The early psychological impacts of the Deepwater Horizon oil spill on Florida and Alabama communities

Using the Environmental Health Disparities Framework to understand Black and Latino perspectives of a local fertilizer plant fire

In February 2022, a fertilizer plant fire burned for four days and displaced thousands of residents, who were mainly low-income and Black or Latino, from their homes in Winston Salem, NC. In partnership with Black and Latino residents and nonprofit organizations, we sought to understand Black and Latino resident perceptions of the chronic and acute health risks, as well as the emotional and financial effects that resulted from the fire, which included the release of nitrous dioxide. We used the Environmental Health Disparities Framework to guide this community-engaged research study, capturing through semi-structured interviews: 1) how residents perceived their community before and after the fire, 2) how the fire impacted physical and mental health, and 3) how individuals coped with stress. We used thematic analysis to analyze the data and identified seven major themes. Participants: 1) perceived their neighborhood positively, 2) were unaware of the potential dangers of the fertilizer plant before the fire, 3) experienced adverse health and financial effects from the fire, 4) took action to protect themselves from the impacts of the fire, 5) raised concerns about the environmental impacts of the fire, 6) raised concerns about the city's response to the fire, and 7) provided recommendations for future city response.

Chemical exposure from the Hebei spirit oil spill accident and its long-term effects on mental health

While evidence indicates that exposure to oil spill incidents can affect mental health, it is unclear whether the mental health effects result from the incident itself or from exposure to associated chemicals. Oil contains chemicals that can impact mental health and these chemicals may have long-term effects due to their persistence in the environment. To address the gap in current knowledge, we conducted cross-sectional and prospective analyses of data from adults who participated in the Health Effects of the Hebei Spirit Oil Spill study. To assess chemical exposure from oil spills, we used indirect exposure indicators such as distance from the contaminated oil band to residences and duration of clean-up work, along with direct exposure indicators such as urine metabolite concentrations of volatile organic compounds and polycyclic aromatic hydrocarbons. Mental health assessments covered posttraumatic stress disorder (PTSD), depression, state anxiety, and trait anxiety. In the cross-sectional analyses, all four mental health issues were found to be associated with proximity to the oil band (p-value<0.05) and showed a positive association with clean-up work duration (p-value<0.05). Cox regression analysis revealed that higher urinary t, t-muconic acid levels were associated with an increased risk of depression (Hazard Ratio [HR] = 1.55, 95 % Confidence Interval [CI] = 1.05-2.28), and elevated 1-hydroxypyrene levels increased the risk of PTSD (HR = 1.60, 95 % CI = 1.03-2.48). Additionally, higher urinary 2-naphthol levels were associated with increased state anxiety (HR = 1.39, 95 % CI = 1.00-1.93) and trait anxiety (HR = 1.64, 95 % CI = 1.15-2.32). These associations persisted even after controlling for distance and duration variables related to psychosocial exposure. Our findings suggest that environmental disaster response plans should prioritize minimizing chemical exposure while also considering the duration and nature of the mental health impacts.

Adverse Effects of the Deepwater Horizon oil spill Amid Cumulative Disasters: A Qualitative Analysis of the Experiences of Children and Families

Limited research has examined the ramifications of the Deepwater Horizon oil spill (DHOS) on children and their families. This study builds on secondary data analysis and representative survey findings from the multi-method, multi-phase Gulf Coast Population Impact (GCPI) project. Specifically, this phase of the GCPI research draws on in-depth, semi-structured interview and focus group data to illuminate the social conditions that influenced poor child health outcomes in the aftermath of the DHOS and amid other disasters. These qualitative data were collected two years after the spill with caregivers, teachers, faith- and community-based leaders in five highly impacted Gulf Coast communities. Exploratory qualitative analysis revealed that children were affected by the DHOS and other related challenges through exposure to familial stress emerging from livelihood disruptions. Such disruptions were the result of ongoing poverty, damage to the fishing industry, and exposure to cumulative and compounding environmental disasters. In cases of severe familial stress, children may have experienced toxic stress because of caregivers' displaced distress; ambiguous loss through caregivers' physical and/or emotional absence; and the children's recognition of their families' dire financial situations. Toxic stress was most often expressed through acute and chronic physiological, emotional, and behavioral health challenges. This study expands current understandings of the impact of technological disasters and cumulative environmental disasters on children and families. It underscores the importance of investing in harm prevention strategies to reduce threats to the health and wellbeing of young people living in ecologically and socioeconomically insecure environments prone to intensifying technological and climate-fueled disasters.

The Pattern of Injuries in the Emergency Room during the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has obviously caused a remarkable change in patients' emergency department (ED) visits; however, data from multicenter studies are lacking. We aimed to present a comprehensive analysis of injury-related ED visits in Republic of Korea before and during the COVID-19 pandemic.

MATERIALS AND METHODS

Data from 23 tertiary hospitals based on Emergency Department-based Injury In-depth Surveillance were used for this retrospective cross-sectional study. A total of 541,515 ED visits (age ≥ 20 years) between 1 January 2018 and 31 December 2020 were included, and the trend of injuries related to motor vehicular accidents, falls, self-harm and suicide, assault, and poisoning were compared between the pre-COVID-19 time period and during the COVID-19 pandemic.

RESULTS

In the first year of the COVID-19 period, a decline in the number of ED visits was observed (41,275, 21%) compared to the previous year. Injuries caused by motor vehicles (36,332 in 2019 vs. 27,144 in 2020), falls and slips (61,286 in 2019 vs. 49,156 in 2020), assaults (10,528 in 2019 vs. 8067 in 2020), and poisonings (7859 in 2019 vs. 7167 in 2020) decreased, whereas self-harm and suicide (8917 in 2019 vs. 8911 in 2020) remained unchanged. The hospitalization (16.6% in 2019 vs. 18.8% in 2020) and ED mortality rate (0.6% in 2019 vs. 0.8% in 2020) also increased.

CONCLUSION

The COVID-19 pandemic led to a decline in the overall number of trauma patients seeking medical care; however, the proportion of patients requiring hospitalization or intensive care unit admission increased, indicating more severe injuries among those who did seek care. Suicide attempt rates remained unchanged, highlighting the need for targeted care and support for vulnerable patients. During the pandemic, EDs had to continue to provide care to patients with medical emergencies unrelated to COVID-19, which requires a delicate and adaptable approach to ED operations. To manage the increased stress and workload caused by the pandemic, increased resources and support for healthcare workers were needed.

Social Illness Before and After the COVID-19 Pandemic: A Regional Study

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has dramatically changed the epidemiology of several diseases. Much evidence on this has been published in the pandemic phase. In addition, many studies have shown that phenomena such as stress, substance abuse, and burnout increased in the general population during the lockdown. Unfortunately, few studies analyze the post-pandemic phase.

STUDY OBJECTIVE

The study aimed to evaluate the trend of broad social problems, such as a diagnosis by the emergency department (ED), in the post-pandemic phase in the Lombardy (Italy) region.

