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Chen DZ, Chen KF, Xu JS, Gao K. Analysis of influencing factors of psychological resilience in patients with traumatic fractures and its effect on posttraumatic growth. World J Psychiatry 2025; 15:100819. [DOI: 10.5498/wjp.v15.i4.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 12/20/2024] [Accepted: 02/05/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Traumatic fractures are mainly caused by various exogenous traumatic events, which not only damage patients’ physical health but also affect their psychological state and aggravate stress responses.
AIM To analyze the influencing factors of psychological resilience of patients with traumatic fractures and the effect of psychological resilience on posttraumatic growth (PTG).
METHODS This study included 188 patients with traumatic fractures admitted to the First People’s Hospital of Shangqiu from November 2022 to November 2023. The participants were categorized based on the patient’s psychological resilience assessed by the Connor-Davidson Resilience Scale (CD-RISC) into the better resilience group (CD-RISC score ≥ 60 points, n = 80) and the poor resilience group (CD-RISC score < 60 points, n = 108). Patients’ sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The identification of the influencing factors of psychological resilience in patients with traumatic fractures was realized by binary Logistic regression (with factors such as sex, age, injury cause, trauma severity, fracture site, personality, and PSQI included for analysis). The determination of the PTG status of all participants used the Chinese version of the Posttraumatic Growth Inventory (C-PTGI). Furthermore, a Spearman correlation analysis was conducted to analyze the association between psychological resilience and PTG.
RESULTS The psychological resilience of patients with traumatic fractures was related to age, sex, trauma severity, and personality. The better resilience group demonstrated statistically lower PSQI scores than the poor resilience group (P < 0.05). The Logistic regression analysis revealed sex, age, trauma severity, personality, and sleep quality as influencing factors of CD-RISC scores in patients with traumatic fractures (all P < 0.05). The score of each C-PTGI dimension and the total score (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life) were higher in the better resilience group than in the poor resilience group (all P < 0.05). Spearman correlation analysis indicated a positive association of the CD-RISC score in patients with traumatic fractures with the scores of all dimensions of C-PTGI and the total C-PTGI score (all P < 0.05).
CONCLUSION The factors influencing the psychological resilience of patients with traumatic fractures include age, sex, trauma severity, personality, and sleep quality, and psychological resilience is closely associated with PTG.
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Affiliation(s)
- Dao-Zhen Chen
- Department of Traumatology, The First People’s Hospital of Shangqiu, Shangqiu 476100, Henan Province, China
| | - Kun-Feng Chen
- Department of Traumatology, The First People’s Hospital of Shangqiu, Shangqiu 476100, Henan Province, China
| | - Ji-Sheng Xu
- Department of Traumatology, The First People’s Hospital of Shangqiu, Shangqiu 476100, Henan Province, China
| | - Kun Gao
- Department of Orthopedics, Henan Province People’s Hospital, Zhengzhou 462000, Henan Province, China
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Huang HY, Chao TY, Huang YT, Chen BK, Shih HI. Increase in short-term and long-term stress-associated mental illness after Jiji earthquake in Taiwan: A twenty-year longitudinal population-based cohort study (1999-2019). J Affect Disord 2025; 368:757-769. [PMID: 39293601 DOI: 10.1016/j.jad.2024.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 09/10/2024] [Accepted: 09/14/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Earthquakes have caused profound physical and mental health impacts in human history. The Jiji earthquake, which had a magnitude of 7.6 on the Richter scale, occurred on 21 September 1999 in Taiwan. A close follow-up on the mental health status of affected adults after major natural disasters to construct the short-term and long-term risk and prevalence of stress-associated mental illnesses has not been performed by using the nationwide health databases. METHODS This population-based cohort study included 468,804 adults affected by Jiji earthquake spanning from 2000 to 2019 who were matched at a 1:4 ratio with unaffected individuals based on age and sex (n = 1,875,216). Employing a subdistribution hazard regression analysis, we assessed the incidence of sleep, anxiety, and depressive disorders after Jiji earthquake. Corrections for multiple comparisons were carried out using the Benjamini-Hochberg procedure. RESULTS Affected adults experienced an increased incidence of short-term (approximately twice) stress-associated psychiatric disorders. The risk of the post-traumatic stress disorder (PTSD) is significantly higher in the affected adults (40-64 years: aSHR: 92.0; ≥65 years: aSHR: 96.7, p < 0.0001). Middle-aged (aged 40-64 years) male adults presented with significantly more short-term (< one year) and long-term (up to 20 years) stress-related mental illnesses, i.e., insomnia, anxiety, and depressive disorders, than individuals in the control group. CONCLUSIONS An earthquake has significant short and long-term effects on sleep quality, anxiety, and depressive disorders in affected adults. Optimal short and long-term close monitoring is needed to deploy medical resources and socioeconomic support to relieve mental stress burdens.
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Affiliation(s)
- Hsiao-Ying Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Yuan Chao
- Department of Urban Planning, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Bo-Ku Chen
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
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Janson M, Felix ED, Jaramillo N, Sharkey JD, Barnett M. A Prospective Examination of Mental Health Trajectories of Disaster-Exposed Young Adults in the COVID-19 Pandemic. Behav Sci (Basel) 2024; 14:787. [PMID: 39336002 PMCID: PMC11428824 DOI: 10.3390/bs14090787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
This longitudinal study examines young adult mental health (MH) trajectories after exposure to natural disasters (i.e., hurricanes, wildfires, mudslides) across four waves, two pre- and two during the COVID-19 pandemic. Participants (n = 205) answered questions about anxiety, depression, and post-traumatic stress symptoms (PTSSs) across Waves (Ws) s 1-4 and pre-pandemic factors (prior trauma history, disaster exposure, life stressors since disaster) at Wave (W) 1. Hierarchical linear modeling was conducted to examine MH trajectories and associations with pre-pandemic factors. Only the PTSS trajectory significantly differed across all Ws, with the largest increase between Ws 2 and 3 (pre- and during-pandemic time points). Prior trauma history and life stressors since the disaster were significantly associated with all MH trajectory intercepts but not growth rates.
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Affiliation(s)
- Melissa Janson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - Erika D. Felix
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA 93106, USA
| | - Natalia Jaramillo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jill D. Sharkey
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA 93106, USA
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA 93106, USA
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Chen Z, Cong Z. Age Differences in Psychological Distress After Multiple Disaster Exposures: The Effect of Multidimensional Negative COVID-19 Impacts. Disaster Med Public Health Prep 2023; 17:e554. [PMID: 38044831 DOI: 10.1017/dmp.2023.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVE This study examined how the multidimensional negative coronavirus disease (COVID-19) impacts contextualized the age differences in psychological distress following exposures to tornadoes and the COVID-19 pandemic. METHODS Data were from a 2-wave panel study conducted at T1 (October 2020-August 2021) and T2 (May-August 2022). Latent class analysis was conducted to explore the patterns of negative COVID-19 impacts based on a sample of 1134 at T1. Negative binomial regressions were performed to examine the age differences in psychological distress at T2, based on the working sample (N = 554), as well as the moderating effect of identified class membership, with baseline psychological distress controlled. RESULTS Three latent classes were identified: class 1 "low overall impacts," class 2 "moderate overall impacts with high emotional distress," and class 3 "severe overall impacts." Individuals ages 65 and over reported lower psychological distress at T2 relative to those ages 18-34 and 35-49. However, compared to people ages 18-34, 35-49, and 50-64, those ages 65 and over reported the greatest increases in T2 psychological distress if they had experienced moderate or severe overall COVID-19 impacts at T1. CONCLUSION There is a pressing need for mental health interventions that are tailored to multi-disaster scenarios and age-related differences in long-term disaster recovery.
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Affiliation(s)
- Zhirui Chen
- Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhen Cong
- Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Matsuoka Y, Haseda M, Kanamori M, Sato K, Amemiya A, Ojima T, Takagi D, Hanazato M, Kondo N. Does disaster-related relocation impact mental health via changes in group participation among older adults? Causal mediation analysis of a pre-post disaster study of the 2016 Kumamoto earthquake. BMC Public Health 2023; 23:1982. [PMID: 37821854 PMCID: PMC10568925 DOI: 10.1186/s12889-023-16877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Disaster-related relocation is associated with depression and post-traumatic stress disorder, especially in older adults. Disaster-related relocation often deprives survivors of opportunities for social group participation, potentially deteriorating their mental health. On the contrary, the relocation could also be an opportunity for optimizing social relationships, ending/reducing unwanted participation. This study examined the potential mediation effects of changing participation for the link of disaster-related relocation to mental health. METHODS We analyzed a pre-post disaster dataset of functionally independent older adults from the Japan Gerontological Evaluation Study. Following the 2013 survey, a follow-up survey was conducted seven months after the 2016 Kumamoto earthquake (n = 828). RESULTS The causal mediation analyses indicated that compared to no relocation, the relative risk for experiencing major depressive episodes among those relocating to temporary housing was 3.79 [95% confidence interval: 1.70-6.64] (natural direct effect). By contrast, the relative risk for those renewing (either ceased or started) group participation was 0.60 [95% CI: 0.34-0.94] (natural indirect effect). CONCLUSIONS Optimization of social ties according to a renewal of group participation status might have protected older adults in temporary housing against depression.
