Survivors Of Natural Disasters Research Articles

Association Between Sleep Disturbance and Low Back Pain: A 3-Year Longitudinal Study After the Great East Japan Earthquake.

A longitudinal study. The aim of this study was to clarify the association between sleep disturbance and low back pain (LBP) using 3-year longitudinal data after the Great East Japan Earthquake, with a focus on the duration or frequency of sleep disturbance and the effect of sleep disturbance on LBP. Sleep disturbance and LBP are common health problems in the general population and natural disaster survivors. However, a longitudinal study in this field is rare, and the association between sleep disturbance and LBP has not been clarified. A 3-year longitudinal study was conducted among people living in disaster-stricken areas after the Great East Japan Earthquake (n = 2059). Sleep disturbance and LBP were assessed at 4, 5, 6, and 7 years after the disaster. Multiple logistic regression analysis was performed to assess the association between the duration or frequency of sleep disturbance and LBP, and the effect of preceding sleep disturbance on the onset of LBP. The χ2 test and crude and multiple logistic regression models were used in data analysis. The duration and frequency of sleep disturbance were significantly associated with LBP, and the effect was stronger with longer duration and increased frequency of sleep disturbance. Furthermore, the duration and frequency of preceding sleep disturbance were significantly associated with the onset of LBP, and the effect was stronger with an increase in the duration and frequency of sleep disturbance. Sleep disturbance is associated with LBP in a dose-dependent manner. Attention should be paid to sleep disturbance for the treatment and prevention of LBP, especially with regard to the duration and frequency of sleep disturbance.Level of Evidence: 3.

Counselors’ Experience with Disaster Survivors of Natural Disasters: A Descriptive Phenomenological Study

Disaster survivors are individuals who are literally survived in the aftermath of disaster situations. They are dislocated from their affected homes to evacuation centers; and forced to leave behind all belongings. Due to the characteristics of disasters that are sudden and catastrophic, disaster survivors often experience substantial symptoms of distress and respond with psychological and psychosocial reactions. This qualitative research was conducted using a descriptive phenomenological study approach to explore, understand, and describe the experience of counselors during natural disasters in Malaysian. The authors were the primary instrument for data collection and analysis. Data included field notes and individual semi-structured in-depth interviews. The authors developed coding categories using ATLAS.ti. The themes that emerged were refined, and became the major and sub-themes for this research. This research found that the experience gained from the disaster survivors during the disaster situations has developed the understanding and addressing the complexity of satisfying disaster survivors’ critical needs during natural disasters. It was also informed that providing crisis support during natural disaster has brought plethora of experiences and knowledge that should be shared with other counselors in Malaysia.

The 5-Year Course of Neck Pain Among Natural Disaster Survivors: The Association of Prior Neck Pain with New Episodes of Neck Pain.

Neck pain is a common health problem among both the general population and natural disaster survivors. However, the long-term course of neck pain has rarely been reported. The aim of this study was to elucidate the 5-year course of neck pain among survivors of the Great East Japan Earthquake (GEJE) by assessing the association of neck pain 2 and 4 years after the disaster with that at 7 years. Longitudinal study. A panel study was conducted on GEJE survivors (n = 1,821) through the administration of a self-reported questionnaire at 2 (first time point), 4 (second time point), and 7 years (third time point) after the disaster. Multivariate logistic regression analyses were performed to assess the association between prior neck pain and subsequent neck pain. The rates of neck pain at the first, second, and third time points were 20.7%, 21.1%, and 20.1%, respectively. Neck pain at the first time point was significantly associated with neck pain at the third time point (adjusted odds ratio [95% confidence interval]: 5.96 [4.53-7.83]). Furthermore, neck pain at the first and second time points was significantly associated with neck pain at the third time point (adjusted odds ratio [95% confidence interval]: 5.71 [4.19-7.78] for neck pain at either time point; 15.94 [10.99-23.12] for neck pain at both time points; P for trend <0.001). Prior neck pain was significantly associated with neck pain 5 years later, and the effect was stronger with an increase of prior neck pain episodes. Clinicians should base their selection of treatment method on an individual's history of neck pain.