METHODS

The study is a retrospective observational cohort study. All admissions to emergency rooms in the Lombardy region registered in the Emergency Urgency OnLine (EUOL) portal made from January through June 2019 were analyzed, having as main causes: psychiatric disorders, self-harm, substance abuse, social disadvantage, and violence. All accesses in emergency rooms in the Lombardy region registered in the EUOL portal made from January 1, 2019 through June 30, 2019 were analyzed and compared with the same period in 2022.

RESULTS

The study recorded an increase in the likelihood of events of self-harm (OR = 2.1; 95% CI, 1.8-2.6; P <.0001), substance abuse (OR = 1.2; 95% CI, 1.1-1.3; P <.0001), violence by others (OR = 1.3; 95% CI, 1.2-1.4; P <.0001), and social disadvantage (OR = 1.2; 95% CI, 1.1-1.4; P = .0045). The events are more concentrated in suburban areas (OR = 1.3; 95% CI, 1.2-1.4; P <.001).

CONCLUSION

The increase in diagnoses of these social problems in the ED is only the culmination of a phenomenon that hides an underlying rise in social illness. In the post-COVID-19 phase, there is a need to invest in community care and social illness prevention policies.

Injury-Related Emergency Department Visits During the COVID-19 Pandemic

INTRODUCTION

On March 13, 2020, the U.S. declared COVID-19 to be a national emergency. As communities adopted mitigation strategies, there were potential changes in the trends of injuries treated in emergency department. This study provides national estimates of injury-related emergency department visits in the U.S. before and during the pandemic.

METHODS

A secondary retrospective cohort study was conducted using trained, on-site hospital coders collecting data for injury-related emergency department cases from medical records from a nationally representative sample of 66 U.S. hospital emergency departments. Injury emergency department visit estimates in the year before the pandemic (January 1, 2019-December 31, 2019) were compared with estimates of the year of pandemic declaration (January 1, 2020-December 31, 2020) for overall nonfatal injury-related emergency department visits, motor vehicle, falls-related, self-harm-, assault-related, and poisoning-related emergency department visits.

RESULTS

There was an estimated 1.7 million (25%) decrease in nonfatal injury-related emergency department visits during April through June 2020 compared with those of the same timeframe in 2019. Similar decreases were observed for emergency department visits because of motor vehicle‒related injuries (199,329; 23.3%) and falls-related injuries (497,971; 25.1%). Monthly 2020 estimates remained relatively in line with 2019 estimates for self-harm‒, assault-, and poisoning-related emergency department visits.

CONCLUSIONS

These findings provide updates for clinical and public health practitioners on the changing profile of injury-related emergency department visits during the COVID-19 pandemic. Understanding the short- and long-term impacts of the pandemic is important to preventing future injuries.

Coping with oil spills: oil exposure and anxiety among residents of Gulf Coast states after the Deepwater Horizon Oil Spill

In April 2010, a fatal explosion on the Deepwater Horizon drilling rig in the Gulf of Mexico resulted in the largest marine oil spill in history. This research describes the association of oil exposure with anxiety after the Deepwater Horizon Oil Spill and evaluates effect modification by self-mastery, emotional support and cleanup participation. To assess the impacts of the Deepwater Horizon Oil Spill, the Centers for Disease Control and Prevention (CDC) conducted the Gulf States Population Survey (GSPS), a random-digit-dial telephone cross-sectional survey completed between December 2010 and December 2011 with 38,361 responses in four different Gulf Coast states: Louisiana, Florida, Alabama and Mississippi. Anxiety severity was measured using the Generalised Anxiety Disorder (GAD) symptom inventory. We used Tobit regression to model underlying anxiety as a function of oil exposure and hypothesised effect modifiers, adjusting for socio-demographics. Latent anxiety was higher among those with direct contact with oil than among those who did not have direct contact with oil in confounder-adjusted models [β = 2.84, 95% confidence interval (CI): 0.78, 4.91]. Among individuals with direct contact with oil, there was no significant interaction between participating in cleanup activities and emotional support for anxiety (p = 0.20). However, among those with direct contact with oil, in confounder-adjusted models, participation in oil spill cleanup activities was associated with lower latent anxiety (β = -3.55, 95% CI: -6.15, -0.95). Oil contact was associated with greater anxiety, but this association appeared to be mitigated by cleanup participation.

Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study

INTRODUCTION

Individual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors.

OBJECTIVE

Our aim was to assess the association between neighborhood-level SES and lung function.

METHODS

We cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV₁; mL), the forced vital capacity (FVC; mL), and the FEV₁/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure.

RESULTS

Greater neighborhood deprivation was associated with lower FEV₁: β_Q2vsQ1: -30 mL (95% CI: -97, 36), β_Q3vsQ1: -70 mL (95% CI: -135, -4) and β_Q4vsQ1: -104 mL (95% CI: -171, -36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV₁/FVC ratio were observed.

CONCLUSION

Neighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV₁ and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.

The Impact of the COVID-19 Pandemic on Mental Disorders. A Critical Review

The COVID-19 pandemic has impacted the lives of the worldwide population. Citizens suffer the social, economic, physiological, and psychological effects of this pandemic. Primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages were used for a consensus critical review. The method was a narrative review of the available literature to summarize the existing literature addressing mental health concerns and stressors related to the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found the pandemic has had a direct impact on psychopathologies such as anxiety, increasing its ratios, and depression. Other syndromes such as burnout and post-traumatic stress disorder have increased with the pandemic, showing a larger incidence among medical personnel. Moreover, eating disorders and violence have also increased. Public authorities must prepare healthcare systems for increasing incidences of mental pathologies. Mental health apps are one of the tools that can be used to reach the general population.

Who has sustained psychological symptoms nine years after the Hebei Spirit oil spill?: The Health Effect Research on Hebei Spirit oil spill (HEROS) study

This study evaluated risk factors for sustained psychological symptoms in affected residents, nine years after the Hebei Spirit oil spill in Korea in 2007. The participants included residents of high-exposure areas, living within 2 km from the contaminated coast (n = 2013), among the cohort of the Health Effect Research on Hebei Spirit oil spill study from 2009 to 2016. Symptoms for post-traumatic stress disorder (PTSD), depression, psychosocial distress, and anxiety, as well as sociodemographic information were assessed through questionnaire interviews. Trajectory analysis was conducted to identify the group with sustained symptoms over time and logistic regression analysis was performed to identify risk factors for sustained symptoms adjusted for covariates. A longer duration of clean-up work, lower household income, and presence of a chronic disease in all type of symptoms, and being female, younger age, and higher educational level in all symptoms but PTSD, showed a significant association with increased risk of sustained symptoms. The highest risk was found in the subgroup with a longer clean-up together with offshore and maritime occupations or lower income in PTSD, depression, and anxiety, compared with those with a shorter clean-up and other occupation or higher income. Increased risk of sustained PTSD in relation to a longer clean-up was limited to those with a lower educational level (p-interaction = 0.009). The results suggested that participating longer in clean-up work increased sustained psychological symptoms, synergistically with socioeconomic factors such as offshore and maritime occupations, lower household income, or economic losses related to educational level.

