ArticleLiterature Review

Mental health challenges and experiences in displaced populations following Hurricane Sandy and Hurricane Harvey: The need for more comprehensive interventions in temporary shelters

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Abstract

Hurricane exposure can have a profound impact on mental health, leading to increased symptoms of stress, anxiety, depression and post-traumatic stress disorder that are still present years after the storm. Those displaced following a hurricane are particularly vulnerable to adverse mental health outcomes, especially if displaced to temporary shelters. The current work highlights the experiences and mental health challenges of displaced populations following Hurricane Sandy and Hurricane Harvey, as well as describing barriers to conducting research in the immediate aftermath of Hurricane Harvey and the need for more comprehensive interventions in these vulnerable populations.

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... Numerous studies indicated that hurricane exposure has a profound impact on mental health, and those displaced to temporary shelters are particularly vulnerable to adverse longer-term mental health outcomes Taioli et al., 2018). The devastating impact of displacement in the aftermath of a hurricane is especially critical among low and middle-income countries, where public health resources are particularly scarce. ...
... Both traumatic experiences during a disaster and the stressful conditions generated by the postdisaster environment have been associated with several health and mental health outcomes. Previ-ous hurricane studies showed that increased symptoms of stress, anxiety, depression (McGuire et al., 2018;Schwartz et al., 2018;Schwartz et al., 2015), and posttraumatic stress disorder (PTSD) were still reported by survivors years after exposure to hurricane (Cerdá et al., 2013;Taioli et al., 2018). Mordeno and colleagues (2017) found that, in their sample, 45.9% (N ϭ 664) Filipino university students exposed to Typhoon Haiyan met the criteria for PTSD. ...
... COR (Hobfoll, 2001) theory points to a need to prioritize intervention on replenishing resources basic to survival as a key approach to attenuating psychological distress arising from postdisaster resource loss (Freedy, Shaw, Jarrell, & Masters, 1992;Wadsworth, Santiago, & Einhorn, 2009). Having on-site mental health support services and crisis management located within temporary shelters, or increasing access to such services for postdisaster survivors in these shelters, would be of particular importance (e.g., Taioli et al., 2018). Efforts should also be made to improve the temporary shelters themselves, such as increased security and availability to medical care, so as to mitigate the potential negative impact of displacement frequency on survivors' subjective health and stress. ...
Article
Displacement from one's home after a natural disaster results not only in physical separation from significant others but also in profound disruptions of psychological and social resources such as community support and sense of belonging. Frequent displacement can exacerbate health and mental health problems brought by the disaster, especially among lower-income families in resource-scarce regions. Objective: The present study examined the association among frequency of displacement after the disaster, health status, and psychological adjustments among survivors four years after the 2013 Super Typhoon Haiyan in the Philippines. Method: The study surveyed 345 typhoon survivors using randomized cluster samples in 13 towns in Eastern Philippines and assessed their physical and mental health status. Result: Path analysis revealed that, after controlling for age, gender, and traumatic exposure severity, frequency of displacement was a significant predictor for subjective health ratings and stress but not for posttraumatic stress symptoms, depression, and anxiety. Conclusion: These findings underscore the detrimental impact of long-term displacement on health outcomes following a disaster, especially in countries where public health resources are largely unavailable. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Shaw was the first to observe a link between overcrowding and various health outcomes (Shaw 2004) and all the shelter guidelines since have adopted minimum standards for shelter space per person (Sphere Project 2018). Taioli (Taioli et al. 2018) reported that chaotic and poorly organised shelter were perceived as more traumatic by households. Participants identified in overcrowded and uncomfortable shelter a determinant of both physical and mental health. ...
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There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants’ health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters’ internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches.
... In our study, adults commonly reported experiencing symptoms of anxiety and depression. Previous studies have shown flood and hurricane victims commonly suffer from acute and long-term mental health effects [17,18]. Research has shown socioeconomic and psychological stress is common and disproportionately affects women, children, adolescents, and the elderly who are dependent on care-giving or have special needs [19,20]. ...
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In the aftermath of Hurricane Harvey in 2017, thousands of residents in the Houston area sought refuge at a convention center “megashelter”. Out of concern for the possibility of communicable diseases spreading rapidly in the crowded shelter, we conducted syndromic surveillance to monitor the health of evacuees using a digital drop-in cot-survey. The cot-to-cot survey design rapidly assessed evacuees to determine if they were experiencing any symptoms of illness each night from 1–7 September 2017. While no outbreak of a specific infection was identified during the surveillance period, runny nose, congestion, cough, achy muscles and joints, anxiety, and depression were the most commonly reported symptoms. Out of the total shelter population, 38% of adults reported symptoms compared to 25% of children (≤18 years). The cot survey took a median of 5.2 min per interview, and the daily participation rate increased throughout the surveillance period starting at 89% and ending at 96% on the last day. The success of this public health response was due, in part, to the effectiveness of survey design and the dissemination of real-time data to the health departments. Digital cot surveys can improve emergency response sustainability, interoperability among emergency responders, and improve evacuee participation.
... Another vulnerability factor that has been largely overlooked until now is that environmental factors can worsen health outcomes for people with preexisting mental illness. For example, extreme heat can increase the risk of disease and death for people with mental illness, people with health comorbidities, or those moved to temporary shelters (Taioli et al. 2018) ...
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Background: To date, health-effects research on environmental stressors has rarely focused on behavioral and mental health outcomes. That lack of research is beginning to change. Science and policy experts in the environmental and behavioral health sciences are coming together to explore converging evidence on the relationship-harmful or beneficial-between environmental factors and mental health. Objectives: To organize evidence and catalyze new findings, the National Academy of Sciences, Engineering, and Medicine (NASEM) hosted a workshop 2-3 February 2021 on the interplay of environmental exposures and mental health outcomes. Methods: This commentary provides a nonsystematic, expert-guided conceptual review and interdisciplinary perspective on the convergence of environmental and mental health, drawing from hypotheses, findings, and research gaps presented and discussed at the workshop. Featured is an overview of what is known about the intersection of the environment and mental health, focusing on the effects of neurotoxic pollutants, threats related to climate change, and the importance of health promoting environments, such as urban green spaces. Discussion: We describe what can be gained by bridging environmental and psychological research disciplines and present a synthesis of what is needed to advance interdisciplinary investigations. We also consider the implications of the current evidence for a) foundational knowledge of the etiology of mental health and illness, b) toxicant policy and regulation, c) definitions of climate adaptation and community resilience, d) interventions targeting marginalized communities, and e) the future of research training and funding. We include a call to action for environmental and mental health researchers, focusing on the environmental contributions to mental health to unlock primary prevention strategies at the population level and open equitable paths for preventing mental disorders and achieving optimal mental health for all. https://doi.org/10.1289/EHP9889.
