18.9, 47.3 ± 13.1, and 43.2 ± 10.2, respectively, meanwhile, 9 (31.0%), 28 (22.2%), and 48 (38.1%) of the survivors met the cut-score for clinical significant symptoms of stress response, anxiety, and depression, respectively. Infected family members, and postinfection physical discomforts were significantly associated with scores on all three scales. Social support, retirement, and being female had significant associations with the PTSD-SS score. The survivors aged 60 or above experienced less severe stress response symptoms, fewer emotional symptoms of depression, and fewer anxiety symptoms than younger survivors.

CONCLUSION

The occurrence rate of psychological distress among the COVID-19 survivors in early convalescence was high, highlighting the need for all COVID-19 survivors to be screened for psychological distress regularly for timely intervention. The predictors indicated by the current study may help to identify those at high-risk. Besides, the results indicated the older survivors suffered less emotional reactivity and fewer stress response symptoms from infectious diseases than the younger ones.

Impact of repeat flooding on mental health and health-related quality of life: a cross-sectional analysis of the English National Study of Flooding and Health

OBJECTIVE

To assess the association between flooding/repeat flooding and: (1) psychological morbidity (anxiety, depression, post-traumatic stress disorder (PTSD)) and (2) health-related quality of life (HRQoL) at 6 months post-flooding.

DESIGN

Cross-sectional analysis of data from the English National Study of Flooding and Health.

SETTING

Cumbria, England.

PARTICIPANTS

Questionnaires were sent to 2500 residential addresses at 6 months post-flooding; 590 people responded.

OUTCOMES

Probable depression was assessed using the Patient Health Questionnaire, probable anxiety using the Generalised Anxiety Disorder scale and probable PTSD using the short-form PTSD checklist (PCL-6). HRQoL was assessed using the EQ-5D-5L. Mental health outcomes were analysed using logistic regression; HRQoL dimensions using ordinal regression; and summary index/Visual Analogue Scale scores using linear regression.

RESULTS

One hundred and nineteen participants had been flooded, over half of whom were experiencing a repeat flooding event (54%; n=64). Mental health outcomes were elevated among flooded compared with unaffected participants (adjusted OR for probable depression: 7.77, 95% CI: 1.51 to 40.13; anxiety: 4.16, 95% CI: 1.18 to 14.70; PTSD: 14.41, 95% CI: 3.91 to 53.13). The prevalence of depression was higher among repeat compared with single flooded participants, but this was not significant after adjustment. There was no difference in levels of anxiety or PTSD. Compared with unaffected participants, those flooded had lower EQ-5D-5L index scores (adjusted coefficient: -0.06, 95% CI: -0.12 to -0.01) and lower self-rated health scores (adjusted coefficient: -6.99, 95% CI: -11.96 to -2.02). There was, however, little difference in HRQoL overall between repeat and single flooded participants.

CONCLUSIONS

Interventions are needed to help minimise the impact of flooding on people's mental health and HRQoL.

Aging in Flood-Prone Coastal Areas: Discerning the Health and Well-Being Risk for Older Residents

Coastal communities are increasingly exposed to more intense and frequent hurricanes, accelerated sea-level rise, and prolonged tidal inundation, yet they are often a preferred retirement destination for older adults vulnerable to flooding and extreme weather events. The unique physical and psychosocial challenges of older population age 65 and over may affect their level of preparedness, capacity to cope with, and ability to respond and recover from a hazard event. Despite the clear vulnerabilities of older residents living in high-risk areas when compared to younger coastal populations, there is a lack of empirical research on the integrated flood risks to this population group in the coastal context. This paper provides a holistic assessment of this emerging problem along the U.S. East Coast by measuring the exposure of older population to sea level rise and storm surge in coastal counties. It further evaluates how age-related vulnerabilities differ between rural and urban settings using the case study approach and geospatial and statistical analysis the paper also conducts a review of scientific literature to identify gaps in the current understanding of health and well-being risks to aging populations in coastal communities. The results show that older populations are unevenly distributed along the U.S. East Coast with some states and counties having significantly higher percent of residents age 65 and older living along the shoreline. Many places with larger older populations have other attributes that further shape the vulnerability of this age group such as older housing stock, disabilities, and lower income and that often differ between rural and urban settings. Lastly, our study found that vast majority of research on aging in high-risk coastal locations has been conducted in relation to major disasters and almost none on the recurrent nuisance flooding that is already affecting many coastal communities.

Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis

BACKGROUND

Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health.AimsOur aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters.

METHOD

This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics.

RESULTS

Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27-0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43-2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies.

CONCLUSIONS

Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects.Declaration of interestNone.

Housing Transitions and Recovery of Older Adults Following Hurricane Sandy

Objectives

This study explores the effects of social and environmental disruption on emergency housing transitions among older adults following Hurricane Sandy. It is based upon the Sandy Child and Family Health (S-CAFH) Study, an observational cohort of 1,000 randomly sampled New Jersey residents living in the nine counties most affected by Sandy.

Methods

This analysis examines the post-Sandy housing transitions and recovery of the young-old (55–64), mid-old (65–74), and old-old (75+) compared with younger adults (19–54). We consider length of displacement, number of places stayed after Sandy, the housing host (i.e., family only, friends only, or multi-host), and self-reported recovery.

Results

Among all age groups, the old-old (75+) reported the highest rates of housing damage and were more likely to stay in one place besides their home, as well as stay with family rather than by themselves after the storm. Despite this disruption, the old-old were most likely to have recovered from Hurricane Sandy.

Discussion

Findings suggest that the old-old were more resilient to Hurricane Sandy than younger age groups. Understanding the unique post-disaster housing needs of older adults can help identify critical points of intervention for their post-disaster recovery.

The Burden of ADHD in Older Adults: A Qualitative Study

OBJECTIVE

To explore how ADHD may have affected the lives of older adults who meet the diagnostic criteria of ADHD, but are unaware of their diagnosis. Our second aim was to examine whether the reported symptoms change over the life span.

METHOD

A qualitative study was conducted. Seventeen Dutch older people (>65 years) diagnosed in this study with ADHD participated in in-depth interviews. Data were analyzed according to techniques of thematic approach.

RESULTS

Seven themes emerged from the analyses. Four themes correspond to ADHD symptoms: "being active," "being impulsive," "attention problems," and "mental restlessness." In addition, the themes "low self-esteem," "overstepping boundaries," and "feeling misunderstood" emerged. The impact of ADHD symptoms seems to have declined with age.

CONCLUSION

ADHD has a negative impact on late life, and older adults with the disorder may benefit from treatment. Moreover, this study's findings call for early detection and treatment of ADHD in children and adults.

Suicidality Risk and (Repeat) Disaster Exposure: Findings From a Nationally Representative Population Survey

OBJECTIVE

Despite growing awareness of adverse mental health consequences, the scarce existing evidence on the link of disaster exposure and suicidality has remained inconclusive, and the differential suicidality risk associated with distinct levels of natural and man-made disaster exposure is unknown. We therefore investigated the lifetime prevalence and risk of suicidal behavior associated with natural and man-made disaster exposure in Australia.

METHOD

We utilized data from a nationally representative mental health survey (n = 8,841). Univariate and multivariate logistic regression analyses examined the lifetime risk of suicidal thoughts, plans, and attempts associated with varied types and levels of disaster exposure. We focused explicitly on natural and man-made disasters while controlling for other types of trauma exposure, including established risk factors for suicidality.

RESULTS

Multivariate analyses indicated that those exposed to multiple natural (adjusted odds ratio [AOR] = 2.21, 95% confidence interval [CI] = [1.04, 4.71], p < .05) or man-made disasters (AOR 3.4, 95% CI = [1.20, 9.58] p < .05) were at significantly greater risk of making suicide attempts, whereas single natural or man-made disaster exposure was not associated with an increased risk of suicidal behavior.

CONCLUSIONS

Our study findings establish the differential suicidality risk associated with natural and man-made disaster exposure in Australia and highlight the critical role of repeat disaster exposure across distinct disaster types. Suicidal behavior may warrant increasing attention in psychosocial recovery schemes, particularly in the context of disaster-prone areas and for population groups at elevated risk of repeat disaster exposure.

Community Resilience, Psychological Resilience, and Depressive Symptoms: An Examination of the Mississippi Gulf Coast 10 Years After Hurricane Katrina and 5 Years After the Deepwater Horizon Oil Spill

OBJECTIVE

This study examined the role of community resilience and psychological resilience on depressive symptoms in areas on the Mississippi Gulf Coast that have experienced multiple disasters.