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Affiliation(s)
- Yoko Matsuoka
- Department of Health and Social Behavior, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Social Epidemiology, Kyoto University, Kyoto-shi, Kyoto, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Maho Haseda
- Department of Social Epidemiology, Kyoto University, Kyoto-shi, Kyoto, Japan
| | - Mariko Kanamori
- Department of Health and Social Behavior, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Social Epidemiology, Kyoto University, Kyoto-shi, Kyoto, Japan
| | - Koryu Sato
- Department of Social Epidemiology, Kyoto University, Kyoto-shi, Kyoto, Japan
| | - Airi Amemiya
- Department of Social Epidemiology, Kyoto University, Kyoto-shi, Kyoto, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Daisuke Takagi
- Department of Health and Social Behavior, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masamichi Hanazato
- Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Kyoto University, Kyoto-shi, Kyoto, Japan.
- Department of Social Epidemiology, Graduate School of Medicine, Faculty of Medicine, Science Frontier Laboratory, Kyoto University, Floor 2, Yoshida-konoe-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan.
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Spiller TR, Na PJ, Merians AN, Duek O, Ben-Zion Z, Tsai J, von Känel R, Harpaz-Rotem I, Pietrzak RH. Changes in mental health among U.S. military veterans during the COVID-19 pandemic: A network analysis. J Psychiatr Res 2023; 165:352-359. [PMID: 37595331 DOI: 10.1016/j.jpsychires.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
Increases of symptoms of posttraumatic stress disorder (PTSD), anxiety and depression have been observed among individuals exposed to potentially traumatic events in the first months of the COVID-19 pandemic. Similarly, associations among different aspects of mental health, such as symptoms of PTSD and suicidal ideation, have also been documented. However, studies including an assessment prior to the onset and during the height of the pandemic are lacking. We investigated changes in symptoms of PTSD, depression, anxiety, suicidal ideation, and posttraumatic growth in a population-based sample of 1232 U.S. military veterans who experienced a potentially traumatic event during the first year of the pandemic. Symptoms were assessed prior to (fall/winter 2019) and one year into the pandemic (fall/winter 2020). We compared changes in symptom interrelations using network analysis, and assessed their associations with pandemic-related PTSD and posttraumatic growth symptoms. A subtle increase in psychopathological symptoms and a decrease in posttraumatic growth was observed one year into the pandemic. The peripandemic network was more densely connected, and pandemic-related PTSD symptoms were positively associated with age, anxiety, worst-event PTSD symptoms, and pandemic-related posttraumatic growth. Our findings highlight the resilience of veterans exposed to a potentially traumatic event during the first year of a pandemic. Similarly, the networks did not fundamentally change from prepandemic to one year into the pandemic. Despite this relative stability on a group level, individual reactions to potentially traumatic events could have varied substantially. Clinicians should individualize their assessments but be aware of the general resilience of most veterans.
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Affiliation(s)
- Tobias R Spiller
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Addie N Merians
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Or Duek
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ziv Ben-Zion
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL, USA; School of Public Health, University of Texas Health Science Center at Houston, TX, USA
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ilan Harpaz-Rotem
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
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Lionetti F, Spinelli M, Moscardino U, Ponzetti S, Garito MC, Dellagiulia A, Aureli T, Fasolo M, Pluess M. The interplay between parenting and environmental sensitivity in the prediction of children's externalizing and internalizing behaviors during COVID-19. Dev Psychopathol 2023; 35:1390-1403. [PMID: 35256026 DOI: 10.1017/s0954579421001309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The interplay of parenting and environmental sensitivity on children's behavioral adjustment during, and immediately after, the COVID-19 lockdown restrictions was investigated in two longitudinal studies involving Italian preschoolers (Study 1, N = 72; 43% girls, Myears = 3.82(1.38)) and primary school children (Study 2, N = 94; 55% girls, Myears = 9.08(0.56)). Data were collected before and during the first-wave lockdown (Studies 1 and 2) and one month later (Study 1). Parental stress and parent-child closeness were measured. Markers of environmental sensitivity in children were temperamental fearfulness and Sensory Processing Sensitivity. Results showed little change in externalizing and internalizing behaviors over time, but differences emerged when considering parenting and children's environmental sensitivity. In preschoolers, greater parenting stress was related to a stronger increase in internalizing and externalizing behaviors, with children high in fearful temperament showing a more marked decrease in externalizing behaviors when parenting stress was low. In school-aged children, parent-child closeness emerged as a protective factor for internalizing and externalizing behaviors during COVID-19, with children high in Sensory Processing Sensitivity showing a marked decrease in internalizing behaviors when closeness was high. Implications for developmental theory and practice in times of pandemic are discussed.
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Affiliation(s)
- Francesca Lionetti
- Department of Neuroscience, Imaging and Clinical Studies, Gabriele d'Annunzio University of Chieti and Pescara, Italy
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
| | - Maria Spinelli
- Department of Neuroscience, Imaging and Clinical Studies, Gabriele d'Annunzio University of Chieti and Pescara, Italy
| | - Ughetta Moscardino
- Department of Developmental Psychology and Socialization, University of Padova, Italy
| | - Silvia Ponzetti
- Department of Neuroscience, Imaging and Clinical Studies, Gabriele d'Annunzio University of Chieti and Pescara, Italy
| | - Maria Concetta Garito
- Department of Neuroscience, Imaging and Clinical Studies, Gabriele d'Annunzio University of Chieti and Pescara, Italy
| | | | - Tiziana Aureli
- Department of Neuroscience, Imaging and Clinical Studies, Gabriele d'Annunzio University of Chieti and Pescara, Italy
| | - Mirco Fasolo
- Department of Neuroscience, Imaging and Clinical Studies, Gabriele d'Annunzio University of Chieti and Pescara, Italy
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
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Samraj JR, Wright DJ, McMurtrie H. Age and adult attachment style predict psychological distress in the Singapore general population during COVID-19. PSYCHOL HEALTH MED 2023; 28:2212-2224. [PMID: 37278229 DOI: 10.1080/13548506.2023.2216466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
To date, there is increasing evidence to suggest that age and adult attachment styles, such as secure, anxious and avoidant attachment are predictive or protective for psychological distress. The study aimed to investigate the extent to which age and adult attachment style, measured by the Attachment Style Questionnaire, predicted psychological distress, measured by the Kessler 10 Psychological Distress Scale, in the Singapore general population during COVID-19. Ninety-nine residents of Singapore (44 females, 52 males, 3 prefer not to state their gender) aged between 18 and 66 completed an online survey, which collected information on age, adult attachment styles and levels of psychological distress. Multiple regression analysis was performed to study the influence of predictive factors on psychological distress. The study identified 20.2%, 13.1% and 14.1% of participants reporting psychological distress at the mild, moderate and severe levels, respectively. The study also reported that age and psychological distress were negatively correlated, and that psychological distress was negatively correlated with both anxious and avoidant attachment styles. It was concluded that age and adult attachment style significantly predicted psychological distress in the Singapore general population during COVID-19. Further studies exploring other variables and risk factors are required to further consolidate these results. At the global level, these findings may help countries predict residents' reactions to future outbreaks and help them prepare strategies and approaches to address these situations.
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Affiliation(s)
- Juliet R Samraj
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - David J Wright
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Hazel McMurtrie
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
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Willroth EC, Smith AM, Graham EK, Mroczek DK, Shallcross AJ, Ford BQ. Emotional responses to a global stressor: Average patterns and individual differences. EUROPEAN JOURNAL OF PERSONALITY 2023; 37:418-434. [PMID: 38603127 PMCID: PMC9111916 DOI: 10.1177/08902070221094448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
Major stressors often challenge emotional well-being-increasing negative emotions and decreasing positive emotions. But how long do these emotional hits last? Prior theory and research contain conflicting views. Some research suggests that most individuals' emotional well-being will return to, or even surpass, baseline levels relatively quickly. Others have challenged this view, arguing that this type of resilient response is uncommon. The present research provides a strong test of resilience theory by examining emotional trajectories over the first 6 months of the COVID-19 pandemic. In two pre-registered longitudinal studies (total N =1147), we examined average emotional trajectories and predictors of individual differences in emotional trajectories across 13 waves of data from February through September 2020. The pandemic had immediate detrimental effects on average emotional well-being. Across the next 6 months, average negative emotions returned to baseline levels with the greatest improvements occurring almost immediately. Yet, positive emotions remained depleted relative to baseline levels, illustrating the limits of typical resilience. Individuals differed substantially around these average emotional trajectories and these individual differences were predicted by socio-demographic characteristics and stressor exposure. We discuss theoretical implications of these findings that we hope will contribute to more nuanced approaches to studying, understanding, and improving emotional well-being following major stressors.
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Affiliation(s)
- Emily C Willroth
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Eileen K Graham
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel K Mroczek
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Melton CC, De Fries CM, Smith RM, Mason LR. Wildfires and Older Adults: A Scoping Review of Impacts, Risks, and Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6252. [PMID: 37444100 PMCID: PMC10341407 DOI: 10.3390/ijerph20136252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Climate change is leading to worsening disasters that disproportionately impact older adults. While research has begun to measure disparities, there is a gap in examining wildfire-specific disasters. To address this gap, this scoping review analyzed literature to explore the nexus of wildfires and older adults. We searched peer-reviewed literature using the following inclusion criteria: (1) published in a peer-reviewed journal; (2) available in English; (3) examines at least one topic related to wildfires; and (4) examines how criterion three relates to older adults in at least one way. Authors screened 261 titles and abstracts and 138 were reviewed in full, with 75 articles meeting inclusion criteria. Findings heavily focused on health impacts of wildfires on older adults, particularly of smoke exposure and air quality. While many articles mentioned a need for community-engaged responses that incorporate the needs of older adults, few addressed firsthand experiences of older adults. Other common topics included problems with evacuation, general health impacts, and Indigenous elders' fire knowledge. Further research is needed at the nexus of wildfires and older adults to highlight both vulnerabilities and needs as well as the unique experience and knowledge of older adults to inform wildfire response strategies and tactics.
