Posttraumatic stress disorder and community collective efficacy following the 2004 Florida hurricanes

Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka

BACKGROUND

Daily stressors have been shown to mediate the relationship of war trauma and trauma-related distress among refugees and internally displaced persons exposed to war and conflict.

AIMS

To examine the extent to which the relationship between war-related trauma and mental distress was mediated by daily stressors and collective efficacy among internally displaced communities a decade after exposure to war.

METHOD

In a cross-sectional study, we recruited a random sample of residents in villages severely affected by conflict in five districts in the Northern Province of Sri Lanka. Measures of war trauma, daily stressors, collective efficacy and post-traumatic stress symptoms (PTSS) were examined. Statistical analyses of the mediating and moderating effects of daily stressors were conducted using regression based methods.

RESULTS

Daily stressors mediated the association of war trauma and PTSS, as both paths of the indirect effect, war trauma to daily stressors and daily stressors to PTSS, were significant. The predictive effect of war trauma on PTSS was positive and significant at moderate and high levels of daily stressors but not at low levels. Higher levels of neighbourhood informal social control, a component of collective efficacy, function as a protective factor to reduce effects of war trauma and daily stressors on mental distress in this population.

CONCLUSIONS

Daily stressors are an important mediator in the well-established relationship between war exposure and traumatic stress among internally displaced persons, even a decade after the conflict. Mental health and psychosocial support programmes that aim to address mental distress among war-affected communities could reduce daily stressors and enhance collective efficacy in this context.

How Does Parenthood Moderate Paths Between Personal and Community Resources and Distress following Collective Trauma?

This study examines the moderating role of parenthood in associations between personal and community resources and psychological distress and somatization following collective exposure to security threats. The research questions were guided by Terror Management Theory that posits that parenthood involves heightened anxiety when children are in danger yet may also provide an existential resource that can reduce the individuals' distress. The study was conducted following the 2014 Israel-Gaza conflict and included 1014 Israelis. The participants completed a questionnaire assessing levels of trauma exposure (the predictors), sense of mastery (personal resource), engagement in community activities and trust in leaders (community resources), and psychological distress and somatization (the outcomes). Results indicated that parenthood moderated several associations between trauma exposure and personal and community resources as well as paths between these resources and psychological distress. In almost all these cases, these paths were statistically significant only among parents in two different directions. Parenthood was associated with more psychological distress through lower sense of mastery and greater engagement in community activities. On the other hand, parenthood was related to lower psychological distress through greater trust in local leaders. In addition, only among parents, lower levels of mastery mediated the association between trauma exposure and somatization. These results offer significant implications for practitioners. Although parents and non-parents can be similarly affected by trauma exposure with respect to trauma-related outcomes, the way to assist them to reduce these negative outcomes should be conducted through different paths involving their personal and community resources.

Communal mastery and associations with depressive and PTSD symptomatology among urban trauma-exposed women

Objective: Racial and ethnic minority women from low-resource urban communities experience disproportionately high rates of trauma exposure. Higher rates of lifetime trauma exposure are strongly associated with subsequent psychological sequela, specifically depression and posttraumatic stress disorder (PTSD). Communal mastery is the ability to cope with challenges and achieve goals by being closely interconnected with friends, family, and significant others. Yet, it is unknown if communal mastery is protective specifically against PTSD and depressive symptoms. Method: Participants (N = 131) were Black and Latina women (88.5% Black, mean monthly income: < $750) recruited from an urban outpatient obstetric-gynecological clinic at an academic medical center. Participants completed an online questionnaire that assessed trauma history, PTSD and depressive symptoms, types of individualistic coping, social support, and communal mastery. Results: Hierarchical multiple regression models demonstrated that communal mastery is uniquely associated with fewer PTSD symptoms (β = -.23, p = .003). More severe trauma history, more use of passive coping skills, and poorer social support were also significantly associated with PTSD symptoms, explaining over half of the variance in PTSD symptoms. Although significantly correlated, communal mastery was not uniquely associated with fewer depressive symptoms (β = -.13, p = .201). Conclusions: These findings suggest that connectedness as assessed through communal mastery serves as an important shield against the effects of traumatic stress for Black and Latina women. Future research would benefit by exploring interventions that aim to increase communal mastery in order to help highly trauma-exposed racial and ethnic minority women in low-resource environments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neighborhood collective efficacy in stressful events: The stress-buffering effect