METHODS

Survey administration took place in the spring of 2015 to a spatially stratified, random sample of households. This analysis included a total of 294 subjects who lived in 1 of the 3 counties of the Mississippi Gulf Coast at the time of both Hurricane Katrina in 2005 and the Deepwater Horizon oil spill in 2010. The survey included the Communities Advancing Resilience Toolkit (CART) scale, the Connor-Davidson Resilience Scale (CD-RISC 10), and the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

There was a significant inverse relationship between psychological resilience and depressive symptoms and a significant positive relationship between community resilience and psychological resilience. The results also revealed that community resilience was indirectly related to depressive symptoms through the mediating variable of psychological resilience.

CONCLUSIONS

These findings highlight the importance of psychological resilience in long-term disaster recovery and imply that long-term recovery efforts should address factors associated with both psychological and community resilience to improve mental health outcomes. (Disaster Med Public Health Preparedness. 2018;12:241-248).

Understanding Older Adults’ Resilience During the Brisbane Floods: Social Capital, Life Experience, and Optimism

Objective

The purpose of this study was to explore how social capital or the impact of life and previous disaster experience facilitated resilience in older adults who experienced the 2011 and 2013 floods in Brisbane, Australia.

Methods

Data were drawn from in-depth interviews of 10 older adults from Brisbane who were evacuated in both the 2011 and 2013 floods. A combined qualitative approach drawing from the methods of constructivist grounded theory and narrative inquiry was applied and the data were analyzed by using (inductive) line-by-line and axial coding.

Results

The narratives of the older adults revealed a strong theme of resilience linked to social capital (bonding, bridging, and linking) and previous disaster experience. The results reflected the changing face of disaster management strategies and sources of social capital.

Conclusions

Changes in disaster management polices (toward self-reliance) and more formalized sources of social capital highlight the need to build strong and healthy resilient communities that are capable of positively recovering from natural disasters. The results from this research emphasize the importance of initiatives that enhance social cohesion, trust, and social capital within local communities. (Disaster Med Public Health Preparedness. 2017;11:72–79)

Adapting to Life after Hurricane Katrina and the Deepwater Horizon Oil Spill: An Examination of Psychological Resilience and Depression on the Mississippi Gulf Coast

The purpose of this study was to examine relationships among depression, psychological resilience, and other sociodemographic factors of individuals who were highly exposed to Hurricane Katrina in 2005 and the Deepwater Horizon Oil Spill in 2010. A spatially stratified random sample of 294 Mississippi Gulf Coast residents living in close proximity to the Gulf of Mexico were surveyed. Findings indicated that low education attainment, financial hardship, and disaster-related damages increased the likelihood of depression, whereas psychological resilience and having health insurance reduced the odds of depression. Implications for enhancing psychological resilience and increasing access to health insurance are discussed.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Are older people more vulnerable to long-term impacts of disasters?

BACKGROUND

Despite the growing interest in the study of disasters, there is limited research addressing the elderly population that lead to prejudiced beliefs that older adults are more vulnerable to disasters than younger adults. This study aimed to compare positive mental health between elderly and young earthquake survivors.

METHOD

Data for this study, consisting of 324 earthquake survivors, were obtained from a population-based cross-sectional survey conducted in Iran, 2015. The long-term effect of earthquake was assessed using the Mental Health Continuum-Short Form questionnaire. A one-way multivariate analysis of covariance (MANCOVA) using SPSS (version 22) was used in data analysis.

RESULTS

Older adults scored significantly a higher level of overall positive mental health (mean [M]=34.31, standard deviation [SD]=10.52) than younger age group (M=27.48, SD=10.56, t=-4.41; P<0.001). Results of MANCOVA revealed a statistically significant difference between older and young adults on the combined positive mental health subscales (F_(3,317)=6.95; P<0.001), after controlling for marital status, sex, and employment status.

CONCLUSION

The present findings showing a higher level of positive mental health among elderly earthquake survivors compared with their younger counterparts in the wake of natural disasters suggest that advancing age per se does not contribute to increasing vulnerability.

Challenges Faced and Support Received: Older Adults' Perceptions of Hurricane Sandy

OBJECTIVE

Individuals exposed to natural disasters are at risk for negative physical and psychological outcomes. Older adults may be particularly vulnerable; however, social support can act as a resource to help individuals respond to severe stressors. This study explored the challenges older people faced before, during, and after Hurricane Sandy in October 2012 and the people they turned to for support.