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Affiliation(s)
| | | | | | - Lisa Reyes Mason
- Graduate School of Social Work, University of Denver, Denver, CO 80210, USA; (C.C.M.); (C.M.D.F.); (R.M.S.)
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Mofaz M, Yechezkel M, Einat H, Kronfeld-Schor N, Yamin D, Shmueli E. Real-time sensing of war's effects on wellbeing with smartphones and smartwatches. COMMUNICATIONS MEDICINE 2023; 3:55. [PMID: 37069232 PMCID: PMC10109229 DOI: 10.1038/s43856-023-00284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Modern wars have a catastrophic effect on the wellbeing of civilians. However, the nature of this effect remains unclear, with most insights gleaned from subjective, retrospective studies. METHODS We prospectively monitored 954 Israelis (>40 years) from two weeks before the May 2021 Israel-Gaza war until four weeks after the ceasefire using smartwatches and a dedicated mobile application with daily questionnaires on wellbeing. This war severely affected civilians on both sides, where over 4300 rockets and missiles were launched towards Israeli cities, and 1500 aerial, land, and sea strikes were launched towards 16,500 targets in the Gaza Strip. RESULTS We identify considerable changes in all the examined wellbeing indicators during missile attacks and throughout the war, including spikes in heart rate levels, excessive screen-on time, and a reduction in sleep duration and quality. These changes, however, fade shortly after the war, with all affected measures returning to baseline in nearly all the participants. Greater changes are observed in individuals living closer to the battlefield, women, and younger individuals. CONCLUSIONS The demonstrated ability to monitor objective and subjective wellbeing indicators during crises in real-time is pivotal for the early detection of and prompt assistance to populations in need.
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Affiliation(s)
- Merav Mofaz
- Department of Industrial Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Matan Yechezkel
- Department of Industrial Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Einat
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel-Aviv, Israel
| | - Noga Kronfeld-Schor
- School of Zoology and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Yamin
- Department of Industrial Engineering, Tel-Aviv University, Tel-Aviv, Israel
- Center for Combating Pandemics, Tel-Aviv University, Tel-Aviv, Israel
| | - Erez Shmueli
- Department of Industrial Engineering, Tel-Aviv University, Tel-Aviv, Israel.
- MIT Media Lab, Cambridge, MA, USA.
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Iriarte E, Larson ME, Behar-Zusman V. The Impact of COVID-19 Household Isolation on Conflict and Cohesion in One-, Two-, and Three-Generation Households With Older Adults. J Gerontol Nurs 2023; 49:47-56. [PMID: 36989472 DOI: 10.3928/00989134-20230310-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The current cross-sectional study examined the effect of coronavirus disease 2019 (COVID-19) household isolation on household conflict and cohesion in one-, two-, and three-generation households with older adults (aged ≥65 years). Participants were 757 adults (aged ≥18 years) with at least one older adult in their household. Respondents were from 51 countries. Study variables were measured with the COVID-19 Household Environmental Scale. Non-parametric tests were used to assess differences between groups. Most participants (n = 437, 57.7%) lived in three-generation homes. Three-generation homes reported greater increases in conflict (p < 0.001) and cohesion (p < 0.001) during household isolation compared to oneand two-generation homes. Findings suggest that older adults living in multigenerational households experienced more cohesive and conflictive household environments as a function of the COVID-19 pandemic. Further research should explore how family or health care interventions could better support older adults and families as a unit of care to avoid adverse outcomes and boost resilience. [Journal of Gerontological Nursing, 49(4), 47-56.].
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13
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Michael YL, Smiley KT, Clay L, Hirsch JA, Lovasi GS. Uneven Growth in Social Capital Organizations After Disasters by Pre-Disaster Conditions in the United States 2000-2014. Disaster Med Public Health Prep 2022; 17:e278. [PMID: 36503707 PMCID: PMC10391527 DOI: 10.1017/dmp.2022.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Community-level social capital organizations are critical pre-existing resources that can be leveraged in a disaster. AIM The study aimed to test the hypothesis that communities with larger pre-disaster stocks of social capital organizations would maintain pre-disaster levels or experience growth. METHODOLOGY An annual panel dataset of counties in the contiguous United States from 2000 to 2014 totaling 46620 county-years, including longitudinal data on disasters and social capital institutions was used to evaluate the effect of disaster on growth of social capital. RESULTS When a county experienced more months of disasters, social capital organizations increased a year later. These findings varied based on the baseline level of social capital organizations. For counties experiencing minor disaster impacts, growth in social capital organizations tends to occur in counties with more social capital organizations in 2000; this effect is a countervailing finding to that of major disasters, and effect sizes are larger. CONCLUSION Given the growing frequency of smaller-scale disasters and the considerable number of communities that experienced these disasters, the findings suggest that small scale events create the most common and potentially broadest impact opportunity for intervention to lessen disparities in organizational growth.
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Affiliation(s)
- Yvonne L Michael
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, and Urban Health Collaborative, Philadelphia, Pennsylvania, USA
| | - Kevin T Smiley
- Department of Sociology, College of Humanities & Social Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Lauren Clay
- Department of Emergency Health Services, College of Arts, Humanities, and Social Sciences, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Jana A Hirsch
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, and Urban Health Collaborative, Philadelphia, Pennsylvania, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, and Urban Health Collaborative, Philadelphia, Pennsylvania, USA
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14
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Weng Hong C, Ajit Singh V, Amar Singh AK. Psychological disorders in patients with orthopaedic oncological diseases and their coping strategies. J Orthop Surg (Hong Kong) 2022; 30:10225536221093431. [PMID: 35410527 DOI: 10.1177/10225536221093431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to determine the prevalence and risk factors of anxiety and depression among orthopaedic oncology patients, their quality of life and coping strategies. METHODS This cross-sectional study recruited patients from the outpatient orthopaedic oncology clinic at a tertiary institution. Data were collected from self-report questionnaires: Hospital Anxiety and Depression Scale Hospital Anxiety Depression Scale, World Health Organization Quality of Life (WHOQOL-BREF) and Brief Coping with Problems Experienced (Brief COPE). Risk factors were analyzed with multiple logistic regression. RESULTS 191 patients were recruited. The median age was 39.4 years old (IQR 35.0). 29.8% had anxiety, 16.2% had depression, and 15.2% had mixed anxiety and depression. Quality of life median scores differed significantly between patients with anxiety and no anxiety and patients with depression and no depression (p < 0.001). Patients with mixed anxiety and depression had a more inferior quality of life (p < 0.001). Age, psychological health and radiotherapy were inversely associated with anxiety. Physical and psychological health were significantly associated with less depression. Ongoing chemotherapy was significantly associated with anxiety and depression. The commonest coping strategies were denial, behavioural disengagement, venting and self-blame. CONCLUSION Anxiety and depression are prevalent among orthopaedic oncology patients. Patients with mixed anxiety and depression had a more inferior quality of life. Patients with ongoing chemotherapy had higher risks of anxiety and depression. The commonest coping strategies were denial, behavioural disengagement, venting and self-blame. Psychosocial evaluation followed by appropriate psychiatric referrals and consultations could be established to facilitate orthopaedic oncology patients during their course of treatment.
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Affiliation(s)
- Chung Weng Hong
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Vivek Ajit Singh
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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15
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Hwong AR, Wang M, Khan H, Chagwedera DN, Grzenda A, Doty B, Benton T, Alpert J, Clarke D, Compton WM. Climate change and mental health research methods, gaps, and priorities: a scoping review. Lancet Planet Health 2022; 6:e281-e291. [PMID: 35278392 DOI: 10.1016/s2542-5196(22)00012-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/29/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Research on climate change and mental health is a new but rapidly growing field. To summarise key advances and gaps in the current state of climate change and mental health studies, we conducted a scoping review that comprehensively examined research methodologies using large-scale datasets. We identified 56 eligible articles published in Embase, PubMed, PsycInfo, and Web of Science between Jan 1, 2000, and Aug 9, 2020. The primary data collection method used was surveys, which focused on self-reported mental health effects due to acute and subacute climate events. Other approaches used administrative health records to study the effect of environmental temperature on hospital admissions for mental health conditions, and national vital statistics to assess the relationship between environmental temperature and suicide rates with regression analyses. Our work highlights the need to link population-based mental health outcome databases to weather data for causal inference. Collaborations between mental health providers and data scientists can guide the formation of clinically relevant research questions on climate change.
