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The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute versus ongoing traumatic events and stressors?

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Abstract

Purpose

Ongoing traumatic events and stressors, rather than acute sources of trauma, may shape long-term post-disaster mental health. The purpose of this study was to compare the influence of acute hurricane-related exposures and ongoing post-hurricane exposures on the short- and long-term course of posttraumatic stress symptoms (PTSS) and functional impairment (FI).

Methods

A random sample of adults (n = 658) in Galveston and Chambers Counties, Texas, was selected 2–6 months after Hurricane Ike and interviewed 3 times over 18 months. Hurricane-related exposures included traumatic events such as death of a family member due to the hurricane and stressors such as loss/damage to personal property due to the hurricane. Post-hurricane exposures included traumatic events such as sexual assault and stressors such as divorce or serious financial problems.

Results

Experiencing an acute hurricane-related traumatic event or stressor was associated with initial post-hurricane PTSS [RR = 1.92 (95 % CI = 1.13–3.26) and RR = 1.62 (1.36–1.94), respectively] and FI [RR = 1.76; (1.05–2.97) and RR = 1.74 (1.46–2.08)], respectively, and acute hurricane-related stressors were associated with a higher rate of increase in FI over time [RR = 1.09; (1.01–1.19)]. In contrast, ongoing post-hurricane daily stressors were not associated within initial PTSS and FI, but were associated with PTSS and FI at the second and third interviews.

Conclusions

While immediate postdisaster interventions may influence short-term mental health, investment in the prevention of ongoing stressors may be instrumental to manage long-term mental health status.

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References

  1. American Association for Public Opinion Research (Aapor) (2009) Standard definitions: Final dispositions of case codes and outcome rates for surveys

  2. Andrykowski MA, Cordova MJ, Studts JL et al (1998) Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. J Consult Clin Psychol 66:586–590

    Article  PubMed  CAS  Google Scholar 

  3. Blanchard EB, Jones-Alexander J, Buckley TC et al (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673

    Article  PubMed  CAS  Google Scholar 

  4. Boardman JD (2004) Stress and physical health: the role of neighborhoods as mediating and moderating mechanisms. Soc Sci Med 58:2473–2483

    Article  PubMed  Google Scholar 

  5. Boardman JD, Finch BK, Ellison CG et al (2001) Neighborhood disadvantage, stress, and drug use among adults. J Health Soc Behav 42:151–165

    Article  PubMed  CAS  Google Scholar 

  6. Bonnano G, Brewin CR, Kaniasty K et al (2010) Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities. Psychol Sci Pub Interest 11:1–49

    Article  Google Scholar 

  7. Bracha H, Williams A, Hynes S et al (2004) The STRS (shortness of breath, tremulousness, racing heart, and sweating): A brief checklist for acute distress with panic-like autonomic indicators; development and factor structure. Ann Gen Hosp Psychiatry 3:8

    Article  PubMed  Google Scholar 

  8. Bracha HS, Williams AE, Haynes SN et al (2004) The STRS (shortness of breath, tremulousness, racing heart, and sweating): a brief checklist for acute distress with panic-like autonomic indicators; development and factor structure. Ann Gen Hosp Psychiatry 3:8

    Article  PubMed  Google Scholar 

  9. Breslau N (2002) Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiat-Rev Can Psychiat 47:923–929

    Google Scholar 

  10. Breslau N, Kessler RC, Chilcoat HD et al (1998) Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626–632

    Article  PubMed  CAS  Google Scholar 

  11. Brewin C, Andrews B, Valentine J (2000) Meta-anaysis of risk factors for post-traumatic stress disorder in trauma-exposed adults. J Consult Clin Psych 68:748–766

    Article  CAS  Google Scholar 

  12. Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68:748–766

    Article  PubMed  CAS  Google Scholar 

  13. Brewin CR, Lanius R, Novac A et al (2009) Reformulating PTSD for DSM-V: life After Criterion A. J Trauma Stress 22:366–373

    Article  PubMed  Google Scholar 

  14. Bromet E, Sonnega A, Kessler RC (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147:353–361

    Article  PubMed  CAS  Google Scholar 

  15. Bui E, Tremblay L, Brunet A et al (2010) Course of posttraumatic stress symptoms over the 5 years following an industrial disaster: a structural equation modeling study. J Trauma Stress 23:759–766

    Article  PubMed  Google Scholar 

  16. Census UBOT (2000) Census 2000. Profile of selected economic characteristics: geographic area. PMSA, Chicago

  17. Curran P, Hussong A (2002) Structural equation modeling of repeated measures data: latent curve analysis. In: Moskowitz D, Hershberger S (eds) Modeling intra-individual variability with repeated measures data: methods and applications. Lawrence Erlbaum Associates, Mahwah