METHODS

Semi-structured interviews were conducted with 20 older adults in New Jersey drawn from the ORANJ BOWL (Ongoing Research on Aging in New Jersey - Bettering Opportunities for Wellness in Life) research panel, who experienced high levels of primary home damage during Hurricane Sandy. Content analysis of interview transcripts classified older adults' perceptions on how they "made it" through-the challenges they faced and the support they received.

RESULTS

The findings suggested that older adults experienced emotional, instrumental, social, and financial challenges before, during, and after the storm. However, by relying on family and friends, as well as neighbors and community networks, older people were able to respond to stressors.

CONCLUSIONS

Our findings carry implications for ensuring that older adults are connected to social networks before, during, and after disasters. The role of neighbors is particularly important when disasters strike. (Disaster Med Public Health Preparedness. 2017;11:39-47).

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSION

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

The Mental Health of Older Persons After Human-Induced Disasters: A Systematic Review and Meta-Analysis of Epidemiological Data

BACKGROUND

Older people are increasingly "in harm's way" following human-induced disasters (HIDs). There is debate in the literature as to the relative impact of disasters on their psychological health compared with other age groups. Natural disasters and HIDs are thought to affect survivors differentially, and this may extend to older adults as a group. In the absence of existing systematic reviews, we aimed to synthesize the available evidence and conduct meta-analyses of the effects of HIDs on the psychological health of older versus younger adults.

METHODS

A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, adjustment disorder, and psychological distress.

RESULTS

We identified 11 papers from 10 studies on HIDs (N = 26,753), of which 8 had sufficient data for a random-effects meta-analysis. Older adults were 2.85 times less likely to experience PTSD symptoms following HID (95% CI: 1.42-5.70) when compared with younger adults. There was no statistically significant difference in terms of anxiety and depressive symptoms.

CONCLUSION

Health and emergency services need to be increasingly prepared to meet the psychological needs of older people, given the global rise in the numbers of older adults affected by disasters of all kinds. Preliminary evidence suggests that old age may be a protective factor for the development of PTSD in the wake of HID.

Early life stress dampens stress responsiveness in adolescence: Evaluation of neuroendocrine reactivity and coping behavior

Stressful experiences during early life (ELS) can affect brain development, thereby exerting a profound and long-lasting influence on mental development and psychological health. The stress inoculation hypothesis presupposes that individuals who have early experienced an attenuated form of stressors may gain immunity to its more virulent forms later in life. Increasing evidence demonstrates that ELS may promote the development of subsequent stress resistance, but the mechanisms underlying such adaptive changes are not fully understood. The present study evaluated the impact of fragmented dam-pup interactions by limiting the bedding and nesting material in the cage during postnatal days 2-9, a naturalistic animal model of chronic ELS, on the physiological and behavioral responses to different stressors in adolescent mice and characterized the possible underlying mechanisms. We found that ELS mice showed less social interaction deficits after chronic social defeat stress and acute restraint-tailshock stress-induced impaired long-term potentiation (LTP) and enhanced long-term depression (LTD) in hippocampal CA1 region compared with control mice. The effects of ELS on LTP and LTD were rescued by adrenalectomy. While ELS did not cause alterations in basal emotional behaviors, it significantly enhanced stress coping behaviors in both the tail suspension and the forced swimming tests. ELS mice exhibited a significant decrease in corticosterone response and trafficking of glucocorticoid receptors to the nucleus in response to acute restraint stress. Altogether, our data support the hypothesis that stress inoculation training, via early exposure to manageable stress, may enhance resistance to other unrelated extreme stressors in adolescence.

Anxiety Sensitivity Among First-Time Fathers Moderates the Relationship Between Exposure to Stress During Birth and Posttraumatic Stress Symptoms

This longitudinal study examined posttraumatic stress disorder (PTSD) and anxiety symptoms among men attending the birth of their first offspring. Furthermore, we examined the moderating role of anxiety sensitivity (AS) and intolerance of uncertainty in the association between exposure to stress during birth and PTSD and anxiety symptoms. Participants were Israeli men (n = 171) who were assessed with self-report questionnaires during the third trimester of pregnancy (T1) and approximately a month following birth (T2). Results show that the rates of postnatal PTSD and anxiety symptoms were relatively low. Subjective exposure to stress during birth and AS predicted PTSD in T2, above and beyond other negative life events and PTSD in T1. In addition, AS moderated the relations between subjective exposure to stress during birth and PTSD symptoms. Pregnancy and childbirth professionals may benefit from the insight that men with high levels of AS might experience childbirth as a highly stressful situation with possible posttraumatic stress symptoms.