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Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA; National Clinician Scholars Program, UCSF and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Margaret Wang
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Hammad Khan
- Department of Psychiatry, University of California Davis, Davis, CA, USA
| | - D Nyasha Chagwedera
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Adrienne Grzenda
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin Doty
- American Psychiatric Association, Washington, DC, USA
| | - Tami Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Alpert
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Diana Clarke
- American Psychiatric Association, Washington, DC, USA
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16
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Moreira-de-Oliveira ME, de Menezes GB, Loureiro CP, Laurito LD, Albertella L, Fontenelle LF. The impact of COVID-19 on patients with OCD: A one-year follow-up study. J Psychiatr Res 2022; 147:307-312. [PMID: 35123340 PMCID: PMC8803396 DOI: 10.1016/j.jpsychires.2022.01.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, concerns regarding its psychological effects on people with preexisting psychiatric disorders have been raised, particularly obsessive-compulsive disorder (OCD). Nevertheless, only a few longitudinal studies have been performed, and a more longstanding follow-up of a clinical sample is needed. In this study, our aim was to investigate the influence of the COVID-19 pandemic on symptom changes in a sample of Brazilian OCD patients for about a one-year period. METHODS Thirty OCD outpatients seen in a specialized OCD clinic in Rio de Janeiro were evaluated at baseline and after one year (during the pandemic). Sociodemographic and clinical variables were collected along with a questionnaire aimed at quantifying the number of stressful events related to the COVID-19 pandemic. Comparisons between two time points (pre vs. during COVID-19) and two subgroups (patients with vs without worsening of symptoms) were carried out. RESULTS As a group, OCD patients treated with SRIs had an overall stabilization of symptoms throughout the follow-up period, regardless of the number of stressful experiences related to coronavirus (median baseline YBOCS remained 22.0 at follow-up). In addition, when individually analyzed, even those who reported an increase in their symptoms did not describe a greater number of COVID-19 related events. CONCLUSIONS Patients with OCD, who were under treatment, did not show significant symptom deterioration as a result of the COVID-19 pandemic. Individual variations in OCD symptom severity did not seem to be related to experiences linked to coronavirus.
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Affiliation(s)
- Maria E. Moreira-de-Oliveira
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,Corresponding author. Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil
| | - Gabriela B. de Menezes
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carla P. Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luana D. Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucy Albertella
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia.
| | - Leonardo F. Fontenelle
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,Department of Psychiatry, Monash University, Clayton, Victoria, Australia
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17
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The age-related positivity effect in cognition: A review of key findings across different cognitive domains. PSYCHOLOGY OF LEARNING AND MOTIVATION 2022. [DOI: 10.1016/bs.plm.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kaya S, Deniz Senli F, Mecit H, Kagitcibasi B, Karabulut M. A study on stress and resilience among hearing-impaired people during the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14861. [PMID: 34516025 PMCID: PMC8646591 DOI: 10.1111/ijcp.14861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
AIM The aim of the study is to determine the acute stress and psychological resilience level of people with hearing impairment during the COVID-19 pandemic and to investigate the relationship between the grade of hearing impairment, psychological resilience and perceived stress level in this period. METHODS A cross-sectional study. A total of 135 hearing-impaired individuals using hearing aids (study group) and 125 healthy individuals (control group) participated. The Turkish versions of the Acute Stress Symptoms Scale (ASSS) and Brief Resilience Scale (BRS) were applied to all participants. The Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (T-AIADH) was also applied to the study group in addition to other scales. The presence of any difference between the groups in terms of ASSS and BRS scores was investigated. RESULTS There was a statistically significant difference between the control group and the study group in terms of ASSS results (Z = -4.4, P = .00). No statistically significant difference was found between the control group and the study group in terms of BRS scores (Z = -0.248, P = .804). Furthermore, T-AIADH scale was observed not to correlate either with ASSS or BRS (P > .05). In the study group, the change in income level after the pandemic, age and sex variables were determined as a significant predictor of ASSS. CONCLUSION Identifying risks and protective factors for hearing-impaired individuals at the early stage of the epidemic is considered to be of critical importance to predict the psychological impact of both the epidemic and the response to the COVID-19 health crisis and to reduce stress.
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Affiliation(s)
- Sule Kaya
- Deparment of AudiologyAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | | | - Hilal Mecit
- Deparment of AudiologyAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | | | - Mustafa Karabulut
- Department of Otorhinolaryngology and Head and Neck SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
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19
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Janson M, Sharkey JD, del Cid DA. Predictors of Mental Health Outcomes in Grocery Store Workers amid the COVID-19 Pandemic and Implications for Workplace Safety and Moral Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168675. [PMID: 34444423 PMCID: PMC8392490 DOI: 10.3390/ijerph18168675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
Limited research exists on the mental health (MH) of grocery store workers (GSWs), who have been on the frontlines throughout the COVID-19 pandemic. A disaster MH conceptual model incorporating demographics, disaster exposure and threat (COVID-19 fear and workplace threat perception), perceived stress, and social support (lack of from family and friends) was utilized to predict MH outcomes (anxiety, depression, and post-traumatic stress symptoms; PTSS) of GSWs. GSWs (n = 842) were recruited through a regional union in California. The participants were diverse (62.1% female) and were 18-69 years of age (M = 41.5, SD = 13.9). They completed an online survey regarding COVID-19 fear, workplace threat perception, perceived stress, lack of social support, and workplace needs/recommendations for support. Three hierarchical linear regression models were run assessing each MH outcome. Thematic analysis coding and an inductive approach were utilized for analyzing open-ended responses of workplace needs/recommendations. Females and younger GSWs (ages 18-29 years old) on average, reported higher MH symptoms than males and older age groups, respectively. COVID-19 fear and perceived stress were significant predictors of anxiety, while COVID-19 fear, workplace threat perception, and perceived stress significantly predicted depression and PTSS, explaining almost half of the variance for each model. Social support and demographics were not predictive of MH outcomes. Almost half of GSWs (40%) requested increased safety protections in the workplace. Feelings of fear of COVID-19, threat in the workplace, and overall perceived stress are predictive of GSWs' MH outcomes. Increasing feelings of safety in the workplace and reducing stress may lessen MH symptoms.
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20
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Tsur N, Haller CS. Self-Rated Health Among Patients With Severe Traumatic Brain Injury and Their Close Relatives: The Role of Posttraumatic Stress Symptoms. Psychosom Med 2021; 83:449-456. [PMID: 33883538 DOI: 10.1097/psy.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Severe traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., posttraumatic stress [PTS] symptoms) has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury-Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives. METHODS Patients with sTBI (assessed by an Abbreviated Injury Scale of the head region score >3) and their close relatives participated in TRAST-MI. One hundred twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury. RESULTS Multilevel modeling revealed that patients' PTS symptoms were associated with consequent SRH (slope = 0.42; p < .001), and relatives' PTS symptoms were associated with their respective SRH (slope = 0.2; p = .012). CONCLUSIONS The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.
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Affiliation(s)
- Noga Tsur
- From the Bob Shapell School of Social Work (Tsur), Tel Aviv University, Tel Aviv, Israel; Department of Psychology (Haller), Harvard University, Cambridge; Division of Public Psychiatry, Massachusetts Mental Health Center (Haller), Harvard Medical School, Boston; and Cognicreate LLC (Haller), Cambridge, Massachusetts
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21
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Conrad RC, Hahm H“C, Koire A, Pinder-Amaker S, Liu CH. College student mental health risks during the COVID-19 pandemic: Implications of campus relocation. J Psychiatr Res 2021; 136:117-126. [PMID: 33588225 PMCID: PMC8635290 DOI: 10.1016/j.jpsychires.2021.01.054] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/10/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE During the COVID-19 pandemic, many universities evacuated their campuses, requiring students to vacate on campus residences. The psychological outcomes of students who relocated during the pandemic remains unknown. We examined mandated relocation experiences related to self-reported worry, grief, loneliness, and depressive, generalized anxiety, and post-traumatic stress disorder (PTSD) symptoms among college students during the COVID-19 pandemic. METHODS We analyzed cross-sectional survey data obtained from April 9 to August 4, 2020 on 791 young adults (ages 18-30 years) who were enrolled at a U.S. university. The CARES 2020 Project (COVID-19 Adult Resilience Experiences Study) is an online survey of young adults' mental health during the COVID-19 pandemic. Recruitment relied on snowball sampling. Participants were asked if they were required to relocate from campus and among those who did, their experiences in moving. COVID-19-related worry and grief, loneliness, and depressive, anxiety, and PTSD symptoms were assessed. RESULTS Approximately one-third of students reported being mandated to relocate. Students mandated to relocate reported more COVID-19-related grief, loneliness, and generalized anxiety symptoms compared to those who did not even after controlling for the severity level of local COVID-19 outbreaks. Students who had to leave behind valuable personal belongings reported more COVID-19-related worries, grief, and depressive, generalized anxiety, and PTSD symptoms. CONCLUSIONS Students who were mandated to relocate reported worse psychological outcomes compared to students who were not mandated to relocate. Our findings have implications for addressing the psychological impact of evacuating college campuses during public health emergencies and other disasters.
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Affiliation(s)
- Rachel C. Conrad
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Hyeouk “Chris” Hahm
- School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
| | - Amanda Koire
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Stephanie Pinder-Amaker
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA,McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA
| | - Cindy H. Liu
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA,Department of Newborn Medicine, 221 Longwood Avenue, Brigham and Women's Hospital, Boston, MA, 02115, USA,Corresponding author. Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
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22
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Rutherford BR, Choi CJ, Chrisanthopolous M, Salzman C, Zhu C, Montes-Garcia C, Liu Y, Brown PJ, Yehuda R, Flory J, Neria Y, Roose SP. The COVID-19 Pandemic as a Traumatic Stressor: Mental Health Responses of Older Adults With Chronic PTSD. Am J Geriatr Psychiatry 2021; 29:105-114. [PMID: 33153871 PMCID: PMC7582036 DOI: 10.1016/j.jagp.2020.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Individuals with post-traumatic stress disorder (PTSD) who experience additional traumas or stressful life events may undergo symptomatic worsening, but no data exist on whether exposure to the COVID-19 pandemic in a high infection area worsens mental health among older adults with chronic PTSD. METHODS Seventy-six older adults (N = 46 with PTSD and N = 30 trauma-exposed comparison subjects [TE]) for whom prepandemic data were available were interviewed between April 1 and May 8, 2020 to quantify depressive (Hamilton Rating Scale for Depression [HRSD]) and PTSD symptom (Post-traumatic Stress Disorder Checklist [PCL-5]) levels. Group differences in baseline characteristics as well as pre-post pandemic symptom levels were examined, and participant characteristics were assessed as moderators of symptom change. RESULTS Compared to TEs, individuals with PTSD more often reported living alone and experiencing a physical illness (χ2 = 5.1, df = 1, p = 0.02). PCL-5 scores among individuals with PTSD decreased during the COVID-19 pandemic by 7.1 points (t(69) = -3.5, p = 0.0008), whereas the TE group did not change significantly. Overall no significant differences in HRSD were found between groups, but a race or ethnicity variable was found to moderate HRSD symptom change. Non-black or Hispanic individuals with PTSD experienced significantly increased HRSD scores during the pandemic compared to black or Hispanic PTSD participants. CONCLUSION The findings are indicative of complexity in the responses of older individuals with PTSD to further stressful life events as well as possibly unique aspects to the COVID-19 pandemic as a stressor. Sources of resilience may exist based on experience with prior traumas as well as increasing age promoting more adaptive coping styles.
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Affiliation(s)
- Bret R. Rutherford
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY,Send correspondence and reprint requests to Bret R. Rutherford, M.D., Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box 98, New York, NY 10032
| | - C. Jean Choi
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY
| | | | | | - Carlen Zhu
- New York State Psychiatric Institute, New York, NY
| | | | - Ying Liu
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY
| | - Patrick J. Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Mt. Sinai School of Medicine, Mt. Sinai, NY
| | - Janine Flory
- James J. Peters VA Medical Center, Mt. Sinai School of Medicine, Mt. Sinai, NY
| | - Yuval Neria
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
| | - Steven P. Roose
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY
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23
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Fitzpatrick KM. Post-traumatic stress symptomatology and displacement among Hurricane Harvey survivors. Soc Sci Med 2021; 270:113634. [DOI: 10.1016/j.socscimed.2020.113634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
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Acierno R, Kauffman B, Muzzy W, Tejada MH, Lejuez C. Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions. Am J Hosp Palliat Care 2021; 38:1470-1478. [DOI: 10.1177/1049909121989021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.
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Affiliation(s)
- Ron Acierno
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
- Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Brooke Kauffman
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
- Department of Psychology, University of Houston, TX, USA
| | - Wendy Muzzy
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Melba Hernandez Tejada
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
| | - Carl Lejuez
- Office of the Provost, University of Connecticut, Storrs, CT, USA
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25
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Shih HI, Chao TY, Huang YT, Tu YF, Wang JD, Chang CM. Increased incidence of stress-associated illnesses among elderly after Typhoon Morakot. J Formos Med Assoc 2021; 120:337-345. [DOI: 10.1016/j.jfma.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/03/2020] [Accepted: 05/13/2020] [Indexed: 11/24/2022] Open
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Hook K, Ando K, Ghebrehiwet S, Harris B, Ojediran B, Syeda H, Henderson D, Borba C. Current state of the literature on mental health in Liberia: A systematic review. S Afr J Psychiatr 2020; 26:1502. [PMID: 33240551 PMCID: PMC7670006 DOI: 10.4102/sajpsychiatry.v26i0.1502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/05/2020] [Indexed: 12/04/2022] Open
Abstract
Background The Republic of Liberia recently experienced several events that resulted in wide-ranging societal impacts, including long-term civil war and an outbreak of Ebola. These types of events are linked to higher prevalence of mental disorders and psychosocial distress. As a result, it is likely that there is an increased prevalence of mental health disorders in the population. Aim To assess and review the recent mental health literature in order to provide insight into existing mental health needs and effective or recommended interventions in post-conflict Liberia. Setting Articles included in this study enrolled Liberians living in Liberia. Methods A search of four databases was conducted for studies of any type that assessed mental health in Liberia between 01 January 2003 and 27 March 2019. After reviewing 363 articles, 21 articles were included in the final analysis. Articles were coded to identify common themes and needs. Results The majority of studies used qualitative designs and were conducted in Monrovia, the capital city of Liberia. Common topics included adolescent mental health, intervention and assessment and post-conflict impacts. One article focused on mental health impacts after recovery from Ebola. Conclusion Overall, there is a dearth of mental health literature that focuses on Liberia. This suggests ample opportunity for researchers to investigate mental health needs amongst the Liberian population and effective psychiatric interventions. Existing recommendations often focus on addressing adolescent health needs, including substance use practices. Opportunities for future research particularly related to needs of adult populations and to mental health impacts of Ebola, abound.
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Affiliation(s)
- Kimberly Hook
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.,Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA,United States of America
| | - Kanako Ando
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Senait Ghebrehiwet
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Benjamin Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Babawale Ojediran
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Haniya Syeda
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - David Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.,Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Christina Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.,Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
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Munjuluri S, Bolin PK, Amy Lin YT, Garcia NL, Gauna L, Nguyen T, Salas R. A Pilot Study on Playback Theatre as a Therapeutic Aid after Natural Disasters: Brain Connectivity Mechanisms of Effects on Anxiety. CHRONIC STRESS 2020; 4:2470547020966561. [PMID: 33210057 PMCID: PMC7643224 DOI: 10.1177/2470547020966561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022]
Abstract
Background Natural disasters can affect mental health and result in symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). Playback Theatre (PT) is a form of improvisation where actors play-back personal stories told by audience members. Whether PT can be therapeutic in post-disaster settings is not known. Method We used a series of PT performances and studied levels of depression, anxiety, and PTSD symptoms in a sample of 13 people affected by Hurricane Harvey that happened in Houston, TX, August 2017. Brain imaging, specifically resting state functional connectivity of the amygdala was also studied before and after the PT performances. Results Both anxiety (p = .001, Cohen’s d = –1.25) and PTSD (p = .002, Cohen’s d = –1.0) symptoms significantly decreased after a series of 4 PT performances from January 2019 – February 2019. Depression reduction was not significant. We performed resting state functional connectivity (RSFC) MRI before and after the series of performances. We used the right and left amygdala as seeds for RSFC analysis and found that the connectivity between the left amygdala and the bilateral supramarginal gyri was increased after PT. The bilateral supramarginal connectivity with the default mode and the saliency networks increased too, which correlated with reduction in anxiety scores. Conclusions PT may offer a form of intervention for anxiety caused by disasters. An increase in left amygdala/supramarginal gyri connectivity may be the underlying mechanism.
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Affiliation(s)
- Sarat Munjuluri
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Houston Playback Theatre, Houston, TX, USA.,The first two authors contributed equally to this work
| | - Peter K Bolin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Houston Baptist University, Houston, TX, USA.,The first two authors contributed equally to this work
| | | | | | - Leslie Gauna
- Houston Playback Theatre, Houston, TX, USA.,College of Education, University of Houston at Clear Lake, TX, USA
| | | | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Houston Playback Theatre, Houston, TX, USA.,Michael E DeBakey VA Medical Center, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
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Fitzpatrick KM, Willis DE, Spialek ML, English E. Food Insecurity in the Post-Hurricane Harvey Setting: Risks and Resources in the Midst of Uncertainty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8424. [PMID: 33203035 PMCID: PMC7696393 DOI: 10.3390/ijerph17228424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022]
Abstract
Food insecurity is of heightened concern during and after natural disasters; higher prevalence is typically reported in post-disaster settings. The current study examines food insecurity prevalence and specific risk/resource variables that may act as barriers or advantages in accessing food in such a setting. Using a modified quota sample (n = 316), Hurricane Harvey survivors participated in face-to-face interviews and/or online surveys that assessed health, social and household factors, and sociodemographic characteristics. Using logistic regression analyses we find that social vulnerabilities, circumstantial risk, and social and psychological resources are important in determining the odds of food insecurity. Hispanic and/or Nonwhite survivors, renters, and those persons displaced during the natural disaster have higher food insecurity odds. Survivors with stronger social ties, higher levels of mastery, and a greater sense of connectedness to their community are found to have lower food insecurity odds. A more nuanced analysis of circumstantial risk finds that while the independent effects of displacement and home ownership are important, so too is the intersection of these two factors, with displaced-renters experiencing significantly higher odds than any other residence and displacement combinations, and particularly those who are homeowners not displaced during the disaster. Strategies for addressing differential risks, as well as practical approaches for implementation and education programming related to disaster recovery, are discussed.
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Affiliation(s)
- Kevin M. Fitzpatrick
- Department of Sociology and Criminology, University of Arkansas, Fayetteville, AR 72701, USA
| | - Don E. Willis
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR 72701, USA;
| | - Matthew L. Spialek
- Department of Communications, University of Arkansas, Fayetteville, AR 72701, USA;
| | - Emily English
- Department of Pediatrics, University of Arkansas for Medical Sciences, Fayetteville, AR 72701, USA;
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29
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Conversano C, Di Giuseppe M, Miccoli M, Ciacchini R, Gemignani A, Orrù G. Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic. Front Psychol 2020; 11:1900. [PMID: 33013503 PMCID: PMC7516078 DOI: 10.3389/fpsyg.2020.01900] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining. METHODS An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms. RESULTS Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; p < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index (r = -0.637; p < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales. DISCUSSION Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders.
