White River Junction, VT, United States
White River Junction, VT, United States

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Lowe S.R.,Columbia University | Tracy M.,Columbia University | Tracy M.,National Center for Disaster Mental Health Research | Cerda M.,Columbia University | And 4 more authors.
Journal of Traumatic Stress | Year: 2013

Previous research has documented that individuals exposed to more stressors during disasters and their immediate aftermath (immediate stressors) are at risk of experiencing longer-term postdisaster stressors. Longer-term stressors, in turn, have been found to play a key role in shaping postdisaster psychological functioning. Few studies have simultaneously explored the links from immediate to longer-term stressors, and from longer-term stressors to psychological functioning, however. Additionally, studies have inadequately explored whether postdisaster psychological symptoms influence longer-term stressors. In the current study, we aimed to fill these gaps. Participants (N = 448) were from population-based study of Hurricane Ike survivors and completed assessments 2-5 months (Wave 1), 5-9 months (Wave 2) and 14-18 months (Wave 3) postdisaster. Through path analysis, we found that immediate stressors, assessed at Wave 1, were positively associated with Wave 2 and Wave 3 stressors, which in turn were positively associated with Wave 2 and Wave 3 posttraumatic stress and depressive symptoms. Wave 2 posttraumatic stress symptoms were positively associated with Wave 3 stressors, and Wave 1 depressive symptoms were positively associated with Wave 2 stressors. The findings suggest that policies and interventions can reduce the impact of disasters on mental health by preventing and alleviating both immediate and longer-term postdisaster stressors. © 2013 International Society for Traumatic Stress Studies.


Cerda M.,Columbia University | Cerda M.,National Center for Disaster Mental Health Research | Bordelois P.M.,Columbia University | Galea S.,Columbia University | And 8 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2013

Purpose: Ongoing traumatic events and stressors, rather than acute sources of trauma, may shape long-term post-disaster mental health. The purpose of this study was to compare the influence of acute hurricane-related exposures and ongoing post-hurricane exposures on the short- and long-term course of posttraumatic stress symptoms (PTSS) and functional impairment (FI). Methods: A random sample of adults (n = 658) in Galveston and Chambers Counties, Texas, was selected 2-6 months after Hurricane Ike and interviewed 3 times over 18 months. Hurricane-related exposures included traumatic events such as death of a family member due to the hurricane and stressors such as loss/damage to personal property due to the hurricane. Post-hurricane exposures included traumatic events such as sexual assault and stressors such as divorce or serious financial problems. Results: Experiencing an acute hurricane-related traumatic event or stressor was associated with initial post-hurricane PTSS [RR = 1.92 (95 % CI = 1.13-3.26) and RR = 1.62 (1.36-1.94), respectively] and FI [RR = 1.76; (1.05-2.97) and RR = 1.74 (1.46-2.08)], respectively, and acute hurricane-related stressors were associated with a higher rate of increase in FI over time [RR = 1.09; (1.01-1.19)]. In contrast, ongoing post-hurricane daily stressors were not associated within initial PTSS and FI, but were associated with PTSS and FI at the second and third interviews. Conclusions: While immediate postdisaster interventions may influence short-term mental health, investment in the prevention of ongoing stressors may be instrumental to manage long-term mental health status. © 2012 Springer-Verlag.


Tracy M.,National Center for Disaster Mental Health Research | Tracy M.,Columbia University | Norris F.H.,National Center for Disaster Mental Health Research | Norris F.H.,National Center for PTSD | And 2 more authors.
Depression and Anxiety | Year: 2011

