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1.  Five Years Later: Recovery from Post Traumatic Stress and Psychological Distress Among Low-Income Mothers Affected by Hurricane Katrina 
Social science & medicine (1982)  2011;74(2):150-157.
Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, exposed area residents to trauma and extensive property loss. However, little is known about the long-run effects of the hurricane on the mental health of those who were exposed. This study documents long-run changes in mental health among a particularly vulnerable group—low income mothers—from before to after the hurricane, and identifies factors that are associated with different recovery trajectories. Longitudinal surveys of 532 low-income mothers from New Orleans were conducted approximately one year before, 7 to 19 months after, and 43 to 54 months after Hurricane Katrina. The surveys collected information on mental health, social support, earnings and hurricane experiences. We document changes in post-traumatic stress symptoms (PTSS), as measured by the Impact of Event Scale-Revised, and symptoms of psychological distress (PD), as measured by the K6 scale. We find that although PTSS has declined over time after the hurricane, it remained high 43 to 54 months later. PD also declined, but did not return to pre-hurricane levels. At both time periods, psychological distress before the hurricane, hurricane-related home damage, and exposure to traumatic events were associated with PTSS that co-occurred with PD. Hurricane-related home damage and traumatic events were associated with PTSS without PD. Home damage was an especially important predictor of chronic PTSS, with and without PD. Most hurricane stressors did not have strong associations with PD alone over the short or long run. Over the long run, higher earnings were protective against PD, and greater social support was protective against PTSS. These results indicate that mental health problems, particularly PTSS alone or in co-occurrence with PD, among Hurricane Katrina survivors remain a concern, especially for those who experienced hurricane-related trauma and had poor mental health or low socioeconomic status before the hurricane.
doi:10.1016/j.socscimed.2011.10.004
PMCID: PMC3286602  PMID: 22137245
Mental health; natural disasters; Hurricane Katrina; USA; women
2.  Resilience after Hurricane Katrina among pregnant and postpartum women 
Background
Although disaster causes distress, many disaster victims do not develop long-term psychopathology. Others report benefits after traumatic experiences (post-traumatic growth). The objective of this study was to examine demographic and hurricane-related predictors of resilience and post-traumatic growth.
Methods
222 pregnant southern Louisiana women were interviewed, and 292 postpartum women completed interviews at delivery and eight weeks later. Resilience was measured by scores lower than a non-affected population, using the Edinburgh Depression Scale and the Post-Traumatic Stress Checklist (PCL). Post-traumatic growth was measured by questions about perceived benefits of the storm. Women were asked about their experience of the hurricane, addressing danger, illness/injury, and damage. Chi-square tests and log-Poisson models were used to calculate associations and relative risks (RR) for demographics, hurricane experience, and mental health resilience and perceived benefit.
Findings
35% of pregnant and 34% of the postpartum women were resilient from depression, while 56% and 49% were resilient from post-traumatic stress disorder. Resilience was most likely among white women, older women, and women who had a partner. A greater experience of the storm, particularly injury/illness or danger, was associated with lower resilience. Experiencing damage due to the storm was associated with increased report of some perceived benefits.
Conclusions
Many pregnant and postpartum women are resilient from the mental health consequences of disaster, and perceive benefits after a traumatic experience. Certain aspects of experiencing disaster reduce resilience, but may increase perceived benefit.
doi:10.1016/j.whi.2009.10.002
PMCID: PMC2822707  PMID: 20123173
resilience; depression; postpartum; pregnancy; disaster; post-traumatic stress disorder
3.  Hurricane Katrina Experience and the Risk of Post-Traumatic Stress Disorder and Depression among Pregnant Women 
Objective
Little is known about the effects of disaster exposure and intensity on the development of mental disorders among pregnant women. The aim of this study was to examine the effect of exposure to Hurricane Katrina on mental health in pregnant women.
Design
Prospective cohort epidemiological study.
Setting
Tertiary hospitals in New Orleans and Baton Rouge, USA.
Participants
Women who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane.
Main outcome measures
Post-traumatic stress disorder (PTSD) and depression.
Results
The frequency of PTSD was higher in women with high hurricane exposure (13.8%) than women without high hurricane exposure (1.3%), with an adjusted odds ratio (aOR) of 16.8; 95 % confidence interval (CI): 2.6-106.6; after adjustment for maternal race, age, education, smoking and alcohol use, family income, parity, and other confounders. The frequency of depression was higher in women with high hurricane exposure (32.3%) than women without high hurricane exposure (12.3%), with aOR of 3.3 (1.6-7.1). Moreover, the risk of PTSD and depression increased with an increasing number of severe experiences of the hurricane.