Spiritually Oriented Expressive Writing and Promoting Positive Outcomes After a Natural Disaster

Natural disasters can disrupt and challenge survivors’ core belief systems, leading to negative health consequences. People often rely on religion/spirituality to help them cope and make meaning, but to date very few studies have specifically focused on exploring spiritually oriented expressive writing interventions with natural disaster survivors. Therefore, the current longitudinal, mixed-methods study utilized an experimental design with random assignment of 132 survivors of the 2016 Louisiana flooding. Quantitative measures were completed before and after the writing intervention, then at 1-month and 6-month follow-up time points. Results indicated that the spiritually oriented intervention was effective in promoting meaning in life but not life satisfaction. Survivors with lower preintervention positive attitudes toward God evidenced the strongest growth over time regarding meaning in life. Qualitative analyses, using a directed content analysis approach, revealed six themes in the experimental group’s written responses that expanded previous research. Finally, we discuss implications for counseling and future research.

The factor structure of major depressive symptoms in a sample of Chinese earthquake survivors

BackgroundExperiencing natural disasters is associated with common mental disorders including major depressive disorder (MDD). However, the latent structure of MDD is widely debated, and few studies tested the MDD factor structure in Chinese natural disaster survivors. Therefore, the aim of the current study was to evaluate the factorial validity of the Patient Health Questionnaire-9 (PHQ-9) for DSM-5 major depressive disorder (MDD) symptoms in Chinese earthquake survivors.MethodParticipants were 1058 Chinese earthquake survivors. Self-reported measures included the PHQ-9 and the Short-Form Health Survey (SF-36). Confirmatory factor analysis (CFA) and structural equation modelling (SEM) was used to examine the latent structure of MDD and the associations between latent factors of MDD and different domains of health-related quality of life (HRQoL), respectively.ResultsIn the current sample, the model consisted of somatic and cognitive/affective (non-somatic) factors demonstrated significantly better fit than the other competing MDD models (χ2 = 173.89, df = 26, CFI = 0.986, TLI = 0.981, RMSEA = 0.073, BIC = 18,091.13). Further SEM analyses indicated that the non-somatic factor was significantly related to both physical (β = − 0.362, p < .01) and psychosocial HRQoL (β = − 0.773, p < .01), while the somatic factor was a uniquely predictor of physical HRQoL (β = − 0.336, p < .01). Furthermore, we found the somatic factor partially mediated the relationship between the cognitive/affective factor and physical HRQoL (all ps < .05).ConclusionsThe MDD symptoms was best captured by a two-factor model comprised of somatic and cognitive/affective factors in Chinese natural disaster survivors. The two MDD factors were differentially associated with physical and psychosocial HRQoL, and the cognitive/affective factor associated physical HRQoL partially through the somatic factor. The current findings increase our understanding of latent structure of MDD symptoms, and carry implications for assessment and intervention of post-disaster mental health problems.

CHALLENGES FACED BY SOCIAL WORKERS DEALING WITH VICTIMS AND SURVIVORS OF NATURAL DISASTERS

Social work practice is a very unique profession and its domain of practice has grown beyond the known traditional one. Due to its wider scope, social workers are seen as frontline workers during natural disasters. The aim of this paper was to explore the challenges faced by social workers dealing with victims and survivors of natural disasters. The study adopted qualitative research approach and exploratory research design. Five social workers were purposively sampled to form part of individual semi-structured interview from Tzaneen Municipality. Data was collected until the level of saturation and analyzed thematically. The study revealed that social workers lack resources and proper training to deal with the victims and survivors of natural disasters. Moreover, the study found that there is poor inter-professional collaboration, role ambiguity and shortage of staff when disasters erupt. The study concludes that social workers are understaffed, have too much workload and are likely to experience burnout in their effort to assist victims and survivors of natural disasters. To that end, the study recommends that Department of Social Development should employ more social workers so that they can to respond during and after natural disasters.