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Affiliation(s)
- Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rebecca Ciacchini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Aune KT, Gesch D, Smith GS. A spatial analysis of climate gentrification in Orleans Parish, Louisiana post-Hurricane Katrina. ENVIRONMENTAL RESEARCH 2020; 185:109384. [PMID: 32240840 PMCID: PMC9045591 DOI: 10.1016/j.envres.2020.109384] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/27/2020] [Accepted: 03/10/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hurricane Katrina made landfall in New Orleans, Louisiana as a Category 3 storm in August 2005. Storm surges, levee failures, and the low-lying nature of New Orleans led to widespread flooding, damage to over 70% of occupied housing, and evacuation of 80-90% of city residents. Only 57% of the city's black population has returned. Many residents complain of gentrification following rebuilding efforts. Climate gentrification is a recently described phenomenon whereby the effects of climate change, most notably rising sea levels and more frequent flooding and storm surges, alter housing values in a way that leads to gentrification. OBJECTIVE To examine the climate gentrification following hurricane Katrina by (1) estimating the associations between flooding severity, ground elevation, and gentrification and (2) whether these relationships are modified by neighborhood level pre- and post-storm sociodemographic factors. METHODS Lidar data collected in 2002 were used to determine elevation. Water gauge height of Lake Ponchartrain was used to estimate flood depth. Using census tracts as a proxy for neighborhoods, demographic, housing, and economic data from the 2000 decennial census and the 2010 and 2015 American Community Survey 5-year estimates US Census records were used to determine census tracts considered eligible for gentrification (median income < 2000 Orleans Parish median income). A gentrification index was created using tract changes in education level, population above the poverty limit, and median household income. Proportional odds ordinal logistic regression was used with product terms to test for effect measure modification by sociodemographic factors. RESULTS Census tracts eligible for gentrification in 2000 were 80.2% black. Median census tract flood depth was significantly lower in areas eligible to undergo gentrification (0.70 m vs. 1.03 m). Residents of gentrification-eligible tracts in 2000 were significantly more likely to be black, less educated, lower income, unemployed, and rent their home rather than own. In 2015 in these same eligible tracts, areas that underwent gentrification became significantly whiter, more educated, higher income, less unemployed, and more likely to live in a multi-unit dwelling. Gentrification was inversely associated with flood depth and directly associated with ground elevation in eligible tracts. Marginal effect modification was detected by the effect of pre-storm black race on the relationships of flood depth and elevation with gentrification. CONCLUSIONS Gentrification was strongly associated with higher ground elevation in New Orleans. These results provide evidence to support the idea of climate gentrification described in other low-elevation major metropolitan areas like Miami, FL. High elevation, low-income, demographically transitional areas in particular - that is areas that more closely resemble high-income area demographics, may be vulnerable to future climate gentrification.
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Affiliation(s)
- Kyle T Aune
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dean Gesch
- U.S. Geological Survey, Sioux Falls, SD, USA
| | - Genee S Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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31
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Hernandez-Tejada MA, Frook G, Steedley M, Watkins J, Acierno R. Demographic-based risk of reporting psychopathology and poor health among mistreated older adults in the national elder mistreatment study wave II. Aging Ment Health 2020; 24:22-26. [PMID: 30450918 DOI: 10.1080/13607863.2018.1509296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Past year elder mistreatment rate is about 11% of community residing older adults, with significant demographic-based variations in prevalence. However, very little research on demographic variable-based differences in correlates of elder abuse, such as mental health, exist. The National Elder Mistreatment Study 8-year follow-up (NEMS II) specifically investigated the relation between demographic factors and the presence of these correlates (i.e. diagnoses of depression, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and self-ratings of physical health).Methods: The NEMS II used random digit dial telephone survey methodology to assess demographic variables and reports of depression PTSD, GAD, and poor health, in 774 older adults. RESULTS: a consistent association was observed between demographic factors related to financial status and poor mental and general health ratings.Discussion: A subset of demographic factors associated with increased risk of reporting elder abuse, low income and financial distress, were also associated with increased risk of reporting correlates of elder abuse that included depression, PTSD GAD and poor health.
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Affiliation(s)
- Melba A Hernandez-Tejada
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Gabrielle Frook
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Mara Steedley
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Watkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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32
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Lazarov A, Suarez-Jimenez B, Tamman A, Falzon L, Zhu X, Edmondson DE, Neria Y. Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: a systematic review. Psychol Med 2019; 49:705-726. [PMID: 30178728 PMCID: PMC6399079 DOI: 10.1017/s0033291718002313] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive models of posttraumatic stress disorder (PTSD) implicate threat-related attentional biases in the etiology and phenomenology of the disorder. However, extant attentional research using reaction time (RT)-based paradigms and measures has yielded mixed results. Eye-tracking methodology has emerged in recent years to overcome several inherent drawbacks of RT-based tasks, striving to better delineate attentional processes. METHODS A systematic review of experimental studies examining threat-related attention biases in PTSD, using eye-tracking methodology and group-comparison designs, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were selected following a systematic search for publications between 1980 and December 2017 in PsycINFO, MEDLINE and the National Center for PTSD Research's Published International Literature on Traumatic Stress (PILOTS) database. Additional records were identified by employing the Similar Articles feature in PubMed, and the Cited Reference Search in ISI Web of Science. Reference sections of review articles, book chapters and studies selected for inclusion were searched for further studies. Ongoing studies were also sought through Clinicaltrials.gov. RESULTS A total of 11 studies (n = 456 participants in total) were included in the final review. Results indicated little support for enhanced threat detection, hypervigilance and attentional avoidance. However, consistent evidence emerged for sustained attention on threat (i.e. attention maintenance) in PTSD. CONCLUSIONS This review is the first to systematically evaluate extant findings in PTSD emanating from eye-tracking studies employing group-comparison designs. Results suggest that sustained attention on threat might serve as a potential target for therapeutic intervention.
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Affiliation(s)
- Amit Lazarov
- Department of Psychiatry,Columbia University Medical Center,New York Psychiatric Institute,New York, NY,USA
| | - Benjamin Suarez-Jimenez
- Department of Psychiatry,Columbia University Medical Center,New York Psychiatric Institute,New York, NY,USA
| | | | - Louise Falzon
- Department of Medicine,Columbia University Medical Center,New York, NY,USA
| | - Xi Zhu
- Department of Psychiatry,Columbia University Medical Center,New York Psychiatric Institute,New York, NY,USA
| | - Donald E Edmondson
- Department of Medicine,Columbia University Medical Center,New York, NY,USA
| | - Yuval Neria
- Department of Psychiatry,Columbia University Medical Center,New York Psychiatric Institute,New York, NY,USA
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Lenane Z, Peacock E, Joyce C, Frohlich ED, Re RN, Muntner P, Krousel-Wood M. Association of Post-Traumatic Stress Disorder Symptoms Following Hurricane Katrina With Incident Cardiovascular Disease Events Among Older Adults With Hypertension. Am J Geriatr Psychiatry 2019; 27:310-321. [PMID: 30581139 PMCID: PMC6476543 DOI: 10.1016/j.jagp.2018.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/10/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association of post-traumatic stress disorder (PTSD) symptoms following Hurricane Katrina with incident cardiovascular disease (CVD) events in older, hypertensive, community-dwelling adults both overall and stratified by age, sex, and race. METHODS This was a prospective cohort study performed in Southeastern Louisiana 12-24 months following Hurricane Katrina through February 2011. Participants were community-dwelling older adults (n = 2,073) enrolled in the Cohort Study of Medication Adherence Among Older Adults with no known history of CVD events. PTSD symptoms were assessed via telephone interview 12-24 months following Hurricane Katrina using the PTSD CheckList-Specific Version. The presence of PTSD symptoms was defined by scores greater than or equal to 37. Incident CVD events (stroke, myocardial infarction, hospitalization for congestive heart failure, or CVD death) were identified and adjudicated over a median 3.8-year follow-up period. RESULTS Overall, 8.6% of participants screened positive for PTSD symptoms, and 11.6% had an incident CVD event during follow-up. PTSD symptoms were associated with an adjusted hazard ratio (aHR) for CVD events of 1.7 (95% confidence interval [CI], 1.1, 2.6). The association was present among blacks (aHR, 3.3, 95% CI, 1.7, 6.3) but not whites (aHR, 0.9, 95% CI, 0.4, 1.9); the interaction of PTSD symptoms and race on CVD events was statistically significant. CONCLUSION PTSD symptoms following Hurricane Katrina were associated with a higher risk of incident CVD in older adults with hypertension, with a stronger association in blacks compared with whites.
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Affiliation(s)
- Zachary Lenane
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Cara Joyce
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Edward D Frohlich
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Richard N Re
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Paul Muntner
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL.
