Faculty Bibliography

BACKGROUND: Only very few studies have investigated the geographic distribution of psychological resilience and associated mental health outcomes after natural or man made disasters. Such information is crucial for location-based interventions that aim to promote recovery in the aftermath of disasters. The purpose of this study therefore was to investigate geographic variability of (1) posttraumatic stress (PTS) and depression in a Hurricane Sandy affected population in NYC and (2) psychological vulnerability and resilience factors among affected areas in NYC boroughs. METHODS: Cross-sectional telephone survey data were collected 13 to 16 months post-disaster from household residents (N = 418 adults) in NYC communities that were most heavily affected by the hurricane. The Posttraumatic Stress Checklist for DSM-5 (PCL-5) was applied for measuring posttraumatic stress and the nine-item Patient Health Questionnaire (PHQ-9) was used for measuring depression. We applied spatial autocorrelation and spatial regimes regression analyses, to test for spatial clusters of mental health outcomes and to explore whether associations between vulnerability and resilience factors and mental health differed among New York City's five boroughs. RESULTS: Mental health problems clustered predominantly in neighborhoods that are geographically more exposed towards the ocean indicating a spatial variation of risk within and across the boroughs. We further found significant variation in associations between vulnerability and resilience factors and mental health. Race/ethnicity (being Asian or non-Hispanic black) and disaster-related stressors were vulnerability factors for mental health symptoms in Queens, and being employed and married were resilience factors for these symptoms in Manhattan and Staten Island. In addition, parental status was a vulnerability factor in Brooklyn and a resilience factor in the Bronx. CONCLUSIONS: We conclude that explanatory characteristics may manifest as psychological vulnerability and resilience factors differently across different regional contexts. Our spatial epidemiological approach is transferable to other regions around the globe and, in the light of a changing climate, could be used to strengthen the psychosocial resources of demographic groups at greatest risk of adverse outcomes pre-disaster. In the aftermath of a disaster, the approach can be used to identify survivors at greatest risk and to plan for targeted interventions to reach them.

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.

BACKGROUND: Longitudinal studies of posttraumatic stress (PTS) have documented environmental factors as predictors of trajectories of higher, versus lower, symptoms, among them experiences of childhood physical abuse. Although it is now well-accepted that genes and environments jointly shape the risk of PTS, no published studies have investigated genes, or gene-by-environment interactions (GxEs), as predictors of PTS trajectories. The purpose of this study was to fill this gap. METHODS AND MATERIALS: We examined associations between variants of the retinoid-related orphan receptor alpha (RORA) gene and trajectory membership among a sample of predominantly non-Hispanic Black urban adults (N = 473). The RORA gene was selected based on its association with posttraumatic stress disorder (PTSD) in the first PTSD genome wide association study. Additionally, we explored GxEs between RORA variants and childhood physical abuse history. RESULTS: We found that the minor allele of the RORA SNP rs893290 was a significant predictor of membership in a trajectory of consistently high PTS, relatively to a trajectory of consistently low PTS. Additionally, the GxE of rs893290 with childhood physical abuse was significant. Decomposition of the interaction showed that minor allele frequency was more strongly associated with membership in consistently high or decreasing PTS trajectories, relative to a consistently low PTS trajectory, among participants with higher levels of childhood physical abuse. CONCLUSION: The results of the study provide preliminary evidence that variation in the RORA gene is associated with membership in trajectories of higher PTS and that these associations are stronger among persons exposed to childhood physical abuse. Replication and analysis of functional data are needed to further our understanding of how RORA relates to PTS trajectories.

High rates of mental health (MH) problems have been documented among disaster relief workers. However, few workers utilize MH services, and predictors of service use among this group remain unexplored. The purpose of this study was to explore associations between predisposing, illness-related, and enabling factors from Andersen's behavioral model of treatment-seeking and patterns of service use among participants who completed at least one full day of cleanup work after the Deepwater Horizon oil spill and participated in home visits for the NIEHS GuLF STUDY (N = 8931). Workers reported on MH symptoms and whether they had used counseling or medication for MH problems since the oil spill. Hierarchical logistic regression models explored associations between predictors and counseling and medication use in the full sample, and type of use (counseling only, medication only, both) among participants who used either service. Analyses were replicated for subsamples of participants with and without symptom inventory scores suggestive of probable post-disaster mental illness. Having a pre-spill MH diagnosis, pre-spill service use, more severe post-spill MH symptoms, and healthcare coverage were positively associated with counseling and medication use in the full sample. Among participants who used either service, non-Hispanic Black race, pre-spill counseling, lower depression, and not identifying a personal doctor or healthcare provider were predictive of counseling only, whereas older age, female gender and pre-spill medication were predictive of medication only. The results were generally consistent among participants with and without probable post-disaster mental illness. The results suggest variability in which factors within Andersen's behavioral model are predictive of different patterns of service use among disaster relief workers.