Conclusion
Pregnant women who had severe hurricane experiences were at a significantly increased risk for PTSD and depression. This information should be useful for screening pregnant women who are at higher risk of developing mental disorders after disaster.
PMCID: PMC3501144  PMID: 20701175
Depression; disaster; Hurricane Katrina; post-traumatic stress disorder; pregnancy
4.  A Comparison of the Nursing Home Evacuation Experience between Hurricanes Katrina (2005) and Gustav (2008) 
Background
One of the tragic legacies of Hurricane Katrina was the loss of life among Louisiana (LA) nursing home (NH) residents. Katrina revealed a staggering lack of emergency preparation and understanding of how to safely evacuate frail populations. Three years later, LA braced for Hurricane Gustav, a storm heralded to rival Katrina's power. Though its magnitude of destruction ultimately paled to Katrina, the warnings and predicted path preceding Gustav yielded a process of NH evacuations similar to Katrina. The goal of this paper was to ascertain whether NH administrative directors (ADs) felt more prepared to evacuate before Gustav.
Methods
In 2006, Dosa, et. al. (JAMDA, 3/07), interviewed 20 NH ADs by qualitative telephone survey to evaluate their lessons learned from Katrina. Administrators at these 20 participating nursing homes were contacted and asked to participate in a follow-up survey to compare hurricane preparedness between 2005 and 2008. Specifically, ADs were asked if they evacuated prior to Gustav, their destination, and about logistical issues with evacuation (e.g., transportation, injuries). ADs were asked to rate their confidence with state assistance, hurricane transportation, and evacuation preparedness on a 10-point scale (10=most confident) and compare their preparedness to Katrina.
Results
Sixteen of the 20 NHs that participated in 2006 agreed to be surveyed – 11 of whom held the same position before Katrina. Unlike Katrina, when only 45% evacuated prior to the storm, all 16 NHs evacuated before Gustav. (56% to another NH and 46% to a church, gym, college, or other facility). Overall, ADs rated their confidence in preparedness for Gustav as a mean of 8.3 (range 5 to 10) – compared with a mean of 5.4 (range 3 to 8) for Katrina, a 54% improvement. Of the 11 ADs employed pre-Katrina, 73% reported improved collaboration with the state and 55% noted improved transportation. Nevertheless, seven ADs noted significant logistical problems during evacuation (mostly transportation); four noted resident injuries (two hip fractures, one traumatic fall, and one cerebrovascular accident); and two noted resident post-traumatic stress.
Conclusions
NH ADs felt more prepared to evacuate their residents for Gustav, owing partly to improved communication and collaboration with state agencies; however, significant morbidity and logistical problems remain with evacuating frail NH residents before hurricanes.
doi:10.1016/j.jamda.2009.06.010
PMCID: PMC2773652  PMID: 19883887
Hurricane Disasters; Emergency Preparedness; Evacuation
5.  Exposure to Hurricane Katrina, Post-Traumatic Stress Disorder and Birth Outcomes 
Background
Little is known about the effects of natural disasters on pregnancy outcomes. We studied mental health and birth outcomes among women exposed to Hurricane Katrina.
Methods
We collected data prospectively from a cohort of 301 women from New Orleans and Baton Rouge. Pregnant women were interviewed during pregnancy about their experiences during the hurricane, as well as whether they had experienced symptoms of post-traumatic stress disorder (PTSD) and/or depression. High hurricane exposure was defined as having three or more of the eight severe hurricane experiences, such as feeling that one's life was in danger, walking through floodwaters, or having a loved one die.
Results
The frequency of low birth weight was higher in women with high hurricane exposure (14.0%) than women without high hurricane exposure (4.7%), with an adjusted odds ratio (aOR): 3.3; 95% confidence interval (CI): 1.13−9.89; p<0.01. The frequency of preterm birth was higher in women with high hurricane exposure (14.0%) than women without high hurricane exposure (6.3%), with aOR: 2.3; 95% CI: 0.82−6.38; p>0.05. There were no significant differences in the frequency of low birth weight or preterm birth between women with PTSD or depression and women without PTSD or depression (p>0.05).
Conclusions
Women who had high hurricane exposure were at an increased risk of having low birth weight infants. Rather than a general exposure to disaster, exposure to specific severe disaster events and the intensity of the disaster experience may be better predictors of poor pregnancy outcomes. To prevent poor pregnancy outcomes during and after disasters, future disaster preparedness may need to include the planning of earlier evacuation of pregnant women to minimize their exposure to severe disaster events.
doi:10.1097/MAJ.0b013e318180f21c
PMCID: PMC2635112  PMID: 18703903
Depression; disaster; low birth weight; post-traumatic stress disorder; pregnancy
6.  Happily Ever After? Pre-and-Post Disaster Determinants of Happiness Among Survivors of Hurricane Katrina 
Journal of happiness studies  2014;16(2):427-442.
This study investigated pre- to post-disaster changes in happiness of 491 women affected by Hurricane Katrina, and identified factors that were associated with the survivors’ happiness after the storm. Participants completed surveys approximately 1 year before and 1 and 4 years after the storm. The surveys collected information on the women’s happiness, social support, household characteristics, and hurricane exposure. We found that happiness significantly decreased from pre-disaster to 1 year post-disaster but there were no significant differences in happiness between the pre-disaster and 4 years post-disaster assessments. An exception were 38 women who continued to have lower levels of happiness 4 years post-disaster than at pre-disaster. These women were more likely to be living on their own after the storm and reported consistently lower levels of perceived social support from the community both before and after the storm than the other women of the sample. Factors associated with the survivor’s happiness after the storm included exposure to hurricane stressors and losing a loved one to the hurricane. These were predictive of lower happiness 1 year post-disaster. Four years after the hurricane only exposure to hurricane stressors was predictive of lower levels of happiness. In contrast, pre-disaster happiness and post-disaster social support were protective against the negative effect of the hurricane on survivors’ happiness.
doi:10.1007/s10902-014-9516-5
PMCID: PMC4465176  PMID: 26078701
Pre-disaster; Post-disaster; Happiness; Social support; Hurricane exposure
7.  A prospective population based study of changes in alcohol use and binge drinking after a mass traumatic event* 
Drug and alcohol dependence  2010;115(1-2):1-8.
Few studies have assessed changes in alcohol use before and after a massive disaster. We investigated the contribution of exposure to traumatic events and stressors related to Hurricanes Katrina and Rita to alcohol use and binge drinking. We used data from the Panel Study of Income Dynamics collected in Mississippi, Louisiana and Alabama on adults aged 18–85 (n=439): 1) data from 1968–2005 on household income; 2) data from 2005 and 2007 on total number of drinks per year and number of days the respondent binged; and 3) data from 2007 on exposure to hurricane-related traumatic events and post-hurricane stressors. Exposure to each additional hurricane-related traumatic event was associated with 79.2 more drinks and 2.46 times higher odds of binge drinking for more days in the past year (95% CI: 1.09, 5.55), while more post-disaster stressors were associated with 16.5 more drinks and 1.23 times higher odds of binge drinking for more days in the past year (95% CI: 0.99, 1.51). Respondents who had followed a lower lifetime income trajectory and were exposed to more lifetime traumatic events experienced the highest risk of reporting increased alcohol use given exposure to hurricane-related traumatic events and post-hurricane stressors. Disaster-related traumatic events and the proliferation of post-disaster stressors may result in increased post-disaster alcohol use and abuse. Disaster-related exposures may have a particularly strong impact among individuals with a history of social and economic adversity, widening preexisting health disparities.
doi:10.1016/j.drugalcdep.2010.09.011
PMCID: PMC3039709  PMID: 20977977
disasters; traumatic events; health disparities; alcohol use
8.  Loss of Resources and Hurricane Experience as Predictors of Postpartum Depression Among Women in Southern Louisiana 
Journal of Women's Health  2010;19(5):877-884.
Abstract
Background
After a natural disaster, mental disorders often become a long-term public health concern. Previous studies under smaller-scale natural disaster conditions suggest loss of psychosocial resources is associated with psychological distress.
Methods
We examined the occurrence of depression 6 and 12 months postpartum among 208 women residing in New Orleans and Baton Rouge, Louisiana, who were pregnant during or immediately after Hurricane Katrina's landfall. Based on the Conservation of Resources (COR) theory, we explored the contribution of both tangible/financial and nontangible (psychosocial) loss of resources (LOR) on the outcome of depression, measured using the Edinburgh Postnatal Depression Scale (EPDS). We also investigated the influence on depression of individuals' hurricane experience through a Hurricane Experience Score (HES) that includes such factors as witnessing death, contact with flood waters, and injury to self or family members.
Results
Both tangible and nontangible LOR were associated with depression cross-sectionally and prospectively. Severe hurricane exposure (high HES) was also associated with depression. Regression analysis showed LOR-associated depression was explained almost entirely by nontangible rather than tangible factors. Consistent with COR theory, however, nontangible LOR explained some of the association between severe hurricane exposure and depression in our models. A similar result was seen prospectively for depression at 12 months, even controlling for depression symptoms at 6 months.
Conclusions
These results suggest the need for preventive measures aimed at preserving psychosocial resources to reduce the long-term effects of disasters.
doi:10.1089/jwh.2009.1693
PMCID: PMC2875990  PMID: 20438305
9.  Postpartum mental health after Hurricane Katrina: A cohort study 
Background
Natural disaster is often a cause of psychopathology, and women are vulnerable to post-traumatic stress disorder (PTSD) and depression. Depression is also common after a woman gives birth. However, no research has addressed postpartum women's mental health after natural disaster.
Methods
Interviews were conducted in 2006–2007 with women who had been pregnant during or shortly after Hurricane Katrina. 292 New Orleans and Baton Rouge women were interviewed at delivery and 2 months postpartum. Depression was assessed using the Edinburgh Depression Scale and PTSD using the Post-Traumatic Stress Checklist. Women were asked about their experience of the hurricane with questions addressing threat, illness, loss, and damage. Chi-square tests and log-binomial/Poisson models were used to calculate associations and relative risks (RR).
Results
Black women and women with less education were more likely to have had a serious experience of the hurricane. 18% of the sample met the criteria for depression and 13% for PTSD at two months postpartum. Feeling that one's life was in danger was associated with depression and PTSD, as were injury to a family member and severe impact on property. Overall, two or more severe experiences of the storm was associated with an increased risk for both depression (relative risk (RR) 1.77, 95% confidence interval (CI) 1.08–2.89) and PTSD (RR 3.68, 95% CI 1.80–7.52).
Conclusion
Postpartum women who experience natural disaster severely are at increased risk for mental health problems, but overall rates of depression and PTSD do not seem to be higher than in studies of the general population.
doi:10.1186/1471-2393-9-21
PMCID: PMC2702337  PMID: 19505322
10.  The Association Between Disaster-Related Experiences and Mental Health Outcomes Among Drug Using African American Hurricane Katrina Evacuees 
Community mental health journal  2010;46(6):612-620.
This article provides a detailed examination of the relationship between disaster-related experiences and mental health outcomes among a sample of drug using African American Hurricane Katrina evacuees. Face-to-face structured interviews were administered to Hurricane Katrina evacuees (n = 350) residing in voucher assisted apartment complexes in Houston, Texas (2006–2007). We use Ordinary Least Squares and logistic regression models to examine both the relevance of disaster-related experiences and the interactive relationships between disaster-related experiences and post-disaster mental health outcomes including psychological distress, severe depression, somatic symptoms, and posttraumatic stress disorder. Results indicate that disaster-related experiences including negative life changes, disaster exposure, post-disaster stressors, and resource loss, have unique, inverse relationships with mental health. While resource loss has the strongest inverse relationship with mental health, disaster exposure has a negative interactive effect on psychological distress and anxiety. Although highly vulnerable populations report low levels of mental health nearly 2 years following a disaster experience, there is a convergence in mental health outcomes with high levels of disaster experiences and disaster exposure that suggests mental resiliency.
doi:10.1007/s10597-009-9286-4
PMCID: PMC2919598  PMID: 20091228
Disasters; Post-traumatic stress disorder; Depression; Mental health
11.  Posttraumatic stress disorder symptom trajectories in Hurricane Katrina affected youth 
Journal of affective disorders  2012;147(0):198-204.
Objective
This study examined trajectories of posttraumatic stress disorder symptoms in Hurricane Katrina affected youth.
Method
A total of 426 youth (51% female; 8–16 years old; mean age=11 years; 75% minorities) completed assessments at 4 time points post-disaster. Measures included Hurricane impact variables (initial loss/disruption and perceived life threat); history of family and community violence exposure, parent and peer social support, and post-disaster posttraumatic stress symptoms.
Results
Latent class growth analysis demonstrated that there were three distinct trajectories of posttraumatic stress disorder symptoms identified for this sample of youth (resilient, recovering, and chronic, respectively). Youth trajectories were associated with Hurricane-related initial loss/disruption, community violence, and peer social support.
Conclusions
The results suggest that youth exposed to Hurricane Katrina have variable posttraumatic stress disorder symptom trajectories. Significant risk and protective factors were identified. Specifically, youth Hurricane and community violence exposure increased risk for a more problematic posttraumatic stress disorder symptom trajectory, while peer social support served as a protective factor for these youth. Identification of these factors suggests directions for future research as well as potential target areas for screening and intervention with disaster exposed youth.
Limitations
The convenience sample limits the external validity of the findings to other disaster exposed youth, and the self-report data is susceptible to response bias.
doi:10.1016/j.jad.2012.11.002
PMCID: PMC4231137  PMID: 23206321
Posttraumatic stress symptoms; Children; Disasters; Growth mixture modeling
12.  Hurricane Katrina-related maternal stress, maternal mental health, and early infant temperament 
Maternal and child health journal  2009;14(4):511-518.