    Google Scholar 

  18. Galea S, Ahern J, Resnick H et al (2002) Psychological sequelae of the September 11 terrorist attacks in New York City. New Engl J Med 346:982–987

    Article  PubMed  Google Scholar 

  19. Galea S, Ahern J, Tracy M et al (2008) The longitudinal determinants of post-traumatic stress in a population-based cohort study. Epidemiology 19:47–54

    Article  PubMed  Google Scholar 

  20. Galea S, Brewin CR, Gruber M et al (2007) Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Arch Gen Psychiat 64:1427–1434

    Article  PubMed  Google Scholar 

  21. Galea S, Nandi A, Vlahov D (2005) The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev 27:78–91

    Article  PubMed  Google Scholar 

  22. Galea S, Tracy M, Norris F et al (2008) Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first 2 years after Hurricane Katrina. J Trauma Stress 21:357–368

    Article  PubMed  Google Scholar 

  23. Galea S, Tracy M, Norris F et al (2008) Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first 2 years after Hurricane Katrina. J Trauma Stress 21:357–368

    Article  PubMed  Google Scholar 

  24. Galea S, Vlahov D, Resnick H et al (2003) Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol 158:514–524

    Article  PubMed  Google Scholar 

  25. Guha-Sapir D, Hargitt D, Hoyois P (2004) Thirty years of natural disasters, 1974–2003: the numbers. Presses Universitaires de Louvain, Louvain

    Google Scholar 

  26. Kessler RC, Galea S, Gruber MJ et al (2008) Trends in mental illness and suicidality after Hurricane Katrina. Mol Psychiatr 13:374–384

    Article  CAS  Google Scholar 

  27. King LA, King DW, Fairbank JA et al (1998) Resilience-recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: hardiness, postwar social support, and additional stressful life events. J Pers Soc Psychol 74:420–434

    Article  PubMed  CAS  Google Scholar 

  28. Koren D, Arnon I, Klein E (1999) Acute stress response and posttraumatic stress disorder in traffic accident victims: a one-year prospective, follow-up study. Am J Psych 156:367–373

    CAS  Google Scholar 

  29. Kroenke K, Spitzer R (2002) The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 32:1–9

    Google Scholar 

  30. Kroenke K, Spitzer R, Williams J (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613

    Article  PubMed  CAS  Google Scholar 

  31. Laskow S (2011) 2011 natural disasters cost a record $265 billion. In: Grist: http://grist.org/list/2011-07-15-2011-climate-disasters-cost-a-record-265-billion/

  32. Levitt JT, Malta LS, Martin A et al (2007) The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack. Behav Res Ther 45:1419–1433

    Article  PubMed  Google Scholar 

  33. Maguen S, Stalnaker M, Mccaslin S et al (2009) PTSD subclusters and functional impairment in Kosovo peacekeepers. Mil Med 174:779–785

    PubMed  Google Scholar 

  34. Malta LS, Levitt JT, Martin A et al (2009) Correlates of functional impairment in treatment-seeking survivors of mass terrorism. Behav Ther 40:39–49

    Article  PubMed  Google Scholar 

  35. Mckibben JB, Bresnick MG, Wiechman Askay SA et al (2008) Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries. J Burn Care Res 29:22–35

    PubMed  Google Scholar 

  36. Mclaughlin KA, Berglund P, Gruber MJ et al (2011) Recovery from PTSD following Hurricane Katrina. Depress Anxiety 28:439–446

    Article  PubMed  Google Scholar 

  37. Mclaughlin KA, Fairbank JA, Gruber MJ et al (2009) Serious emotional disturbance among youths exposed to Hurricane Katrina 2 years postdisaster. J Am Acad Child Adolesc Psychiatry 48:1069–1078

    Article  PubMed  Google Scholar 

  38. Muthen LK, Muthen BO (2005) Mplus : statistical analysis with latent variables : user’s guide. Muthén & Muthén, Los Angeles

    Google Scholar 

  39. Needham B (2007) Gender differences in trajectories of depressive symptomatology and substance use during the transition from adolescence to young adulthood. Soc Sci Med 65:1166–1179

    Article  PubMed  Google Scholar 

  40. Neria Y, Nandi A, Galea S (2008) Post-traumatic stress disorder following disasters: a systematic review. Psych Med 38:467–480