Background: Hurricane Ike struck the Galveston Bay area of Texas on September 13, 2008, leaving substantial destruction and a number of deaths in its wake. We assessed differences in the determinants of posttraumatic stress disorder (PTSD) and depression after this event, including the particular hurricane experiences, including postevent nontraumatic stressors, that were associated with these pathologies. Methods: 658 adults who had been living in Galveston and Chambers counties, TX in the month before Hurricane Ike were interviewed 2-5 months after the hurricane. We collected information on experiences during and after Hurricane Ike, PTSD and depressive symptoms in the month before the interview, and socio-demographic characteristics. Results: The prevalence of past month hurricane-related PTSD and depression was 6.1 and 4.9%, respectively. Hurricane experiences, but not socio-demographic characteristics, were associated with Ike-related PTSD. By contrast, lower education and household income, and more lifetime stressors were associated with depression, as were hurricane exposures and hurricane-related stressors. When looking at specific hurricane-related stressors, loss or damage of sentimental possessions was associated with both PTSD and depression; however, health problems related to Ike were associated only with PTSD, whereas financial loss as a result of the hurricane was associated only with depression. Conclusions: PTSD is indeed a disorder of event exposure, whereas risk of depression is more clearly driven by personal vulnerability and exposure to stressors. The role of nontraumatic stressors in shaping risk of both pathologies suggests that alleviating stressors after disasters has clear potential to mitigate the psychological sequelae of these events. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc.


Pietrzak R.H.,National Center for Posttraumatic Stress Disorder | Pietrzak R.H.,Yale University | Pietrzak R.H.,National Center for Disaster Mental Health Research | Van Ness P.H.,Yale University | And 5 more authors.
Journal of Psychiatric Research | Year: 2013

This study examined the nature and determinants of longitudinal trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms in older persons affected by a large-magnitude disaster. Two hundred six adults age 60 or older (mean = 69, range = 60-92) who resided in the Galveston Bay area when Hurricane Ike struck in September 2008 completed telephone interviews an average of 3-, 6-, and 15-months after this disaster. Latent growth mixture modeling was employed to identify predominant trajectories of disaster-related PTSD symptoms over time; and pre-, peri-, and post-disaster determinants of these trajectories were then examined. A 3-class solution optimally characterized PTSD symptom trajectories, with the majority (78.7%) of the sample having low/no PTSD symptoms over all assessments (i.e., resistant); 16.0% having chronically elevated symptoms (i.e., chronic); and 5.3% having a delayed onset course of symptoms (i.e., delayed-onset). Lower education, greater severity of Hurricane Ike exposure (i.e., Ike-related physical illness or injury and high level of community destruction), and greater number of traumatic and stressful life events after Hurricane Ike, particularly financial problems, were associated with a chronic PTSD trajectory. Greater number of traumatic and stressful life events, particularly financial problems after Hurricane Ike, was also associated with a delayed-onset trajectory. These findings suggest that there are heterogeneous trajectories of disaster-related PTSD symptoms in older adults and that these trajectories have common and unique determinants. They also underscore the importance of prevention efforts designed to mitigate the deleterious effects of post-disaster stressors, most notably financial distress, in older persons affected by disasters. © 2012.


Schumacher J.A.,University of Mississippi Medical Center | Coffey S.F.,University of Mississippi Medical Center | Norris F.H.,National Center for Disaster Mental Health Research | Tracy M.,University of Michigan | And 2 more authors.
Violence and Victims | Year: 2010

This study sought to establish the prevalence and correlates of intimate partner violence (IPV) victimization in the 6 months before and after Hurricane Katrina. Participants were 445 married or cohabiting persons who were living in the 23 southernmost counties of Mississippi at the time of Hurricane Katrina. Data for this study were collected as part of a larger, population-based, representative study. The percentage of women reporting psychological victimization increased from 33.6% prior to Hurricane Katrina to 45.2% following Hurricane Katrina (p <.001). The percentage of men reporting psychological victimization increased from 36.7% to 43.1% (p =.01). Reports of physical victimization increased from 4.2% to 8.3% for women (p =.01) but were unchanged for men. Significant predictors of post-Katrina victimization included pre-Katrina victimization, age, educational attainment, marital status, and hurricane-related stressors. Reports of IPV were associated with greater risk of post-Katrina depression and posttraumatic stress disorder. Data from the first population-based study to document IPV following a large-scale natural disaster suggest that IPV may be an important but often overlooked public health concern following disasters. © 2010 Springer Publishing Company.


Norris F.H.,National Center for Disaster Mental Health Research | Sherrieb K.,National Center for Disaster Mental Health Research | Galea S.,National United University
Rehabilitation Psychology | Year: 2010

Objective: To explore the extent to which disasters may be a source of injury and disability in community populations, we examined the prevalence and short-term consequences of disaster-related illness and injury for distress, disability, and perceived needs for care. Design: A random population survey was conducted 2-6 months after Hurricane Ike struck Galveston Bay on September 13, 2008. Participants: The sample was composed of 658 adults representative of Galveston and Chambers Counties, Texas. Results: The prevalences of personal injury (4%) and household illness (16%) indicated that approximately 7,700 adults in the two-county area were injured, and another 31,500 adults experienced household-level illness. Risk for injury/illness increased with area damage and decreased with evacuation. In bivariate tests, injury or illness or both were related to all outcome measures. In multivariate analyses that controlled for co-occurring stressors representing trauma, loss, adversities, and community effects, injury or illness or both were associated with global stress, posttraumatic stress, dysfunction, days of disability, and perceived needs for care, but not with depression or anxiety. Conclusions: The associations of injury with distress and disability suggest that community programs should reach out to injured persons for early mental health and functional assessments and, where indicated, intervene in ways that reduce further disability and need for complex rehabilitative services. The results also point to the potential effectiveness of evacuation incentives with regard to the prevention of disaster-related injury and disability. © 2010 American Psychological Association.


Pietrzak R.H.,Yale University | Pietrzak R.H.,National Center for Disaster Mental Health Research | Galea S.,National Center for Disaster Mental Health Research | Galea S.,Columbia University | And 4 more authors.
Journal of Affective Disorders | Year: 2013

Background: Little is known about the specificity of the interaction of serotonin transporter 5-HTTLPR genotype x trauma exposure in relation to contemporary structural models of PTSD symptomatology, which suggest that 4- or 5-factor models provide a better representation of the phenotypic expression of this disorder. Methods: One hundred forty-nine respondents of a representative sample of adults affected by Hurricane Ike were interviewed 2-5 months after this 2008 disaster. Results: After adjustment for age, sex, and ancestral proportion scores, the interaction of 5-HTTPLR genotype x trauma exposure was significantly associated with both severity (β=.40, p<.001) and probable diagnosis (Wald=4.55, p=.033; odds ratio=3.81, 95% CI=1.11-13.03) of Ike-related PTSD. Respondents with the low-expression variant of the 5-HTTPLR polymorphism (S allele carriers) who were highly exposed to Hurricane Ike reported significantly greater severity of PTSD symptoms and were more likely to screen positive for PTSD than respondents homozygous for the L allele who were highly exposed to Hurricane Ike. Confirmatory factor analyses revealed that a 5-factor model of intercorrelated re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms provided the best structural representation of PTSD symptomatology. The 5-HTTPLR genotype x exposure interaction was significant only for anxious arousal (β=.44, p<.001) and re-experiencing (β=.35, p<.001) symptoms, but not avoidance, numbing, or dysphoric arousal symptoms (all βs≤.20, all ps>.13). Limitations: The small sample size and employment of self-report measures may limit generalizability of these findings. Conclusions: Results of this pilot study suggest that the low-expression variant of the 5-HTTLPR polymorphism modifies risk for PTSD, but that this effect may be specific to anxious arousal and re-experiencing symptoms.


Pietrzak R.H.,Yale University | Pietrzak R.H.,National Center for Disaster Mental Health Research | Southwick S.M.,Yale University | Southwick S.M.,National Center for Disaster Mental Health Research | And 5 more authors.
Journal of Affective Disorders | Year: 2012