Effect of a chemical dispersant (Corexit 9500A) on the structure and ion transport function of blue crab (Callinectes sapidus) gills

Chemical dispersants are commercially available mixtures of surfactants and solvents that have become important tools in the remediation of spilled oil. Given the importance of oil to the world economy, the recurring nature of spills, and the prevalence of dispersant use in remediation, there is a critical need to understand potential toxic impacts of dispersants on invertebrate and vertebrate animals. Blue crabs (Callinectes sapidus) play ecologically important roles in the environments they inhabit and support economically important fisheries along the Atlantic Coast and in the Gulf of Mexico. In studies reported here, we assessed the impact of a chemical dispersant, Corexit 9500A, on the structure and ion transport function of blue crab gills. Exposure of blue crabs to Corexit 9500A for 24 h (0-300 ppm in artificial seawater under static conditions) revealed a 24-h lethal concentration 50 (LC₅₀) estimate of 210 ppm. A histological analysis of gills from crabs exposed for 24 h to a sub-lethal concentration of Corexit 9500A (125 ppm) revealed evidence of loss or disruption of cuticle, and an increase in stained amorphous material in the hemolymph spaces of gill lamellae. Quantitative image analysis of stained gill sections revealed the area/length ratio of gill lamellae in crabs exposed to Corexit 9500A (24 h, 125 ppm), was greater than that in gill lamellae from control crabs; the results are consistent with the presence of edematous swelling in gill lamellae from dispersant-exposed crabs. Quantitative PCR was used to measure the relative abundance of transcripts encoding three ion transport proteins (Na⁺/K⁺ ATPase, plasma membrane Ca²⁺ ATPase (PMCA), and sarcoplasmic reticulum/endoplasmic reticulum Ca²⁺ ATPase (SERCA)) in gills from Corexit-exposed and control crabs. In general, the abundance of transcripts encoding each ion transport protein was lower in gills from dispersant-exposed crabs than in gills from control crabs. The combined results are consistent with the hypothesis that 24-h exposure of blue crabs to a sublethal concentration of Corexit 9500A impacts both the structure and ion transport function of gills.

Survey of psychiatric impairment among residents exposed to environmental pollution from a petrochemical complex

PURPOSE

This study first assessed the occurrence of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), symptoms of poor sleep quality and high levels of distress among residents, caused by reported long-term stress from environmental pollution emitted from the biggest petroleum chemistry factory (PCF) in the world.

METHODS

A total of 328 long-term residents (Mean age = 57.5, SD = 16.5 years, ranging from 22 to 95) were recruited randomly from a total population of 26,632 in Mailiao township in Taiwan next to the PCF. Trained assistants used the Disaster-Related Psychological Screening test, the Perception of Life Threats Caused by the SCNP questionnaire and the Sleep Quality Scale to interview the participants.

RESULTS

The results support our hypotheses that most of the residents (71%) would report life threats caused by the PCF. The residents displayed higher rates of major depressive episodes (24.1%), PTSD (24.5%) and symptoms of poor sleep quality. The more they felt threat from the PCF, the stronger the connection with MDD and PTSD symptoms.

CONCLUSION

The results indicate an increased prevalence of MDD, PTSD and symptoms of poor sleep quality in those exposed to environmental pollution from the PCF, highlighting the need for prompt prevention, diagnostic and therapeutic attention.

Psychological Effects of Home Confinement and Social Distancing Derived from COVID-19 in the General Population-A Systematic Review

(1) Background: Home confinement and social distancing are two of the main public health measures to curb the spread of SARS-Cov-2, which can have harmful consequences on people’s mental health. This systematic review aims to identify the best available scientific evidence on the impact that home confinement and social distancing, derived from the SARS-CoV-2 pandemic, have had on the mental health of the general population in terms of depression, stress and anxiety. (2) Methods: A systematic search was conducted on PubMed, Scopus, Web of Science and ScienceDirect between 2 January 2021 and 7 January 2021, in accordance with the recommendations of the PRISMA Declaration. The selection of studies and the evaluation of their methodological quality were performed in pairs, independently and blindly, based on predetermined eligibility criteria. (3) Results: The 26 investigations reviewed were developed in different regions and countries. Factors that are associated with poor mental health were female gender, young ages, having no income and suffering from a previous psychiatric illness. Inadequate management of the pandemic by authorities and a lack or excess of information also contributed to worse mental health. (4) Conclusions: There are groups of people more likely to suffer higher levels of anxiety, depression and stress during the restrictive measures derived from COVID-19.

Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic

IMPORTANCE

The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence.

OBJECTIVE

To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC.

MAIN OUTCOMES AND MEASURES

Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex.

RESULTS

From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV.

CONCLUSIONS AND RELEVANCE

These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.

Psychosocial impacts of post-disaster compensation processes: Community-wide avoidance behaviors

RATIONALE

There is a small but growing body of literature on litigation- and compensation-related stress after disasters. Results of these studies are consistent and unsurprising: compensation processes are a source of stress to plaintiffs and their families. "Litigation Response Syndrome"-anxiety, stress, and depression-is common among those exposed to the pressures of litigation (Lees-Haley 1988). However, little is known about how compensation processes-claims, litigation, and settlements-affect communities at large.

OBJECTIVE

Building on prior research, we examine adverse impacts of compensation processes in Roane County, Tennessee five years following the Tennessee Valley Authority coal ash spill. We investigate whether compensation-related stress occurs at a community level, as well as avoidance behaviors as measured by the Impact of Event Scale.

METHOD

Based on data from a 2014 household mail survey of a random sample of 716 residents of Roane County, we examine the relationship between compensation processes and event-related avoidance behaviors.

RESULTS

We found that compensation-related stress is not limited to those directly involved with compensation processes. Respondents view these processes as adversely impacting the community at large. The strongest contributors to event-related avoidance behaviors are beliefs about adverse compensation impacts and the effectiveness of cleanup and restoration activities, socioeconomic status, and economic resource loss. Therefore, it appears that Litigation Response Syndrome can extend to some members of the community who were not directly involved in litigation and compensation processes.

Pipes or Prisms? Personal Networks, Network Mechanisms, and Formal Support Receipt In The Wake Of Deepwater Horizon Oil Spill

Social networks are commonly discussed in reference to processes of disaster recovery but rarely explicitly measured. We employ a mixed-methods approach drawing upon the personal-network data of 265 oysterworkers in the wake of the Deepwater Horizon oil spill and qualitative accounts of individual experiences during the recovery process. We find evidence of two potential mechanisms linking network structure with the receipt of formal support: a networks-as-pipes approach linking networks and access to relevant information in the wake of a disaster and a networks-as-prisms approach where networks signal their social identities, shaping post-disaster actions and behaviors.