The purpose of this study is to examine the association between oral contraceptive use (any current use, duration, and type) and major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) in a nationally representative sample of women in the USA. Data were drawn from 1,105 women aged 20-39 in the National Health and Nutrition Examination Surveys from 1999 to 2004. The associations between self-reported use of oral contraceptives in the past year and DSM-IV diagnosed and subthreshold MDD, GAD, and PD in the past year were assessed comparing oral contraceptive users to all non-users, former users, and former long-term users. Women using oral contraceptives had a lower past-year prevalence of all disorders assessed, other than subthreshold MDD. When adjusted for confounders, women using oral contraceptives in the past year had significantly lower odds of subthreshold PD, compared to former users (odds ratio (OR) = 0.34, 95 % CI 0.14-0.84). Effects estimates were strongest for monophasic (versus multiphasic) oral contraceptive users. Hormonal contraceptive use was associated with reduced risk of subthreshold PD. A potential mental health benefit of hormonal contraceptives has substantial public health implications; prospective longitudinal studies are needed to confirm whether hormonal contraceptive use improves mental health.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and depression are known to be highly comorbid. However, previous findings regarding the nature of this comorbidity have been inconclusive. This study prospectively examined whether PTSD and depression are distinct constructs in an epidemiologic sample, as well as assessed the directionality of the PTSD-depression association across time. METHODS: Nine hundred and forty-two Detroit residents (males: n = 387; females: n = 555) were interviewed by phone at three time points, 1 year apart. At each time point, they were assessed for PTSD (using the PCL-C), depression (PHQ-9), trauma exposure, and stressful life events. RESULTS: First, a confirmatory factor analysis showed PTSD and depression to be two distinct factors at all three waves of assessments (W1, W2, and W3). Second, chi-square analysis detected significant differences between observed and expected rates of comorbidity at each time point, with significantly more no-disorder and comorbid cases, and significantly fewer PTSD only and depression only cases, than would be expected by chance alone. Finally, a cross-lagged analysis revealed a bidirectional association between PTSD and depression symptoms across time for the entire sample, as well as for women separately, wherein PTSD symptoms at an early wave predicted later depression symptoms, and vice versa. For men, however, only the paths from PTSD symptoms to subsequent depression symptoms were significant. CONCLUSIONS: Across time, PTSD and depression are distinct, but correlated, constructs among a highly-exposed epidemiologic sample. Women and men differ in both the risk of these conditions, and the nature of the long-term associations between them.

Exposure to natural disasters has been linked to a range of adverse outcomes, including mental health problems (e.g., posttraumatic stress symptoms [PTSS], depression), declines in role functioning (e.g., occupational difficulties), and physical health problems (e.g., somatic complaints). However, prior research and theory suggest that the modal postdisaster response in each of these domains is resilience, defined as low levels of symptoms or problems in a given outcome over time, with minimal elevations that are limited to the time period during the disaster and its immediate aftermath. However, the extent to which disaster survivors exhibit mental health wellness (resilience across multiple mental health conditions) or general wellness (resilience across mental health, physical health, and role functioning domains) remains unexplored. The purpose of this study was to quantify mental health and general wellness, and to examine predictors of each form of wellness, in a three-wave population-based study of Hurricane Ike survivors (N = 658). Latent class growth analysis was used to determine the frequency of resilience on four outcomes (PTSS: 74.9%; depression: 57.9%; functional impairment: 45.1%; days of poor health: 52.6%), and cross-tabulations were used to determine the frequency of mental health wellness (51.2%) and general wellness (26.1%). Significant predictors of both mental health and general wellness included lower peri-event emotional reactions and higher community-level collective efficacy; loss of sentimental possessions or pets and disaster-related financial loss were negative predictors of mental health wellness, and loss of personal property was a negative predictor of general wellness. The results suggest that studies focusing on a single postdisaster outcome may have overestimated the prevalence of mental health and general wellness, and that peri-event responses, personal property loss and collective efficacy have a cross-cutting influence across multiple domains of postdisaster functioning.

BACKGROUND: The majority of disaster survivors suffering from psychological symptoms do not receive mental health services. Research on barriers to service use among disaster survivors is limited by a lack of longitudinal studies of representative samples and investigations of predictors of barriers. The purpose of this study was to address these limitations through analysis of a three-wave population-based study of Hurricane Ike survivors (N = 658). METHODS: Frequencies of preference, outcome expectancy, resource, and stigma barriers among participants with unmet mental health needs were documented and logistic regression using a generalized estimating equations approach explored predisposing (e.g., age), illness-related (e.g., posttraumatic stress) and enabling (e.g., insurance coverage) factors as predictors of each type of barrier. RESULTS: Preference barriers were most frequently cited at each wave, whereas stigma barriers were least frequently cited. Older age and higher emotional support predicted preference barriers; being a parent of a child under 18-years old at the time of the hurricane, higher generalized anxiety, and lack of insurance predicted resource barriers; and higher posttraumatic stress predicted stigma barriers. CONCLUSIONS: These findings suggest that postdisaster practices targeting subpopulations most likely to have barriers to service use may be indicated.

Several individual-level factors are known to promote psychological resilience in the aftermath of disasters. Far less is known about the role of community-level factors in shaping postdisaster mental health. The purpose of this study was to explore the influence of both individual- and community-level factors on resilience after Hurricane Sandy. A representative sample of household residents (N = 418) from 293 New York City census tracts that were most heavily affected by the storm completed telephone interviews approximately 13-16 months postdisaster. Multilevel multivariable models explored the independent and interactive contributions of individual- and community-level factors to posttraumatic stress and depression symptoms. At the individual-level, having experienced or witnessed any lifetime traumatic event was significantly associated with higher depression and posttraumatic stress, whereas demographic characteristics (e.g., older age, non-Hispanic Black race) and more disaster-related stressors were significantly associated with higher posttraumatic stress only. At the community-level, living in an area with higher social capital was significantly associated with higher posttraumatic stress. Additionally, higher community economic development was associated with lower risk of depression only among participants who did not experience any disaster-related stressors. These results provide evidence that individual- and community-level resources and exposure operate in tandem to shape postdisaster resilience.

The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre- and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale-Revised (IES-R), and self-reported postdisaster asthma attacks. A 1-point increase in the IES-R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning.