Prevalence and Risk Factors for Depressive Reaction among Resident Survivors after the Tsunami following the Great East Japan Earthquake,March 11, 2011

Objectives

The Great East Japan Earthquake caused a gigantic tsunami which devastated coastal areas of northern Japan on 11 March 2011. Despite the large number of ‘resident survivors’ who continued to reside in their damaged houses on the second or upper floors, research on the mental health of these individuals has been limited. This study explored the prevalence of depressive reaction and risk factors for depressive reaction among these resident survivors.

Methods

A cross-sectional household health support needs screening was conducted for resident survivors in Higashi-Matsushima city, Miyagi prefecture, two to four months after the tsunami. The health interview that was conducted including mental status, assessed by the Patient Health Questionnaire-2 (PHQ-2).

Results

Of 5,454 respondents, 8.1% had depressive reaction. After adjustment by the number of weeks from the tsunami and the mortality rate at each respondent''s place of residence, depressive reaction was significantly associated with house flooding below or above the ground floor (odds ratios of 1.92, 2.36, respectively), the unavailability of gas supply (odds ratio, 1.67), being female (odds ratio, 1.47), middle aged or elderly (odds ratios of 2.41, 2.42, respectively), regular intake of psychotropic medicine(s) since before the tsunami (odds ratio, 2.53) and the presence of one to five or more than six cohabiters (odds ratios of 0.61, 0.52, respectively).

Conclusions

The results suggest a considerable psychological burden (depressive reaction) following the tsunami among resident survivors. Special supports for families with psychiatric problems need to be considered among resident survivors. Restoration of lifeline utilities and the strengthening of social ties of persons living alone may help prevent depressive reaction among resident survivors after a tsunami.     

Clinically Significant Behavior Problems among Young Children 2 Years after the Great East Japan Earthquake

Background

On March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake.

Method

Participants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems.

Results

Rates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10–5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area.

Conclusions

One in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be useful for developing future interventions in child mental health after a natural disaster.     

Changes in Cognitive Functions in the Elderly Living in Temporary Housing after the Great East Japan Earthquake

On March 11, 2011, Japan experienced an earthquake of magnitude 9.0 and subsequent enormous tsunamis. This disaster destroyed many coastal cities and caused nearly 20,000 casualties. In the aftermath of the disaster, many tsunami survivors who lost their homes were forced to live in small temporary apartments. Although all tsunami survivors were at risk of deteriorating health, the elderly people were particularly at a great risk with regard to not only their physical health but also their mental health. In the present study, we performed a longitudinal cohort study to investigate and analyze health conditions and cognitive functions at 28, 32, and 42 months after the disaster in the elderly people who were forced to reside in temporary apartments in Kesennuma, a city severely damaged by the tsunamis. The ratio of people considered to be cognitively impaired significantly increased during the research period. On the other hand, the mean scores of the Kessler Psychological Distress Scale-6 and Athens Insomnia Scale improved based on the comparison between the data at 24 and 42 months. The multiple logistic regression analysis revealed that frequency of “out-of-home activities” and “walking duration” were independently associated with an increase in the ratio of people with cognitive impairment. We concluded that the elderly people living in temporary apartments were at a high risk of cognitive impairment and “out-of-home activities” and “walking” could possibly maintain the stability of cognitive functions.     

Regional landscape-scale comparison of species composition and recruitment in remnant tree patches 3 years after the 2011 Great East Japan Earthquake and tsunami

Understanding species composition and other characteristics of remnant trees that survive large-scale low-frequency disturbances such as tsunamis is an important step in monitoring and managing the process of recovery. This research was implemented in a study area along the shores of Sendai Bay, a region that was heavily damaged by the tsunami following the Great East Japan Earthquake of 2011. Field surveys of all the remnant patches of trees in the study area were conducted in 2014, three years after the disturbance. A total of 202 remnant patches were identified, and all the tree species, including both canopy trees and newly established seedlings, were recorded for each patch. The identified trees totaled 88 species, which were classified into three indicator-species types by a hierarchical cluster analysis. Comparisons based on species composition and similarity showed that species composition and other characteristics of the remnant patches were influenced by vegetation histories and other factors that only become visible at the regional landscape scale. The number of tree and seedling species per unit area was highest in patches that originated from pine plantations. Seven of the 25 seedling species identified were not present in any of the canopy layers in the study area, indicating that they dispersed from outside this area. These results show that, despite the immense scale of the tsunami, many diverse patches of trees managed to survive the disturbance. These patches function as hubs for species dispersion and accelerate recovery of species diversity in the disturbed area.