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Kobayashi I, Sledjeski EM, Delahanty DL. Gender and age interact to predict the development of posttraumatic stress disorder symptoms following a motor vehicle accident. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2019; 11:328-336. [PMID: 29446964 PMCID: PMC7006741 DOI: 10.1037/tra0000366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Women have a greater overall risk of developing posttraumatic stress disorder (PTSD) than men after exposure to trauma. In addition to gender, other sociodemographic factors have been identified as risk factors for PTSD; however, research has typically examined these factors separately. Age has been found to contribute to the development of psychiatric disorders, and both linear and curvilinear relationships have been reported between age and risk of developing PTSD. Recent research has suggested that this relationship may vary depending on gender. METHOD We performed a secondary analysis of data from a prospective study of 287 (164 men, 123 women) motor vehicle accident (MVA) patients (aged 18-81) who completed clinical interviews 6 weeks, 6 months, and/or 1 year after an MVA. RESULTS Overall, women developed more severe PTSD symptoms than men; however, gender differences were small in the young (18-24 years) and the old (55 and older) groups. In women, age was not associated with PTSD symptoms at 6 weeks and 6 months; however, age was curvilinearly associated with PTSD severity at 1-year post-MVA such that middle-aged women reported greater symptom severity than younger and older women. Prior trauma exposure and social support mediated this relationship. In men, PTSD severity was not associated with age, but was related to income and social support. CONCLUSIONS These findings highlight age-based subgroups of women at elevated risk for PTSD following a traumatic injury and suggest that psychosocial intervention with middle-aged women following trauma exposure may help reduce the risk of persistent PTSD symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Spialek ML, Houston JB, Worley KC. Disaster Communication, Posttraumatic Stress, and Posttraumatic Growth following Hurricane Matthew. JOURNAL OF HEALTH COMMUNICATION 2019; 24:65-74. [PMID: 30714877 DOI: 10.1080/10810730.2019.1574319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Disaster survivors may experience a range of mental health reactions that can include posttraumatic stress (PTS) and posttraumatic growth (PTG). The current study examines the associations between citizen disaster communication, PTS, and PTG among individuals in North Carolina communities impacted by Hurricane Matthew, approximately six weeks following the event. Participants who communicated more frequently following the hurricane exhibited more PTS and PTG. Communication activities focused on connecting with loved ones and cognitively restructuring the disaster experience were associated with PTS and PTG, whereas communication activities confirming disaster reports and assisting with disaster recovery were associated solely with PTG. Results illustrate the need for robust disaster communication ecologies to facilitate public disaster mental health response and coordination.
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Affiliation(s)
- Matthew L Spialek
- a Department of Communication , University of Arkansas , Fayetteville , AR , USA
| | - J Brian Houston
- b Disaster and Community Crisis Center, Department of Communication , University of Missouri , Columbia , MO , USA
| | - Kyle C Worley
- a Department of Communication , University of Arkansas , Fayetteville , AR , USA
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36
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Gibson A, Walsh J, Brown LM. A perfect storm: Challenges encountered by family caregivers of persons with Alzheimer's disease during natural disasters. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:775-789. [PMID: 29781774 DOI: 10.1080/01634372.2018.1474158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Since Hurricane Katrina there has been a movement across the U.S. to examine best practice for disaster response within the aging population. However, little is known about the experience of natural disasters from the perspective of family caregivers of persons with Alzheimer's disease and related dementia (ADRD). In this exploratory, qualitative study, family caregivers (n=27) were interviewed about their experience with the historic 2015 South Carolina flood. By using thematic analysis, themes were identified to better understand what unique challenges caregivers of person with ADRD experienced. While many caregivers stated they had experienced a natural disaster previously, none had ever done so in their current caregiving role. The caregiving role affected their ability to prepare for the storm and influenced their decision-making regarding evacuation and utilization of recovery resources. Thus, caregivers were confronted by a "perfect storm" of circumstances and uncertainty. Family caregivers need to have actionable emergency plans for disasters that are specific to their role as caregivers of persons with ADRD. Study implications also suggest the role social work professionals can have in educating, advocating, evaluating, and coordinating support to assist caregivers of persons with ADRD as a potentially vulnerable and at-risk population during all phases of disaster.
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Affiliation(s)
- Allison Gibson
- a College of Social Work , University of Kentucky , Lexington , KY , USA
| | - Jessica Walsh
- b Clinical Psychology , Palo Alto University , Palo Alto , CA , USA
| | - Lisa M Brown
- b Clinical Psychology , Palo Alto University , Palo Alto , CA , USA
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Ashida S, Zhu X, Robinson EL, Schroer A. Disaster preparedness networks in rural Midwest communities: Organizational roles, collaborations, and support for older residents. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:735-750. [PMID: 29771200 DOI: 10.1080/01634372.2018.1474157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study investigated the roles and interconnections among community organizations belonging to local disaster coalitions in Midwest in supporting older residents. Representatives from 44 organizations participated in one-time survey. Most were non-profit (68%) or federal/state/local government agencies (23%). The analyses of 761 relationships showed stronger collaborations in assessment (average strength=2.88 on a 5-point scale), emergency response (2.72), and planning (2.61); and weaker collaborations in co-sponsoring programs (1.71) and supporting older residents (2.03). The extent of collaboration (network density) to support older adults was also low. Coalitions may enhance network density and centralization by developing sub-committee structure and strengthening existing collaborations.
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Affiliation(s)
- Sato Ashida
- a Department of Community and Behavioral Health , The University of Iowa College of Public Health, Iowa City, IA
- b The University of Iowa Aging Mind and Brain Initiative, Iowa City, IA
| | - Xi Zhu
- c Department of Health Management and Policy , The University of Iowa College of Public Health, Iowa City, IA
| | - Erin L Robinson
- d School of Social Work , University of Missouri, Columbia, MO
| | - Audrey Schroer
- a Department of Community and Behavioral Health , The University of Iowa College of Public Health, Iowa City, IA
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When Natural Disaster Follows Economic Downturn: The Incremental Impact of Multiple Stressor Events on Trajectories of Depression and Posttraumatic Stress Disorder. Disaster Med Public Health Prep 2018; 13:173-182. [PMID: 29704903 DOI: 10.1017/dmp.2018.12] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy. METHOD Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy. RESULTS We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy. CONCLUSION We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2019;13:173-182).
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Labra O, Maltais D, Gingras-Lacroix G. Medium-Term Health of Seniors Following Exposure to a Natural Disaster. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018766667. [PMID: 29701115 PMCID: PMC5946600 DOI: 10.1177/0046958018766667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The article aims to describe the medium-term impacts of a major earthquake event (Chile, February 27, 2010) on 26 seniors. The authors adopted a qualitative study approach. Data obtained using the Impact of Event Scale-Revised (IES-R) show the presence of manifestations of posttraumatic stress in the majority of respondents. In addition, data collected in interviews demonstrated a progressive deterioration of the health of respondents over a period of 4 years following the disaster. Seniors are particularly vulnerable to the effects of material loss, emotional stress, and postdisaster health complications. These impacts are exacerbated by low economic status. Furthermore, broader research is necessary involving elderly living in poverty who have survived natural disasters and others without such experiences, in order to better identify and differentiate between health complications associated with exposure to disaster events and those linked more strictly with natural aging processes.
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Affiliation(s)
- Oscar Labra
- 1 Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Canada
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Krishnan S, Pappadis MR, Runo R, Graham JE. Experiences and Needs of Older Adults Following Hurricane Ike: A Pilot Study of Long-Term Consequences. Health Promot Pract 2018; 20:31-37. [PMID: 29614922 DOI: 10.1177/1524839918761385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study explored the experiences and needs of older adults during and following Hurricane Ike. METHOD Two focus group interviews were conducted among older adults who lived in or around Galveston Island before Hurricane Ike. Nine older adults (six women and three men) participated in two focus group sessions. These qualitative interviews were audio recorded, transcribed, and analyzed using thematic content analyses. RESULTS The findings of this study reveal the need for continuity in health care services, medications, psychological support, social and family support, community-level services, and information among older adults. CONCLUSIONS The contribution of factors such as health care continuity and psychological support reinforces the importance of specific postdisaster resources to meet the needs of older adults following hurricanes. These results suggest the importance of designing hurricane preparedness guidelines specifically for older adults.
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Affiliation(s)
| | | | - Ray Runo
- 3 Preparedness & Response Partners, LLC, Tallahassee, FL, USA
| | - James E Graham
- 2 The University of Texas Medical Branch, Galveston, TX, USA
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Lazarov A, Zhu X, Suarez-Jimenez B, Rutherford BR, Neria Y. Resting-state functional connectivity of anterior and posterior hippocampus in posttraumatic stress disorder. J Psychiatr Res 2017; 94. [PMID: 28633076 PMCID: PMC5605418 DOI: 10.1016/j.jpsychires.2017.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with altered resting-state functional connectivity (rs-FC) of several brain regions within the salience (SN) and default-mode (DMN) networks, including the hippocampus. However, most rs-FC studies have not focused primarily on the hippocampus, nor have they appreciated its structural heterogeneity, despite clear evidence for a dissociation between posterior and anterior hippocampal connectivity. Here, we examine rs-FC of anterior and posterior hippocampus with key regions in the SN (amygdala, insula, and dorsal anterior cingulate cortex/pre-supplementary motor area) and DMN (ventromedial prefrontal cortex, posterior cingulate cortex, and precuneus) previously implicated in PTSD, using a seed-based approach. Resting-state magnetic resonance images were obtained from 48 PTSD patients and 34 trauma-exposed healthy participants (TEHC). Results indicated no group differences when examining the hippocampus as a whole. However, examining the anterior and posterior hippocampus revealed a loss of anterior to posterior connectivity differentiation in PTSD patients. The PTSD group also demonstrated lower negative connectivity of the posterior hippocampus-precuneus pathway compared with the TEHC group. Finally, as differences in anterior and posterior hippocampus connectivity have been also related to age, we performed a secondary analysis exploring the association between age and posterior- and anterior-hippocampus connectivity in both groups. Results showed that among PTSD patients, increased age had the effect of normalizing posterior hippocampus-precuneus and hippocampus-posterior cingulate cortex connectivity, whereas no such effect was noted for the control group. These findings highlight the need for PTSD connectivity research to consider sub-parts of the hippocampus and to account for age-related connectivity differences.
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Affiliation(s)
- Amit Lazarov
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Xi Zhu
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Benjamin Suarez-Jimenez
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Bret R Rutherford
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Columbia University Medical Center, 722 west 168th st., New York, NY 10032, USA.