Although research on neighborhood effects has shown positive outcomes of collective efficacy in mental health, few studies have examined whether its protective role is universally applicable to all residents or the vulnerable population. Building on a stress-buffering model, this study examines whether or not neighborhood collective efficacy serves as a stress buffer to ameliorate the deleterious effects of exposure to stressful events across different population groups. Analyses are conducted based on a city-wide representative sample in Hong Kong linked to suicide events through spatial and temporal information. Neighborhood-level collective efficacy is constructed by the aggregated mean score of individual perceived collective efficacy within the same residential neighborhoods. Results from the logistic regression models show that individuals exposed to suicide in the residential surroundings have a higher risk of mental distress symptoms. Moreover, neighborhood-level collective efficacy tends to alleviate the mental distress upon exposure, but such a stress-buffering effect is only observed in older adults. Our findings provide a new perspective informed by the variation of stress-buffering effect across population groups. Thus, this study contributes to the understandings of neighborhood collective by demonstrating the stress-buffering effects among the vulnerable population.

Exploring the Shared Experiences of Yazidis Who Survived Genocide

In August 2014, the Islamic State of Iraq (ISIS) and the Levant (ISIL) brutally attacked the Yazidi people and occupied Sinjar and other villages in Northern Iraq. The massacre of Yazidis that began in August 2014 was declared by the United Nations as genocide. To gain a better understanding and raise awareness of these atrocities, we conducted a qualitative, phenomenological study with 35 Yazidis, who survived the genocide. The aim of the study was to elucidate the Yazidis' processing of the genocide and how it affects their psychological functioning. Coding and theming were the methods used to categorize, bring meaning and identity to Yazidis'genocidal experiences. The interviews took place between April and June 2019. Data analysis of the interview transcripts revealed that Yazidis, who survived the genocide of 2014, commonly experienced 11 themes related to hopelessness, fear, loss, grief, distrust, change, advocacy, optimism, shock, intrusive memories, and guilt. Results from this study reveal the vulnerabilities of ethnic minorities at risk of being abducted, killed, raped, and displaced. Moreover, the inherent risk of future genocides is illustrated through the experiences shared by the Yazidis.

Resilience after natural disasters: the process of harnessing resources in communities differentially exposed to a flood

Background: Disasters negatively impact mental health and well-being. Studying how people adapt and recover after adversity is crucial for disaster preparedness and response. Objective: This study examined how differentially affected communities harness their resources to adapt to the aftermath of a flood. We predicted that stronger individual, interpersonal, and community resources protect against psychosocial resource loss and, through that, are related to fewer symptoms of posttraumatic stress and depression and higher life satisfaction. We also predicted that these effects would be stronger in a flooded community, compared to a threatened, but non-flooded community. Method: Participants were randomly sampled community members from two neighbouring municipalities. One municipality was severely flooded during the 2014 floods in South East Europe (affected community, na = 223), the other was threatened but not flooded (comparison community, nc = 224). Interviews were conducted one and a half years after the disaster using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale, the Psychosocial Resource Loss Scale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale Revised and the Satisfaction with Life Scale. Results: Stronger individual, interpersonal, and community resources were found to be related to better post-disaster outcomes directly and indirectly through psychosocial resource loss. In the affected community, interpersonal resources and community social capital and engagement were stronger predictors of positive adaptation. In the comparison community, community economic development and trust in community leadership were more important. Conclusion: This study provides evidence that people affected by disasters can harness their individual, interpersonal, and community resources to recover and adapt. Post-disaster interventions should aim to strengthen family and community ties, thus increasing available social support and community connectedness.