Exposure to the Deepwater Horizon Oil Spill, Associated Resource Loss, and Long-Term Mental and Behavioral Outcomes

OBJECTIVE

The aim of this study was to (1) assess the long-term mental and behavioral health outcomes of the Deepwater Horizon Oil Spill of residents in the Gulf Coast and to (2) identify populations that may be particularly vulnerable to future disasters.

METHODS

The Survey of Trauma, Resilience, and Opportunity in Neighborhoods in the Gulf (STRONG) is a population-representative sample of 2520 coastal residents surveyed in Texas, Louisiana, Alabama, Mississippi, and Florida in 2016. We present prevalence estimates for positive screens of depression, anxiety, and alcohol misuse, as well as receipt of health care services. We examine differences in these outcomes across states, affected occupational groups, and demographic groups.

RESULTS

Resource loss attributed to the spill was associated with positive screens for depression and anxiety. Almost 50% of adults screened positive for depression, anxiety, or alcohol misuse, but less than 20% of these currently access mental health care. Black residents were less likely to have health insurance and a usual source of care but were more likely to have visited the emergency room in the past 12 months.

CONCLUSIONS

Surveillance data from STRONG can help policy-makers and other stakeholders develop targeted approaches to foster resilience, particularly among vulnerable populations, and thereby mitigate the effects of future disasters.

Behavioral Health and Response for COVID-19

Research from financial stress, disasters, pandemics, and other extreme events, suggests that behavioral health will suffer, including anxiety, depression, and posttraumatic stress symptoms. Furthermore, these symptoms are likely to exacerbate alcohol or drug use, especially for those vulnerable to relapse. The nature of coronavirus disease 2019 (COVID-19) and vast reach of the virus, leave many unknows for the repercussions on behavioral health, yet existing research suggests that behavioral health concerns should take a primary role in response to the pandemic. We propose a 4-step services system designed for implementation with a variety of different groups and reserves limited clinical services for the most extreme reactions. While we can expect symptoms to remit overtime, many will also have longer-term or more severe concerns. Behavioral health interventions will likely need to change overtime and different types of interventions should be considered for different target groups, such as for those who recover from COVID-19, health-care professionals, and essential personnel; and the general public either due to loss of loved ones or significant life disruption. The important thing is to have a systematic plan to support behavioral health and to engage citizens in prevention and doing their part in recovery by staying home and protecting others.

An Assessment of Environmental Health Measures in the Deepwater Horizon Research Consortia

Research consortia play a key role in our understanding of how environmental exposures influence health and wellbeing, especially in the case of catastrophic events such as the Deepwater Horizon oil spill. A common challenge that prevents the optimal use of these data is the difficulty of harmonizing data regarding the environmental exposures and health effects across the studies within and among consortia. A review of the measures used by members of the Deepwater Horizon Research Consortia highlights the challenges associated with balancing timely implementation of a study to support disaster relief with optimizing the long-term value of the data. The inclusion of common, standard measures at the study design phase and a priori discussions regarding harmonization of study-specific measures among consortia members are key to overcoming this challenge. As more resources become available to support the use of standard measures, researchers now have the tools needed to rapidly coordinate their studies without compromising research focus or timely completion of the original study goals.

Prolonged Financial Distress After the Deepwater Horizon Oil Spill Predicts Behavioral Health

The economic impact of disasters is well known; however, the link between financial loss and behavioral health problems is unknown. Participants included 198 adults of ages 21 to 82, living within 10 miles of the Gulf Coast during the Deepwater Horizon Oil Spill and were involved in the fishing, harvesting, seafood processing, or service/tourism industries. The functional impact of financial resource loss at 2.5 years post spill was measured using the 26-item Financial Life Events Checklist (FLEC). Individuals responded to financial distress by reducing social events and utility bills and changing food-shopping habits. The FLEC significantly predicted higher drug use (Drug Abuse Screening Test), alcohol use (Alcohol Use Disorders Identification Test), mood problems (Profile of Mood States), and depressive symptoms (Beck Depression Inventory II) (p values ≤ 0.05) 4.5 years after the spill. This preliminary study supports the notion that the functional impact of financial loss has a long-term impact on behavioral health after an oil spill.

Persistent Risk-Related Worry as a Function of Recalled Exposure to the Deepwater Horizon Oil Spill and Prior Trauma

Large oil spills are disasters associated with psychological effects for exposed communities. The amount of worry that individuals experience after a disaster may be influenced by many factors, such as the type and extent of exposure to disaster impacts, prior trauma, and sociodemographic characteristics. This study examined the nature and predictors of worry about ongoing impacts of the 2010 Deepwater Horizon (DH) oil spill reported by Gulf of Mexico coastal residents. A random sample of 2,520 adult residents of Gulf of Mexico coastal counties were administered a telephone survey in 2016, including items about persistent worry and exposure to DH impacts, prior trauma, residence at the time of the spill, and sociodemographic characteristics. Respondents varied in the amount of worry they reported about ongoing health, social, and economic impacts. Controlling for sociodemographic characteristics, higher exposure to the DH oil spill was related to higher levels of worry about ongoing impacts, with past traumatic events related specifically to worry about health impacts. Unexpectedly, those who moved into the region after the spill showed similar levels of worry to residents exposed to the spill, and higher levels than residents who did not recall being exposed to the DH oil spill. This study highlights the impact of the DH oil spill on coastal residents many years after the DH disaster. The findings underscore the need to examine multiple pathways by which individuals experience disasters and for risk researchers to close knowledge gaps about long-term impacts of oil spills within a multi-dimensional framework.

Mechanisms of resiliency against depression following the Deepwater Horizon Oil Spill

Prior studies of oil spills have reported adverse impacts on mental health, but have not examined some potentially important moderators. In this cross-sectional analysis of n=38,361 responses to the 2010-2011 Gulf States Population Survey, we assessed the association of direct oil contact with depression severity following the Deepwater Horizon oil spill, and modification by self-mastery, emotional support, and cleanup participation using Tobit regression models accounting for the complex survey design. Oil contact was associated with increased depression severity. Among respondents with oil contact, depression was more severe for those reporting lower self-mastery. However, respondents with oil contact had lower depression severity if they participated in cleanup efforts, compared to exposed individuals who did not participate. This potential protective effect was larger for respondents with lower self-mastery. Our results are consistent with the notion that participation in recovery efforts may reduce depressive symptoms following oil spills among impacted individuals.