Mental health implications for older adults after natural disasters--a systematic review and meta-analysis

BACKGROUND

Natural disasters affect the health and well-being of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared with younger adults. To date, no systematic review has evaluated this. We aimed to synthesize the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults.

DESIGN

A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, adjustment disorder, and psychological distress.

RESULTS

We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms and 1.73 more likely to develop adjustment disorder when exposed to natural disasters when compared with younger adults.

CONCLUSIONS

Given the global rise in the number of older adults affected by natural disasters, mental health services need to be prepared to meet their needs following natural disasters, particularly around the early detection and management of PTSD.

Long-term psychological outcomes in older adults after disaster: relationships to religiosity and social support

OBJECTIVES

Natural disasters are associated with catastrophic losses. Disaster survivors return to devastated communities and rebuild homes or relocate permanently, although the long-term psychological consequences are not well understood. The authors examined predictors of psychological outcomes in 219 residents of disaster-affected communities in south Louisiana.

METHOD

Current coastal residents with severe property damage from the 2005 Hurricanes Katrina and Rita, and exposure to the 2010 British Petroleum Deepwater Horizon oil spill were compared and contrasted with former coastal residents and an indirectly affected control group. Participants completed measures of storm exposure and stressors, religiosity, perceived social support, and mental health.

RESULTS

Non-organizational religiosity was a significant predictor of post-traumatic stress disorder (PTSD) in bivariate and multivariate logistic regressions. Follow-up analyses revealed that more frequent participation in non-organizational religious behaviors was associated with a heightened risk of PTSD. Low income and being a coastal fisher were significant predictors of depression symptoms in bivariate and multivariate models. Perceived social support had a protective effect for all mental health outcomes, which also held for symptoms of depression and GAD in multivariate models.

CONCLUSION

People who experienced recent and severe trauma related to natural and technological disasters are at risk for adverse psychological outcomes in the years after these events. Individuals with low income, low social support, and high levels of non-organizational religiosity are also at greater risk. Implications of these data for current views on the post-disaster psychological reactions and the development of age-sensitive interventions to promote long-term recovery are discussed.

Factors associated with resilience of adult survivors five years after the 2008 Sichuan earthquake in China

Given the paucity of quantitative empirical research on survivors’ resilience and its predictors in the context of long-term recovery after disasters, we examined how resilience predictors differed by gender among adult survivors five years after the Sichuan earthquake. This was a cross-sectional survey study of adult survivors (N = 495; aged 18–60) living in reconstructed communities five years into the recovery process after the Wenchuan earthquake. The instruments we used included assessments of sociodemographic characteristics and earthquake exposure level, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale. Support-seeking behaviors emerged as a significant predictor of male survivors’ resilience, while subjective support and marital status were found to be predictors of female survivors’ resilience. Annual household income and chronic disease were predictors for both male and female groups. The findings of this study can be used in devising methods to boost survivors’ resilience by promoting their satisfaction with social support and their ability to obtain effective support. Additionally, the results suggest how to assist survivors who may have relatively poor resilience.

War leaves an enduring legacy in combatants' lives

The memory of combat experience endures in World War II veterans. As veterans age, traumatic memory that previously may have been suppressed in the busyness of family and everyday life can re-emerge. Combat stress may affect not only the veterans, but also those people closely associated with them. Interviews were conducted with World War II veteran aircrew, wives, children, grandchildren, siblings, and friends to examine the impact of combat experience on the veterans and the family across the life course from the perspectives of the various participants. The combat experience significantly affected the life course of most.

Risk of social isolation among Great East Japan Earthquake survivors living in tsunami-affected Ishinomaki, Japan

OBJECTIVE

The Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.

METHODS

The surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants' risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.

RESULTS

The elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.

CONCLUSIONS

Our findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention.