Longitudinal Study of Hurricane Preparedness Behaviors: Influence of Collective Efficacy

OBJECTIVE

Community characteristics, such as collective efficacy, a measure of community strength, can affect behavioral responses following disasters. We measured collective efficacy 1 month before multiple hurricanes in 2005, and assessed its association to preparedness 9 months following the hurricane season.

METHODS

Participants were 631 Florida Department of Health workers who responded to multiple hurricanes in 2004 and 2005. They completed questionnaires that were distributed electronically approximately 1 month before (6.2005-T1) and 9 months after (6.2006-T2) several storms over the 2005 hurricane season. Collective efficacy, preparedness behaviors, and socio-demographics were assessed at T1, and preparedness behaviors and hurricane-related characteristics (injury, community-related damage) were assessed at T2. Participant ages ranged from 21-72 (M(SD) = 48.50 (10.15)), and the majority were female (78%).

RESULTS

In linear regression models, univariate analyses indicated that being older (B = 0.01, SE = 0.003, P < 0.001), White (B = 0.22, SE = 0.08, P < 0.01), and married (B = 0.05, SE = 0.02, p < 0.001) was associated with preparedness following the 2005 hurricanes. Multivariate analyses, adjusting for socio-demographics, preparedness (T1), and hurricane-related characteristics (T2), found that higher collective efficacy (T1) was associated with preparedness after the hurricanes (B = 0.10, SE = 0.03, P < 0.01; and B = 0.47, SE = 0.04, P < 0.001 respectively).

CONCLUSION

Programs enhancing collective efficacy may be a significant part of prevention practices and promote preparedness efforts before disasters.

Ecological Disasters and Mental Health: Causes, Consequences, and Interventions

Ecological disasters highlight the importance of understanding natural disasters as they relate to a changing global climate. Such disasters often have a predictable pattern of evolving over time and anticipated psychological and behavioral problems and community disruptions. Various factors enhance transmission of these adverse effects beyond the geographic location of the ecological disaster, with certain populations being particularly vulnerable to these effects. Understanding the range and pattern of these effects can aid in optimizing interventions. The use of evidence-informed interventions can reduce distress, enhance well-being, and improve functioning for affected individuals and communities. Effective preparedness involves an understanding of these factors, incorporation of them at all stages of disaster management, and continuous education and training for disaster planners and responders.

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

Posttraumatic stress disorder (PTSD) is a psychological disorder, which could be caused by traumatic events. The prevalence of PTSD among survivors after a typhoon or hurricane varied widely. Therefore, this study aimed to determine a combined prevalence of PTSD among survivors after a typhoon or hurricane. A systematic search of literature was performed in the 3 English databases: PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Embase (Elsevier, Amsterdam, Netherlands). Also, a similar search was performed in the 2 Chinese databases such as Chinese National Knowledge Infrastructure and WanFang. Loney et al.'s criteria were used to evaluate the quality of the selected articles for this study. The combined prevalence of PTSD among the study population was estimated using the Freeman-Tukey double arcsine transformation method. Subgroup analyses and a meta-regression analysis were carried out to explore the origin of heterogeneity. Thirty-nine eligible articles were included in this study. They comprised 43 123 typhoon and hurricane survivors of which 9373 were diagnosed with PTSD. The combined prevalence of PTSD among this population was 17.81%. Subgroup analyses revealed that the combined prevalence of PTSD related to typhoon and hurricane Categories 5, 4, and 2 showing a corresponding decreasing tendency. About 18% of people who experienced a severe typhoon or hurricane develop PTSD with the prevalence decreasing with reduced severity of the typhoon or hurricane.

Collective Efficacy as a Key Context in Neighborhood Support for Urban Youth

Neighborhood context, including the physical and social environment, has been implicated as important contributors to positive youth development. A transactional approach to neighborhood asserts that place and people are mutually constitutive; negative perceptions of place are intrinsically bound with negative portrayals of stigmatized groups, including youth. Adult perceptions of neighborhood youth may contribute to an increased sense of alienation and youth antisocial behavior. This study uses street-intercept interviews with adults (N = 408) to examine the relationship between neighborhood conditions and adult support for neighborhood youth. A path model was used to examine the direct and indirect relationship of neighborhood constructs (safety, aesthetic quality, and walkability) on adult support for neighborhood youth. Neighborhood aesthetic quality and the walking environment were directly associated with adult support for youth, whereas perceived safety was indirectly associated. Collective efficacy partially explained these relationships. Findings support theorized relationships between people and places; improvements to neighborhood physical environment may directly impact resident adults' perceptions of neighborhood young people.