To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n=288) in 2006–2007 was conducted. Questionnaires and interviews assessed the mother’s experiences during the hurricane, living conditions, and psychological symptoms, two months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and “difficult temperament” was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with 3 or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63–3.58 at 2 months; 0.58, 0.15–2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at one year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61–5.41), depression, (aOR 3.16, 95% CI 1.22–8.20) or hostility (aOR 2.17, 95% CI 0.81–5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother’s mental health.
doi:10.1007/s10995-009-0486-x
PMCID: PMC3472436  PMID: 19554438
infant temperament; natural disaster; postpartum depression; post-traumatic stress disorder
13.  Hurricane Katrina: Maternal Depression Trajectories and Child Outcomes 
Background
The authors examined depression trajectories over two years among mothers exposed to Hurricane Katrina. Risk and protective factors for depression trajectories, as well as associations with child outcomes were analyzed.
Method
This study included 283 mothers (age at time 1, M = 39.20 years, SD = 7.21; 62% African American). Mothers were assessed at four time points over two years following Hurricane Katrina. Mothers reported posttraumatic stress symptoms, hurricane exposure, traumatic life events, and social support at time 1. Depressive symptoms were modeled at times 2, 3, and 4. Youth reported their distress symptoms (posttraumatic stress, depression, and anxiety) at time 4.
Results
Latent class growth analyses identified three maternal depression trajectories among mothers exposed to Hurricane Katrina: low (61%), resilient (29%), and chronic (10%). Social support was identified as a protective factor among mothers.
Conclusions
Three main trajectories of maternal depression following Hurricane Katrina were identified. Social support was protective for mothers. Identified trajectories were not associated with children’s distress outcomes. These results have implications for disaster responses, screening efforts, and interventions targeted towards families. Future studies warrant the investigation of additional risk and protective factors that can affect maternal and child outcomes.
doi:10.1007/s12144-015-9338-6
PMCID: PMC4704451  PMID: 26752938
Depressive Symptoms; Posttraumatic Stress Symptoms; Trajectories; Parents; Children; Disasters; Growth Mixture Modeling
14.  Pre-Hurricane Perceived Social Support Protects Against Psychological Distress: A Longitudinal Analysis of Low-Income Mothers 
Objective
In this study, we examined the influence of pre-disaster perceived social support on post-disaster psychological distress among survivors of Hurricane Katrina.
Method
Participants (N = 386) were low-income mothers between 18 and 34 years of age at baseline (M = 26.4, SD = 4.43). The majority (84.8%) was African American; 10.4% identified as Caucasian, 3.2% identified as Hispanic, and 1.8% identified as other. Participants were enrolled in an educational intervention study in 2004 and 2005. Those who had completed a 1-year follow-up assessment prior to Hurricane Katrina were reassessed approximately 1 year after the hurricane. Measures of perceived social support and psychological distress were included in pre-and post-disaster assessments. Using structural equation modeling and multiple mediator analysis, we tested a model wherein pre-disaster perceived social support predicted post-disaster psychological distress both directly and indirectly through its effects on pre-disaster psychological distress, exposure to hurricane-related stressors, and post-disaster perceived social support. We predicted that higher pre-disaster perceived social support would be predictive of lower pre-disaster psychological distress, lower hurricane-related stressors, and higher post-disaster perceived social support, and that these variables would, in turn, predict lower post-disaster psychologically distress.
Results
Our analyses provide partial support for the hypothesized model. Although pre-disaster perceived social support did not exert a direct effect on post-disaster psychological distress, the indirect effects of all 3 proposed mediators were significant.
Conclusions
Pre-disaster social support can decrease both exposure to natural disasters and the negative psychological effects of natural disaster exposure. These findings underscore the importance of bolstering the post-disaster social support networks of low-income mothers.
doi:10.1037/a0018317
PMCID: PMC3618961  PMID: 20658811
natural disasters; social support; low-income populations; mothers
15.  Recovery from PTSD following Hurricane Katrina 
Depression and anxiety  2011;28(6):439-446.
Background
We examined patterns and correlates of speed of recovery of estimated posttraumatic stress disorder (PTSD) among people who developed PTSD in the wake of Hurricane Katrina.
Method
A probability sample of pre-hurricane residents of areas affected by Hurricane Katrina was administered a telephone survey 7-19 months following the hurricane and again 24-27 months post-hurricane. The baseline survey assessed PTSD using a validated screening scale and assessed a number of hypothesized predictors of PTSD recovery that included socio-demographics, pre-hurricane history of psychopathology, hurricane-related stressors, social support, and social competence. Exposure to post-hurricane stressors and course of estimated PTSD were assessed in a follow-up interview.