Depression, anxiety, stress, and resilience among the primary survivors of natural disaster: A study with special reference to Kerala Flood

Background: Kerala, the southernmost state in India experienced the worst flood in its history, in August 2018. The disaster led its survivors to psychological trauma, along with several other impacts. Aims: The present study assessed the mental health status and level of resilience among the primary survivors in the postdisaster phase of Kerala flood, and the possible interlinkage of demographic factors with the study variables. Materials and Methods: The study has done on a sample of 50 primary survivors of flood selected using a purposive sampling method. Two rating scales-Depression Anxiety Stress Scale-21 and brief resilience scale-were used for collecting data, along with a sociodemographic information sheet prepared by the researcher, which was administered in a face to face interview with the participants. IBM SPSS software (version 21) was used for data analysis and statistical tests such as t-test, analysis of variance, and Pearson's correlation tests were used to interpret the data. Results: Results revealed the prevalence of depression, anxiety, and stress among the survivors in the postdisaster phase. Statistically significant difference was found in depression and stress scores in terms of education, where survivors with higher education showed lower stress and depression. Results also showed a comorbidity of depression, anxiety, and stress and a negative correlation between resilience and stress scores. Conclusions: The disaster had a significant impact on the survivors' mental health and need medical interventions to address it. The educational status and resilience level of the survivors are important determinants of postdisaster mental health.

A 5-year Longitudinal Study of Low Back Pain in Survivors of the Great East Japan Earthquake.

A longitudinal panel study. The aim of this study was to examine the occurrence of low back pain (LBP), especially the association of previous LBP with further episodes of LBP, in survivors of the Great East Japan Earthquake (GEJE) during the course of 5 years. LBP is common among survivors of natural disasters, but its long-term course is not clear. A 5-year longitudinal study was conducted among survivors of the GEJE (n = 1821). The presence of LBP was assessed using a self-reported questionnaire at 2, 4, and 7 years after the disaster (termed the first, second, and third time points, respectively). Multiple logistic regression analysis was performed to assess a potential association between LBP at the first and second time points with LBP at the third time point, and the odds ratios (ORs) and 95% confidence intervals (CI) were calculated. The prevalence of LBP was 25.3%, 27.3%, and 27.2% at the first, second, and third time points, respectively. The occurrence of LBP at the first time point was significantly associated with LBP at the third time point, and the adjusted odds ratio (OR) (95% confidence interval [CI]) was 5.47 (4.28-6.98). Furthermore, LBP at the first and second time points was significantly associated with LBP at the third time point. Compared to no LBP at the first and second time points, the adjusted OR (95% CIs) for LBP at the third time point was 4.12 (3.14-5.41) in the case of LBP at either of the first or second time points and 10.73 (7.80-14.76) for LBP at both time points (P for trend < 0.001). Previous LBP was associated with LBP 5 years later among survivors of the GEJE. Furthermore, the effect on subsequent LBP was stronger with a higher frequency of previous LBP episodes.Level of Evidence: 3.

Art-based psychosocial interventions in Japan: cross-cultural encounters

ABSTRACT Background: This article describes a psychosocial art-based group intervention for professional caregivers in Japan led by Israeli and Japanese mental health professionals, and explores the cross-cultural dilemmas related to this intervention. Context: The interventions took place from 2012 to 2016 in response to the tsunami and its aftermath. Two case descriptions explore the role of art and the implementation of art therapy in Japanese culture. Approach: The art-based group interventions were developed in conjunction with local Japanese mental-health professionals and include individual and group artistic expression. Outcomes: Several dilemmas associated with the cross-cultural encounter emerged. These touch on the ways in which a culture-bound phenomenon such as art can relate to the development of coping methods attuned to Japanese culture. Conclusions: Although psychosocial art-based interventions may elicit cultural dilemmas as depicted here, joint art-making can function as a societal process that enables the expression of community trauma, and can contribute to building individual and shared resilience. Implications for research: It is likely that art-based interventions will be needed all over the world. Future studies should continue to identify the dilemmas associated with the adaptation of art-based psychosocial interventions as a function of individual cultures. Plain-language summary This article describes a series of psychosocial art-based interventions in Japan led by Israeli and Japanese mental health professionals and funded by IsraAID, an Israeli non-profit organization that works with natural disaster survivors. The interventions took place from 2012 to 2016 in response to the 11 March 2011 earthquake and tsunami, and its aftermath. Local mental health professionals, health workers and educators collaborated with the IsraAID team to build a training programme using the arts, while at the same time providing self-care and support to these professionals who had experienced this disaster. The art-based group interventions methods are presented in vignettes from two groups, which highlight the role of art and the important cross-cultural aspects about these interventions. These case studies show that creating art together can serve a societal function and enable the expression of community trauma, while fostering individual and community resilience. As reflecting on the process, several dilemmas associated with the cross-cultural encounter in these art-based interventions came to the surface. Future researches could examine the participants' experiences in using art in trauma care, in the context of the cross- cultural encounter, by examining the long-term effects of these interventions.