... Studies have established that disaster-induced displacement has a negative impact on mental health, especially in the short to medium term ( (Munro et al., 2017;Shuhei Nomura et al., 2016;North & Pfefferbaum, 2013;Taioli et al., 2018;Uscher-Pines, 2009;Vernberg et al., 2008). ...
Article
Formulating disaster responses that mitigate social inequalities is crucial because disasters disproportionately harm marginalized communities. This study seeks to inform more equitable post-disaster policies by examining how post-disaster residential outcomes relate to subsequent income and health outcomes among a sample of Hurricane Katrina survivors. Analyzing pre-hurricane survey data, three waves of survey data over 12–15 years post-disaster for 385 low-income women, as well as qualitative data from a subset of participants, we show that durable residence in counties previously shown to promote greater intergenerational socioeconomic advancement predicts higher income, but not better mental or self-rated health. Statistical control for prospectively collected, pre-disaster confounders, coupled with qualitative insights, suggest causal relationships between county-level opportunity and income. We further find that persistence in high opportunity counties was driven by family obligations, relationship changes, or access to job opportunities, not differences in individual priorities. Disaster policy should better support displaced survivors’ ability to access high opportunity areas.
... A few studies highlight the short-and long-term mental health effects of Hurricane Harvey, and this remains an important and active research area. 11,20,24,25 With such a high rate of toxicological emergencies and physical trauma in our study population, it is highly likely that many of those patients would also be at risk for anxiety, post-traumatic stress disorder, depression, and other mental health conditions that may not have been diagnosed in the ED or UCC setting. 11,20,24,26,27 Furthermore, although this study includes over 38,000 patient encounters, it is limited to one hospital network and does not include patients who may have sought care in other facilities or may not have had access to care. ...
Article
Introduction: Natural disasters are increasingly common and devastating. It is essential to understand children's health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness. Methods: This was a retrospective cross-sectional study of patients seen at pediatric emergency departments (ED) and urgent care centers (UCC) 30 days before (late summer) and after (early fall) the hurricane and from the same time period in 2016. We collected demographic information and the first five discharge diagnoses from a network of EDs and UCCs affiliated with a quaternary care children's hospital in Houston, Texas. We calculated the odds of disease outcomes during various timeframes using binary logistic regression modeling. Results: There were 20,571 (median age: 3.5 years, 48.1% female) and 18,943 (median age: 3.5 years, 47.3% female) patients in 2016 and 2017, respectively. Inpatient admission rates from the ED a month after Harvey were 20.5%, compared to 25.3% in the same period in 2016 (P<0.001). In both years, asthma and other respiratory illnesses increased from late summer to early fall. After controlling for these seasonal trends, the following diseases were more commonly seen after the hurricane: toxicological emergencies (adjusted odds ratio [aOR]: 2.61, 95% [confidence interval] CI, 1.35-5.05); trauma (aOR: 1.42, 95% CI, 1.32-1.53); and dermatological complaints (aOR: 1.34, 95% CI, 1.23-1.46). Conclusion: We observed increases in rashes, trauma, and toxicological diagnoses in children after a major flood. These findings highlight the need for more medication resources and public health and education measures focused on pediatric disaster preparedness and management.
... Throughout the Houston metropolitan area, over 70 fatalities were reported (Sebastian et al., 2017). While much is known about the immediate effects of the hurricane on displacement and short-term morbidity (Norris et al., 2010;Taioli et al., 2018), our understanding of the long-term mental health consequences of Hurricane Harvey remains limited. ...
Article
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Background. Although the literature has reported increases in the prevalence of mental distress after natural disasters, less is known about the role the environment may play in mitigating posttraumatic stress disorder (PTSD) in hurricane-impacted communities. Aim. This study aims to investigate the extent to which concentration and perceived quality of neighborhood greenness are associated with lower levels of PTSD and investigate the potential mechanisms through which this effect occurs. Methods. We conducted a cross-sectional survey of individuals (N=272) from 30 Houston neighborhoods that endured severe loss during Hurricane Harvey. Perceived quality of neighborhood green space was measured using a scale adapted from the Neighborhood Open Space (NOS) scale, and concentration of greenness was objectively measured using normalized difference vegetation index (NDVI). Probable PTSD was measured using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and hurricane-related distress was measured using the Impact of Event Scale (IES-R). We used generalized linear mixed models to fit the outcomes and structural equation models to test the direct and indirect pathways. Models adjusted for neighborhood and individual level confounders. Results. Results showed that greater perceived quality of neighborhood green space was significantly associated with a lower likelihood of probable PTSD and hurricane-related distress. Higher levels of emotional resilience mediated the effects of perceived quality of green space on hurricane-related distress. Social cohesion, although significantly correlated with PTSD and distress, did not mediate the effect of perceived quality of greenness on PTSD or distress. Unlike perceived quality of green space, neighborhood NDVI was significantly associated with hurricane-related distress, but not with PTSD. Conclusion Living in neighborhoods with greater perceived quality of green space is associated with lower levels of post-hurricane distress, especially through the emotional resilience pathway. These findings suggest more attention should be paid to the benefits of neighborhood green infrastructure in the disaster recovery policy framework.
... Psychische Folgen individueller lebensbedrohlicher Situationen sind vorbeschrieben [37,43]. Ebenso sind psychische Erkrankungen als Folge kollektiver und globaler Bedrohungen bekannt -z.B. bei Naturkatastrophen [33], im Krieg [16] oder auf der Flucht [18]. In dieser aktuellen Pandemie werden weltweit vermehrt psychische Erkrankungen beobachtet. ...