The association between disaster exposure and media use on post-traumatic stress disorder following Typhoon Hato in Macao, China

Background: Direct exposure to natural disasters and related losses are associated with post-traumatic stress disorder (PTSD). It is less clear whether indirect media exposure is associated with PTSD. Objective: This study investigated key exposure-related risk factors for PTSD and examined the effect of media exposure on the prevalence of disaster-related PTSD. Method: Typhoon Hato directly hit Macao on 23 August 2017. It was one of the most serious natural disasters ever to strike southern China. One month after the event, 1876 Chinese university students in Macao were recruited into a cross-sectional study (mean age 20.01 years, SD = 2.63; 66.2% female). Self-reported typhoon exposure, media use and exposure to disaster-related content, and PTSD symptoms were collected using an electronic survey. Univariable analyses assessed associations between risk factors and PTSD, which were then included in a series of multivariable logistic regressions. Results: The prevalence of PTSD was 5.1%. Adjusted models demonstrated that being male (vs female) [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI) 1.07-2.63], home damage (aOR = 2.86, 95% CI 1.71-4.78), witnessing people injured (aOR = 2.33, 95% CI 1.36-4.00), and almost drowning during the storm (aOR = 8.99, 95% CI 1.92-41.99) were associated with PTSD. After adjusting for direct exposure, indirect exposure to disaster-related social media content, including information related to drowning victims (aOR = 1.29, 95% CI 1.00-1.67) and residents' emotional reactions (aOR = 1.98, 95% CI 1.44-2.72), was associated with PTSD. Viewing more information about the storm itself (aOR = 0.37, 95% CI 0.28-0.49) and images of heroic acts (aOR = 0.72, 95% CI 0.55-0.94) were significantly associated with lower odds of PTSD. Conclusion: These findings add to the literature demonstrating that some types of media use and certain media content following a natural disaster are associated with PTSD.

Posttraumatic Stress Disorder and Mental Distress Following the 2004 and 2005 Florida Hurricanes

OBJECTIVE

Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons.

METHODS

Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher.

RESULTS

In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96).

CONCLUSIONS

Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44-52).

Hurricanes and Indigenous Families: Understanding connections with discrimination, social support, and violence on PTSD

The purpose of this article is to use the culturally grounded Framework of Historical Oppression, Resilience, and Transcendence (FHORT) to examine (a) the experiences and impacts of hurricanes on Indigenous (i.e., Native American) family members in the Gulf Coast and (b) to identify how experiencing hurricanes and natural disasters, family and community support, adverse childhood experiences (ACE), discrimination and intimate partner violence (IPV) may be related to post-traumatic stress disorder (PTSD) among two Southeastern tribes. Results were drawn from a convergent mixed-methodology design, which incorporates ethnographic qualitative data and a culturally grounded quantitative follow-up survey. Thematic analysis of qualitative data with 208 participants from a coastal Indigenous community revealed several emergent themes, namely (a) the Impact of Federal Recognition on Hurricane Affected Communities; (b) Rapidly Changing Landscape, Lives, and Communities; and (C) Family and Personal Effects of Hurricane Experiences. Descriptive and hierarchical regression analysis of 127 participants across two Southeastern tribes indicate that many participants frequently thought of losses from hurricanes and disasters and that over one-third of the sample met the criteria for clinically significant PTSD. Regression results affirmed the independent effects of hurricane experiences, ACE, community and family support as they relate to PTSD; yet IPV and discrimination were the strongest predictors of PTSD. Results reveal the extensive repercussions of hurricanes on Indigenous families of the Southeast, which are inseparable from and exacerbated by the insidious historical oppression, including discrimination, already experienced by these groups.

Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

BACKGROUND AND OBJECTIVES

Present study, conducted in the aftermath of the 2014 Israel-Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

DESIGN

This cross-sectional study was conducted between 2 and 3 months after the hostilities.

METHOD

Participants (N = 764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

RESULTS

Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

CONCLUSIONS

Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.

Criticism by community people and poor workplace communication as risk factors for the mental health of local welfare workers after the Great East Japan Earthquake: A cross-sectional study

After a large-scale natural disaster, demand for social welfare services increases, and the mental health of local social welfare workers becomes a matter of great concern because of their dual role as support providers and disaster survivors. We examined whether work-related social stressors, including criticism by community people and poor workplace communication, were associated with increased risk of post-traumatic stress disorder (PTSD), depression, or psychological distress 20-22 months after the Great East Japan Earthquake (GEJE; March 11, 2011) in local social welfare workers. Demographic characteristics, disaster-related risk factors (near-death experience, dead/missing family members, loss of housing), and work-related social risk factors (criticism, lack of communication) were obtained 20-22 months after the GEJE from 822 local workers. Questionnaires measured PTSD, depression, and psychological stress. Bivariate and multivariate regression analyses were applied. More local social welfare workers suffered from mental health problems than would be expected. Criticism by community people was significantly associated with probable PTSD and high psychological distress (adjusted odds ratio = 2.31 and 2.55, respectively). Furthermore, lack of workplace communication was associated with probable PTSD, depression, and high psychological distress (adjusted odds ratio = 3.97, 4.27, and 4.65, respectively). Almost 2 years after the disaster, local relief workers still suffered from mental health problems. Because post-disaster work-related social stressors constitute risk factors for these mental health problems, measures to improve working conditions and prevent and treat mental disorders should be a priority.

Understanding Postdisaster Substance Use and Psychological Distress Using Concepts from the Self-Medication Hypothesis and Social Cognitive Theory

This article applies constructs from the Self-Medication Hypothesis and Social Cognitive Theory to explain the development of substance use and psychological distress after a disaster. A conceptual model is proposed, which employs a sequential mediation model, identifying perceived coping self-efficacy, psychological distress, and self-medication as pathways to substance use after a disaster. Disaster exposure decreases perceived coping self-efficacy, which, in turn, increases psychological distress and subsequently increases perceptions of self-medication in vulnerable individuals. These mechanisms lead to an increase in postdisaster substance use. Last, recommendations are offered to encourage disaster researchers to test more complex models in studies on postdisaster psychological distress and substance use.

Exposure to Hurricane Sandy, neighborhood collective efficacy, and post-traumatic stress symptoms in older adults

OBJECTIVES

Older adults exposed to natural disasters are at risk for negative psychological outcomes such as post-traumatic stress disorder (PTSD). Neighborhood social capital can act as a resource that supports individual-level coping with stressors. This study explores the ability of perceived neighborhood collective efficacy, a form of social capital, to moderate the association between exposure to Hurricane Sandy and PTSD symptoms in older adults.

METHOD

Data from 2205 older individuals aged 54-80 residing in New Jersey who self-reported exposure to Hurricane Sandy in October of 2012 were identified and extracted from the ORANJ BOWL™ research panel. Participants completed baseline assessments of demographic and individual-level characteristics in 2006-2008 and follow-up assessments about storm exposure, perceived neighborhood collective efficacy (social cohesion and social control), and PTSD symptoms 8-33 months following the storm. Zero-inflated Poisson regression models were tested to examine the association between exposure, neighborhood collective efficacy, and PTSD symptoms.

RESULTS

After accounting for known demographic and individual-level covariates, greater storm exposure was linked to higher levels of PTSD symptoms. Social cohesion, but not social control, was linked to lower reports of PTSD symptoms and moderated the association between exposure and PTSD. The impact of storm exposure on PTSD symptoms was less for individuals reporting higher levels of social cohesion.

CONCLUSION

Mental health service providers and disaster preparedness and response teams should consider the larger social network of individuals served. Building social connections in older adults' neighborhoods that promote cohesion can reduce the negative psychological impact of a disaster.