Psychological predictors of posttraumatic growth among adult survivors of Wenchuan earthquake in China.

The current research investigates the applicability of the posttraumatic growth inventory and psychological predictors of posttraumatic growth among adult survivors of the Wenchuan earthquake in China. The results indicated that although the survivors reported a high degree of posttraumatic stress symptoms, they also experienced a moderate to high level of posttraumatic growth two years after the earthquake. The simplified Chinese version of the Posttraumatic Growth Inventory had good reliability in the current study. Confirmatory factor analysis of the simplified Chinese version of the Posttraumatic Growth Inventory verified that the original five-factor model fit the data better than the four-factor model documented by Ho et al. (2004, 2011) among Chinese cancer patients. The current study also demonstrates that positive changes in outlook, positive affect, and perceived social support are significant predictors of posttraumatic growth among adult survivors of the Wenchuan earthquake. Directions for future research on posttraumatic growth among survivors of natural disasters and implications for developing psychological interventions to help people recover from traumatic events are discussed.

Providing Immediate Hope to Survivors of Natural Disasters: A Miracle Question Intervention

Natural disasters can greatly impact the physical and psychological well-being of individuals, families, and communities. Experiencing the event is only the beginning of negative outcomes endured by families. The loss of a home, livelihood, possessions, and a sense of safety can cause depression, anxiety, posttraumatic stress disorder, and a vast array of other psychological challenges. This article proposes the use of the Miracle Question (MQ), an intervention from Solution focused Brief Therapy, for individuals and families recovering from a natural disaster. A case study example will also be provided to demonstrate the empathetic and effective use of the intervention.

Information-Seeking and Use of Primary Care Mental Health Services Among Gulf Coast Survivors of Natural Disasters.

This study sought to understand factors related to weather-related disaster survivors' health information and mental health-care-seeking behaviors. In November 2017, we conducted a quantitative survey of 170 Gulf Coast residents who experienced weather-related disasters. The survey assessed how individual and psychosocial factors affect health-care-seeking behavior. Nearly 66% of participants reported a high frequency of depression and/or anxiety symptoms, yet only 39% saw a medical professional. Of participants who visited a medical professional, 76% sought information from nonmedical sources. Seeking medical care was strongly correlated with seeking information from nonmedical sources and previous healthcare experiences, but not with fear and stigma. Positive communication and strong support systems have the potential to mitigate the reluctance people have in seeking help for mental health problems. Although it is discouraging that few people seek professional care, it is promising that participants were not avoiding care due to fear of being stigmatized. Less opposition to mental health care by survivors offers opportunity for mental health professionals to treat the psychological problems survivors experience. Providing necessary information may make headway to mental health care where it is greatly needed.