Post-traumatic stress disorder among survivors two years after the 2010 Mount Merapi volcano eruption: A survey study

The Mount Merapi volcanic eruption in October 2010 was one of Indonesia's largest and most recent natural disasters. A cross-sectional study was undertaken to measure the psychosocial impact of the eruption on survivors in two locations in Yogyakarta, Java, Indonesia. The Impact of Event Scale Revised was used to assess participants' symptoms of post-traumatic stress disorder. Post-Traumatic Stress Disorder responses and demographic characteristics were compared in both locations by conducting bivariate analysis using Mann-Whitney and t tests. The relative contributions of demographic variables and psychosocial impact were examined using multiple linear regression analyses. Two years after the eruption, survivors from the area closest to the eruption had significantly higher Impact of Event Scale Revised scores than those in the comparison area. In particular, females, adults between the ages of 18 and 59, and people who owned their own home experienced the highest levels of psychosocial impact. Nurses and other health professionals need to be aware of the impact of natural disasters on survivors and develop interventions to help people adjust to the psychosocial impact of these events.

Pre-earthquake burden of illness and postearthquake health and preparedness in veterans

BACKGROUND

During an earthquake, vulnerable populations, especially those with chronic conditions, are more susceptible to adverse, event-induced exacerbation of chronic conditions such as limited access to food and water, extreme weather temperatures, and injury. These circumstances merit special attention when health care facilities and organizations prepare for and respond to disasters.

METHODS

This study explores the relationship between pre-earthquake burden of illness and post earthquake health-related and preparedness factors in the US. Data from a cohort of male veterans who were receiving care at the Sepulveda Veterans Affairs Medical Center (VAMC) in Los Angeles, California USA during the 1994 Northridge earthquake were analyzed.

RESULTS

Veterans with one or more chronic conditions were more likely to report pain lasting two or more days, severe mental/emotional stress for more than two weeks, broken/lost medical equipment, having difficulty refilling prescriptions, and being unable to get medical help following the quake compared to veterans without chronic conditions. In terms of personal emergency preparedness, however, there was no association between burden of illness and having enough food or water for at least 24 hours after the earthquake.

CONCLUSION

The relationship that exists between health care providers, including both individual providers and organizations like the US Department of Veterans Affairs (VA), and their vulnerable, chronically-ill patients affords providers the unique opportunity to deliver critical assistance that could make this vulnerable population better prepared to meet their post disaster health-related needs. This can be accomplished through education about preparedness and the provision of easier access to medical supplies. Disaster plans for those who are burdened with chronic conditions should meet their social needs in addition to their psychological and physical needs.

Previous exposure to the World Trade Center terrorist attack and posttraumatic symptoms among older adults following Hurricane Sandy

OBJECTIVE

The present study tested the maturation and inoculation hypotheses by examining whether age and previous exposure to the September 11, 2001, World Trade Center (WTC) terrorist attack moderated the relationship between degree of exposure to Hurricane Sandy and related posttraumatic stress disorder (PTSD) symptoms.

METHOD

An online sample of 1,000 participants from affected states completed self-report questionnaires one month after Hurricane Sandy hit the East Coast. Participants reported their degree of exposure to the WTC terrorist attack and to Hurricane Sandy, and their posttraumatic stress disorder (PTSD) symptoms following Hurricane Sandy.

RESULTS

The positive relationship between degree of exposure to Hurricane Sandy and level of PTSD symptoms was weaker among older adults. An additional significant three-way interaction suggested that both age and previous exposure to the WTC terrorist attack moderated the relationship between degree of exposure to Hurricane Sandy and level of PTSD symptoms. Previous high degree of exposure to the WTC terrorist attack was related to a weaker effect of current exposure to Hurricane Sandy on PTSD symptoms among older adults. However, among younger adults, previous high degree of exposure to the WTC terrorist attack was related to a stronger effect of current exposure on PTSD symptoms.

CONCLUSIONS

When confronted by a natural disaster, American older adults are generally resilient. Supporting the inoculation hypothesis, resilience of older adults may be partly related to the strength successfully extracted from previous exposure to adverse events.

Psychological resilience in older U.S. veterans: results from the national health and resilience in veterans study

BACKGROUND

Although a large body of empirical research has examined negative psychological outcomes in older veterans, relatively little is known about the prevalence and determinants of psychological resilience in this population.

METHODS

A nationally representative sample of 2,025 U.S. veterans aged 60 and older (mean = 71.0, standard deviation = 7.1, range = 60-96) completed a web-based survey as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of measures of lifetime potentially traumatic events, and current PTSD, major depression, and generalized anxiety symptoms was used to classify psychological outcomes.

