Skip to main content

Advertisement

Log in

Examining the Dose–Response Relationship: Applying the Disaster Exposure Matrix to Understand the Mental Health Impacts of Hurricane Sandy

  • Original Paper
  • Published:
Clinical Social Work Journal Aims and scope Submit manuscript

Abstract

Disaster exposure is a strong predictor of survivor mental health following large-scale disasters. However, there is continued debate regarding how disaster exposure should be measured and quantified, as well as whether specific types of disaster exposure are more likely to influence certain mental health outcomes like psychological distress or post-traumatic stress disorder (PTSD). In this article, we propose the Disaster Exposure Matrix to explain how specific types and levels of disaster exposure are associated with particular mental health outcomes. We use data from the Sandy Child and Family Health study—an observational cohort study of 1000 randomly selected New Jersey residents who were living in the nine counties most-affected by Hurricane Sandy (2012)—to examine how direct and indirect disaster exposure at both the individual and community levels influence the likelihood of experiencing psychological distress and probable PTSD in the two years after Hurricane Sandy. Weighted logistic regression models demonstrate that particular measures of individual-level direct and indirect exposure uniquely influence probable PTSD and psychological distress, respectively. Community-level indirect exposure is significantly associated with psychological distress but not with probable PTSD. Findings highlight the importance of specificity when measuring the effects of disaster exposure on mental health, including separating exposures that occur at the individual and community level, as well as distinguishing those that are experienced directly from the event from those that are indirect and experienced after the meteorological or geophysical event has passed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Abramson, D. M., Van Alst, D., Merdjanoff, A., Piltch-Loeb, R., Beedasy, J., Findley, P., Peek, L., Mordy, M., Moroso, S., Ocasio, K., Park, Y. S., Sury, J., Tobin, J. (2015). “The Hurricane Sandy Place Report: Evacuation Decisions, Housing Issues and Sense of Community.” The Sandy Child and Family Health Study. Rutgers University School of Social Work, New York University College of Global Public Health, Columbia University National Center for Disaster Preparedness, Colorado State University Center for Disaster and Risk Analysis, Briefing Report 2015_1.

  • Arvidsdotter, T., Marklund, B., Kylén, S., Taft, C., & Ekman, I. (2016). Understanding persons with psychological distress in primary health care. Scandinavian Journal of Caring Sciences, 30(4), 687–694.

    Article  PubMed  Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90.

    Article  PubMed  Google Scholar 

  • Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673.

    Article  PubMed  Google Scholar 

  • Brandes, D., Ben-Schachar, G., Gilboa, A., Bonne, O., Freedman, S., & Shalev, A. Y. (2002). PTSD symptoms and cognitive performance in recent trauma survivors. Psychiatry Research, 110(3), 231–238.

    Article  PubMed  Google Scholar 

  • Brewin, C. R., Fuchkan, N., Huntley, Z., & Scragg, P. (2010). Diagnostic accuracy of the Trauma Screening Questionnaire after the 2005 London bombings. Journal of Traumatic Stress, 23(3), 393–398.

    PubMed  Google Scholar 

  • Brewin, C. R., Rose, S., Andrews, B., Green, J., Tata, P., McEvedy, C., Turner, S., & E. B. Foa. (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry, 181, 158–162.

    Article  Google Scholar 

  • Chan, C. S., & Rhodes, J. E. (2014). Measuring exposure in hurricane Katrina: A meta-analysis and an integrative data analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0092899

    Article  PubMed  PubMed Central  Google Scholar 

  • Cutter, S. L. (1996). Vulnerability to environmental hazards. Progress in Human Geography, 20(4), 529–539.

    Article  Google Scholar 

  • Cutter, S. L., Boruff, B. J., & Shirley, W. L. (2003). Social vulnerability to environmental hazards. Social Science Quarterly, 84(2), 242–261.

    Article  Google Scholar 

  • De Bont, P. A. J. M., Van Den Berg, D. P. G., Van Der Vleugel, B. M., De Roos, C., De Jongh, A., Van Der Gaag, M., & Van Minnen, A. (2015). Predictive validity of the trauma screening questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. British Journal of Psychiatry, 206(5), 408–416. https://doi.org/10.1192/bjp.bp.114.148486

    Article  Google Scholar 

  • First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2014). Structured clinical interview for DSM-5 disorders–research version (SCID-5-RV). American Psychiatric Assocation.

    Google Scholar 

  • Foa, E. B., & Tolin, D. F. (2000). Comparison of the PTSD symptom scale–interview version and the clinician-administered PTSD scale. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 13(2), 181–191.