Abstract A099: Benefit finding and depressive symptoms: The role of socioeconomic status and positive affect among immigrant cancer survivors

Abstract Purpose: Benefit finding, or finding benefits within adversity, has been shown to be linked to better psychological well-being among those who have undergone trauma such as cancer patients and survivors of natural disasters. According to the National Cancer Institute, up to 25% of cancer survivors experience symptoms of depression. Positive emotions have been shown to promote positive meaning and buffer against depressive symptoms among individuals whom have undergone through challenging life circumstances (Tugade &amp; Frederickson, 2004; Frederickson et al., 2003) and resilient individuals report using greater positive emotions following a challenging task which predicted faster cardiovascular recovery (Tugade &amp; Frederickson, 2004). Furthermore, literature has documented ethnic and racial disparities in cancer survival and care. However, socioeconomic disparities in psychosocial adjustment to breast cancer have garnered little attention. This study addresses this gap by examining the association between benefit finding and depressive symptoms, state positive affect as an underlying mechanism, and the potential moderating role of socioeconomic indicators (i.e., personal income, household income, and education) among Chinese American breast cancer survivors (CABCS). Methods: Ninety-six CABCS completed a questionnaire packet assessing these variables. Results: Benefit finding was positively associated with positive affect and negatively associated with depressive symptoms. Educational attainment but neither personal nor household income was negatively associated with depressive symptoms. Positive affect explained the relationship between benefit finding and depressive symptoms. Only educational attainment moderated the relation between benefit finding and depressive symptoms such that benefit finding was most beneficial for those with high educational attainment. Conclusion: This study suggests that benefit finding is linked to lower depressive symptoms among CABCS through the mechanism of positive emotions. That is, positive emotions may broaden an individual's personal resources (e.g., social and psychological) that enhance health and well-being and help regulate negative emotions, thereby promoting resiliency. Furthermore, socioeconomic indicators such as education and income may be differentially related to depressive symptoms among CABCS. These findings underscore the importance of implementing psychosocial interventions targeted at increasing benefit finding and positive affectivity to address socioeconomic disparities among immigrant cancer survivors. Citation Format: Carol Wang, Qian Lu. Benefit finding and depressive symptoms: The role of socioeconomic status and positive affect among immigrant cancer survivors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A099.

Psychological Well-Being and The Sense of Community Among Displaced (Women) Natural Disaster Survivors

The present study investigates the psychological well-being and sense of community of women who were displaced by natural disasters. The study explored the interrelationship between the sense of community (SOC), psychological well-being (PWB), relocation status, and socio-demographic variables. One hundred and ninety women participated in the study (N = 190). Participants completed several self-report measurements (e.g., SCI, PWBS) and were categorized into two groups: those who still dwelled in temporary shelters (n = 96) and those who had permanently relocated (n = 94). There were no significant differences in overall SOC and PWB between the two groups; however, there was a significant difference in personal growth dimension —one out of six PWB dimensions— between those who had permanently relocated and those who still stayed in temporary shelters. The two groups also significantly differed on three SOC dimensions: influence, integration, and fulfillment of needs, and shared emotional connection. Three significant predictors for PWB were found: SOC, marital status, and educational attainment. Overall, SOC was a stronger predictor of PWB than displacement status, or any other socio-demographic variables. Keywords disaster; psychological well-being; internally displaced person; the sense of community; relocation; Indonesia

Multivariate classification of earthquake survivors with post-traumatic stress disorder based on large-scale brain networks.

The identification of post-traumatic stress disorder (PTSD) among natural disaster survivors is remarkably challenging, and there are no reliable objective signatures that can be used to assist clinical diagnosis and optimize treatment. The current study aimed to establish a neurobiological signature of PTSD from the connectivity of large-scale brain networks and clarify the brain network mechanisms of PTSD. We examined fifty-seven unmedicated survivors with chronic PTSD and 59 matched trauma-exposed healthy controls (TEHCs) using resting-state functional magnetic resonance imaging (rs-fMRI). We extracted the node-to-network connectivity and obtained a feature vector with a dimensionality of 864 (108 nodes×8 networks) to represent each subject's functional connectivity (FC) profile. Multivariate pattern analysis with a relevance vector machine was then used to distinguish PTSD patients from TEHCs. We achieved a promising diagnostic accuracy of 89.2% in distinguishing PTSD patients from TEHCs. The most heavily weighted connections for PTSD classification were among the default mode network (DMN), visual network (VIS), somatomotor network, limbic network, and dorsal attention network (DAN). The strength of the anticorrelation of FC between the ventral medial prefrontal cortex (vMPFC) in DMN and the VIS and DAN was associated with the severity of PTSD. This study achieved relatively high accuracy in classifying PTSD patients vs. TEHCs at the individual level. This performance demonstrates that rs-fMRI-derived multivariate classification based on large-scale brain networks can provide potential signatures both to facilitate clinical diagnosis and to clarify the underlying brain network mechanisms of PTSD caused by natural disasters.

