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1.  Exposure to Hurricane Katrina, Post-Traumatic Stress Disorder and Birth Outcomes 
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.
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.
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).
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.
PMCID: PMC2635112  PMID: 18703903
Depression; disaster; low birth weight; post-traumatic stress disorder; pregnancy
2.  Postpartum mental health after Hurricane Katrina: A cohort study 
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.
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).
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).
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.
PMCID: PMC2702337  PMID: 19505322
3.  Hurricane Katrina Experience and the Risk of Post-Traumatic Stress Disorder and Depression among Pregnant Women 
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.
Prospective cohort epidemiological study.
Tertiary hospitals in New Orleans and Baton Rouge, USA.
Women who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane.
Main outcome measures
Post-traumatic stress disorder (PTSD) and depression.
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.
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.  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.
PMCID: PMC2788001  PMID: 19296263
female juvenile offenders; hurricane exposure; family stressors; anxiety; depression
5.  Mental Illness and Suicidality after Hurricane Katrina 
To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey.
The earlier survey interviewed 826 adults in the Census Divisions affected by Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the area prior to the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of post-traumatic personal growth (e.g., increased closeness to loved one, increased religiosity). Outcome measures were the K6 screening scale of serious (SMI) and mild-moderate (MMI) mental illness and questions about suicide ideation, plans and attempts.
Post-Katrina respondents had significantly higher estimated prevalence of SMI (13.8% vs. 6.1%, χ21 = 24.6, p < .001) and MMI (21.3% vs. 9.7%, χ21 = 33.8, p < .001) than respondents in the earlier survey. Suicidal ideation and plans given estimated mental illness were significantly lower in the post-Katrina survey (0.6% vs. 8.4%, χ21 = 14.3, p < .001 ideation; 0.2% vs. 3.6%, χ21 = 13.3, p < .001 plans). This lower suicidality was strongly related to two dimensions of post-traumatic personal growth (increased sense of meaning and purpose in life, realization of inner strength), without which between-survey differences in suicidality were insignificant.
Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.
PMCID: PMC1852424  PMID: 17242828
6.  Recovery from PTSD following Hurricane Katrina 
Depression and anxiety  2011;28(6):439-446.
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.
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.
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.
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.
PMCID: PMC3138333  PMID: 21308887
Disasters; Post-traumatic stress disorders; PTSD; Stressful Events; Time Factors
7.  Exposure to Hurricane-Related Stressors and Mental Illness After Hurricane Katrina 
Archives of general psychiatry  2007;64(12):1427-1434.
Uncertainty exists about the prevalence, severity, and correlates of mental disorders among people exposed to Hurricane Katrina.
To estimate the prevalence and associations between DSM-IV anxiety-mood disorders and hurricane-related stressors separately among prehurricane residents of the New Orleans metropolitan area and the remainder of the areas in Alabama, Louisiana, and Mississippi affected by Katrina.
Community survey.
Setting and Participants:
A probability sample of 1043 English-speaking prehurricane residents of the areas affected by Hurricane Katrina was administered via telephone survey between January 19 and March 31, 2006. The survey assessed hurricane-related stressors and screened for 30-day DSM-IV anxiety-mood disorders.
Main Outcome Measures:
The K6 screening scale of anxiety-mood disorders and the Trauma Screening Questionnaire scale for posttraumatic stress disorder (PTSD), both calibrated against blinded structured clinical reappraisal interviews to approximate the 30-day prevalence of DSM-IV disorders.
Prehurricane residents of the New Orleans metropolitan area were estimated to have a 49.1% 30-day prevalence of any DSM-IV anxiety-mood disorder (30.3% estimated prevalence of PTSD) compared with 26.4% (12.5% PTSD) in the remainder of the sample. The vast majority of respondents reported exposure to hurricane-related stressors. Extent of stressor exposure was more strongly related to the outcomes in the New Orleans metropolitan area subsample than the remainder of the sample. The stressors most strongly related to these outcomes were physical illness/injury and physical adversity in the New Orleans metropolitan area subsample and property loss in the remainder of the sample. Sociodemographic correlates were not explained either by differential exposure or reactivity to hurricane-related stressors.
The high prevalence of DSM-IV anxiety-mood disorders, the strong associations of hurricane-related stressors with these outcomes, and the independence of sociodemographics from stressors argue that the practical problems associated with ongoing stressors are widespread and must be addressed to reduce the prevalence of mental disorders in this population.
PMCID: PMC2174368  PMID: 18056551
8.  The Impact of Hurricane Katrina on the Mental and Physical Health of Low-Income Parents in New Orleans 
The purpose of this study was to document changes in mental and physical health among 392 low-income parents exposed to Hurricane Katrina and to explore how hurricane-related stressors and loss relate to post-Katrina well being. The prevalence of probable serious mental illness doubled, and nearly half of the respondents exhibited probable PTSD. Higher levels of hurricane-related loss and stressors were generally associated with worse health outcomes, controlling for baseline socio-demographic and health measures. Higher baseline resources predicted fewer hurricane-associated stressors, but the consequences of stressors and loss were similar regardless of baseline resources. Adverse health consequences of Hurricane Katrina persisted for a year or more, and were most severe for those experiencing the most stressors and loss. Long-term health and mental health services are needed for low-income disaster survivors, especially those who experience disaster-related stressors and loss.
PMCID: PMC3276074  PMID: 20553517
9.  Resilience after Hurricane Katrina among pregnant and postpartum women 
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.
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.
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.
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.
PMCID: PMC2822707  PMID: 20123173
resilience; depression; postpartum; pregnancy; disaster; post-traumatic stress disorder
10.  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.
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.
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.
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.
These results suggest the need for preventive measures aimed at preserving psychosocial resources to reduce the long-term effects of disasters.
PMCID: PMC2875990  PMID: 20438305
11.  Trends in mental illness and suicidality after Hurricane Katrina 
Molecular psychiatry  2008;13(4):374-384.
A representative sample of 815 pre-hurricane residents of the areas affected by Hurricane Katrina was interviewed 5-8 months after the hurricane and again one year later as the Hurricane Katrina Community Advisory Group (CAG). The follow-up survey was carried out to study patterns-correlates of recovery from hurricane-related post-traumatic stress disorder (PTSD), broader anxiety-mood disorders, and suicidality. The TSQ screening scale of PTSD and the K6 screening scale of anxiety-mood disorders were used to generate DSM-IV prevalence estimates. Contrary to results in other disaster studies, where post-disaster mental disorder typically decreases with time, prevalence increased significantly in the CAG for PTSD (20.9% vs. 14.9% at baseline), serious mental illness (SMI; 14.0% vs. 10.9%), suicidal ideation (6.4% vs. 2.8%), and suicide plans (5% vs. 1.0%). The increases in PTSD-SMI were confined to respondents not from the New Orleans Metropolitan Area, while the increases in suicidal ideation-plans occurred both in the New Orleans sub-sample and in the remainder of the sample. Unresolved hurricane-related stresses accounted for large proportions of the inter-temporal increases in SMI (89.2%), PTSD (31.9%), and suicidality (61.6%). Differential hurricane-related stress did not explain the significantly higher increases among respondents from areas other than New Orleans, though, as this stress was both higher initially and decreased less among respondents from the New Orleans Metropolitan Area than from other areas affected by the hurricane. Outcomes were only weakly related to socio-demographic variables, meaning that high prevalence of hurricane-related mental illness remains widely distributed in the population nearly two years after the hurricane.
PMCID: PMC2556982  PMID: 18180768
Anxiety disorder; epidemiology; mood disorder; natural disaster; post-traumatic stress disorder (PTSD)
12.  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.
PMCID: PMC2919598  PMID: 20091228
Disasters; Post-traumatic stress disorder; Depression; Mental health
13.  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.
PMCID: PMC3286602  PMID: 22137245
Mental health; natural disasters; Hurricane Katrina; USA; women
14.  Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event 
Depression and anxiety  2011;28(8):666-675.