     

Change in and Long-Term Investigation of Neuro-Otologic Disorders in Disaster-Stricken Fukushima Prefecture: Retrospective Cohort Study before and after the Great East Japan Earthquake

On March 11, 2011, Japan’s northeast Pacific coast was hit by a gigantic earthquake and subsequent tsunami. Soma City in Fukushima Prefecture is situated approximately 44 km north of Fukushima Daiichi Nuclear Power Plant. Soma General Hospital is the only hospital in Soma City that provides full-time otolaryngological medical care. We investigated the changes in new patients from one year before to three years after the disaster. We investigated 18,167 new patients treated at our department during the four years from April 1, 2010 to March 31, 2014. Of the new patients, we categorized the diagnoses into Meniere’s disease, acute low-tone sensorineural hearing loss, vertigo, sudden deafness, tinnitus, and facial palsy as neuro-otologic symptoms. We also investigated the changes in the numbers of patients whom we examined at that time concerning other otolaryngological disorders, including epistaxis, infectious diseases of the laryngopharynx, and allergic rhinitis. The total number of new patients did not change remarkably on a year-to-year basis. Conversely, cases of vertigo, Meniere’s disease, and acute low-tone sensorineural hearing loss increased in number immediately after the disaster, reaching a plateau in the second year and slightly decreasing in the third year. Specifically, 4.8% of patients suffering from these neuro-otologic diseases had complications from depression and other mental diseases. With regard to new patients in our department, there was no apparent increase in the number of patients suffering from diseases other than neuro-otologic diseases, including epistaxis, and allergic rhinitis. Patients suffering from vertigo and/or dizziness increased during the first few years after the disaster. These results are attributed to the continuing stress and tension of the inhabitants. This investigation of those living in the disaster area highlights the need for long-term support.     

Prosocial Behaviors during School Activities among Child Survivors after the 2011 Earthquake and Tsunami in Japan: A Retrospective Observational Study

Background

The 2011 Japan massive tsunami traumatized many children. The aim of this study was to assess changes in strengths and difficulties experienced in home and school by among surviving children after the 2011 tsunami, in comparison with published normal Japanese data.

Methods

In November 2012 (20 months after the disaster) and September 2013 (30 months after the disaster), the Strengths and Difficulties Questionnaire (SDQ), a questionnaire on children''s strengths and difficulties in home and school activities, were distributed to 12,193 and 11,819 children, respectively. An effective response of children 20 months and 30 month after the disaster was obtained in 10,597 children (86.9%), and 10,812 children (91.4%), respectively. The SDQ scores evaluated by parents and teachers were compared with published normal Japanese SDQ scores.

Results

The SDQ scores (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, and total difficulty score) evaluated by parents of children in the 4th to 9th grade who were evaluated after 30 and 20 months were significantly high compared with the published normal data of children without traumatic experiences (all P<0.001). The SDQ scores (prosocial behavior) evaluated by teachers of children in the 4th to 9th grade who were evaluated after 30 and 20 months were significantly low compared with the published normal data of children without traumatic experiences (all P<0.001).

Conclusions

This study showed that the experience of the disaster affected those children with prosocial behaviors towards teachers and friends at school. However, no significant changes (in their prosocial attitude) had been seen at home, where they continued to keep their respect and caring feelings for parents. These results indicate that for accurate diagnosis, clinicians should not only evaluate these children''s daily activities at home but also try to objectively assess their daily activities at school.     

Gender Differences in Mental Health Outcomes before,during, and after the Great Recession

We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities.     

Modelling psychological responses to the Great East Japan earthquake and nuclear incident

The Great East Japan (Tōhoku/Kanto) earthquake of March 2011 was followed by a major tsunami and nuclear incident. Several previous studies have suggested a number of psychological responses to such disasters. However, few previous studies have modelled individual differences in the risk perceptions of major events, or the implications of these perceptions for relevant behaviours. We conducted a survey specifically examining responses to the Great Japan earthquake and nuclear incident, with data collected 11-13 weeks following these events. 844 young respondents completed a questionnaire in three regions of Japan; Miyagi (close to the earthquake and leaking nuclear plants), Tokyo/Chiba (approximately 220 km from the nuclear plants), and Western Japan (Yamaguchi and Nagasaki, some 1000 km from the plants). Results indicated significant regional differences in risk perception, with greater concern over earthquake risks in Tokyo than in Miyagi or Western Japan. Structural equation analyses showed that shared normative concerns about earthquake and nuclear risks, conservation values, lack of trust in governmental advice about the nuclear hazard, and poor personal control over the nuclear incident were positively correlated with perceived earthquake and nuclear risks. These risk perceptions further predicted specific outcomes (e.g. modifying homes, avoiding going outside, contemplating leaving Japan). The strength and significance of these pathways varied by region. Mental health and practical implications of these findings are discussed in the light of the continuing uncertainties in Japan following the March 2011 events.     

Peritraumatic distress, watching television, and posttraumatic stress symptoms among rescue workers after the Great East Japan earthquake

Background

The Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake.

Methodology/Principal Findings

In this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms.

Conclusions/Significance

The PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.     

Decrease in the Traumatic Symptoms Observed in Child Survivors within Three Years of the 2011 Japan Earthquake and Tsunami

Background

On March 11, 2011, Japan was struck by a massive earthquake and tsunami. The tsunami caused tremendous damage and traumatized several people, including children. The aim of this study was to assess changes in traumatic symptoms 8, 20, and 30 months of the 2011 tsunami.

Methods

The study comprised three groups. Copies of the Post-Traumatic Stress Symptoms for Children 15 items (PTSSC-15), a self-rating questionnaire on traumatic symptoms, were distributed to 12,524 children (8-month period), 12,193 children (20-month period), and 11,819 children (30-month period). An effective response of children 8 months, 20 months, and 30 month after the disaster was obtained in 11,639 (92.9%), 10,597 (86.9%), and 10,812 children (91.4%), respectively. We calculated the total score, PTSD subscale, and Depression subscale of PTSSC-15. We calculated the total score, PTSD subscale, and Depression subscale of PTSSC-15.

Results

The PTSSC-15 total score and PTSD subscale of children belonging to 1st–9th grade groups who were tested 30 and 20 months after the tsunami significantly decreased compared with those of children tested 8 months after the tsunami. The PTSSC-15 total score and PTSD subscale of children in 1st–9th grade groups tested after 30 months did not decrease significantly compared with those of children tested after 20 months. The PTSSC-15 Depression subscale and PTSD subscale of children in 1st–9th grade groups tested after 30 months significantly decreased compared with those of children tested 8 months after the tsunami. The PTSSC-15 Depression subscale of children in 1st–9th grade groups evaluated after 30 months significantly decreased compared with those of children evaluated after 20 months.

Conclusions

This study demonstrates that the traumatic symptoms of children who survived the massive tsunami improved with time. Nonetheless, the traumatic symptoms, which in some cases did not improve with time.     

Factors Related to Social Support in Neurological and Mental Disorders

Despite the huge body of research on social support, literature has been primarily focused on its beneficial role for both physical and mental health. It is still unclear why people with mental and neurological disorders experience low levels of social support. The main objective of this study was to explore what are the strongest factors related to social support and how do they interact with each other in neuropsychiatric disorders. The study used cross-sectional data from 722 persons suffering from dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson''s disease, schizophrenia, stroke, and substance use disorders. Multiple linear regressions showed that disability was the strongest factor for social support. Extraversion and agreeableness were significant personality variables, but when the interaction terms between personality traits and disability were included, disability remained the only significant variable. Moreover, level of disability mediated the relationship between personality (extraversion and agreeableness) and level of social support. Moderation analysis revealed that people that had mental disorders experienced lower levels of support when being highly disabled compared to people with neurological disorders. Unlike previous literature, focused on increasing social support as the origin of improving disability, this study suggested that interventions improving day-to-day functioning or maladaptive personality styles might also have an effect on the way people perceive social support. Future longitudinal research, however, is warranted to explore causality.     