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Background The outbreak of the COVID-19 disease and the rapid spread of the inducing coronavirus SARS-CoV‑2 threatens not only people’s physical health but also their mental health. Its influence on incidence and course of existing illnesses in the psychiatric outpatient sector in Germany is still unknown.Methods The medical reports of 682 persons in psychiatric treatment were retrospectively investigated, regarding their subjective response to this pandemic and its clinical relevance.ResultsOf the patients 60.5% (n = 378) experienced greater psychological stress, 14.5% (n = 99) reported fear of the SARS-CoV‑2 and the possible danger of infection, 25.5% (n = 174) reported fear resulting from the protective measures taken (lock down) and 4.3% (n = 29) reported fear of both. This differed significantly across diagnoses: people with anxiety disorders reported significantly greater stress as well as greater fear of the virus, whereas people with psychoses were significantly less affected than the other patients. Of the participants 43.7% (n = 132) were so strongly affected that acute treatment had to be implemented and 6.0% (n = 18) had to be referred to inpatient care.DiscussionPeople with mental illnesses are particularly vulnerable to the psychological strain of the COVID-19 pandemic. Long-term studies on the further course of disease will be necessary. Additional studies that test interventions to build resilience in this population will also be needed.
... China's extended eastern coastline is affected by tropical cyclones, which can cause injury and death, infectious diseases, and negative mental health effects. [19][20][21][22][23][24] Unique to the Chinese Lancet Countdown report, this indicator tracks cyclone exposure and damage, with the use of national data. 25,26 The tropical cyclones are described in terms of frequency, intensity, and spatial-temporal distribution at the provincial level. ...
... China's extended eastern coastline is affected by tropical cyclones, which can cause injury and death, infectious diseases, and negative mental health effects. [19][20][21][22][23][24] Unique to the Chinese Lancet Countdown report, this indicator tracks cyclone exposure and damage, with the use of national data. 25,26 The tropical cyclones are described in terms of frequency, intensity, and spatial-temporal distribution at the provincial level. ...
... 20 Another study found that many persons who relocated to shelters after Harvey had high levels of anxiety as a result. 21 A survey of 41 persons in the Houston MSA found that hurricane exposure and property damage were associated with increased symptoms of PTS. 22 Although these studies identified health effects resulting from Harvey, they were not based on representative, population-based samples but instead were based on convenience samples. ...
Article
Objectives Although research shows that public health is substantially affected during and after disasters, few studies have examined the health effects of Hurricane Harvey, which made landfall on the Texas coast in August 2017. We assessed disparities in physical health, mental health, and health care access after Hurricane Harvey among residents of the Houston–The Woodlands–Sugar Land, Texas, metropolitan statistical area (ie, Houston MSA). Methods We used structured survey data collected through telephone and online surveys from a population-based random sample of Houston MSA residents (n = 403) collected from November 29, 2017, through January 6, 2018. We used descriptive statistics to describe the prevalence of physical health/mental health and health care access outcomes and multivariable generalized linear models to assess disparities (eg, based on race/ethnicity, socioeconomic status, disability) in health outcomes. Results Physical health problems disproportionately affected persons who did not evacuate (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.19-0.87). Non-Hispanic black persons were more likely than non-Hispanic white persons to have posttraumatic stress (OR = 5.03; 95% CI, 1.90-13.10), as were persons in households that experienced job loss post-Harvey (vs did not experience job loss post-Harvey; OR = 2.89; 95% CI, 1.14-7.32) and older persons (OR = 1.04; 95% CI, 1.01-1.06). Health care access was constrained for persons whose households lost jobs post-Harvey (vs did not lose jobs post-Harvey; OR = 2.73; 95% CI, 1.29-5.78) and for persons with disabilities (vs without disabilities; OR = 3.19; 95% CI, 1.37-7.45). Conclusions Our findings underscore the need to plan for and ameliorate public health disparities resulting from climate change–related disasters, which are expected to occur with increased frequency and magnitude.
... We have previously published that Hurricane Sandy and Hurricane Harvey exposures have long-term mental health consequences, particularly among populations who are most vulnerable, such as those with preexisting mental health conditions [15,16]. Here, those with existing mental health conditions prior to the hurricane were more frequently living in lower-income areas, where the most flooding extent occurred. ...
Article
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Disparities exist in post-disaster flooding exposure and vulnerable populations bear a disproportionate impact of this exposure. We describe the unequal burden of flooding in a cohort of New York residents following Hurricane Sandy and assess whether the likelihood of flooding was distributed equally according to socioeconomic demographics, and whether this likelihood differed when analyzing self-reported or FEMA flood exposure measures. Residents of New York City and Long Island completed a self-administered survey 1.5–4.0 years after the storm. Multivariable logistic regressions were performed to determine the relationship between sociodemographic characteristics and flood exposure. Participants (n = 1231) residing in areas of the lowest two quartiles of median household income experienced flooding the most often (FEMA/self-reported:
... We then examined the association of Veillonella spp. with other top hurricane-related stressors, including drinking water insecurity and displacement (17,30). As shown in Supplemental Figure 3 A (online), the relative abundance of Veillonella spp. is not associated with prenatal drinking water security. ...
Article
Hurricane Maria struck Puerto Rico on 20 September 2017 causing catastrophic devastation. Prolonged shortage of food had been a substantial challenge to the residents after Maria. Experiencing food insecurity in utero has been associated with negative health outcomes later in life. We aim to examine whether there is any alteration in the infant gut microbiome that is associated with prenatal food insecurity. We established a cohort of infants aged 2–6 months who were exposed in utero to Hurricane Maria near San Juan, Puerto Rico and examined the gut microbiota (n = 29) using 16S ribosomal RNA gene sequencing. Among the enrolled infants, 30% of their mothers experienced “post-Maria poor access to food” for at least 1 month during pregnancy. The relative abundance of gut Veillonella spp. is significantly decreased among infants who experienced prenatal food insecurity, compared to those who did not (adjusted p = 0.025). There is no significant difference observed by prenatal food insecurity at the microbial community level in this cohort. Our finding indicated that infants who experienced prenatal food insecurity post hurricane harbor microbial alternations of specific bacterial taxa, which may further influence the microbial maturation and place the individual at a high-risk health trajectory. We identified that in utero exposure to food insecurity post Hurricane Maria is associated with decreased abundance of Veillonella in the infant gut. Our findings indicated that infants who experienced prenatal food insecurity post hurricane may harbor alterations of specific bacterial taxa in their gut microbiota. This study showed the association between prenatal adverse exposure and alterations of gut microbiome early in life in the context of an extreme event. This study provided insights into the mechanisms underlying prenatal adverse exposure and increased disease risks later in life. Our findings will potentially raise awareness of the negative impact of extreme climate events on the unborn.
... Displacement to shelters often results in separation from social support networks and creates a disruption in normal psychological processes, particularly familiarity, attachment and identity, and decrease in perceived social support in the months following the hurricane, which in turn has been shown to be associated with increased symptoms of general psychological distress. Being moved from one shelter to another is traumatic, compounded by the limited amount of healthcare services (91). ...