Preceding Poor Physical Function Is Associated with New-Onset Musculoskeletal Pain among Older Natural Disaster Survivors: A Longitudinal Study after the Great East Japan Earthquake.

Musculoskeletal pain is a major problem among survivors of natural disasters. Functional disabilities in older adults increase after disasters and can lead to musculoskeletal pain. However, the effects of poor physical function on musculoskeletal pain after natural disasters remain unclear. This study aimed to elucidate the association of poor physical function with new-onset musculoskeletal pain among older survivors after the Great East Japan Earthquake (GEJE). Survivors aged ≥ 65 years, 3 years after the GEJE, were assessed longitudinally for 1 year (n = 646). Musculoskeletal pain was assessed using a self-reported questionnaire, and new-onset musculoskeletal pain was defined as absence and presence of pain at 3 years and 4 years, respectively, after the disaster. Physical function at 3 years after the disaster was assessed using the Kihon Checklist physical function score, which consists of 5 yes/no questions, and poor physical function was defined as a score of ≥ 3/5. Multivariate logistic regression analyses were used to assess the association of poor physical function with new-onset musculoskeletal pain. The incidence of new-onset musculoskeletal pain was 22.4%. Participants with poor physical function had a significantly higher rate of new-onset musculoskeletal pain. Compared with high physical function, the adjusted odds ratio (95% confidence interval) for new-onset musculoskeletal pain was 2.25 (1.37-3.69) in poor physical function (P = 0.001). Preceding poor physical function was associated with new-onset musculoskeletal pain among older survivors after the GEJE. There is need to focus on the maintenance of physical function to prevent musculoskeletal pain after natural disasters.

A Tale of Three Women: Framing as a Patriarchal Practice in the News Coverage of Women in Distress

Women in situations of distress receive a disproportionate amount of news coverage. As survivors (or perpetrators) of crime, violence, or natural disasters, they are naturally “newsworthy”—a newsroom term for the subjective lens with which truthtellers define and select their news frames. These frames, which govern the identification and coverage of what is “newsworthy,” box women into specific, patriarchal roles. Women who do not fall within the traditional feminine archetypes are labeled as dissidents or insurgents, and are excluded, dismissed, rejected, or worse persecuted, until the news recasts them into more familiar molds. This is exemplified in the Philippine Daily Inquirer’s news coverage of Mary Jane Veloso, a Filipina convicted of drug trafficking in Indonesia and sentenced to death in 2010. An examination of the Inquirer’s coverage of the Veloso case unearthed the gender biases that are inherent in the subjective rules that govern the patterns of selection and depiction in mainstream newsrooms.

Defining ‘Better’ Better

This paper explores the importance of house and home for survivors of natural disaster: it protects from hazards and contributes to health, well-being and economic security. It examines the reconstruction of homes after a disaster as an opportunity to Build Back Better, re-defining ‘better’ as an holistic and people-centred improvement in housing. It questions the humanitarian shelter sector’s emphasis on structural safety while poor sanitation, inadequate vector control and smoke inhalation are responsible for many more deaths worldwide than earthquakes and storms. The paper extends this discussion by arguing that promoting ‘safer’ for a substantial number of families is better than insisting on ‘safe’ for fewer. The overall benefit in terms of lives saved, injuries avoided and reduced economic loss is greater when safer is prioritised over safe, and it frees resources for wider consideration of a ‘good home’ and the pursuance of ‘self-recovery’. The paper is informed by field research conducted in 2017 and 2018. Finally, implications for humanitarian shelter practice are outlined, with particular reference to self-recovery. It highlights a need for adaptive programming, knowledge exchange and close accompaniment so that families and communities can make informed choices with respect to their own recovery pathways.