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.
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.
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.
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.
PMCID: PMC3145817  PMID: 21618672
Post-traumatic stress disorders; Depression; Disasters; Stressful Events; Trauma; Life Stress
15.  Landscape-Scale Analysis of Wetland Sediment Deposition from Four Tropical Cyclone Events 
PLoS ONE  2012;7(11):e50528.
Hurricanes Katrina, Rita, Gustav, and Ike deposited large quantities of sediment on coastal wetlands after making landfall in the northern Gulf of Mexico. We sampled sediments deposited on the wetland surface throughout the entire Louisiana and Texas depositional surfaces of Hurricanes Katrina, Rita, Gustav, and the Louisiana portion of Hurricane Ike. We used spatial interpolation to model the total amount and spatial distribution of inorganic sediment deposition from each storm. The sediment deposition on coastal wetlands was an estimated 68, 48, and 21 million metric tons from Hurricanes Katrina, Rita, and Gustav, respectively. The spatial distribution decreased in a similar manner with distance from the coast for all hurricanes, but the relationship with distance from the storm track was more variable between events. The southeast-facing Breton Sound estuary had significant storm-derived sediment deposition west of the storm track, whereas sediment deposition along the south-facing coastline occurred primarily east of the storm track. Sediment organic content, bulk density, and grain size also decreased significantly with distance from the coast, but were also more variable with respect to distance from the track. On average, eighty percent of the mineral deposition occurred within 20 km from the coast, and 58% was within 50 km of the track. These results highlight an important link between tropical cyclone events and coastal wetland sedimentation, and are useful in identifying a more complete sediment budget for coastal wetland soils.
PMCID: PMC3503965  PMID: 23185635
16.  Examining the Aftereffects of Hurricane Katrina in New Orleans: A Qualitative Study of Faculty and Staff Perceptions 
The Scientific World Journal  2012;2012:864529.
Researchers have reported how Hurricane Katrina has affected teachers who work with Kindergarten to Grade 12 (K-12), yet little is known about how the natural disaster has affected other important K-12 faculty and staff (e.g., coaches, librarians, school counselors, and cafeteria workers). Missing from the literature is the impact that this natural disaster has had on these formal (school counselors) and informal (coaches, librarians) helpers of K-12 students. Using a focus group methodology, the authors examined the aftereffects of Hurricane Katrina on 12 school employees in New Orleans, Louisiana, 18 months after the hurricane. Informed by qualitative content analysis, three emergent themes were identified: emotion-focused aftereffects, positive coping, and worry and fear. The implications for future research and promoting hope in mental health counseling are discussed.
PMCID: PMC3353662  PMID: 22629217
17.  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.
PMCID: PMC3039709  PMID: 20977977
disasters; traumatic events; health disparities; alcohol use
18.  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.
PMCID: PMC3472436  PMID: 19554438
infant temperament; natural disaster; postpartum depression; post-traumatic stress disorder
19.  Disruption of Existing Mental Health Treatments and Failure to Initiate New Treatments After Hurricane Katrina 
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.
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.
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.
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.
PMCID: PMC2248271  PMID: 18086749
Hurricane Katrina; mental illness; mental health services
20.  Children’s Mental Health Care following Hurricane Katrina: A Field Trial of Trauma-Focused Psychotherapies 
Journal of traumatic stress  2010;23(2):223-231.
New Orleans school children participated in an assessment and field trial of two interventions 15 months after Hurricane Katrina. Children (N = 195) reported on hurricane exposure, lifetime trauma exposure, peer and parent support, posttraumatic stress disorder (PTSD), and depressive symptoms. Teachers reported on behavior. At baseline, 60.5% screened positive for PTSD symptoms and were offered a group intervention at school or individual treatment at a mental health clinic. Uptake of the mental health care was uneven across intervention groups, with 98% beginning the school intervention, compared to 37% beginning at the clinic. Both treatments led to significant symptom reduction of PTSD symptoms but many still had elevated PTSD symptoms at post treatment. Implications for future postdisaster mental health work are discussed.
PMCID: PMC2860874  PMID: 20419730
21.  Improving Disaster Mental Health Care in Schools 
American journal of preventive medicine  2009;37(6 Suppl 1):S225.
Although schools are often the first institution to provide recovery efforts for children post-disaster, few studies have involved the school community in research to improve the delivery of these mental health services on campuses. This community partnered study explores post-disaster counseling services ten months following Hurricane Katrina.
In July 2006, nine focus groups, comprised of 39 school-based mental health counselors and 6 program administrators (10 men, 35 women), were conducted following a two-day clinical training regarding a youth trauma intervention following Hurricane Katrina. Participants discussed types of services they had been providing prior to the training and potential barriers to delivering services.
Participants identified high mental health needs of students and described populations that did not seem to be adequately supported by current funding sources, including those with preexisting traumatic experiences and mental health issues, indirect psychological and social consequences of the storms, and those students relocated to less impacted communities. Participants also described the need for a centralized information system.
Participants described the need for greater organizational structure that supports school counselors and provides system-level support for services. Implications for next steps of this community partnered approach are described.
PMCID: PMC2822649  PMID: 19896023
22.  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.
PMCID: PMC3618366  PMID: 21626083
Religiousness; Hurricane Katrina; Psychosocial resources
23.  A Test of the Family Stress Model on Toddler-Aged Children’s Adjustment Among Hurricane Katrina Impacted and Nonimpacted Low-Income Families 
Hurricane Katrina dramatically altered the level of social and environmental stressors for the residents of the New Orleans area. The Family Stress Model describes a process whereby felt financial strain undermines parents’ mental health, the quality of family relationships, and child adjustment. Our study considered the extent to which the Family Stress Model explained toddler-aged adjustment among Hurricane Katrina affected and nonaffected families. Two groups of very low-income mothers and their 2-year-old children participated (pre-Katrina, n = 55; post-Katrina, n = 47). Consistent with the Family Stress Model, financial strain and neighborhood violence were associated with higher levels of mothers’ depressed mood; depressed mood was linked to less parenting efficacy. Poor parenting efficacy was associated to more child internalizing and externalizing problems.
PMCID: PMC2893557  PMID: 18645744
24.  The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute vs. ongoing traumatic events and stressors? 
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).
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 eighteen 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.
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.
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.
PMCID: PMC3504624  PMID: 22878832
Posttraumatic stress disorder; Disasters; Functional impairment; Traumatic events; Daily stressors
25.  Experience of Hurricane Katrina and reported intimate partner violence 
Journal of interpersonal violence  2010;26(4):833-845.
Intimate partner violence (IPV) has been associated with stress, but few studies have examined the effect of natural disaster on IPV. In this study, we examine the relationship between experience of Hurricane Katrina and reported relationship aggression and violence in a cohort of 123 postpartum women. Hurricane experience was measured using a series of questions about damage, injury, and danger during the storm; IPV was measured using the Conflict Tactics Scale (CTS-2). Multiple log-poisson regression was used to calculate relative risks, adjusted for potential confounders. Most reported that they and their partners had explained themselves to each other, showed each other respect, and also insulted, swore, or shouted during conflicts with each other. Much smaller proportions reported physical violence, sexual force, or destroying property, though in each case at least 5% endorsed that it had happened at least once in the last six months. Similar proportions reported that they and their partners had carried out these actions. Experiencing damage due to the storm was associated with increased likelihood of most conflict tactics. Strong relative risks were seen for the relationship between damage due to the storm and aggression or violence, especially being insulted, sworn, shouted, or yelled at (adjusted relative risk [aRR]1.23, 1.02–1.48), pushed, shoved, or slapped (aRR 5.28, 95% CI 1.93–14.45), or being punched, kicked, or beat up (aRR 8.25, 1.68–40.47). Our results suggest that certain experiences of the hurricane are associated with an increased likelihood of violent methods of conflict resolution. Relief and medical workers may need to be aware of the possibility of increased IPV after disaster.
PMCID: PMC3472442  PMID: 20495099

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