Article
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Background Climate change is one of the great challenges of our time. The consequences of climate change on exposed biological subjects, as well as on vulnerable societies, are a concern for the entire scientific community. Rising temperatures, heat waves, floods, tornadoes, hurricanes, droughts, fires, loss of forest, and glaciers, along with disappearance of rivers and desertification, can directly and indirectly cause human pathologies that are physical and mental. However, there is a clear lack in psychiatric studies on mental disorders linked to climate change.Methods Literature available on PubMed, EMBASE, and Cochrane library until end of June 2019 were reviewed. The total number of articles and association reports was 445. From these, 163 were selected. We looked for the association between classical psychiatric disorders such as anxiety schizophrenia, mood disorder and depression, suicide, aggressive behaviors, despair for the loss of usual landscape, and phenomena related to climate change and extreme weather. Review of literature was then divided into specific areas: the course of change in mental health, temperature, water, air pollution, drought, as well as the exposure of certain groups and critical psychological adaptations.ResultsClimate change has an impact on a large part of the population, in different geographical areas and with different types of threats to public health. However, the delay in studies on climate change and mental health consequences is an important aspect. Lack of literature is perhaps due to the complexity and novelty of this issue. It has been shown that climate change acts on mental health with different timing. The phenomenology of the effects of climate change differs greatly—some mental disorders are common and others more specific in relation to atypical climatic conditions. Moreover, climate change also affects different population groups who are directly exposed and more vulnerable in their geographical conditions, as well as a lack of access to resources, information, and protection. Perhaps it is also worth underlining that in some papers the connection between climatic events and mental disorders was described through the introduction of new terms, coined only recently: ecoanxiety, ecoguilt, ecopsychology, ecological grief, solastalgia, biospheric concern, etc.Conclusions The effects of climate change can be direct or indirect, short-term or long-term. Acute events can act through mechanisms similar to that of traumatic stress, leading to well-understood psychopathological patterns. In addition, the consequences of exposure to extreme or prolonged weather-related events can also be delayed, encompassing disorders such as posttraumatic stress, or even transmitted to later generations.
... Preliminary data have been published on the acute mental health impacts of Hurricane Harvey. 26,27 However, this report builds on the existing literature by assessing longer term psychological health at 5 months post-hurricane. The current study aims to assess whether increased negative experiences due to Hurricane Harvey are associated with increased symptoms of PTSD, perceived stress, anxiety, and depression within the context of a highly diverse and geographically unique setting. ...
Article
Objective Hurricane Harvey made landfall on August 25, 2017 and resulted in widespread flooding in Houston and the surrounding areas. This study aimed to explore the associations between exposure to Hurricane Harvey and various mental health symptoms. Methods Self-reported demographics, hurricane exposure, and mental health symptomatology were obtained from residents of the greater Houston area through convenience sampling for a pilot study, 5 months after the storm from January 25-29, 2018 (N = 161). Results Increased hurricane exposure score was significantly associated with increased odds for probable depression, probable anxiety, and probable posttraumatic stress disorder after adjusting for other factors associated with mental health. No significant associations were found between demographic characteristics and risk of mental health difficulties. Conclusions Mental health difficulties associated with exposure to Hurricane Harvey were still present 5 months after the storm. Future disaster response programs should focus on providing long-term mental health services to hurricane survivors.
... The impact of natural disasters on the mental health of victims has been researched over the past two decades (11), with studies examining mental health impacts on survivors of disasters like Hurricane Katrina in 2005, Hurricane Sandy in 2012, the Fukushima nuclear disaster in 2011, and the terror attack on the World Trade Center in 2001. Extensive findings from these, and other natural disasters, suggest that a proportion of survivors will continue to have mental health issues for an extended period of time following the disaster, and sometimes for the rest of their lives (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). ...
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Objectives: To assess prevalence of likely posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in patients attending the only out-of-hours primary care clinic in Fort McMurray some 18 months following a major fire. Methods: A quantitative cross-sectional survey was used to collect data through self-administered paper-based questionnaires to determine likely PTSD, MDD, and GAD using the PTSD Checklists for Diagnostic and Statistical Manual (DSM) 5, Patient Health Questionnaire (PHQ) 9, and GAD-7, respectively, from residents of Fort McMurray who were impacted by the wildfires. This was carried out eighteen (18) months after a major wildfire, which required the rapid evacuation of the entire city population (approximately 90,000 individuals). Results: We achieved a response rate of 48% and results from the 290 respondents showed the 1 month prevalence rate for likely PTSD was 13.6%, likely MDD was 24.8%, and likely GAD was 18.0%. Compared to self-reported prevalence rates before the wildfire (0%, 15.2%, and 14.5% respectively), these were increased for all diagnoses. After controlling for other factors in a logistic regression model, there were statistically significant associations between individuals who had likely PTSD, MDD, and GAD diagnoses and multiple socio-demographic, clinical, and exposure-related variables as follows: PTSD: History of anxiety disorder and received counselling had odds ratios (ORs) of 5.80 and 7.14, respectively. MDD: Age, witnessed the burning of homes, history of depressive disorder, and receiving low level support from friends and family had ORs of 2.08, 2.29, 4.63, and 2.5, respectively. GAD: Fearful for their lives or the lives of friends/family, history of depressive disorder, and history of anxiety disorder had ORs of 3.52, 3.04, and 2.68, respectively. There were also associations between individuals with a likely psychiatric diagnosis and those who also had likely alcohol or drug abuse/dependence. Conclusion: Our study suggests there are high prevalence rates for mental health and addiction conditions in patients attending the out-of-hours clinic 18 months after the wildfires, with significant associations between multiple variables and likely PTSD, MDD, and GAD. Further studies are needed to explore the impact of population-based mental health interventions on the long-term mental health effects of the wildfires.
... Unlike the vast majority of other post-disaster studies which involve convenience sampling (e.g., Schwartz et al., 2018;Taioli et al., 2018;Zhang et al., 2007), our study participants were initially randomly selected using a probability-based design for a survey about social vulnerability to flood hazards in summer 2012. Our follow-up with some of the same set of respondents within 90 days of Harvey enables a pre-/post-event study design, which is uncommon to research on disasters (Horney et al., 2018). ...
