The Impact of Child-Related Stressors on the Psychological Functioning of Lower-Income Mothers After Hurricane Katrina

Pre- and peri-traumatic event stressors drive gender differences in chronic stress-related psychological sequelae: A prospective cohort study of COVID-19 frontline healthcare providers

Women are at heightened risk for chronic stress-related psychological sequelae (SRPS), including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in response to potentially traumatic events, including the COVID-19 pandemic. However, few studies have examined pre- and peri-event stressors that could account for gender differences in chronic SRPS. To address this gap, we conducted a prospective cohort study of healthcare providers (HCPs) caring for patients with COVID-19 at a large tertiary care hospital in New York City, and measured mental health risk factors and symptoms of MDD, GAD, and PTSD at baseline (April 2020) and at a 7-month follow-up (December 2020). We defined chronic SRPS as the presence of probable MDD, GAD, and/or PTSD at both timepoints. We conducted a mediation analysis to evaluate whether pre- and peri-event stressors explained women's increased risk for chronic SRPS. Among our sample of 786 HCPs, 571 (72.6%) were women. Compared with men, women were twice as likely to have chronic SRPS (18.7% vs. 8.8%, χ²[1] = 11.38, p < 0.001). However, after accounting for pre- and peri-event stressors, being a woman was no longer associated with chronic SRPS (p = 0.58). The pre- and peri-event stressors that accounted for this heightened risk among women included being in a woman-prevalent profession (specifically nursing; estimate = 0.08, SE = 0.04, p = 0.05), pre-pandemic burnout (estimate = 0.11, SE = 0.05, p = 0.04), greater family-related (estimate = 0.09, SE = 0.03, p = 0.004), infection-related (estimate = 0.06, SE = 0.02, p = 0.007), and work-related concerns (estimate = 0.11, SE = 0.03, p < 0.001), and lower leadership support (estimate = 0.07, SE = 0.03, p = 0.005). These findings can inform institutional interventions to mitigate the risk of chronic SRPS among women HCPs.

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

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

Experiencing Meaningful Work as a Lower Socioeconomic Status Worker: An Interpretative Phenomenological Analysis

Meta-analytic evidence suggests that experiencing one’s work as meaningful is associated with many psychological benefits. The experience of meaningful work in people with lower socioeconomic status (LSES), however, is underrepresented in the literature. This study examines how LSES individuals describe their experience of meaningful work (MW) in their unique contexts through an interpretative phenomenological analysis approach. Eight LSES workers in the Western United States from diverse backgrounds were interviewed. Data analysis resulted in five domains and 17 nested super-ordinate themes which captured participants’ definitions and experiences of MW, psychosocial and contextual conditions that support or hinder MW, and the impact of MW in their personal lives. LSES individuals navigated their own way to experience MW in their unique contexts despite socioeconomic barriers. Implications for future research and practice for LSES workers are discussed.

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

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

Life after Hurricane Katrina: The Resilience in Survivors of Katrina (RISK) Project

This article presents an overview of the findings to date of the Resilience in Survivors of Katrina (RISK) Project, a longitudinal study of 1,019 young, predominantly female and African American community college students who were surveyed a year before Hurricane Katrina in New Orleans and then two to three times afterward. This study combines a multidisciplinary, multimethod approach to understanding the immediate and long-term effects of the Katrina disaster on physical and mental health, economic and social functioning, and neighborhood attainment. I discuss what we can learn from the rare inclusion of predisaster data and our unusual ability to follow participants for years after the disaster. I argue that it is important to follow the recovery of individuals and communities as well as the recovery of the city, as these are often not the same, especially in Katrina where a large proportion of the city never returned.

Birth Outcomes in a Disaster Recovery Environment: New Orleans Women After Katrina

OBJECTIVES

To examine how the recovery following Hurricane Katrina affected pregnancy outcomes.

METHODS

308 New Orleans area pregnant women were interviewed 5-7 years after Hurricane Katrina about their exposure to the disaster (danger, damage, and injury); current disruption; and perceptions of recovery. Birthweight, gestational age, birth length, and head circumference were examined in linear models, and low birthweight (<2500 g) and preterm birth (<37 weeks) in logistic models, with adjustment for confounders.

RESULTS

Associations were found between experiencing damage during Katrina and birthweight (adjusted beta for high exposure = -158 g) and between injury and gestational age (adjusted beta = -0.5 days). Of the indicators of recovery experience, most consistently associated with worsened birth outcomes was worry that another hurricane would hit the region (adjusted beta for birthweight: -112 g, p = 0.08; gestational age: -3.2 days, p = 0.02; birth length: -0.65 cm, p = 0.06).

CONCLUSIONS

Natural disaster may have long-term effects on pregnancy outcomes. Alternately, women who are most vulnerable to disaster may be also vulnerable to poor pregnancy outcome.

Hurricane Katrina: Maternal Depression Trajectories and Child Outcomes

BACKGROUND

The authors examined depression trajectories over two years among mothers exposed to Hurricane Katrina. Risk and protective factors for depression trajectories, as well as associations with child outcomes were analyzed.