Developing Large-Scale Research in Response to an Oil Spill Disaster: a Case Study

Research conducted in the wake of a disaster can provide information to help mitigate health consequences, support future recovery efforts, and improve resilience. However, a number of barriers have prevented time-sensitive research responses following previous disasters. Furthermore, large-scale disasters present their own special challenges due to the number of people exposed to disaster conditions, the number of groups engaged in disaster response, and the logistical challenges of rapidly planning and implementing a large study. In this case study, we illustrate the challenges in planning and conducting a large-scale post-disaster research study by drawing on our experience in establishing the Gulf Long-term Follow-up (GuLF) Study following the 2010 Deepwater Horizon disaster. We describe considerations in identifying at-risk populations and appropriate comparison groups, garnering support for the study from different stakeholders, obtaining timely scientific and ethics review, measuring and characterizing complex exposures, and addressing evolving community health concerns and unmet medical needs. We also describe the NIH Disaster Research Response (DR2) Program, which provides a suite of resources, including data collection tools, research protocols, institutional review board guidance, and training materials to enable the development and implementation of time-critical studies following disasters and public health emergencies. In describing our experiences related to the GuLF Study and the ongoing efforts through the NIH DR2 Program, we aim to help improve the timeliness, quality, and value of future disaster-related data collection and research studies.

PTSD symptom profiles among Louisiana women affected by the 2010 Deepwater Horizon Oil Spill: A latent profile analysis

BACKGROUND

Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms.

METHODS

To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes.

RESULTS

Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis.

LIMITATIONS

This study was limited by use of self-reported data and one-time assessment of PTSD symptoms.

DISCUSSION

Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted.

Enhancing Disaster Resilience by Reducing Stress-Associated Health Impacts

Disasters are a recurring fact of life, and major incidents can have both immediate and long-lasting negative effects on the health and well-being of people, communities, and economies. A primary goal of many disaster preparedness, response, and recovery plans is to reduce the likelihood and severity of disaster impacts through increased resilience of individuals and communities. Unfortunately, most plans do not address directly major drivers of long-term disaster impacts on humans-that is, acute, chronic, and cumulative stress-and therefore do less to enhance resilience than they could. Stress has been shown to lead to or exacerbate ailments ranging from mental illness, domestic violence, substance abuse, post-traumatic stress disorders, and suicide to cardiovascular disease, respiratory problems, and other infirmities. Individuals, groups, communities, organizations, and social ties are all vulnerable to stress. Based on a targeted review of what we considered to be key literature about disasters, resilience, and disaster-associated stress effects, we recommend eight actions to improve resiliency through inclusion of stress alleviation in disaster planning: (1) Improve existing disaster behavioral and physical health programs to better address, leverage, and coordinate resources for stress reduction, relief, and treatment in disaster planning and response. (2) Emphasize pre- and post-disaster collection of relevant biomarker and other health-related data to provide a baseline of health status against which disaster impacts could be assessed, and continued monitoring of these indicators to evaluate recovery. (3) Enhance capacity of science and public health early-responders. (4) Use natural infrastructure to minimize disaster damage. (5) Expand the geography of disaster response and relief to better incorporate the displacement of affected people. (6) Utilize nature-based treatment to alleviate pre- and post-disaster stress effects on health. (7) Review disaster laws, policies, and regulations to identify opportunities to strengthen public health preparedness and responses including for stress-related impacts, better engage affected communities, and enhance provision of health services. (8) With community participation, develop and institute equitable processes pre-disaster for dealing with damage assessments, litigation, payments, and housing.

Conservation of resources and suicide proneness after oilrig disaster

The current study applied the Conservation of Resources (COR) disaster theory to explain suicide proneness after the Deepwater Horizon oilrig explosion. We had 213 residents in affected areas with complete measures of resource stability, distress, and coping 18 months after the disaster. Overall, 10% expressed clinically elevated suicide proneness. The COR model had excellent fit that accounted for 41% of inter-individual differences in suicide proneness. Aligned with theory, residents lacking resources who experienced distress and coped by avoidance were more suicide-prone. Fostering resource stability and constructive coping after catastrophe may help reduce suicide proneness and prevent suicide in disaster-impacted citizens.

Behavioral Health of Gulf Coast Residents 6 Years After the Deepwater Horizon Oil Spill: The Role of Trauma History

OBJECTIVE

The purpose of this study was to examine the associations between oil spill exposure, trauma history, and behavioral health 6 years after the Deepwater Horizon oil spill (DHOS). We hypothesized that prior trauma would exacerbate the relationship between oil spill exposure and behavioral health problems.

METHODS

The sample included 2,520 randomly selected adults in coastal areas along the Gulf of Mexico. Participants reported their level of oil spill exposure, trauma history, depression, anxiety/worry, illness anxiety, and alcohol use.

RESULTS

Individuals with more traumatic experiences had a significantly higher risk for all measured behavioral health problems after controlling for demographic factors and DHOS exposure. Those with higher levels of DHOS exposure were not at greater risk for behavioral health problems after controlling for prior trauma, with the exception of illness anxiety. There was no evidence that trauma history moderated the association between DHOS exposure and behavioral health.

CONCLUSIONS

Findings suggest that trauma exposure may be a better indicator of long-term behavioral health risk than DHOS exposure among disaster-prone Gulf Coast residents. DHOS exposure may be a risk factor for illness anxiety but not more general behavioral health concerns. Trauma history did not appear to exacerbate risk for behavioral health problems among Gulf residents exposed to the DHOS. (Disaster Med Public Health Preparedness. 2019;13:497-503).

Psychometric properties of the 10-item Conner-Davidson resilience scale on toxic chemical-exposed workers in South Korea

Background

Resilient individuals have a comprehensive ability to adapt to various life circumstances. Psychological resilience predicts an individual's physiological response to stress. The 10-item Connor-Davidson Resilience Scale (CD-RISC) is a widely used measure to quantify the level of self-perceived resilience. This study examined the psychometric properties of a Korean version of the 10-item Connor-Davidson Resilience Scale (10-item K-CD-RISC) on workers in Gumi, South Korea, exposed to hydrofluoric acid (HF).

Methods

The questionnaires included the 10-item K-CD-RISC and Beck Anxiety Inventor (BAI), the Impact of Event Scale-Revised-Korean version (IES-R-K), the Rosen-berg Self Esteem Scale (RSES), the Center for Epidemiologic Studies-Depression Scale (CES-D), and the Perceived Stress Scale (PSS). These were randomly distributed at 237 workplaces near the HF-spill site, in the Gumi 4 complex. The responses of 991 (67.3%) workers were analyzed.

Results

The exploratory factor analysis shown that a single-factor model was consistent with the original design of the 10-item CD-RISC. The scale also demonstrated good internal consistency (Cronbach's alpha = 0.95). Scores on the scale reflected different levels of resilience with respect to personal factors (age, gender, marital status, and education and income levels) that are thought to be differentiated. Differences of resilience were also reflected by psychiatric symptoms (anxiety and depression). Moreover, the total score of scale positively correlated with RSES, whereas the IES-R-K, BAI, CES-D, and the PSS negatively correlated with the 10-item K-CD-RISC.

Conclusions

The 10-item K-CD-RISC has good psychometric properties and is applicable for victims exposed to noxious chemical such as HF.