Results
An estimated 17.1% of respondents had a history of estimated hurricane-related PTSD at baseline and 29.2% by the follow-up survey. Of the respondents who developed estimated hurricane-related PTSD, 39.0% recovered by the time of the follow-up survey with a mean duration of 16.5 months. Predictors of slow recovery included exposure to a life-threatening situation, hurricane-related housing adversity, and high income. Other socio-demographics, history of psychopathology, social support, social competence, and post-hurricane stressors were unrelated to recovery from estimated PTSD.
Conclusions
The majority of adults who developed estimated PTSD after Hurricane Katrina did not recover within 18-27 months. Delayed onset was common. Findings document the importance of initial trauma exposure severity in predicting course of illness and suggest that pre- and post-trauma factors typically associated with course of estimated PTSD did not influence recovery following Hurricane Katrina.
doi:10.1002/da.20790
PMCID: PMC3138333  PMID: 21308887
Disasters; Post-traumatic stress disorders; PTSD; Stressful Events; Time Factors
16.  Intimate partner violence and Hurricane Katrina: Predictors and associated mental health outcomes 
Violence and Victims  2010;25(5):588-603.
This study sought to establish the prevalence and correlates of intimate partner violence (IPV) victimization in the six 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 < 0.001). The percentage of men reporting psychological victimization increased from 36.7% to 43.1% (p = 0.01). 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.
PMCID: PMC3394178  PMID: 21061866
17.  When Is Exposure to a Natural Disaster Traumatic? Comparison of a Trauma Questionnaire and Disaster Exposure Inventory 
PLoS ONE  2015;10(4):e0123632.
Few studies have compared the sensitivity of trauma questionnaires to disaster inventories for assessing the prevalence of exposure to natural disaster or associated risk for post-disaster psychopathology. The objective of this analysis was to compare reporting of disaster exposure on a trauma questionnaire (Brief Trauma Questionnaire [BTQ]) to an inventory of disaster experience. Between 2011 and 2014, a sample of 841 reproductive-aged southern Louisiana women were interviewed using the BTQ and completed a detailed inventory about exposure to hurricanes and flooding. Post-traumatic stress disorder (PTSD) symptomology was measured with the Post-Traumatic Stress Checklist, and depression with the Edinburgh Depression Scale. The single question addressing disaster exposure on the BTQ had a sensitivity of between 65% and 70% relative to the more detailed questions. Reporting disaster exposure on the BTQ was more likely for those who reported illness/injury due to a hurricane or flood (74%-77%) or danger (77-79%), compared to those who reported damage (69-71%) or evacuation (64-68%). Reporting disaster exposure on the BTQ was associated with depression (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.43-3.68). A single question is unlikely to be useful for assessing the degree of exposure to disaster across a broad population, and varies in utility depending on the mental health outcome of interest: the single trauma question is useful for assessing depression risk.
doi:10.1371/journal.pone.0123632
PMCID: PMC4390192  PMID: 25853820
18.  Hurricane Katrina’s Impact on the Mental Health of Adolescent Female Offenders 
Anxiety, stress, and coping  2009;22(4):433-448.
Exposure to multiple traumatic events and high rates of mental health problems are common among juvenile offenders. This study draws on Conservation of Resources (COR) stress theory to examine the impact of a specific trauma, Hurricane Katrina, relative to other adverse life events on the mental health of female adolescent offenders in Mississippi. Teenage girls (N = 258, 69% African American) were recruited from 4 juvenile detention centers and the state training school. Participants were interviewed about the occurrence and timing of adverse life events and hurricane-related experiences and completed a self-administered mental health assessment. Hierarchical linear regression models were used to identify predictors of anxiety and depression. Pre-hurricane family stressors, pre-hurricane traumatic events, hurricane-related property damage, and receipt of hurricane-related financial assistance significantly predicted symptoms of anxiety and depression. Findings support COR theory. Family stressors had the greatest influence on symptoms of anxiety and depression, highlighting the need for family-based services that address the multiple, inter-related problems and challenges in the lives of female juvenile offenders.
doi:10.1080/10615800802290634
PMCID: PMC2788001  PMID: 19296263
female juvenile offenders; hurricane exposure; family stressors; anxiety; depression
19.  Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event 
Depression and anxiety  2011;28(8):666-675.
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 post-event non-traumatic stressors, that were associated with these pathologies.
Methods
658 adults who had been living in Galveston and Chambers counties, Texas 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 prior to 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 non-traumatic stressors in shaping risk of both pathologies suggests that alleviating stressors after disasters has clear potential to mitigate the psychological sequelae of these events.
doi:10.1002/da.20838
PMCID: PMC3145817  PMID: 21618672
Post-traumatic stress disorders; Depression; Disasters; Stressful Events; Trauma; Life Stress
20.  Disruption of Existing Mental Health Treatments and Failure to Initiate New Treatments After Hurricane Katrina 
Objective:
To examine disruption of ongoing treatments among pre-existing cases and failure to initiate treatments among cases with new onset disorders in the aftermath of hurricane Katrina.
Methods:
A telephone survey was administered to a probability sample of 1,043 English-speaking adult Katrina survivors between January 19 and March 31, 2006. The survey assessed post-hurricane treatment of emotional problems and barriers to treatment among respondents with self-reported pre-hurricane mental disorders and those with post-hurricane onsets of mental disorders.
Results:
Among respondents who had pre-existing mental disorders and used services in the year before the hurricane, 22.9% experienced reductions or terminations of their treatments after Katrina. Among those without pre-hurricane disorders who developed new-onset ones, 18.5% received some form of treatment for emotional problems since the disaster. Reasons for failing to continue treatments among pre-existing cases largely involved structural barriers to treatment, while reasons for failing to seek treatment among new-onset cases largely involved low perceived needs for treatment. The majority (64.5%) of respondents using post-Katrina treatments received them from general medical providers and received medication but no psychotherapy. Treatment of new-onset cases was positively related to age and income, while continued treatment of pre-existing cases was positively related to being Non-Hispanic White and having health insurance.
Conclusions:
Hurricane Katrina survivors with mental disorders experienced large unmet needs for treatment, including frequent disruptions of existing care and widespread failure to initiate treatments among those with new onset disorders. Future disaster management plans should anticipate both types of need.
doi:10.1176/appi.ajp.2007.07030502
PMCID: PMC2248271  PMID: 18086749
Hurricane Katrina; mental illness; mental health services
21.  Serious Emotion Disturbance among Youth Exposed to Hurricane Katrina Two Years Post-Disaster 
Objective
To estimate the prevalence of serious emotional disturbance (SED) among children and adolescents exposed to Hurricane Katrina along with the associations of SED with hurricane-related stressors, socio-demographics, and family factors 18–27 months following the hurricane.
Method
A probability sample of pre-hurricane residents of areas affected by Hurricane Katrina was administered a telephone survey. Respondents provided information on up to two of their children (n=797) aged 4–17. The survey assessed hurricane-related stressors and lifetime history of psychopathology in respondents, screened for 12-month SED in respondents’ children using the Strengths and Difficulties Questionnaire (SDQ), and determined whether children’s emotional and behavioral problems were attributable to Hurricane Katrina.
Results
The estimated prevalence of SED was 14.9%, and 9.3% of youth were estimated to have SED that is directly attributable to Hurricane Katrina. Stress exposure was associated strongly with SED, and 20.3% of youth with high stress exposure had hurricane-attributable SED. Death of a loved one had the strongest association with SED among pre-hurricane residents of New Orleans, whereas exposure to physical adversity had the strongest association in the remainder of the sample. Among children with stress exposure, parental psychopathology and poverty were associated with SED.
Conclusions
The prevalence of SED among youth exposed to Hurricane Katrina remains high 18–27 months after the storm, suggesting a substantial need for mental health treatment resources in the hurricane-affected areas. Youth who were exposed to hurricane-related stressors, have a family history of psychopathology, and have lower family incomes are at greatest risk for long-term psychiatric impairment.
doi:10.1097/CHI.0b013e3181b76697
PMCID: PMC3992889  PMID: 19797983
Hurricane Katrina; SED; natural disaster; child mental health
22.  Trends in Serious Emotional Disturbance among Youths Exposed to Hurricane Katrina 
Objective
To examine patterns and predictors of trends in DSM-IV serious emotional disturbance (SED) among youths exposed to Hurricane Katrina.
Method
A probability sample of adult pre-hurricane residents of the areas affected by Katrina completed baseline and follow-up telephone surveys 18-27 months post-hurricane and 12-18 months later. Baseline adult respondents residing with children (ages 4-17) provided informant reports about the emotional functioning of these youths (n = 576) with the Strengths and Difficulties Questionnaire (SDQ). The surveys also assessed hurricane-related stressors and ongoing stressors experienced by respondent families.
Results
SED prevalence decreased significantly across survey waves from 15.1% to 11.5%, although even the latter prevalence was considerably higher than the pre-hurricane prevalence of 4.2% estimated in the US National Health Interview Survey. Trends in hurricane-related SED were predicted by both stressors experienced in the hurricane and ongoing stressors, with SED prevalence decreasing significantly only among youths with moderate stress exposure (16.8% vs. 6.5%). SED prevalence did not change significantly between waves among youths with either high stress exposure (30.0% vs. 41.9%) or low stress exposure (3.5% vs. 3.4%). Pre-hurricane functioning did not predict SED persistence among youths with high stress exposure, but did predict SED persistence among youth with low-moderate stress exposure.