METHOD

This study included 283 mothers (age at time 1, M = 39.20 years, SD = 7.21; 62% African American). Mothers were assessed at four time points over two years following Hurricane Katrina. Mothers reported posttraumatic stress symptoms, hurricane exposure, traumatic life events, and social support at time 1. Depressive symptoms were modeled at times 2, 3, and 4. Youth reported their distress symptoms (posttraumatic stress, depression, and anxiety) at time 4.

RESULTS

Latent class growth analyses identified three maternal depression trajectories among mothers exposed to Hurricane Katrina: low (61%), resilient (29%), and chronic (10%). Social support was identified as a protective factor among mothers.

CONCLUSIONS

Three main trajectories of maternal depression following Hurricane Katrina were identified. Social support was protective for mothers. Identified trajectories were not associated with children's distress outcomes. These results have implications for disaster responses, screening efforts, and interventions targeted towards families. Future studies warrant the investigation of additional risk and protective factors that can affect maternal and child outcomes.

Frequencies and predictors of barriers to mental health service use: a longitudinal study of Hurricane Ike survivors

BACKGROUND

The majority of disaster survivors suffering from psychological symptoms do not receive mental health services. Research on barriers to service use among disaster survivors is limited by a lack of longitudinal studies of representative samples and investigations of predictors of barriers. The purpose of this study was to address these limitations through analysis of a three-wave population-based study of Hurricane Ike survivors (N = 658).

METHODS

Frequencies of preference, outcome expectancy, resource, and stigma barriers among participants with unmet mental health needs were documented and logistic regression using a generalized estimating equations approach explored predisposing (e.g., age), illness-related (e.g., posttraumatic stress) and enabling (e.g., insurance coverage) factors as predictors of each type of barrier.

RESULTS

Preference barriers were most frequently cited at each wave, whereas stigma barriers were least frequently cited. Older age and higher emotional support predicted preference barriers; being a parent of a child under 18-years old at the time of the hurricane, higher generalized anxiety, and lack of insurance predicted resource barriers; and higher posttraumatic stress predicted stigma barriers.

CONCLUSIONS

These findings suggest that postdisaster practices targeting subpopulations most likely to have barriers to service use may be indicated.

Predicting Mothers' Reports of Children's Mental Health Three Years after Hurricane Katrin

This study explored pathways through which hurricane-related stressors affected the psychological functioning of elementary school aged children who survived Hurricane Katrina. Participants included 184 mothers from the New Orleans area who completed assessments one year pre-disaster (Time 1), and one and three years post-disaster (Time 2 and Time 3, respectively). Mothers rated their children's behavior problems at Time 3 only (n = 251 children; 53.0% male; Mean age: 10.19 years, SD = 1.68 years). A path analytic model indicated that hurricane-related stressors were associated with increased maternal psychological distress and school mobility in the first post-disaster year, which were associated with higher child internalizing and externalizing symptoms three years post-disaster. Mediation analysis indicated that hurricane-related stressors were associated with child symptoms indirectly, through their impact on maternal psychological distress. Findings underscore the importance of interventions that boost maternal and child mental health and support children through post-disaster school transitions.

The effect of Hurricane Katrina on the prevalence of health impairments and disability among adults in New Orleans: differences by age, race, and sex

We examined the effects of Hurricane Katrina on disability-related measures of health among adults from New Orleans, U.S.A., in the year after the hurricane, with a focus on differences by age, race, and sex. Our analysis used data from the American Community Survey to compare disability rates between the pre-Katrina population of New Orleans with the same population in the year after Katrina (individuals were interviewed for the study even if they relocated away from the city). The comparability between the pre- and post-Katrina samples was enhanced by using propensity weights. We found a significant decline in health for the adult population from New Orleans in the year after the hurricane, with the disability rate rising from 20.6% to 24.6%. This increase in disability reflected a large rise in mental impairments and, to a lesser extent, in physical impairments. These increases were, in turn, concentrated among young and middle-aged black females. Stress-related factors likely explain why young and middle-aged black women experienced worse health outcomes, including living in dwellings and communities that suffered the most damage from the hurricane, household breakup, adverse outcomes for their children, and higher susceptibility.

Changes in Marital and Partner Relationships in the Aftermath of Hurricane Katrina: An Analysis With Low-Income Women

Little is known about the impact of natural disasters on marital and partner relationships. In this study, the authors aimed to fill this gap by investigating the changes in such relationships in a sample of 40 low-income, mostly African American women who survived Hurricane Katrina. Through in-depth interviews, participants described how the hurricane affected their intimate relationships. The authors found that, although many participants reported negative changes in their relationships, others reported that their relationships grew stronger, often despite initial strain. As a framework for understanding the processes underlying participants' negative and positive outcomes, the authors drew on the family stress model. Consistent with the model, participants reported that the hurricane led to external stressors, including unemployment and prolonged separations, and that these stressors, in turn, undermined both individual functioning and relational processes (e.g., communication and support). Conversely, participants reporting positive changes experienced new employment opportunities, a greater sense of perspective, and high levels of effective communication and support in their relationships. Based on the findings, policies that reduce the economic strain of low-income families in the aftermath of disasters and empirically supported, culturally sensitive, clinical interventions for individuals and couples are recommended.