Range of Consequences Experienced by Disaster Survivors
The range of consequences experienced by disaster survivors is broad, including various psychological problems, such as depression (MD), anxiety, and most notably post-traumatic stress disorder (PTSD); physical and behavioral health problems, such as sleep disruption, somatic complaints, impaired immune function, and substance use; chronic problems in living, such as troubled interpersonal relationships and financial stress; and resource loss, such as declines in perceived control and perceived social support. While such problems are prevalent initially, they often decline sharply over time.
Multi-wave disaster studies show that levels of distress often stabilize after an initial period of recovery, suggesting that some survivors are recovering while others are not. Few if any studies have had the combination of features necessary to study all of the relevant trajectories together, and no study, to our knowledge, has explicitly aimed to assess their prevalence and determinants.
Characterizing these patterns, and understanding their determinants, is the central focus of the proposed epidemiologic research. In particular, we are concerned with individual wellness, defined as the absence of psychopathology, healthy patterns of behavior, adequate role functioning, and high quality of life.
Aims for Epidemiological Study
Our specific aims for the epidemiologic portion of the NCDMHR work therefore are as follows.
First, we aim to document the trajectories of wellness among a representative population-based cohort of persons recruited after a disaster. Documenting these patterns and trajectories allows us to test a conceptual framework that posits four central postdisaster trajectories.
Second we aim to assess differences in components and trajectories of wellness between subgroups differing in predisaster resources (socioeconomic position, social supports), socio-demographic characteristics (race/ethnicity, gender, age), and disaster experiences (peri-event emotional reactions, traumatic exposures).
Third, we aim to assess the influence of predisaster community resources (e.g., availability of social services), community-level exposure to the disaster (e.g., extent of damage), and postdisaster resources (e.g., social cohesion) on components and trajectories of wellness and to assess whether community characteristics moderate the relation between individual disaster exposure and resilience trajectories.
Longitudinal Research Project
In order to meet the aims of this study we will implement a longitudinal research project. We will recruit a sample of ~1500-1800 persons who are representative of a particular sampling frame of interest after a disaster.
Initial interviews occur at 2 months post-event. We will then administer follow-up interviews approximately 2 and 12 months after baseline. Longitudinal follow-up will allow us to study components of wellness at three time points and trajectories of wellness over time and to determine the multiple factors that may be associated with these components and trajectories in the postdisaster context.
Analyses will include individual regression modeling, growth mixture modeling, and hierarchical modeling.