Continuous Traumatic Situations in the Face of Ongoing Political Violence: The Relationship Between CTS and PTSD

This article presents a literature review of the concept of continuous traumatic situations (CTS), which relates to residents living in ongoing situations of political violence and national security threats. The first aim of this review is to narrow the gap regarding knowledge about the concept of CTS by presenting findings from studies that have assessed the effects of CTS on civilian populations. The second aim is to describe CTS in a way that highlights the differences and similarities between posttraumatic stress disorder and responses to CTS. This distinction is a necessary precondition for examining CTS, as is a careful clinical analysis of the development and course of symptoms. This literature review also highlights the importance of adopting a supplementary perspective for understanding the psychological impact of ongoing exposure to real threats, which can be used as a basis for developing intervention strategies that are appropriate for coping with life in the context of persistent violence. CTS can be manifested as emotions, behaviors, and perceptions among individuals, families, communities, and societies. The nature of the proposed model of CTS is a circular one, combining past and future perceptions and emotional reactions that have resulted from continuous and repeated traumatic experiences over an extended period of time. This wider understanding reflects the complexity of the CTS phenomenon. Various micro and macro interventions relating to CTS as the result of political violence situations and national security threats are presented, and recommendations for practice, policy, and future research are offered.

Community Unemployment and Disaster-Related Stressors Shape Risk for Posttraumatic Stress in the Longer-Term Aftermath of Hurricane Sandy

Persons living in communities with limited resources are at heightened risk of posttraumatic stress (PTS) after disasters, especially if they were highly exposed. The support deterrence desistence model and the conservation of resources theory suggest that this risk might increase in the longer-term aftermath of disasters. In the present study, we aimed to test this hypothesis. Two population-based samples of New York City residents in communities affected by Hurricane Sandy were surveyed at either 13-16 months (Time 1; n = 421) or 25-28 months (Time 2; n = 420) postdisaster. Participants reported on their exposure to disaster-related stressors and PTS. The percentage of residents who were unemployed in participants' census tracts was collected from the 2008-2012 American Community Survey. Multilevel models found that disaster-related stressors were more strongly associated with PTS for participants living in communities with high unemployment, but only at Time 2 (Est. = .58, SE = .21, p = .006). Mapping of community unemployment and disaster-related stressors suggested that communities in southern Brooklyn and Queens, and northeastern Staten Island were at particularly high risk for PTS at Time 2. The results suggest the need for ongoing support to economically disadvantaged communities in which residents have endured disaster-related stressors.

Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review

BACKGROUND

When disasters occur, there are many different occupational groups involved in rescue, recovery and support efforts. This study aimed to conduct a systematic literature review to identify social and occupational factors affecting the psychological impact of disasters on responders.

METHODS

Four electronic literature databases (MEDLINE®, Embase, PsycINFO® and Web of Science) were searched and hand searches of reference lists were carried out. Papers were screened against specific inclusion criteria (e.g. published in peer-reviewed journal in English; included a quantitative measure of wellbeing; participants were disaster responders). Data was extracted from relevant papers and thematic analysis was used to develop a list of key factors affecting the wellbeing of disaster responders.

RESULTS

Eighteen thousand five papers were found and 111 included in the review. The psychological impact of disasters on responders appeared associated with pre-disaster factors (occupational factors; specialised training and preparedness; life events and health), during-disaster factors (exposure; duration on site and arrival time; emotional involvement; peri-traumatic distress/dissociation; role-related stressors; perceptions of safety, threat and risk; harm to self or close others; social support; professional support) and post-disaster factors (professional support; impact on life; life events; media; coping strategies).

CONCLUSIONS

There are steps that can be taken at all stages of a disaster (before, during and after) which may minimise risks to responders and enhance resilience. Preparedness (for the demands of the role and the potential psychological impact) and support (particularly from the organisation) are essential. The findings of this review could potentially be used to develop training workshops for professionals involved in disaster response.

Perceived Service Need After Hurricane Sandy in a Representative Sample of Survivors: The Roles of Community-Level Damage and Individual-Level Stressors

OBJECTIVE

We aimed to explore how individually experienced disaster-related stressors and collectively experienced community-level damage influenced perceived need for mental health services in the aftermath of Hurricane Sandy.

METHODS

In a cross-sectional study we analyzed 418 adults who lived in the most affected areas of New York City at the time of the storm. Participants indicated whether they perceived a need for mental health services since the storm and reported on their exposure to disaster-related stressors (eg, displacement, property damage). We located participants in communities (n=293 census tracts) and gathered community-level demographic data through the US Census and data on the number of damaged buildings in each community from the Federal Emergency Management Agency Modeling Task Force.

RESULTS

A total of 7.9% of participants reported mental health service need since the hurricane. Through multilevel binomial logistic regression analysis, we found a cross-level interaction (P=0.04) between individual-level exposure to disaster-related stressors and community-level building damage. Individual-level stressors were significantly predictive of individual service needs in communities with building damage (adjusted odds ratio: 2.56; 95% confidence interval: 1.58-4.16) and not in communities without damage.

CONCLUSION

Individuals who experienced individual stressors and who lived in more damaged communities were more likely to report need for services than were other persons after Hurricane Sandy. (Disaster Med Public Health Preparedness. 2016;10:428-435).

Risk Factors for Posttraumatic Stress Symptoms Among Avalanche Survivors: A 16-Year Follow-Up

Few natural disaster studies have assessed factors associated with posttraumatic stress disorder (PTSD) beyond a decade after trauma. Using North's disaster model as a framework, the aim of this study was to identify factors associated with clinically significant posttraumatic stress symptoms (CS-PTSDS) in avalanche survivors (n = 399) 16 years after the disaster. Completed self-report questionnaires were received from 286 (72%) survivors. CS-PTSDS were assessed with the Posttraumatic Diagnostic Scale. Predictors of CS-PTSDS in a multivariate analysis were secondary sequelae factors of lack of social support (adjusted relative risk [RR], 2.90; 95% confidence interval [CI], 1.37-6.13) and financial hardship in the aftermath of the trauma (adjusted RR, 2.47; 95% CI, 1.16-5.26). In addition, the community factor of providing assistance in the aftermath of the avalanche (adjusted RR, 1.95; 95% CI, 1.04-3.64) was inversely associated with CS-PTSDS. Screening for these factors may be useful in identifying those most vulnerable to developing chronic PTSD after this unique type of disaster.

Brains in the city: Neurobiological effects of urbanization

With a majority of humans now living in cities, strategic research is necessary to elucidate the impact of this evolutionarily unfamiliar habitat on neural functions and well-being. In this review, both rodent and human models are considered in the evaluation of the changing physical and social landscapes associated with urban dwellings. Animal models assessing increased exposure to artificial physical elements characteristic of urban settings, as well as exposure to unnatural sources of light for extended durations, are reviewed. In both cases, increased biomarkers of mental illnesses such as major depression have been observed. Additionally, applied human research emphasizing the emotional impact of environmental threats associated with urban habitats is considered. Subjects evaluated in an inner-city hospital reveal the impact of combined specific genetic vulnerabilities and heightened stress responses in the expression of posttraumatic stress disorder. Finally, algorithm-based models of cities have been developed utilizing population-level analyses to identify risk factors for psychiatric illness. Although complex, the use of multiple research approaches, as described herein, results in an enhanced understanding of urbanization and its far-reaching effects--confirming the importance of continued research directed toward the identification of putative risk factors associated with psychiatric illness in urban settings.

MILITARY FAMILIES: MEASUREMENT OF COMMUNITY RESOURCE ADEQUACY

Understanding features of community strength both on and off the military installation will help identify and address the needs of military families. This study introduced a measure to identify adequacy of community resources for military families. Using confirmatory factor analysis with data from 717 service users (M age = 37.3 yr., SD = 10.6) representing four large U.S. Army installations, two domains of community resource adequacy were identified: resources on the installation and resources off the installation. This measure could be used in health research with military families and in improving resources available to this population.