The Louisiana Mental and Behavioral Health Capacity Project Trauma-Informed Integrated Care Model and Improved Posttraumatic Stress Outcomes

OBJECTIVE

The Mental and Behavioral Health Capacity Project in Louisiana has been addressing health disparities by increasing accessibility and availability through integrating services into primary care clinics. Integrated health is becoming the standard of care, providing an opportunity to address the trauma-specific needs of communities, and allowing for informed and less stigmatized services. The purpose of this study is to test the efficacy of the Mental and Behavioral Health Capacity Project in Louisiana model in the primary care settings to reduce posttraumatic stress symptoms and physical health complaints.

DESIGN

A pre-experimental time series design was used on the basis of participants self-reporting at least 1 trauma at intake and follow-up collected at 1-, 3-, and 6-month intervals. The hypotheses were that posttraumatic stress and physical health complaints would significantly decrease over the course of treatment.

SETTING

This study was part of a larger study to evaluate the effectiveness of the Mental and Behavioral Health Capacity Project in Louisiana-integrated health efforts. Sample parameters included (1) intake date from January 2013 through December 2015; (2) at least 18 years of age; and (3) presented at 1 of 5 primary health care clinics in Southeast Louisiana.

PARTICIPANTS

A total of 235 patients were selected; the mean age was 44.7 years (SD = 13.6) and the majority were white (68%) and female (76%).

INTERVENTION

Brief behavioral-based trauma treatment was delivered using both on-site and telemedicine therapies provided by a psychologist, psychiatrist, or through a combined treatment model.

MAIN OUTCOME MEASURE

The main outcome measures were the Posttraumatic Stress Civilian Checklist (PCL-C) and the Patient Health Questionnaire (PHQ-15).

RESULTS

The hypothesis was supported. Statistically significant decreases in posttraumatic stress symptoms and physical health complaints were shown over the course of treatment, with 63% of the group demonstrating clinically significant change.

CONCLUSIONS

This study supports brief trauma treatment in primary care clinics as an effective method of reducing trauma and physical health symptoms in postdisaster environments.

A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context

CONTEXT

Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels.

PROGRAM

This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health.

IMPLEMENTATION

The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues.

EVALUATION

The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories.

DISCUSSION

This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

Predictors of blood volatile organic compound levels in Gulf coast residents

To address concerns among Gulf Coast residents about ongoing exposures to volatile organic compounds, including benzene, toluene, ethylbenzene, o-xylene, and m-xylene/p-xylene (BTEX), we characterized current blood levels and identified predictors of BTEX among Gulf state residents. We collected questionnaire data on recent exposures and measured blood BTEX levels in a convenience sample of 718 Gulf residents. Because BTEX is rapidly cleared from the body, blood levels represent recent exposures in the past 24 h. We compared participants' levels of blood BTEX to a nationally representative sample. Among nonsmokers we assessed predictors of blood BTEX levels using linear regression, and predicted the risk of elevated BTEX levels using modified Poisson regression. Blood BTEX levels in Gulf residents were similar to national levels. Among nonsmokers, sex and reporting recent smoky/chemical odors predicted blood BTEX. The change in log benzene was -0.26 (95% CI: -0.47, -0.04) and 0.72 (0.02, 1.42) for women and those who reported odors, respectively. Season, time spent away from home, and self-reported residential proximity to Superfund sites (within a half mile) were statistically associated with benzene only, however mean concentration was nearly an order of magnitude below that of cigarette smokers. Among these Gulf residents, smoking was the primary contributor to blood BTEX levels, but other factors were also relevant.

Preliminary Assessment of Hurricane Harvey Exposures and Mental Health Impact

Hurricane Harvey made landfall in Houston, Texas on 25 August 2017, the psychological and physical effects of which are still unknown. We assessed hurricane exposure and the immediate mental health needs of the population to define public health priorities for a larger epidemiological study. Convenience sampling was used to recruit participants (n = 41) from the greater Houston area aged &ge;18 years. Participants completed a questionnaire about demographics, hurricane exposures, and physical/mental health. Post-Traumatic Stress Disorder (PTSD) was measured with the Post-Traumatic Stress Disorder Checklist-S (PCL-S; a score &ge;30 indicated probable PTSD symptoms). The Patient Health Questionnaire-4 (PHQ-4) was used to assess symptoms of depression and generalized anxiety disorder. The average PTSD score was 32.9 (SD = 17.1); a total of 46% of participants met the threshold for probable PTSD. Increased overall hurricane exposure (adjusted odds ratio (OR_adj) 1.42; 95% confidence interval (CI): 1.06⁻2.05) and property-related exposure (OR_adj 1.53; 95% CI: 1.07⁻2.18) were both statistically significantly associated with increased odds of probable PTSD symptoms. A perception of chemical/toxin exposure due to Hurricane Harvey was reported by 44% of participants. A higher number of personal or property exposures were associated with greater mental health symptoms three weeks post-hurricane. This work has implications for the ongoing response to Hurricane Harvey and for assessing the immediate needs of the population.

A Retrospective Review of Microbiological Methods Applied in Studies Following the Deepwater Horizon Oil Spill

The Deepwater Horizon (DWH) oil spill in the Gulf of Mexico in 2010 resulted in serious damage to local marine and coastal environments. In addition to the physical removal and chemical dispersion of spilled oil, biodegradation by indigenous microorganisms was regarded as the most effective way for cleaning up residual oil. Different microbiological methods were applied to investigate the changes and responses of bacterial communities after the DWH oil spills. By summarizing and analyzing these microbiological methods, giving recommendations and proposing some methods that have not been used, this review aims to provide constructive guidelines for microbiological studies after environmental disasters, especially those involving organic pollutants.

The Deepwater Horizon Oil Spill Through the Lens of Human Health and the Ecosystem

This review examines current research ascertaining the impact of the Deepwater Horizon oil spill on human health and ecosystems. Driven by the need to strategically focus research funding, the authors also assess the implications of those findings and promote a transdisciplinary research agenda addressing critical gaps.Epidemiologic studies conducted in workers and vulnerable communities in the spill's aftermath showed that non-chemical stressors affect resilience. Ecosystem-wise salt marsh species showed variability in structural and functional changes, attributed to species-specific tolerance, oil exposure, and belowground plant organs damage.Lacking baseline exposure assessment data hampers assessing the impact of chemical stressors. Research priorities include leveraging existing women/child dyads and worker cohorts to advance exposure characterization and counter early adverse effects in most vulnerable populations. Key policy gaps include mandated just-in-time emergency resources to ascertain immediate post-event exposures and contemporary legislation addressing human and ecosystem health in an integrated rather than silo fashion.

The Long-Term Effects of the Deepwater Horizon Oil Spill on Women's Depression and Mental Distress

OBJECTIVE

The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS).

METHODS

The Women and Their Children's Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress.

RESULTS

After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed.

CONCLUSION

A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183-190).