Article
Most studies in the disasters literature rely on convenience sampling and ‘after only’ designs to assess impacts, which are limitations we address. Focused on Hurricane Harvey and leveraging a pre‐sol;post‐event sample of Greater Houston households (n=71), this paper establishes baselines for disaster preparedness and home structure flood hazard mitigation; reports on household‐level impacts; and examines how preparedness and mitigation relate to post‐Harvey health effects, event exposures, and recovery. 70–80% took preparedness measures. Mitigation actions varied with 6% having interior‐drainage systems and 83% having elevated indoor heatingsol;cooling components. 60% reported home damage. Half reported allergies and two‐thirds indicated some level of post‐traumatic stress. Three‐quarters worried about family memberssol;friends. Results from generalized linear models revealed that greater pre‐event mitigation was associated with fewer physical health problems and adverse experiences, lower post‐traumatic stress, and faster recovery. The pre‐sol;post‐design allowed us to discern broad benefits of home structure flood hazard mitigation for households post‐Harvey. This article is protected by copyright. All rights reserved
Article
Since the start of the pandemic, some U.S. communities have faced record storms, fires, and floods. Communities have confronted the increased challenge of curbing the spread of COVID-19 amid evacuation orders and short-term displacement that result from hazards. This raises the question of whether disasters, evacuations, and displacements have resulted in above-average infection rates during the COVID-19 pandemic. This study investigates the relationship between disaster intensity, sheltering-in-place, evacuation-related mobility, and contagion following Hurricane Zeta in Southeastern Louisiana and The Wildfires in Napa and Sonoma Counties, California, known as the Glass Fire. We draw on data from the county subdivision level and mapped and aggregated tallies of Facebook user movement from the Facebook Data for Good program’s GeoInsights Portal. We test the effects of disasters, evacuation, and shelter-in-place behaviors on COVID-19 spread using panel data models, matched panel models, and synthetic control experiments. Our findings suggest associations between disaster intensity and higher rates of COVID-19 cases. We also find that while sheltering-in-place led to decreases in the spread of COVID-19, evacuation-related mobility did not result in our hypothesized surge of cases immediately after the disasters. The findings from this study aim to inform policymakers and scholars about how to better respond to disasters during multi-crisis events, such as offering hotel accommodations to evacuees instead of mass shelters and updating intake and accommodation procedures at shelters, such as administration temperature screenings, offering hand sanitizing stations, and providing isolated areas for ill evacuees.
Article
Background Patient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients’ needs increase, whereas available resources, specifically access to care, become limited. Objective This study aims to examine patients’ health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts. Methods We explored patient portal use data from a large Greater Houston area health care system focusing on the initial week of the Hurricane Harvey disaster, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients’ immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis used logistic regression models to assess the predictive characteristics of patients using the portal during Hurricane Harvey. This study also included encounters by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (before, during, and after Hurricane Harvey). For qualitative analysis, the content of these messages was examined using the constant comparative method to identify emerging themes found within the message texts. Results Out of a total of 557,024 patients, 4079 (0.73%) sent a message during Hurricane Harvey, whereas 31,737 (5.69%) used the portal. Age, sex, race, and ethnicity were predictive factors for using the portal and sending a message during the natural disaster. We found that prior use of the patient portal increased the likelihood of portal use during Hurricane Harvey (odds ratio 13.688, 95% CI 12.929-14.491) and of sending a portal message during the disaster (odds ratio 14.172, 95% CI 11.879-16.907). Having an encounter 4 weeks before or after Hurricane Harvey was positively associated with increased use of the portal and sending a portal message. Patients with encounters during the main Hurricane Harvey week had a higher increased likelihood of portal use across all five encounter types. Qualitative themes included: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, and Hurricane Harvey–related injuries), mental health, technical difficulties, and provider constraints. Conclusions The patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first known study to include encounter data to understand portal use compared with care provisioning. Prior use was predictive of both portal use and message sending during Hurricane Harvey. These findings could inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency health care management during natural disasters.
Article
While much research investigates how social capital relates to mental health after disasters, less work employs a multi‐scalar, multi‐dimensional framework on social capital. We apply such a framework of social capital to an analysis of novel survey data of approximately 1,000 urban and rural Texans after Hurricane Harvey. On the individual level, we find that greater social support is linked to less mental health impacts, but that greater civic and organizational engagement is linked to greater mental health impacts. At the community level, we find that neither a density of bridging social capital organizations nor of bonding social capital organizations is associated with poorer mental health, although we find that greater bonding organizations are linked to negative mental health impacts for rural residents. We conclude by focusing on how individual and community social capital relationships with mental health are contingent on measurement, scale, and rural or urban location. This article is protected by copyright. All rights reserved
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Losing material possessions during flood events is emotionally distressing and may contribute to the etiology of mental illness in flood survivors. Disaster research has investigated the tangible and intangible value of material possessions lost to flooding and the psychological impact of that forced removal. While these studies treat loss as a secondary disaster stressor, there is evidence that survivors’ cognitions and behaviors towards their possessions during primary exposure to flooding may impact their wellbeing. This exploratory qualitative study aims to describe essential features of flood survivors’ lived experience of material loss caused by flooding during Hurricane Harvey. Thirty open-ended interviews with Hurricane Harvey survivors were collected from minority households in areas of Houston that saw severe residential flooding. Phenomenological and narrative approaches to qualitative inquiry were chosen to inductively reveal core emotional, sensory, and relational characteristics constituting their narrative of living through loss during Harvey. Participants’ narratives followed a three-part structure: projections about agency and the losing control, the realization of material losses, and the interpretation of that loss in the aftermath. Participants characterized their experience of loss as unfolding over time and under various material circumstances and settings. Analysis revealed a typology reflecting substantial variation in the phenomena surrounding ir experience of material loss related within narratives. Participants who evacuated experienced the reality of their loss in the abstract until returning home to recognize the extent and emotional weight of their loss. Participants who did not evacuate gave vivid descriptions of the sensory experience and emotional distress of witnessing their dispossession firsthand and of trying and failing to prevent losses as they were occurring. This qualitative inquiry into participants’ lived experiences during hurricane Harvey offers the first empirical evidence towards characterizing the impact of primary exposure to material loss on subjective wellbeing.