    Article  Google Scholar 

  • Fredman, S. J., Monson, C. M., Schumm, J. A., Adair, K. C., Taft, C. T., & Resick, P. A. (2010). Associations among disaster exposure, intimate relationship adjustment, and PTSD symptoms: Can disaster exposure enhance a relationship? Journal of Traumatic Stress, 23(4), 446–451.

    Article  PubMed  PubMed Central  Google Scholar 

  • Freedy, J. R., Kilpatrick, D. G., & Resnick, H. S. (1993). Natural disasters and mental health: Theory, assessment, and intervention. Journal of Social Behavior and Personality, 8(5), 49.

    Google Scholar 

  • Gaston, S., Volaufova, J., Peters, E.S., Ferguson, T.F., Robinson, W.T., Nugent, N., Trapido, E. J., & A. L. Rung. (2017). Individual-level exposure to disaster, neighborhood environmental characteristics, and their independent and combined associations with depressive symptoms in women. Social Psychiatry and Psychiatric Epidemiology, 52(9), 1183–1194.

    Article  PubMed  PubMed Central  Google Scholar 

  • Germain, C. B., & Gitterman, A. (1996). The life model of social work practice: Advances in theory & practice. Columbia University Press.

    Google Scholar 

  • Goldmann, E., & Galea, S. (2014). Mental health consequences of disasters. Annual Review of Public Health, 35, 169–183. https://doi.org/10.1146/annurev-publhealth-032013-182435

    Article  PubMed  Google Scholar 

  • Gonzalez, A., Rasul, R., Molina, L., Schneider, S., Bevilacqua, K., Bromet, E. J., Luft, B., Taioli, E., & R. Schwartz. (2019). Differential effect of Hurricane Sandy exposure on PTSD symptom severity: Comparison of community members and responders. Occupational and Environmental Medicine, 76(12), 881–887.

    Article  PubMed  Google Scholar 

  • Green, B. L., & Solomon, S. D. (1995). The mental health impact of natural and technological disasters. In J. R. Freedy & S. E. Hobfoll (Eds.), In traumatic stress: From theory to practice. Plenum Press.

    Google Scholar 

  • Harville, E. W., Jacobs, M., & Boynton-Jarrett, R. (2015). When is exposure to a natural disaster traumatic? Comparison of a trauma questionnaire and disaster exposure inventory. PLoS ONE, 10(4), e0123632.

    Article  PubMed  PubMed Central  Google Scholar 

  • Heir, T., & Weisæth, L. (2008). Acute disaster exposure and mental health complaints of Norwegian tsunami survivors six months post disaster. Psychiatry: Interpersonal and Biological Processes, 71(3), 266–276.

    Article  Google Scholar 

  • Kar, N., & Bastia, B. K. (2006). Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: A study of comorbidity. Clinical Practice and Epidemiology in Mental Health, 2(1), 17.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., Green, J. G., Gruber, M. J., Sampson, N. A., Bromet, E., Cuitan, M., Furukawa, T. A., Gureje, O., Hinkov, H., Hu, C., Lara, C., Lee, S., Mneimhen, Z., Myer, L., Oakley-Browne, M., Posada-Villa, J., Sagar, R., Viana, M. C., & A. M. Zaslavsky. (2010). Screening for serious mental illness in the general population with the K6 screening scale: Results from the WHO World Mental Health (WMH) survey initiative. International Journal of Methods in Psychiatric Research, 19(S1), 4–22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515.

    Article  Google Scholar 

  • La Greca, A., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (1996). Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64(4), 712–723.

    Article  PubMed  Google Scholar 

  • Lieberman-Cribbin, W., Liu, B., Schneider, S., Schwartz, R., & Taioli, E. (2017). Self-reported and FEMA flood exposure assessment after Hurricane Sandy: Association with mental health outcomes. PLoS ONE, 12(1), e0170965.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lindell, M. K., & Prater, C. S. (2003). Assessing community impacts of natural disasters. Natural Hazards Review, 4(4), 176–185. https://doi.org/10.1061/(ASCE)1527-6988(2003)4:4(176)

    Article  Google Scholar 

  • Lowe, S. R., Sampson, L., Gruebner, O., & Galea, S. (2015). Psychological resilience after Hurricane Sandy: The influence of individual-and community-level factors on mental health after a large-scale natural disaster. PLoS ONE, 10(5), e0125761.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merdjanoff, A. A. (2013). There’s no place like home: Examining the emotional consequences of Hurricane Katrina on the displaced residents of New Orleans. Social Science Research, 42(5), 1222–1235. https://doi.org/10.1016/j.ssresearch.2013.04.004

    Article  PubMed  Google Scholar 

  • Merdjanoff, A. A., & Piltch-Loeb, R. (2021). Hurricanes and Health: Vulnerability in an age of climate change. In K. E. Pinkerton & W. N. Rom (Eds.), Climate change and global public health (pp. 339–351). Springer.