Objective: To examine the prevalence and correlates of disaster-related posttraumatic stress disorder (PTSD), depression, and needs for psychological care in older persons affected by Hurricane Ike. Method: A total of 193 adults aged 60 or older who resided in the Galveston Bay area were interviewed 2-5 months following Hurricane Ike. Pre-, peri-, and post-disaster variables hypothesized to be related to PTSD and depressive symptoms, and perceived needs for psychological care were assessed. Results: Weighted prevalences of past-month Ike-related PTSD and depression were 7.6% and 8.6%, respectively. Risk factors for Ike-related PTSD symptoms were predominantly peri-disaster in nature, with greater hurricane exposure, and peri-event dissociative and autonomic activation symptoms associated positively with these symptoms. Risk factors for depressive symptoms were predominantly pre-disaster in nature, with being married/living with partner associated negatively, and prior disaster exposure and pre-disaster PTSD or depression associated positively with these symptoms. 27.2% of the sample endorsed at least one of the perceived needs for psychological care assessed. A history of PTSD or depression, greater peri-event autonomic activation, and Ike-related PTSD and depressive symptoms were associated with greater need for psychological care. Limitations: This study is limited by its cross-sectional design and employment of psychiatric screening instruments. Conclusions: A substantial proportion of older adults may have PTSD and depression, as well as perceived needs for psychological care, after a disaster. Assessment of disaster exposures, and peri-event dissociative and autonomic symptoms may help identify older adults at risk for disaster-related psychopathology. Older adults with a history of PTSD or depression, and greater peri-event autonomic activation and PTSD symptoms may be more likely to have needs for psychological care. © 2011 Elsevier B.V. All rights reserved.


Pietrzak R.H.,Yale University | Pietrzak R.H.,National Center for Disaster Mental Health Research | Van Ness P.H.,Yale University | Fried T.R.,Yale University | And 4 more authors.
International Psychogeriatrics | Year: 2012

Background: Little research has examined the diagnostic utility and factor structure of commonly used posttraumatic stress disorder (PTSD) assessment instruments in older persons. Methods: A total of 206 adults aged 60 or older (mean age = 69 years; range = 60-92), who resided in the Galveston Bay area when Hurricane Ike struck in September 2008, completed a computer-assisted telephone interview two-five months after this disaster. Using the PTSD Checklist (PCL), PTSD symptoms were assessed related both to this disaster and to participants' worst lifetime traumatic event. Total PCL scores were compared to PCL-based, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)-derived probable diagnoses of PTSD to determine optimal cut scores. Confirmatory factor analyses (CFAs) were conducted to evaluate PTSD symptom structure. Results: Receiver operating characteristic analyses indicated that a PCL score of 39 achieved optimal sensitivity and specificity in assessing a PCL-based, algorithm-derived DSM-IV diagnosis of worst event-related PTSD; and that a score of 37 optimally assessed probable Ike-related PTSD. CFAs revealed that a recently proposed five-factor model - comprised of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal factors-provided a better fitting representation of both worst event- and disaster-related PTSD symptoms than alternative models. Current Ike-related anxious arousal symptoms demonstrated a significantly stronger association with current generalized anxiety than depressive symptoms, thereby supporting the construct validity of this five-factor model of PTSD symptomatology. Conclusions: A PCL score of 37 to 39 may help identify probable PTSD in older persons. The expression of PTSD symptoms in older adults may be best characterized by a recently proposed five-factor model with distinct dysphoric arousal and anxious arousal clusters. © Copyright International Psychogeriatric Association 2012.


Pfefferbaum R.L.,Phoenix Community College | Pfefferbaum R.L.,The University of Oklahoma Health Sciences Center | Neas B.R.,The University of Oklahoma Health Sciences Center | Pfefferbaum B.,The University of Oklahoma Health Sciences Center | And 3 more authors.
International Journal of Emergency Mental Health | Year: 2013

While building community resilience to disasters is becoming an important strategy in emergency management, this is a new field of research with few available instruments for assessing community resilience. This article describes the development of the Communities Advancing Resilience Toolkit (CART) survey instrument. CART is a community intervention designed to enhance community resilience to disasters, in part, by engaging communities in measuring it. The survey instrument, originally based on community capacity and related literature and on key informant input, was refined through a series of four field tests. Community organizations worked with researchers in a participatory action process that provided access to samples and helped to guide the research. Exploratory factor analysis performed after each field test led to the identification of four interrelated constructs (also called domains) which represent the foundation for CART: Connection and Caring, Resources, Transformative Potential, and Disaster Management. This model was confirmed using confirmatory factor analysis on two community samples. The CART survey can provide data for organizations and communities interested in assessing a community's resilience to disasters. Baseline data, preferably collected pre disaster, can be compared to data collected post disaster and/or post intervention. © 2013 Chevron.

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