Managing Type 2 Diabetes Mellitus through Periodical Hospital Visits in the Aftermath of the Great East Japan Earthquake Disaster: A Retrospective Case Series

AimsTo assess the impact of the Great East Japan Earthquake Disaster on daily diabetes practice and to determine the feasibility of controlling type 2 diabetes mellitus in an outpatient department.MethodsWe retrospectively reviewed the data on disaster-affected patients with type 2 diabetes who periodically attended outpatient department of Soma Central Hospital. There were 767 patients with type 2 diabetes mellitus in total. The primary outcome measure was the change in HbA1c.ResultsHbA1c levels of 58 patients with periodical hospital visits did not deteriorate after the disasters. Moreover, there observed no significant difference in the mean of HbA1c levels among all age and sex throughout the year. While several changes in diabetes medication usage occurred, DPP4-inhibitor was the only oral diabetic agent that increased in frequency (+60%).ConclusionsPatients with type 2 diabetes who were managed with periodical hospital visits did not show significant deterioration in HbA1c levels.     

Mental Health Problems among the Survivors in the Hard-Hit Areas of the Yushu Earthquake

Background

On April 14, 2010, an earthquake registering 7.1 on the Richter scale shook Qinghai Province in southwest China. The earthquake caused numerous casualties and much damage. The epicenter, Yushu County, suffered the most severe damage. As a part of the psychological relief work, the present study evaluated the mental health statuses of the people affected and identified the mental disorder risk factors related to earthquakes.

Methods

Five hundred and five earthquake survivors living in Yushu County were investigated 3–4 months after the earthquake. Participant demographic data including gender, age, marital status, ethnicity, educational level, and religious beliefs were collected. The Earthquake-Specific Trauma Exposure Indicators assessed the intensity of exposure to trauma during the earthquake. The PTSD Checklist-Civilian version (PCL-C) and the Hopkins Symptoms Checklist-25 (HSCL-25) assessed the symptoms and prevalence rates of probable Posttraumatic Stress Disorder (PTSD) as well as anxiety and depression, respectively. The Perceived Social Support Scale (PSSS) evaluated subjective social support.

Results

The prevalence rates of probable PTSD, anxiety, and depression were 33.7%, 43.8% and 38.6%, respectively. Approximately one fifth of participants suffered from all three conditions. Individuals who were female, felt initial fear during the earthquake, and had less social support were the most likely to have poor mental health.

Conclusions

The present study revealed that there are serious mental problems among the hard–hit survivors of the Yushu earthquake. Survivors at high risk for mental disorders should be specifically considered. The present study provides useful information for rebuilding and relief work.     

Factors relating to the mental health of women who were pregnant at the time of the Great East Japan earthquake: analysis from month 10 to month 48 after the earthquake

Background

The Great East Japan Earthquake occurred at 2:46 p.m. on March 11, 2011. The epicenter was off the coast of Miyagi prefecture, and the magnitude of the earthquake was 9.0 with a maximum seismic intensity of 7.0. Although it has already been four years, victims continue to have complex problems. In the stricken areas of Miyagi prefecture, almost ten percent of the residents continue to live in temporary housing. Life altering events that force relocation and a change of living environment are known to adversely affect mental health. The purpose of this study was to examine the mental health of mothers of infants who experienced this disaster in Miyagi prefecture.

Methods

We conducted a survey using The Edinburgh Postnatal Depression Scale (10 months) and The General Health Questionnaire-28, an efficient screening tool for psychiatric distress. Eight hundred eighty-six mothers of children born from February to October, 2011 in Miyagi prefecture were surveyed 10, 16, 24, 36 and 48 months after the disaster. Data were analyzed with the use of SPSS 21.0 J for Windows. The study was approval by the review board of ethics at Tohoku University.

Results

The questionnaire was answered by the following number of mothers at the specified months after the disaster: 677 at 10 months, 384 at 16 months, 351 at 24 months, 250 at 36 months and 193 at 48 months. Results at all time periods indicated a high prevalence of psychiatric distress among the mothers surveyed. The percentage of Japanese adults with high-risk GHQ-28 scores is 14 %, thus psychological distress among the subjects in the present study is considerably more widespread. General Health Questionnaire-28 scores were significantly higher for those mothers experiencing dissatisfaction in their marital relationships. We found that mothers have experienced severe mental distress since the disaster, which we think is a possible cause of depression that is leading to poor mental health.

Conclusion

The results indicate that the upheaval caused by the tsunami affected the mental health of the mothers. Psychological distress continued to be prevalent up to four years after the disaster. Different factors were found to be associated with their distress. The most common issues were economic problems, dissatisfaction in the marital relationship, and no support with childcare.

     

Health Related Quality of Life and Influencing Factors among Welders

Background

Occupational exposure to welding fumes is a serious occupational health problem all over the world. Welders are exposed to many occupational hazards; these hazards might cause some occupational diseases. The aim of the study was to assess the health related quality of life (HRQL) of electric welders in Shanghai China and explore influencing factors to HRQL of welders.

Methods

301 male welders (without pneumoconiosis) and 305 non-dust male workers in Shanghai were enrolled in this study. Short Form-36 (SF-36) health survey questionnaires were applied in this cross-sectional study. Socio-demographic, working and health factors were also collected. Multiple stepwise regress analysis was used to identify significant factors related to the eight dimension scores.

Results

Six dimensions including role-physical (RP), bodily pain (BP), general health (GH), validity (VT), social function (SF), and mental health (MH) were significantly worse in welders compared to non-dust workers. Multiple stepwise regress analysis results show that native place, monthly income, quantity of children, drinking, sleep time, welding type, use of personal protective equipment (PPE), great events in life, and some symptoms including dizziness, discomfort of cervical vertebra, low back pain, cough and insomnia may be influencing factors for HRQL of welders. Among these factors, only sleep time and the use of PPE were salutary.

Conclusions

Some dimensions of HRQL of these welders have been affected. Enterprises which employ welders should take measures to protect the health of these people and improve their HRQL.     

Leg Extension Power Is a Pre-Disaster Modifiable Risk Factor for Post-Traumatic Stress Disorder among Survivors of the Great East Japan Earthquake: A Retrospective Cohort Study

Background

Post-traumatic stress disorder (PTSD) is a common psychological problem following natural disasters. Although pre-disaster risk factors are important for early detection and proactive support, the examination of such has been limited to sociodemographic factors, which were largely unaffected by the disasters. We examined the association between pre-disaster physical functioning and lifestyle and PTSD symptoms five months after the earthquake in the Great East Japan Earthquake survivors who were participating in a pre-existing cohort study.

Methods

We designed a retrospective cohort study of a cooperative association in Sendai from August 2010 to August 2011. In 2010, lifestyle, physical condition, and sociodemographic factors were examined by self-reported questionnaires completed by 522 employees of this organization. We also measured the leg extension power of all the participants. PTSD symptoms were evaluated by the Japanese version of the Impact of Event Scale-Revised (IES-R-J) following the earthquake of 2011.

Results

In multivariate linear regression analysis, leg extension power (β = –0.128, P = 0.025), daily drinking (β  = 0.203, P = 0.006), and depressive symptoms (β  = 0.139, P = 0.008) were associated with total score of the IES-R-J among men. Moreover, for the IES-R-J subscale, leg extension power was also negatively associated with Intrusion (β = –0.114, P = 0.045) and Hyperarousal (β = –0.163, P = 0.004) after adjusting for all other significant variables. For women, hypertension (β  = 0.226, P = 0.032) and depressive symptoms (β  = 0.205, P = 0.046) were associated with the total score of the IES-R-J.

Conclusions

Leg extension power is a potentially modifiable pre-disaster risk factor among men for attenuating the severity of PTSD symptoms associated with great disasters such as the Great East Japan Earthquake among men.     

Faith after an Earthquake: A Longitudinal Study of Religion and Perceived Health before and after the 2011 Christchurch New Zealand Earthquake

On 22 February 2011, Christchurch New Zealand (population 367,700) experienced a devastating earthquake, causing extensive damage and killing one hundred and eighty-five people. The earthquake and aftershocks occurred between the 2009 and 2011 waves of a longitudinal probability sample conducted in New Zealand, enabling us to examine how a natural disaster of this magnitude affected deeply held commitments and global ratings of personal health, depending on earthquake exposure. We first investigated whether the earthquake-affected were more likely to believe in God. Consistent with the Religious Comfort Hypothesis, religious faith increased among the earthquake-affected, despite an overall decline in religious faith elsewhere. This result offers the first population-level demonstration that secular people turn to religion at times of natural crisis. We then examined whether religious affiliation was associated with differences in subjective ratings of personal health. We found no evidence for superior buffering from having religious faith. Among those affected by the earthquake, however, a loss of faith was associated with significant subjective health declines. Those who lost faith elsewhere in the country did not experience similar health declines. Our findings suggest that religious conversion after a natural disaster is unlikely to improve subjective well-being, yet upholding faith might be an important step on the road to recovery.     

Psychological Resilience after Hurricane Sandy: The Influence of Individual- and Community-Level Factors on Mental Health after a Large-Scale Natural Disaster

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.