    Chapter  Google Scholar 

  • Merdjanoff, A. A., Piltch-Loeb, R., Friedman, S., & Abramson, D. M. (2019). Housing transitions and recovery of older adults following hurricane sandy. Journals of Gerontology—Series B Psychological Sciences and Social Sciences, 74(6), 1041–1052. https://doi.org/10.1093/geronb/gby126

    Article  PubMed  Google Scholar 

  • Mewton, L., Kessler, R., Slade, T., Hobbs, M. J., Brownhill, L., Birrell, L., Tonks, Z., Teesson, M., Newton, N., Chapman, C., Allsop, S., Hides, L., McBride, N., and G. Andrews. (2016). The psychometric properties of the Kessler Psychological Distress Scale (K6) in a general population sample of adolescents. Psychological Assessment, 28(10), 1232.

    Article  PubMed  Google Scholar 

  • Mong, M. D., Noguchi, K., & Ladner, B. (2012). Immediate psychological impact of the deepwater horizon oil spill: Symptoms of PTSD and coping skills. Journal of Aggression, Maltreatment & Trauma, 21(6), 691–704. https://doi.org/10.1080/10926771.2012.694402

    Article  Google Scholar 

  • Moore, W., Pedlow, S., Krishnamurty, P., Wolter, K., & Chicago, I. L. (2000). National longitudinal survey of youth 1997 (NLSY97). Technical Sampling Report: National Opinion Research Center.

  • Nandi, A., Galea, S., Ahern, J., & Vlahov, D. (2005). Probable cigarette dependence, PTSD, and depression after an urban disaster: Results from a population survey of New York City residents 4 months after September 11, 2001. Psychiatry Interpersonal and Biological Processes, 68(4), 299–310.

    Article  Google Scholar 

  • Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: A systematic review. Psychological Medicine, 38(4), 467–480. https://doi.org/10.1017/S0033291707001353

    Article  PubMed  Google Scholar 

  • Norris, F. H., Friedman, M. J., & Watson, P. J. (2002a). 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry, 65(3), 240–260.

    Article  PubMed  Google Scholar 

  • Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002b). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry, 65(3), 207–239.

    Article  PubMed  Google Scholar 

  • North, C. S., & Pfefferbaum, B. (2013). Mental health response to community disasters: A systematic review. JAMA, 310(5), 507–518. https://doi.org/10.1001/jama.2013.107799

    Article  PubMed  Google Scholar 

  • North, C. S., Kawasaki, A., Spitznagel, E. L., & Hong, B. A. (2004). The course of PTSD, major depression, substance abuse, and somatization after a natural disaster. The Journal of Nervous and Mental Disease, 192(12), 823–829.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.

    Article  Google Scholar 

  • Ridner, S. H. (2004). Psychological distress: Concept analysis. Journal of Advanced Nursing, 45(5), 536–545.

    Article  PubMed  Google Scholar 

  • Sabucedo, J. M., Arce, C., Senra, C., Seoane, G., & Vazquez, I. (2010). Symptomatic profile and healthrelated quality of life of persons affected by the Prestige catastrophe. Disasters, 34(3), 809–820. https://doi.org/10.1111/j.0361-3666.2010.01170.x

    Article  PubMed  Google Scholar 

  • Schwartz, R. M., Rasul, R., Gargano, L. M., Lieberman-Cribbin, W., Brackbill, R. M., & Taioli, E. (2019). Examining associations between Hurricane Sandy exposure and posttraumatic stress disorder by community of residence. Journal of Traumatic Stress, 32(5), 677–687.

    Article  PubMed  Google Scholar 

  • Schwartz, R. M., Sison, C., Kerath, S. M., Murphy, L., Breil, T., Sikavi, D., & Taioli, E. (2015). The impact of Hurricane Sandy on the mental health of New York area residents. American Journal of Disaster Medicine, 10(4), 339–346.

    Article  PubMed  Google Scholar 

  • Shenassa, E. D., Daskalakis, C., Liebhaber, A., Braubach, M., & Brown, M. (2007). Dampness and mold in the home and depression: An examination of mold-related illness and perceived control of one’s home as possible depression pathways. American Journal of Public Health, 97(10), 1893–1899.