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Flash floods, heatwave, coldwave, droughts, strong winds and storms, etc. are few examples of extreme weather conditions. 2003 heatwaves in Western and Central Europe resulted in the death of more than 70,000 people, and 2005 Katrina hurricane was considered the costliest disaster that devastated southern USA. It caused $160 billion worth of damages to the Gulf Coast. Hurricanes Harvey, Irma and Maria combined with devastating California wildfires and other natural catastrophes to make 2017 the most expensive year (about $306 billion), on record for disasters in the USA. 2018 brought Hurricane Michael, which struck the Florida coast in October, and the Camp Fire is California’s deadliest and most destructive fire on record. The 1999 Orissa (now Odisha) cyclone in India was the strongest recorded tropical cyclone in the North Indian Ocean and among the most destructive in the region. Devastations as a result of unusual flooding in Uttarakhand in 2013, Kashmir in 2014, Kerala in 2018 and typhoon Mangkhut in Philippines in 2018 are examples of extreme weather events. Scientists assert that Europe’s death toll from weather disasters could rise 50-fold by the end of twenty-first century, with extreme heat alone causing deaths of more than 1,50,000 a year if nothing is done to curb the effects of climate change. In July 2019, Europe has been confounded by another massive heat wave that could break records again.
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Hurricane Sandy hit the eastern coast of the United States in October 2012, causing billions of dollars in damage and acute physical and mental health problems. The long-term mental health consequences of the storm and their predictors have not been studied. New York City and Long Island residents completed questionnaires regarding their initial Hurricane Sandy exposure and mental health symptoms at baseline and 1 year later (N = 130). There were statistically significant decreases in anxiety scores (mean difference = −0.33, p < 0.01) and post-traumatic stress disorder (PTSD) scores (mean difference = −1.98, p = 0.001) between baseline and follow-up. Experiencing a combination of personal and property damage was positively associated with long-term PTSD symptoms (ORadj 1.2, 95% CI [1.1–1.4]) but not with anxiety or depression. Having anxiety, depression, or PTSD at baseline was a significant predictor of persistent anxiety (ORadj 2.8 95% CI [1.1–6.8], depression (ORadj 7.4 95% CI [2.3–24.1) and PTSD (ORadj 4.1 95% CI [1.1–14.6]) at follow-up. Exposure to Hurricane Sandy has an impact on PTSD symptoms that persists over time. Given the likelihood of more frequent and intense hurricanes due to climate change, future hurricane recovery efforts must consider the long-term effects of hurricane exposure on mental health, especially on PTSD, when providing appropriate assistance and treatment.
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The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards. The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key health journal databases (Medline, Embase, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium (HMIC)) were searched via the OvidSP search engine. Search terms were identified by consulting MeSH terms. The inclusion criteria comprised articles published from January 2003 to August 2013, written in English and containing an abstract. The exclusion criteria included abstracts for conferences or dissertations, book chapters and articles written in a language other than English. A total of 70 articles which fulfilled the inclusion criteria were included in this systematic review. All relevant information was collated regarding medication loss, prescription loss and refills, and medical aids loss which indicated a significant burden on the medical relief teams. Data also showed the difficulty in filling prescriptions due to lack of information from the evacuees. People with chronic conditions are most at risk when their medication is not available. This systematic review also showed that medical aids such as eye glasses, hearing aids as well as dental treatment are a high necessity among evacuees. This systematic review revealed that a considerable number of patients lose their medication during evacuation, many lose essential medical aids such as insulin pens and many do not bring prescriptions with them when evacuated.. Since medication loss is partly a responsibility of evacuees, understanding the impact of medication loss may lead to raising awareness and better preparations among the patients and health care professionals. People who are not prepared could have worse outcomes and many risk dying when their medication is not available.
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Communications infrastructure is critical to managing the complex, dynamic operations that evolve in disaster environments. The impact of Hurricane Katrina destroyed the communications infrastructure within the New Orleans metro- politan region, leaving emergency response personnel and the public with little capacity to exchange information vital for coordinating response actions. The loss of communications proved especially damaging, given the size of the geo- graphic region and the number of people affected. The authors used content analysis of news reports to identify the network of organizations that emerged in response to Hurricane Katrina, and network analysis to examine patterns of interaction among the organizations. The patterns reveal significant asymmetry in information among organizations at different levels of authority and responsi- bility in the disaster response system, a condition that contributed to the collapse of coordination in disaster operations. Conversely, well-designed communica- tions and information infrastructure can contribute significantly to the resilience of communities exposed to recurring risk.
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Background: Depression is a common and potentially debilitating consequence of traumatic events. Mass traumatic events cause wide-ranging disruptions to community characteristics, influencing the population risk of depression. In the aftermath of such events, population displacement is common. Stressors associated with displacement may increase risk of depression directly. Indirectly, persons who are displaced may experience erosion in social cohesion, further exacerbating their risk for depression. Methods: Using data from a population-based cross-sectional survey of adults living in the 23 southernmost counties of Mississippi (N = 708), we modeled the independent and joint relations of displacement and county-level social cohesion with depression 18-24 months after Hurricane Katrina. Results: After adjustment for individual- and county-level socio-demographic characteristics and county-level hurricane exposure, joint exposure to both displacement and low social cohesion was associated with substantially higher log-odds of depression (b = 1.34 [0.86-1.83]). Associations were much weaker for exposure only to low social cohesion (b = 0.28 [-0.35-0.90]) or only to displacement (b = 0.04 [-0.80-0.88]). The associations were robust to additional adjustment for individually perceived social cohesion and social support. Conclusion: Addressing the multiple, simultaneous disruptions that are a hallmark of mass traumatic events is important to identify vulnerable populations and understand the psychological ramifications of these events.
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On October 22, 2012, a late-season tropical system was named Sandy by the US National Hurricane Center. The system meandered for several days in warm Caribbean waters, intensifying slowly, gaining forward momentum, and passing directly over Jamaica, eastern Cuba, and the Bahamas. Sandy’s outer rain bands deluged Haiti’s deforested terrain, triggering severe floods and mudslides. Although Sandy was a minimal hurricane, millions were affected across 5 Caribbean nations and Puerto Rico, 100 persons were killed or reported missing, and thousands of homes were damaged. Estimated economic losses ranged from $5 million in Jamaica to $2 billion in Cuba.1 What catapulted this system into a “superstorm” was a rare climate event. At mid-latitudes, Sandy interacted with a polar jet stream that steered the system toward the mid-Atlantic coastline, transforming the system into a hybrid blend of posttropical cyclone and winter storm. The system’s cloud canopy expanded to 1000 miles in diameter as circulating winds funneled ocean waves into the New Jersey shoreline, Long Island Sound, and New York Harbor, inundating portions of Staten Island and southern Manhattan. In the United States, an estimated 60 million people across 24 states experienced a range of storm effects at varying intensities, including wind, rain, flood, coastal surge, and blizzard. The effects of the storm on vulnerable and fragile infrastructure produced power outages for more than 8 million residents; flooded New York City’s subway system and East River tunnels; set off a major fire that destroyed 111 housing units in the Breezy Point section of Queens; disrupted communications; and created acute shortages of gasoline, food, and commodities. Sandy was blamed for 113 US deaths and damaged 200 000 homes. Costs have been estimated at $50 billion, second only to Hurricane Katrina as the nation’s costliest natural disaster.2,3 Over the past 2 decades, considerable research efforts have been focused on populations affected by natural disasters. A rapidly growing body of knowledge is now available to assist in estimating the potential mental health effects of Superstorm Sandy and the differential risks for specific populations and communities. The availability of data from randomized controlled trials on the efficacy of interventions for trauma-exposed populations may enable better planning and implementation of prevention strategies to mitigate the adverse mental health effects of the disaster.
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The association between ages and psychological impact of natural disasters has not been well characterized. A population-based study was conducted 15 months after the 2008 Sichuan earthquake to assess whether elderly survivors were more likely to develop posttraumatic stress disorder (PTSD) and general psychiatric morbidity. A population-based survey of 327 survivors (152 elders, 175 younger adults) was conducted in severely affected areas by the earthquake, using a multi-stage systematic sampling design. Compared with the younger adult survivors, the elderly were more likely to have symptoms of PTSD (22.5% vs. 8.0%, p = 0.001) and general psychiatric morbidity (42.0% vs. 25.4%, p = 0.003). Risk factors, such as being elderly, having been in serious danger, having lost family members, and having felt guilt concerning one's death or injury were significantly associated with developing PTSD; being elderly, having family members or friends seriously injured, and having felt guilt concerning one's death or injury were significantly associated with developing general psychiatric morbidity. Utilization of mental health services is strongly associated with the decreased risk for developing both of the symptoms. Compared with the younger adults, the elderly survivors were more likely to develop PTSD and general psychiatric morbidity. More mental health services should be distributed to the elderly and groups at particular risk, to ensure their smooth mental health reconstruction after the earthquake.
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This study examined predictors of symptom trajectories of 93 adult survivors of Hurricane Katrina who were displaced and relocated to Colorado. Survivors were interviewed within six months of the hurricane and then again six months later. Four symptom trajectories were identified for clinical levels of depression and post-traumatic stress: resilient, recovered, delayed onset, and chronic. High levels of adaptive coping and coping efficacy characterized the resilient groups and low levels of both characterized the chronic groups. The recovered groups were characterized by low levels of adaptive coping coupled with high coping efficacy, and the delayed groups were characterized by high secondary control coping in the presence of low primary control coping, though some symptom-specific differences were found for these two groups. African American (67%) participants did not differ from European American (28%) participants in terms of membership in trajectory groups, though analyses revealed that displacement stress and positive religious coping were especially relevant predictors for African American participants. The results are interpreted in light of the Conservation of Resources Theory (Hobfoll, 2001) and implications for treatment and preventive intervention are discussed.
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When catastrophic disasters such as Hurricane Katrina strike, psychologists and other mental health professionals often wonder how to use resources and fill needed roles. We argue that conducting clinical research in response to disasters is 1 important way that these professionals can contribute. However, we recognize that designing and implementing a clinical research study can be a daunting task, particularly in the context of the personal and system-wide chaos that follows most disasters. Thus, we offer a detailed description of our own experiences with conducting clinical research as part of our response to Hurricane Katrina. We describe our study design, recruitment and data collection efforts, and summarize and synthesize the lessons we have learned from this endeavor. Our hope is that others who may wish to conduct disaster-related research will learn from our mistakes and successes.
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The purpose of this article is to describe the psychological processes that are affected by geographic displacement. The literature from the fields of geography, psychology, anthropology, and psychiatry was reviewed to develop a "psychology of place" and to determine the manner in which place-related psychological processes are affected by upheaval in the environment. The psychology of place is an emerging area of research that explores the connection between individuals and their intimate environments. The psychology of place posits that individuals require a "good enough" environment in which to live. They are linked to that environment through three key psychological processes: attachment, familiarity, and identity. Place attachment, which parallels, but is distinct from, attachment to person, is a mutual caretaking bond between a person and a beloved place. Familiarity refers to the processes by which people develop detailed cognitive knowledge of their environs. Place identity is concerned with the extraction of a sense of self based on the places in which one passes one's life. Each of these psychological processes-attachment, familiarity, and place identity-is threatened by displacement, and the problems of nostalgia, disorientation, and alienation may ensue. As a result of war, decolonization, epidemics, natural disasters, and other disruptive events, millions of people are currently displaced from their homes. Protecting and restoring their mental health pose urgent problems for the mental health community.
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In this paper we synthesise past disaster research that addresses issues of race and ethnicity in the United States. Using an eight-stage typology to organise the findings, this literature review presents the results from a wide range of studies. The synthesis shows how various racial and ethnic groups perceive natural hazard risks and respond to warnings, how groups may be differentially affected, both physically and psychologically, and how disaster effects vary by race and ethnicity during the periods of emergency response, recovery and reconstruction. We show that studies have important findings, many illustrating that racial and ethnic communities in the US are more vulnerable to natural disasters, due to factors such as language, housing patterns, building construction, community isolation and cultural insensitivities. By presenting these studies together, we are able to witness patterns of racial and ethnic inequalities that may be more difficult to see or interpret in individual studies that take place in one specific time and place. We conclude the review with policy and research recommendations.
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Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.
Article
Objective: To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area. Design: Prospective, cross sectional. Setting: NYC area residents, including Queens, Staten Island, and Long Island. Participants: In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use. Main outcome measures: Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use. Results: Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted odds ratio [AOR]: 2.21, 95% CI: 1.73-2.82), depression (AOR: 1.37, 95% CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95% CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends/family versus at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95% CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95% CI: 0.30-0.92). Conclusions: Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.
Article
Objective: To evaluate the long-term psychological impact of Hurricane Sandy on New York residents. Design: Prospective, cross-sectional study. Setting: Community-based study. Participants: From October 2013 to February 2015, 669 adults in Long Island, Queens, and Staten Island completed a survey on their behavioral and psychological health, demographics, and hurricane impact (ie, exposure). Main outcome measures: Depression, anxiety, and post-traumatic stress disorder (PTSD). Results: Using multivariable logistic regression models, the relationships between Hurricane Sandy exposure and depression, anxiety, and PTSD were examined. Participants experienced an average of 3.9 exposures to Hurricane Sandy, most of which were related to property damage/loss. Probable depression was reported in 33.4 percent of participants, probable anxiety in 46 percent, and probable PTSD in 21.1 percent. Increased exposure to Hurricane Sandy was significantly associated with a greater likelihood of depression (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.04-1.14), anxiety (OR = 1.08, 95% CI: 1.03-1.13), and probable PTSD (OR = 1.32, 95% CI: 1.23-1.40), even after controlling for demographic factors known to increase susceptibility to mental health issues. Conclusions: Individuals affected by Hurricane Sandy reported high levels of mental health issues and were at an increased risk of depression, anxiety, and PTSD in the years following the storm. Recovery and prevention efforts should focus on mental health issues in affected populations.
Technical Report
After Hurricane Katrina, in the Gulf Coast region, millions of lives were impacted because of the lack of availability of transportation, shelter, food, water, drugs, etc. Hurricane Katrina raised many concerns in terms of the federal government's capability, including their operational plant and necessary coordination strategies between state and federal governments to come up with a robust response in these catastrophic incidents. It has become apparent that developing a better operational plan is needed. To improve disaster relief, better logistics planning, which also requires better forecasting methods, is needed. Further more, to increase collaboration at all levels, it is also necessary to have more reliable communication technologies and a better information technology structure which will enable better coordination between different agencies. Utilizing technologies such as geographic information systems (GIS) and real-time tracking systems will ensure that the available disaster relief stocks will be distributed fairly to everybody.
Article
The relationship between factors associated with perceived trust in hospital and medical services in the aftermath of a natural disaster is understudied. An online sample of 1000 people mainly from affected states was surveyed after Hurricane Sandy. Participants completed a survey which included disaster related questions and PTSD symptoms. Logistic regression revealed a significant association between perceived trust in hospital services to education, subjective well-being, being scared for the life of a loved one and perceived trust in emergency services. These findings may emphasis the positive association between maintaining active hospital services and mental health among the general population during crisis.
Article
The authors briefly review the deaths, injuries, and diseases attributed to hurricanes that made landfall in the United States prior to Hurricane Katrina; recent hurricane evacuation studies and their potential for reducing death, injury, and disease; information available to date about mortality, injury, and disease attributed to Hurricane Katrina; and psychological distress attributable to hurricanes. Drowning in salt water caused by storm surges has been reduced over the past thirty years, while deaths caused by fresh water (inland) flooding and wind have remained steady. Well-planned evacuations of coastal areas can reduce death and injury associated with hurricanes. Hurricane Katrina provides an example of what happens when evacuation is not handled appropriately. Preliminary data indicate that vulnerable elderly people were substantially overrepresented among the dead and that evacuees represent a population potentially predisposed to a high level of psychological distress, exacerbated by severe disaster exposure, lack of economic and social resources, and an inadequate government response.
Article
To investigate predisaster mental illness as a risk factor of poor postdisaster mental health outcomes, veterans with (n = 249) and without (n = 250) preexisting mental illness residing in the Gulf Coast during Hurricane Katrina were surveyed after Katrina and screened for posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder, and panic. Logistic regression examined the association between preexisting mental disorders and positive screens after the hurricane, adjusting for demographics and exposure to hurricane-related stressors. The odds of screening positive for any new mental disorder were 6.8 times greater for those with preexisting mental illness compared with those without preexisting mental illness. Among those with preexisting PTSD, the odds of screening positive for any new mental illness were 11.9 times greater; among those with schizophrenia, 9.1 times greater; and among those with affective disorders, 4.4 times greater. Persons with preexisting mental illnesses, particularly PTSD, should be considered a high-risk group for poor outcomes after a disaster.
Article
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.
Article
To describe a disaster recovery model focused on developing mental health services and capacity-building within a disparities-focused, community-academic participatory partnership framework. Community-based participatory, partnered training and services delivery intervention in a post-disaster setting. Post-Katrina Greater New Orleans community. More than 400 community providers from more than 70 health and social services agencies participated in the trainings. Partnered development of a training and services delivery program involving physicians, therapists, community health workers, and other clinical and non-clinical personnel to improve access and quality of care for mental health services in a post-disaster setting. Services delivery (outreach, education, screening, referral, direct treatment); training delivery; satisfaction and feedback related to training; partnered development of training products. Clinical services in the form of outreach, education, screening, referral and treatment were provided in excess of 110,000 service units. More than 400 trainees participated in training, and provided feedback that led to evolution of training curricula and training products, to meet evolving community needs over time. Participant satisfaction with training generally scored very highly. This paper describes a participatory, health-focused model of community recovery that began with addressing emerging, unmet mental health needs using a disparities-conscious partnership framework as one of the principle mechanisms for intervention. Population mental health needs were addressed by investment in infrastructure and services capacity among small and medium sized non-profit organizations working in disaster-impacted, low resource settings.
Article
Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting. A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability. More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health. Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae.
Article
Prior research has shown that losses of personal, social, and material resources resulting from traumatic events significantly contribute to psychopathology. Gains of such resources have been shown to have protective effects on posttrauma mental health. Few previous studies of resource change, however, have controlled for pretrauma mental health. The current study, which included 402 survivors of Hurricane Katrina, made use of data collected prehurricane to examine patterns of loss and gain and subsequent mental health. The loss of social support, physical health, and personal property were shown to significantly affect posthurricane psychological distress over and above the effect of prehurricane psychological functioning and disaster exposure. Gains in resources showed no effect. Implications for practice and policy were discussed.
Article
To shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters, we examined the experiences of evacuees housed in Houston area shelters 2 weeks after the hurricane. A survey was conducted September 10 through 12, 2005, with 680 randomly selected respondents who were evacuated to Houston from the Gulf Coast as a result of Hurricane Katrina. Interviews were conducted in Red Cross shelters in the greater Houston area. Many evacuees suffered physical and emotional stress during the storm and its aftermath, including going without adequate food and water. In comparison with New Orleans and Louisiana residents overall, disproportionate numbers of this group were African American, had low incomes, and had no health insurance coverage. Many had chronic health conditions and relied heavily on the New Orleans public hospital system, which was destroyed in the storm. Our results highlight the need for better plans for emergency communication and evacuation of low-income and disabled citizens in future disasters and shed light on choices facing policymakers in planning for the long-term health care needs of vulnerable populations.
Comparison of disaster logistics planning and execution for 2005 Hurricane Season
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Effectiveness of a linkage to mental health care program after Hurricane Sandy. Oral and poster presentation at the 5th Annual
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