Contamination by oil crude extraction - Refinement and their effects on human health

The harmful effects of oil on various species of flora and fauna have been studied extensively; however, few studies have studied the effects of oil exposure on human health. The objective of this research was to collect information on the acute health effects and serious psychological symptoms of the possible consequences of such exposure to crude oil. Some studies focused on the composition of different chemicals used in the extraction process, and wastes generated proved to be highly harmful to human health. Thus, studies have shown that individuals who live near oil fields or wells - or who take part in activities of cleaning oil spills - have presented health conditions, such as irritation to the skin, eyes, mucous membranes, kidney damage, liver, reproductive, among others. In Ecuador, this reality is not different from other countries, and some studies have shown increased diseases related with oil crude and oil spills, like skin irritation, throat, liver, lung, infertility, and abortions, and it has been linked to childhood leukemia. Other studies suggest a direct relationship between DNA damage because of oil resulting in a genetic instability of the main enzymes of cellular metabolism as well as a relationship with some cancers, such as leukemia.

The Gulf Coast Health Alliance: Health Risks Related to the Macondo Spill (GC-HARMS) Study: Self-Reported Health Effects

The Deepwater Horizon (DWH) explosion in 2010 is the largest oil spill (Macondo) in U.S. history. We focused on gaining an understanding of the physical health and mental health effects attributable to the Macondo oil spill. This is a report of a cross-sectional cohort study (wave 1) to establish ‘baseline’ findings and meant to provide descriptive information to be used for a multi-wave, longitudinal study. Gulf Coast Health Alliance: health Risks related to the Macondo Spill (GC-HARMS) uses a Community-Based Participatory Research approach, thus including multi-disciplinary, multi-institutional academic partners and representatives of three communities impacted by the spill. Three research sites were selected for human sampling along the Gulf of Mexico coast including two from Mississippi and one from Louisiana, with Galveston, Texas, serving as a comparison site, given that it was not directly impacted by the spill. One hundred participants were selected from each community, representing adults, seniors and children, with approximately equal numbers of males and females in each group. Participants completed initial assessments including completion of a ‘baseline’ survey and, rigorous physical assessments. Results from wave 1 data collection reported herein reveal changes in self-reported physical health and mental health status following the oil spill, disparities in access to healthcare, and associations between mental health and emotional conditions related to displacement/unemployment. Few environmental health studies have been conducted in communities impacted by significant oil spills. Results imply potential prolonged effects on mental health and community vulnerability.

Mental health indicators associated with oil spill response and clean-up: cross-sectional analysis of the GuLF STUDY cohort

BACKGROUND

Adverse mental health effects have been reported following oil spills but few studies have identified specific responsible attributes of the clean-up experience. We aimed to analyse the effects of the 2010 Deepwater Horizon (Gulf of Mexico) disaster on the mental health of individuals involved in oil spill response and clean-up.

METHODS

We used data from the Gulf Long-term Follow-up Study, a cohort of workers and volunteers involved in oil spill clean-up after the Deepwater Horizon disaster. We included 8968 workers (hired after completing training for oil spill response and clean-up) and 2225 non-workers (completed training but were not hired) who completed a Patient Health Questionnaire-8 and four-item Primary Care PTSD Screen to assess for probable depression and post-traumatic stress disorder (PTSD) indicators. Participants were recruited between March 28, 2011, and March 29, 2013. The mental health indicators were assessed at home visits done between May 12, 2011, and May 15, 2013. We used regression models to analyse the effect of potentially stressful job experiences, job type, and total hydrocarbon exposure on mental health indicators.

FINDINGS

Oil spill response and clean-up work was associated with increased prevalence of depression (prevalence ratio [PR] 1·22, 95% CI 1·08-1·37) and PTSD (PR 1·35, 95% CI 1·07-1·71). Among workers, individuals who reported smelling oil, dispersants, or cleaning chemicals had an elevated prevalence of depression (1·56, 1·37-1·78) and PTSD (2·25, 1·71-2·96). Stopping work because of the heat was also associated with depression (1·37, 1·23-1·53) and PTSD (1·41, 1·15-1·74), as was working as a commercial fisherman before the spill (1·38, 1·21-1·57; and 2·01, 1·58-2·55, respectively). An increase in exposure to total hydrocarbons appeared to be associated with depression and PTSD, but after taking into account oil spill job experiences, only the association between the highest amount of total hydrocarbons and PTSD remained (1·75, 1·11-2·76).

INTERPRETATION

Oil spill clean-up workers with high amounts of total hydrocarbon exposure or potentially stressful job experiences had an increased prevalence of depression and PTSD. These findings provide evidence that response and clean-up work is associated with adverse psychological effects and suggest the need for mental health services both before and after the event.

FUNDING

National Institutes of Health (NIH) Common Fund and the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.

Individual-level exposure to disaster, neighborhood environmental characteristics, and their independent and combined associations with depressive symptoms in women

PURPOSE

The severity of the stress response to experiencing disaster depends on individual exposure and background stress prior to the event. To date, there is limited research on the interaction between neighborhood environmental stress and experiencing an oil spill, and their effects on depression. The objective of the current study was to assess if the association between exposure to the Deepwater Horizon Oil Spill (DHOS) and depressive symptoms varied by neighborhood characteristics.

METHODS

US Census data (2010) and longitudinal data collected in two waves (2012-2014 and 2014-2016) from female residents [N = 889 (Wave I), 737 (Wave II)] of an area highly affected by the DHOS were analyzed. Multilevel and individual-level negative binomial regressions were performed to estimate associations with depressive symptoms in both waves. An interaction term was included to estimate effect modification of the association between DHOS exposure and depressive symptoms by neighborhood characteristics. Generalized estimating equations were applied to the negative binomial regression testing longitudinal associations.

RESULTS

Census tract-level neighborhood characteristics were not associated with depressive symptoms. Exposure to the DHOS and neighborhood physical disorder were associated with depressive symptoms cross-sectionally. There was no evidence of effect modification; however, physical/environmental exposure to the DHOS was associated with increased depressive symptoms only among women living in areas with physical disorder. Exposure to the DHOS remained associated with depressive symptoms over time.

CONCLUSIONS

Findings support the enduring consequences of disaster exposure on depressive symptoms in women and identify potential targets for post-disaster intervention based on residential characteristics.

The Women and Their Children's Health (WaTCH) study: methods and design of a prospective cohort study in Louisiana to examine the health effects from the BP oil spill

PURPOSE

The Deepwater Horizon Oil Spill is the largest marine oil spill in US history. Few studies have evaluated the potential health effects of this spill on the Gulf Coast community. The Women and Their Children's Health (WaTCH) study is a prospective cohort designed to investigate the midterm to long-term physical, mental and behavioural health effects of exposure to the oil spill.

PARTICIPANTS

Women were recruited by telephone from pre-existing lists of individuals and households using an address-based sampling frame between 2012 and 2014. Baseline interviews obtained information on oil spill exposure, demographics, physical and mental health, and health behaviours. Women were also asked to provide a household roster, from which a child between 10 and 17 years was randomly selected and recruited into a child substudy. Telephone respondents were invited to participate in a home visit in which blood samples, anthropometrics and neighbourhood characteristics were measured. A follow-up interview was completed between 2014 and 2016.