    Article  CAS  Google Scholar 

  41. Norris F, Uhl G (1993) Chronic stress as a mediator of acute stress: the case of hurricane Hugo. J Appl Soc Psychol 23:1263–1284

    Article  Google Scholar 

  42. Norris FH, Donahue SA, Felton CJ et al (2006) A psychometric analysis of Project Liberty’s adult enhanced services referral tool. Psychiatr Serv 57:1328–1334

    Article  PubMed  Google Scholar 

  43. Norris FH, Friedman MJ, Watson PJ et al (2002) 60,000 disaster victims speak: part I. an empirical review of the empirical literature, 1981–2001. Psychiatry 65:207–239

    PubMed  Google Scholar 

  44. Onder E, Tural U, Aker T et al (2006) Prevalence of psychiatric disorders 3 years after the 1999 earthquake in Turkey: marmara Earthquake Survey (MES). Soc Psych Psych Epid 41:868–874

    Article  Google Scholar 

  45. Ozer EJ, Best SR, Lipsey TL et al (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 129:52–73

    Article  PubMed  Google Scholar 

  46. Priebe S, Grappasonni I, Mari M et al (2009) Posttraumatic stress disorder 6 months after an earthquake: findings from a community sample in a rural region in Italy. Soc Psych Psych Epid 44:393–397

    Article  Google Scholar 

  47. Raghunathan T, Van Hoewyk J, Solenberger P (2002) IVEware: imputation and variance estimation software user guide. In: Institute for Social Research (ed) Survey Methodology Program SRC, University of Michigan, Ann Arbor

  48. Riad J, Norris F (1996) The influence of relocation on the environmental, social, and psychological stress experienced by disaster victims. Environ Behav 28:163–182

    Article  Google Scholar 

  49. Ruggiero KJ, Del Ben K, Scotti JR et al (2003) Psychometric properties of the PTSD Checklist-Civilian Version. J Trauma Stress 16:495–502

    Article  PubMed  Google Scholar 

  50. Shea MT, Vujanovic AA, Mansfield AK et al (2010) Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF National Guard and reserve veterans. J Trauma Stress 23:100–107

    PubMed  Google Scholar 

  51. Spitzer R, Kroenke K, Williams J (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care study. JAMA 282:1737–1744

    Article  PubMed  CAS  Google Scholar 

  52. The Economist Online (2011) Natural disasters: counting the cost. In: The Economist. http://www.economist.com/blogs/dailychart/2011/03/natural_disasters

  53. Tracy M, Norris FH, Galea S (2011) Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event. Depress Anxiety 28:666–675

    Article  PubMed  Google Scholar 

  54. Weathers FW, Ford J (1996) Psychometric review of PTSD checklist (PCL-C, PCL-S, PCL-M, PCL-PR). In: Stamm BH (ed) Measurement of stress, trauma, and adaptation. Sidran Press, Lutherville

    Google Scholar 

  55. Westphal M, Olfson M, Gameroff MJ et al (2011) Functional impairment in adults with past posttraumatic stress disorder: findings from primary care. Depress Anxiety 28:686–695

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Dr. Qixuan Chen and Dr. Linda Muthen for advice on the estimation of the applied statistical models. This research was supported by the National Center for Disaster Mental Health Research (NIMH Grant 5 P60 MH082598) and individual grants to MC (DA030449–01) and KCK (MH093612–01 and MH078928–04). The National Institute of Mental Health and the National Institute on Drug Abuse had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Epidemiology, Columbia University, University Mailman School of Public Health, 722 W168th St, 10032, New York, NY, USA

    M. Cerdá, P. M. Bordelois, S. Galea, M. Tracy & K. C. Koenen

  2. National Center for Disaster Mental Health Research, White River Junction, VT, USA

    M. Cerdá, S. Galea, F. Norris & M. Tracy

  3. National Center for PTSD, VA Medical Center, White River Junction, VT, USA

    F. Norris

  4. Department of Psychiatry, Dartmouth Medical School, Dartmouth University, Hanover, NH, USA

    F. Norris

  5. Department of Epidemiology, School of Public Health University of Michigan, Ann Arbor, MI, USA

    M. Tracy

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  1. M. Cerdá
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Correspondence to M. Cerdá.

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Cerdá, M., Bordelois, P.M., Galea, S. et al. The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute versus ongoing traumatic events and stressors?. Soc Psychiatry Psychiatr Epidemiol 48, 385–395 (2013). https://doi.org/10.1007/s00127-012-0560-3

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  • DOI: https://doi.org/10.1007/s00127-012-0560-3

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