Association of Postdisaster Depression and Posttraumatic Stress Disorder With Mortality Among Older Disaster Survivors of the 2011 Great East Japan Earthquake and Tsunami

Depression and posttraumatic stress disorder (PTSD) represent 2 common mental health sequelae of natural disasters. However, to date, no studies have examined whether postdisaster depression and PTSD are associated with increased risk of mortality among community-dwelling survivors of natural disasters. To assess whether postdisaster depression and PTSD were associated with mortality in older disaster survivors. In this cohort study, prospective data were retrieved from older Japanese adults in Iwanuma City, Miyagi Prefecture, which was directly affected by the 2011 Great East Japan Earthquake and Tsunami. The baseline was established 7 months before the disaster (August 2010), and follow-up surveys were conducted approximately 2.5 years afterward (October 1, 2013, to January 31, 2014). Invitations were mailed to every citizen 65 years or older in Iwanuma City. Mortality data were obtained through March 4, 2017. Data analysis was performed from December 1, 2018, to June 30, 2019. Postdisaster depression (Geriatric Depression Scale Short Form score ≥5) and PTSD (Screening Questionnaire for Disaster Mental Health PTSD subscale score ≥4) were measured in 2013. Mortality data were obtained by linkage to the national long-term care insurance database. Cox proportional hazards regression models were adjusted for predisaster sociodemographic characteristics, health behaviors, social cohesion, predisaster depression, and disaster experiences. The response rate for the baseline survey was 59.0% (5058 of 8567 individuals), and the follow-up rate was 82.1% (3594 of 4380 eligible respondents). A total of 2965 individuals (mean [SD] age, 73.4 [6.2] years; 1621 [54.7%] female) participated in the study. The mean (SD) follow-up since the 2013 survey was 3.3 (0.5) years. Overall, 974 (32.8%) reported postdisaster depression and 747 (25.2%) reported PTSD. In adjusted models, depression was associated with more than double the risk of mortality (hazard ratio, 2.29; 95% CI, 1.54-3.42); PTSD was not associated with increased risk of mortality (hazard ratio, 1.10; 95% CI, 0.73-1.64). When evaluating the association of the 4-category comorbid depression and PTSD variable with mortality, survivors with depression only (HR, 2.24; 95% CI, 1.43-3.49) as well as those with comorbid depression and PTSD (HR, 2.54; 95% CI, 1.50-4.27) were at increased risk of death during the follow-up period compared with those with neither depression nor PTSD. Depression, but not PTSD, was associated with mortality during 3.3 years of follow-up among older disaster survivors. These findings suggest that long-term mental health consequences of natural disasters may exist and that treating depression in older survivors of disasters may be beneficial.

Neuropsychological Outcomes of Exposure to Hurricane Katrina and Relocation.

Survivors of natural disasters are at risk for mental health sequela, including deficits in neurocognitive functioning. This study explores links between hurricane exposure and resulting psychiatric symptoms and deficits in cognitive processing, attention, learning, and memory. Relocated Katrina survivors and demographically matched controls completed neurocognitive tests assessing processing speed (Trail Making Test, Part A), mental flexibility (Trail Making Test, Part B), sustained attention (Conner's Continuous Performance Test), and learning and memory (Rey Auditory-Verbal Learning Test). PTSD (Clinician-Administered PTSD Scale) and depressive symptoms (BDI- II) were also measured. Survivors had more PTSD and depression symptoms and weaker performance in cognitive processing, mental flexibility, and sustained attention, but not memory and learning compared to controls. When controlling for depression and PTSD symptoms (analysis of covariances), only CPT-II response time remained significantly different for survivors, so that sustained attention deficits were independent of emotional symptoms. Survivors had more psychiatric symptoms and neurocognitive dysfunctions than controls in most assessed measures. Our study had mixed results in identifying cognitive deficits related to psychopathology. Results suggest that disaster survivors, even those without psychopathology, should be assessed for cognitive issues that may affect their ability to process post-disaster instructions and access assistance in recovery efforts.