FINDINGS TO DATE

2852 women completed the baseline interview, 1231 of whom participated in the home visit, and 628 children participated in the child's health substudy. The follow-up interview successfully reinterviewed 2030 women and 454 children.

FUTURE PLANS

WaTCH continues to conduct follow-up surveys, with a third wave of interviews planned in 2017. Also, we are looking to enhance the collection of spatially related environmental data to facilitate assessment of health risks in the study population. In addition, opportunities to participate in behavioural interventions for subsets of the cohort have been initiated. There are ongoing studies that examine the relationship between genetic and immunological markers with mental health.

Transformative Environmental Threats: Behavioral and Attitudinal Change Five Years after the Deepwater Horizon Oil Spill

Does experiencing an environmental disaster have the transformative power to change people's attitudes, behaviors, and political actions? Do these effects persist in the longer term? And what elements of environmental disasters are most effective at spurring change?Using survey data collected in two affected coastal counties around the five-year anniversary of the Deepwater Horizon oil spill, we find that many residents reported mobilizing effects from the disaster: over two-thirds of respondents participated in political activities, about half engaged in environmentally-friendly lifestyle changes, and about half of the respondents reported more concern for the environment. We also investigate whether certain grievancesare more or less powerful in their transformative consequences, and differentiate damagescaused by perceived economic losses, social corrosion, physical health effects, ecological degradation, and emotional reactions. Interestingly, the strongest predictor of political, behavioral, or attitudinal changes was whether residents were affected emotionally by the oil spill, like feeling angry or distressed. Surprisingly, perceived economic losses had few effects, with the exception of becoming more opposed to offshore drilling. These results suggest that environmental threats can motivate political, lifestyle, or attitudinal changesand that certain elements of the experience may have more mobilizing power than others.

A Conceptual Model to Assess Stress-Associated Health Effects of Multiple Ecosystem Services Degraded by Disaster Events in the Gulf of Mexico and Elsewhere

Few conceptual frameworks attempt to connect disaster-associated environmental injuries to impacts on ecosystem services (the benefits humans derive from nature) and thence to both psychological and physiological human health effects. To our knowledge, this study is one of the first, if not the first, to develop a detailed conceptual model of how degraded ecosystem services affect cumulative stress impacts on the health of individual humans and communities. Our comprehensive Disaster-Pressure State-Ecosystem Services-Response-Health (DPSERH) model demonstrates that oil spills, hurricanes, and other disasters can change key ecosystem components resulting in reductions in individual and multiple ecosystem services that support people's livelihoods, health, and way of life. Further, the model elucidates how damage to ecosystem services produces acute, chronic, and cumulative stress in humans which increases risk of adverse psychological and physiological health outcomes. While developed and initially applied within the context of the Gulf of Mexico, it should work equally well in other geographies and for many disasters that cause impairment of ecosystem services. Use of this new tool will improve planning for responses to future disasters and help society more fully account for the costs and benefits of potential management responses. The model also can be used to help direct investments in improving response capabilities of the public health community, biomedical researchers, and environmental scientists. Finally, the model illustrates why the broad range of potential human health effects of disasters should receive equal attention to that accorded environmental damages in assessing restoration and recovery costs and time frames.

Untangling the disaster-depression knot: The role of social ties after Deepwater Horizon

The mental health consequences of disasters, including oil spills, are well known. The goal of this study is to examine whether social capital and social support mediate the effects of exposure to the Deepwater Horizon oil spill on depression among women. Data for the analysis come from the first wave of data collection for the Women and Their Children's Health Study, a longitudinal study of the health effects of women exposed to the oil spill in southern Louisiana, USA. Women were interviewed about their exposure to the oil spill, depression symptoms, structural social capital (neighborhood organization participation), cognitive social capital (sense of community and informal social control), and social support. Structural equation models indicated that structural social capital was associated with increased levels of cognitive social capital, which were associated with higher levels of social support, which in turn were associated with lower levels of depression. Physical exposure to the oil spill was associated with greater economic exposure, which in turn was associated with higher levels of depression. When all variables were taken into account, economic exposure was no longer associated with depression, and social support and cognitive social capital mediated the effect of economic exposure on depression, explaining 67% of the effect. Findings support an extension of the deterioration model of social support to include the additional coping resource of social capital. Social capital and social support were found to be beneficial for depression post-oil spill; however, they were themselves negatively impacted by the oil spill, explaining the overall negative effect of the oil spill on depression. A better understanding of the pathways between the social context and depression could lead to interventions for improved mental health in the aftermath of a disaster.

Individual and community-level determinants of mental and physical health after the deepwater horizon oil spill: findings from the gulf States population survey

The 2010 Deepwater Horizon oil spill had enormous consequences on the environment. Prevalence of mental and physical health conditions among Gulf residents after the disaster, however, are still being assessed. The Gulf State Population Survey (GSPS) was a representative survey of 38,361 residents in four Gulf States and was conducted from December 2010 to December 2011. Analysis of the GSPS data showed that differences in individual characteristics and direct or indirect exposure to the disaster drove the individual-level variation in health outcomes (mental distress, physical distress, and depression). Direct exposure to the disaster itself was the most important determinant of health after this event. Selected county-level characteristics were not found to be significantly associated with any of our health indicators of interest. This study suggests that in the context of an overwhelming event, persons who are most directly affected through direct exposure should be the primary focus of any public health intervention effort.

Why Does Disaster Recovery Work Influence Mental Health?: Pathways through Physical Health and Household Income

Disaster recovery work increases risk for mental health problems, yet the mechanisms underlying this association are unclear. We explored links from recovery work to post-traumatic stress (PTS), major depression (MD), and generalized anxiety disorder (GAD) symptoms through physical health symptoms and household income in the aftermath of the Deepwater Horizon oil spill. As part of the NIEHS GuLF STUDY, participants (N = 10,141) reported on cleanup work activities, spill-related physical health symptoms, and household income at baseline, and mental health symptoms an average of 14.69 weeks (SD = 16.79) thereafter. Cleanup work participation was associated with higher physical health symptoms, which in turn were associated with higher PTS, MD, and GAD symptoms. Similar pattern of results were found in models including workers only and investigating the influence of longer work duration and higher work-related oil exposure on mental health symptoms. In addition, longer worker duration and higher work-related oil exposure were associated with higher household income, which in turn was associated with lower MD and GAD symptoms. These findings suggest that physical health symptoms contribute to workers' risk for mental health symptoms, while higher household income, potentially from more extensive work, might mitigate risk.

Then and now: lessons learned from community- academic partnerships in environmental health research

On the occasion of the 50^th anniversary of the National Institutes of Environmental Health Sciences we reflect on how environmental research incorporating community members as active partners has evolved, benefited communities and advanced environmental health research. We highlight the commitment to community partnerships in the aftermath of the 2010 Deep Water Horizon Oil Spill, and how that commitment helped improve science. We provide examples of community-academic partnerships across the engagement spectrum. Finally, we offer suggestions to improve the community engagement in order to cultivate more long partnerships and better scientific research.