Conclusions
The prevalence of SED among youths exposed to Hurricane Katrina remains significantly elevated several years after the storm despite meaningful decrease since baseline. Youths with high stress exposure have the highest risk of long-term hurricane-related SED and consequently represent an important target for mental health intervention.
doi:10.1016/j.jaac.2010.06.012
PMCID: PMC3228600  PMID: 20855044
Hurricane Katrina; SED; natural disaster; child mental health; stress
23.  Healthy Start: Description of a Safety Net for Perinatal Support during Disaster Recovery 
Maternal and child health journal  2015;19(4):819-827.
Objectives
Publicly funded programs and safety net organizations have key roles during post disaster recovery to care for vulnerable populations, including pregnant women with low resources. The objective of this study was to compare the health of prenatal women who accessed the New Orleans Healthy Start program to those women who only used traditional prenatal care (PNC) during long-term recovery from the Hurricane Katrina disaster.
Methods
During 2010-2012, this descriptive, cross-sectional study recruited 402 prenatal women (24-40 weeks) from prenatal clinics and classes. All women were enrolled in PNC, with 282 experiencing only traditional PNC, while 120 women added Healthy Start participation to their usual PNC. Measures were obtained to determine, past hurricane experience, hurricane recovery, perceptions of prenatal care, mental health, and birth outcomes.
Results
Women accessing Healthy Start-New Orleans were more socially “at risk” (younger, lower income, not living with a partner, African American), lived through more hurricane trauma, and had a higher incidence of depression (40%) and PTSD (15%) than women in traditional PNC (29% depression; 6.1 % PTSD). Women using Healthy Start reported more mental health counseling and prenatal education than did women in only traditional PNC. Birth outcomes were similar in the two groups.
Conclusions
The Healthy Start participants with less resources and more mental health difficulties after disaster, represented a more vulnerable population in need of additional support. This study underscores the necessity for community and governmental programs to develop disaster response plans that address needs of vulnerable populations during prolonged recovery.
doi:10.1007/s10995-014-1579-8
PMCID: PMC4303559  PMID: 25047787
24.  A Prospective Study of Religiousness and Psychological Distress Among Female Survivors of Hurricanes Katrina and Rita 
This prospective study examined the pathways by which religious involvement affected the post-disaster psychological functioning of women who survived Hurricanes Katrina and Rita. The participants were 386 low-income, predominantly Black, single mothers. The women were enrolled in the study before the hurricane, providing a rare opportunity to document changes in mental health from before to after the storm, and to assess the protective role of religious involvement over time. Results of structural equation modeling indicated that, controlling for level of exposure to the hurricanes, pre-disaster physical health, age, and number of children, pre-disaster religiousness predicted higher levels of post-disaster (1) social resources and (2) optimism and sense of purpose. The latter, but not the former, was associated with better post-disaster psychological outcome. Mediation analysis confirmed the mediating role of optimism and sense of purpose.
doi:10.1007/s10464-011-9445-y
PMCID: PMC3618366  PMID: 21626083
Religiousness; Hurricane Katrina; Psychosocial resources
25.  Psychosocial Status of Hemodialysis Patients One Year After Hurricane Katrina 
Background
Hemodialysis patients experience a high degree of psychosocial impairment.
Methods
The psychosocial status of hemodialysis patients after Hurricane Katrina was evaluated using the Hurricane Coping Self-Efficacy (HCSE) measure, the Short Form-12 Health Survey (physical component summary [PCS] and mental component summary [MCS]), and the Center for Epidemiologic Studies Short Depression Scale (CES-D). These scales were administered to 391 hemodialysis patients (86% participation rate), 7 to 14 months after Hurricane Katrina.
Results
The mean score (standard deviation) was 36.2 (9.6) for the HCSE scale, 37.1 (10.9) and 46.7 (12.7) for the PCS and MCS, respectively, and 10.0 (6.5) on the CES-D. Symptoms of depression (CES-D scores ≥10) were present in 45.5% of patients. After age, race and gender adjustment, evacuating less than 2 days prior to Hurricane Katrina making landfall and more fear of dying were associated with less favorable scores on the HCSE, MCS and CES-D scales. Patients placed in a shelter and with a longer displacement had significantly lower MCS scores and more depressive symptoms. More depressive symptoms were observed among patients hospitalized in the month following the storm. Those who evacuated to a hotel, with more fear of dying and who were hospitalized in the month following Hurricane Katrina had lower scores on the PCS.
Conclusions
Impaired psychosocial status was common among dialysis patients surviving Hurricane Katrina and associated with reduced coping. These data demonstrate the need for screening and management of psychosocial issues in hemodialysis patients after disasters.
doi:10.1097/MAJ.0b013e318180f1f1
PMCID: PMC2644213  PMID: 18703900
hemodialysis; natural disasters; psychosocial status

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