Depressive Symptom Severity and Community Collective Efficacy following the 2004 Florida Hurricanes

There is a lack of research investigating community-level characteristics, such as community collective efficacy, mitigating the impact of disasters on psychological health, specifically depression. We examined the association of community collective efficacy with depressive symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Cross-sectional anonymous questionnaires were distributed electronically to all Florida Department of Health (FDOH) personnel that assessed depressive symptom severity and collective efficacy nine months after the 2004 hurricane season. Analyses were conducted at the individual level and community level using zip codes. The majority of participants were female (81.9%), and ages ranged from 20 to 78 years (median = 49 years). The majority of participants (73.4%) were European American, 12.7% were African American, and 9.2% were Hispanic. Using multilevel analysis, our data indicate that higher community-level and individual-level collective efficacy were associated with significantly lower depressive symptom severity (b = -0.09 [95% CI: -0.13, -0.04] and b = -0.09 [95% CI: -0.12, -0.06], respectively) even after adjusting for individual sociodemographic variables, community socioeconomic characteristics, individual injury/damage, and community storm damage. Lower levels of depressive symptom severity were associated with communities with high collective efficacy. Our study highlights the possible importance of programs that enrich community collective efficacy for disaster communities.

Psychological resilience after Hurricane Sandy: the influence of individual- and community-level factors on mental health after a large-scale natural disaster

Several individual-level factors are known to promote psychological resilience in the aftermath of disasters. Far less is known about the role of community-level factors in shaping postdisaster mental health. The purpose of this study was to explore the influence of both individual- and community-level factors on resilience after Hurricane Sandy. A representative sample of household residents (N = 418) from 293 New York City census tracts that were most heavily affected by the storm completed telephone interviews approximately 13–16 months postdisaster. Multilevel multivariable models explored the independent and interactive contributions of individual- and community-level factors to posttraumatic stress and depression symptoms. At the individual-level, having experienced or witnessed any lifetime traumatic event was significantly associated with higher depression and posttraumatic stress, whereas demographic characteristics (e.g., older age, non-Hispanic Black race) and more disaster-related stressors were significantly associated with higher posttraumatic stress only. At the community-level, living in an area with higher social capital was significantly associated with higher posttraumatic stress. Additionally, higher community economic development was associated with lower risk of depression only among participants who did not experience any disaster-related stressors. These results provide evidence that individual- and community-level resources and exposure operate in tandem to shape postdisaster resilience.

Mental health and general wellness in the aftermath of Hurricane Ike

Exposure to natural disasters has been linked to a range of adverse outcomes, including mental health problems (e.g., posttraumatic stress symptoms [PTSS], depression), declines in role functioning (e.g., occupational difficulties), and physical health problems (e.g., somatic complaints). However, prior research and theory suggest that the modal postdisaster response in each of these domains is resilience, defined as low levels of symptoms or problems in a given outcome over time, with minimal elevations that are limited to the time period during the disaster and its immediate aftermath. However, the extent to which disaster survivors exhibit mental health wellness (resilience across multiple mental health conditions) or general wellness (resilience across mental health, physical health, and role functioning domains) remains unexplored. The purpose of this study was to quantify mental health and general wellness, and to examine predictors of each form of wellness, in a three-wave population-based study of Hurricane Ike survivors (N = 658). Latent class growth analysis was used to determine the frequency of resilience on four outcomes (PTSS: 74.9%; depression: 57.9%; functional impairment: 45.1%; days of poor health: 52.6%), and cross-tabulations were used to determine the frequency of mental health wellness (51.2%) and general wellness (26.1%). Significant predictors of both mental health and general wellness included lower peri-event emotional reactions and higher community-level collective efficacy; loss of sentimental possessions or pets and disaster-related financial loss were negative predictors of mental health wellness, and loss of personal property was a negative predictor of general wellness. The results suggest that studies focusing on a single postdisaster outcome may have overestimated the prevalence of mental health and general wellness, and that peri-event responses, personal property loss and collective efficacy have a cross-cutting influence across multiple domains of postdisaster functioning.