RESULTS

A three-group solution best fit the data: Control (low number of lifetime traumas, low current psychological distress; 60.4%); Resilient (high number of lifetime traumas, low current psychological distress; 27.5%); and distressed (high number of lifetime traumas, high current psychological distress; 12.1%). Among older veterans with a high number of traumas, 69.5% were in the Resilient group. Compared to the Distressed group, the Resilient group was more likely to have college or higher level of education, and to be married or living with a partner. They also scored higher on measures of emotional stability, social connectedness (i.e., secure attachment style, social support), protective psychosocial characteristics (e.g., community integration, purpose in life), and positive perceptions of the military's effect on one's life; and lower on measures of physical health difficulties and psychiatric problems, and openness to experiences.

CONCLUSIONS

Among older U.S. veterans who have endured a high number of traumas in their lifetimes, nearly 70% are psychologically resilient in later life. Prevention efforts targeted toward bolstering social connectedness, community integration, and purpose in life may help promote psychological resilience in older veterans who endured a significant number of traumas in their lives.

The impact of recurrent disasters on mental health: a study on seasonal floods in northern India

INTRODUCTION

Very little is known on the impact of recurrent disasters on mental health. Aim The present study examines the immediate impact of a recurrent flood on mental health and functioning among an affected population in the rural district of Bahraich, Uttar Pradesh, India, compared with a population in the same region that is not affected by floods.

METHODS

The study compared 318 affected respondents with 308 individuals who were not affected by floods. Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25). Psychological and physical functioning was assessed by using the Short Form-12 (SF-12).

RESULTS

The affected group showed large to very large differences with the comparison group on symptoms of anxiety (D = .92) and depression (D = 1.22). The affected group scored significantly lower on psychological and physical functioning than the comparison group (respectively D = .33 and D = .80). However, hierarchical linear regressions showed no significant relationship between mental health and the domains of functioning in the affected group, whereas mental health and the domains of functioning were significantly related in the comparison group.

CONCLUSION

This study found a large negative impact of the recurrent floods on mental health outcomes and psychological and physical functioning. However, in a context with recurrent floods, disaster mental health status is not a relevant predictor of functioning. The findings suggest that the observed mental health status and impaired functioning in this context are also outcomes of another mechanism: Both outcomes are likely to be related to the erosion of the social and environmental and material context. As such, the findings refer to a need to implement psychosocial context-oriented interventions to address the erosion of the context rather than specific mental health interventions.

Impact of the Northridge Earthquake on the Mental Health of Veterans: Results From a Panel Study

Objective: The 1994 earthquake that struck Northridge, California, led to the closure of the Veterans Health Administration Medical Center at Sepulveda. This article examines the earthquake's impact on the mental health of an existing cohort of veterans who had previously used the Sepulveda Veterans Health Administration Medical Center.

Methods: From 1 to 3 months after the disaster, trained interviewers made repeated attempts to contact participants by telephone to administer a repeated measures follow-up design survey based on a survey that had been done preearthquake. Postearthquake data were obtained on 1144 of 1800 (64%) male veterans for whom there were previous data. We tested a predictive latent variable path model of the relations between sociodemographic characteristics, predisaster physical and emotional health measures, and postdisaster emotional health and perceived earthquake impact.

Results: Perceived earthquake impact was predicted by predisaster emotional distress, functional limitations, and number of health conditions. Postdisaster emotional distress was predicted by preexisting emotional distress and earthquake impact. The regression coefficient from earthquake impact to postearthquake emotional distress was larger than that of the stability coefficient from preearthquake emotional distress. Postearthquake emotional distress also was affected indirectly by preearthquake emotional distress, health conditions, younger age, and lower socioeconomic status.

Conclusions: The postdisaster emotional health of veterans who experienced greater earthquake impact would have likely benefited from postdisaster intervention, regardless of their predisaster emotional health. Younger veterans and veterans with generally poor physical and emotional health were more vulnerable to greater postearthquake emotional distress. Veterans of lower socioeconomic status were disproportionately likely to experience more effects of the disaster because they had more predisaster emotional distress, more functional limitations, and a greater number of health conditions. Because many veterans use non–Department of Veterans Affairs (VA) health care providers for at least some of their health needs, future disaster planning for both VA and non-VA providers should incorporate interventions targeted at these groups.

(Disaster Med Public Health Preparedness. 2011;5:S220-S226)