    Article  PubMed  PubMed Central  Google Scholar 

  • Spialek, M. L., Houston, J. B., Shin, H., Okker-Edging, K., & Suzuki, V. P. (2020). Individual disaster communication in the Latinx community after Hurricane Harvey: The role of disaster exposure, perceived discrimination stress, and social trust. Communication Monographs. https://doi.org/10.1080/03637751.2020.1851038

    Article  Google Scholar 

  • Steinglass, P., & Gerrity, E. (1990). Natural disasters and post-traumatic stress disorder short-term versus long-term recovery in two disaster-affected communities 1. Journal of Applied Social Psychology, 20(21), 1746–1765.

    Article  Google Scholar 

  • Valliant, R., Dever, J. A., & Kreuter, F. (2013). Practical tools for designing and weighting survey samples. Springer.

    Book  Google Scholar 

  • Van den Berg, B., Wong, A., van der Velden, P. G., Boshuizen, H. C., & Grievink, L. (2012). Disaster exposure as a risk factor for mental health problems, eighteen months, four and ten years post-disaster–a longitudinal study. BMC Psychiatry, 12(1), 147.

    Article  PubMed  PubMed Central  Google Scholar 

  • Veit, C. T., & Ware, J. E. (1983). The structure of psychological distress and well-being in general populations. Journal of Consulting and Clinical Psychology, 51(5), 730.

    Article  PubMed  Google Scholar 

  • Vera, M., Juarbe, D., Hernández, N., Obén, A., Pérez-Pedrogo, C., & Chaplin, W. F. (2012). Probable posttraumatic stress disorder and psychiatric co-morbidity among Latino primary care patients in Puerto Rico. Journal of Depression & Anxiety, 1(5), 124.

    Google Scholar 

  • Walters, J. T. R., Bisson, J. I., & Shepherd, J. P. (2007). Predicting post-traumatic stress disorder: Validation of the Trauma Screening Questionnaire in victims of assault. Psychological Medicine, 37(1), 143–150.

    Article  PubMed  Google Scholar 

  • Wang, X., Gao, L., Zhang, H., Zhao, C., Shen, Y., & Shinfuku, N. (2000). Post-earthquake quality of life and psychological well-being: Longitudinal evaluation in a rural community sample in northern China. Psychiatry and Clinical Neurosciences, 54(4), 427–433.

    Article  PubMed  Google Scholar 

  • Ware, J. E., & Kosinski, M. (2001). SF-36 Physical & Mental Health Summary Scales: A manual for users of version 1. QualityMetric Incorporated.

    Google Scholar 

  • Ware, J. E., Keller, S. D., & Kosinski, M. (1995). SF-12: How to score the SF-12 physical and mental health summary scales. Health Institute, New England Medical Center.

    Google Scholar 

  • Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.

    Article  PubMed  Google Scholar 

  • Wasiak, J., Mahar, P., Lee, S. Paul, E., Spinks, A., Pfitzer, B., Cleland, H. and B. Gabbe. (2013). 12-month generic health status and psychological distress outcomes following an Australian natural disaster experience: 2009 Black Saturday Wildfires. Injury, 44(11), 1443–1447.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Watts, S. E., Marsee, M. A., Taylor, L. K., Costa, N. M., Cannon, M. F., Carrion, V. G., & A. A. Pina. (2007). The psychosocial impact of Hurricane Katrina: Contextual differences in psychological symptoms, social support, and discrimination. Behaviour Research and Therapy, 45(10), 2295–2306. https://doi.org/10.1016/j.brat.2007.04.013

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The authors would also like to thank the anonymous reviewers for their thoughtful feedback. The authors would also like to thank Meghan Mordy and Jennifer Tobin for their assistance on the S-CAFH study.

Funding

This work was supported by the New Jersey State Department of Health, using Social Services Block Grant funds. All views expressed in this paper represent those of the authors and not necessarily those of the funding agency.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexis A. Merdjanoff.

Ethics declarations

Conflict of interest

The authors have nothing to disclose.

Data Availability

Data are propriety and not publicly available.

Code Availability

Code is available upon request.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merdjanoff, A.A., Abramson, D.M., Piltch-Loeb, R. et al. Examining the Dose–Response Relationship: Applying the Disaster Exposure Matrix to Understand the Mental Health Impacts of Hurricane Sandy. Clin Soc Work J 50, 400–413 (2022). https://doi.org/10.1007/s10615-021-00814-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10615-021-00814-y

Keywords

Navigation