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Acierno R, Hernandez-Tejada MA, Anetzberger GJ, Loew D, Muzzy W. The National Elder Mistreatment Study: An 8-year longitudinal study of outcomes. J Elder Abuse Negl 2017; 29:254-269. [DOI: 10.1080/08946566.2017.1365031] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ron Acierno
- Office of Research, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Melba A Hernandez-Tejada
- Office of Research, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
- Mental Health Service, Ralph H Johnson Veteran’s Administration Medical Center, Charleston, SC
| | | | | | - Wendy Muzzy
- Office of Research, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Heid AR, Pruchno R, Cartwright FP, Wilson-Genderson M. Exposure to Hurricane Sandy, neighborhood collective efficacy, and post-traumatic stress symptoms in older adults. Aging Ment Health 2017; 21:742-750. [PMID: 26911314 DOI: 10.1080/13607863.2016.1154016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Older adults exposed to natural disasters are at risk for negative psychological outcomes such as post-traumatic stress disorder (PTSD). Neighborhood social capital can act as a resource that supports individual-level coping with stressors. This study explores the ability of perceived neighborhood collective efficacy, a form of social capital, to moderate the association between exposure to Hurricane Sandy and PTSD symptoms in older adults. METHOD Data from 2205 older individuals aged 54-80 residing in New Jersey who self-reported exposure to Hurricane Sandy in October of 2012 were identified and extracted from the ORANJ BOWL™ research panel. Participants completed baseline assessments of demographic and individual-level characteristics in 2006-2008 and follow-up assessments about storm exposure, perceived neighborhood collective efficacy (social cohesion and social control), and PTSD symptoms 8-33 months following the storm. Zero-inflated Poisson regression models were tested to examine the association between exposure, neighborhood collective efficacy, and PTSD symptoms. RESULTS After accounting for known demographic and individual-level covariates, greater storm exposure was linked to higher levels of PTSD symptoms. Social cohesion, but not social control, was linked to lower reports of PTSD symptoms and moderated the association between exposure and PTSD. The impact of storm exposure on PTSD symptoms was less for individuals reporting higher levels of social cohesion. CONCLUSION Mental health service providers and disaster preparedness and response teams should consider the larger social network of individuals served. Building social connections in older adults' neighborhoods that promote cohesion can reduce the negative psychological impact of a disaster.
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Affiliation(s)
- Allison R Heid
- a Department of Geriatrics, New Jersey Institute for Successful Aging , Rowan University School of Osteopathic Medicine , Stratford , NJ , USA
| | - Rachel Pruchno
- a Department of Geriatrics, New Jersey Institute for Successful Aging , Rowan University School of Osteopathic Medicine , Stratford , NJ , USA
| | - Francine P Cartwright
- a Department of Geriatrics, New Jersey Institute for Successful Aging , Rowan University School of Osteopathic Medicine , Stratford , NJ , USA
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Kornfield SL, Lenze EJ, Rawson KS. Predictors of Posttraumatic Stress Symptoms and Association with Fear of Falling After Hip Fracture. J Am Geriatr Soc 2017; 65:1251-1257. [PMID: 28240778 DOI: 10.1111/jgs.14771] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To determine whether fall-related hip fracture, alone or in the presence of Fear of Falling, is likely to induce PTSD in an elderly population. DESIGN A longitudinal prospective study of patients admitted for hip fracture. SETTING Eight St. Louis, Missouri, area hospitals. PARTICIPANTS Individuals aged 60 and older admitted for surgical hip fracture repair after a fall (N = 456). MEASUREMENTS Rates of partial and full posttraumatic stress disorder (pPTSD and fPTSD) were compared with rates of FoF. PTSD and FoF were assessed 4 and 12 weeks after surgery. Baseline characteristics including depression, stress, pain, cognitive functioning, and anesthesia type were also analyzed as potential predictors of PTSD symptoms 12 weeks after surgery. RESULTS No participants met criteria for fPTSD at 4 or 12 weeks, and rates of pPTSD were low 12 weeks after surgery (7.4%), in contrast to high rates of FoF symptoms at the same time point (58.5%). Higher ratings of stress and depressive symptoms at baseline were associated with higher levels of PTSD symptoms 12 weeks after surgery. CONCLUSIONS Hip fracture, despite its considerable morbidity, does not induce fPTSD and infrequently induces pPTSD. Individuals with higher rates of stress and depressive symptoms after hip fracture repair may be more likely to develop PTSD symptoms.
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Affiliation(s)
- Sara L Kornfield
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri.,Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric J Lenze
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri
| | - Kerri S Rawson
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri
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Shultz JM, Cela T, Marcelin LH, Espinola M, Heitmann I, Sanchez C, Jean Pierre A, Foo CY, Thompson K, Klotzbach P, Espinel Z, Rechkemmer A. The trauma signature of 2016 Hurricane Matthew and the psychosocial impact on Haiti. DISASTER HEALTH 2016; 3:121-138. [PMID: 28321360 DOI: 10.1080/21665044.2016.1263538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
Background. Hurricane Matthew was the most powerful tropical cyclone of the 2016 Atlantic Basin season, bringing severe impacts to multiple nations including direct landfalls in Cuba, Haiti, Bahamas, and the United States. However, Haiti experienced the greatest loss of life and population disruption. Methods. An established trauma signature (TSIG) methodology was used to examine the psychological consequences of Hurricane Matthew in relation to the distinguishing features of this event. TSIG analyses described the exposures of Haitian citizens to the unique constellation of hazards associated with this tropical cyclone. A hazard profile, a matrix of psychological stressors, and a "trauma signature" summary for the affected population of Haiti - in terms of exposures to hazard, loss, and change - were created specifically for this natural ecological disaster. Results. Hazard characteristics of this event included: deluging rains that triggered mudslides along steep, deforested terrain; battering hurricane winds (Category 4 winds in the "eye-wall" at landfall) that dismantled the built environment and launched projectile debris; flooding "storm surge" that moved ashore and submerged villages on the Tiburon peninsula; and pummeling wave action that destroyed infrastructure along the coastline. Many coastal residents were left defenseless to face the ravages of the storm. Hurricane Matthew's slow forward progress as it remained over super-heated ocean waters added to the duration and degree of the devastation. Added to the havoc of the storm itself, the risks for infectious disease spread, particularly in relation to ongoing epidemics of cholera and Zika, were exacerbated. Conclusions. Hurricane Matthew was a ferocious tropical cyclone whose meteorological characteristics amplified the system's destructive force during the storm's encounter with Haiti, leading to significant mortality, injury, and psychological trauma.
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Affiliation(s)
- James M Shultz
- Center for Disaster & Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine , Miami, FL, USA
| | - Toni Cela
- Interuniversity Institute for Research and Development (INURED), Port-au-Prince, Haiti; Department of Anthropology, University of Miami, Miami, FL, USA
| | - Louis Herns Marcelin
- Interuniversity Institute for Research and Development (INURED), Port-au-Prince, Haiti; Social Sciences, Department of Anthropology, University of Miami, Coral Gables, FL, USA
| | - Maria Espinola
- Department of Psychiatry and Behavioral Neuroscience, Clinical Psychiatry, University of Cincinnati College of Medicine , Cincinnati, OH, USA
| | | | | | | | | | - Kip Thompson
- Department of Psychiatry and Behavioral Neuroscience, Clinical Psychiatry, University of Cincinnati College of Medicine , Cincinnati, OH, USA
| | | | - Zelde Espinel
- Department of Psychiatry and Behavioral Health, University of Miami Miller School of Medicine, and Jackson Memorial Hospital , Miami, FL, USA
| | - Andreas Rechkemmer
- Graduate School of Social Work (GSSW), University of Denver , Denver, CO, USA
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Horikoshi N, Iwasa H, Kawakami N, Suzuki Y, Yasumura S. Residence-related factors and psychological distress among evacuees after the Fukushima Daiichi nuclear power plant accident: a cross-sectional study. BMC Psychiatry 2016; 16:420. [PMID: 27881162 PMCID: PMC5121974 DOI: 10.1186/s12888-016-1134-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 11/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relocation following a disaster can impact the psychological well-being of evacuees. This study investigated the associations between residence-related factors and psychological distress among evacuees living in temporary housing after the Fukushima Daiichi Nuclear Power Plant accident. METHODS Data from 525 participants living in temporary housing were collected. Associations between residence-related factors (frequent relocation, dissatisfaction with the residence, and plan to move to permanent housing) and psychological distress were measured. The psychological distress of evacuees was measured using the Japanese version of the 6-item Kessler scale (K6). We used a cut-off score of five to identify cases with psychological distress, the basis of Kessler's 6 items for psychological distress. RESULTS Multivariate logistic regression analysis (n = 418) showed that frequent relocation (OR = 2.05, 95% CI: 1.14-3.66, p = 0.016) and dissatisfaction with the residence (OR = 2.48, 95% CI: 1.60-3.83, p < 0.001) was significantly associated with psychological distress. After stratifying by gender, dissatisfaction with the residence was associated with psychological distress, and a plan to move to permanent housing was significantly associated with psychological distress in women (OR = 1.93, 95% CI: 1.03-3.63, p = 0.041). CONCLUSIONS Frequent relocation and dissatisfaction with the residence were associated with psychological distress among evacuees following the Fukushima nuclear disaster. Evacuees should be provided with comfortable living spaces, and steps should be taken to reduce repeated relocation of evacuees. Thus, particular attention should be paid to women with a plan to move to permanent housing within this context.
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Affiliation(s)
- Naoko Horikoshi
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Hajime Iwasa
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan ,Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015 Japan
| | - Norito Kawakami
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654 Japan
| | - Yuriko Suzuki
- National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553 Japan
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
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Motivating rural older residents to prepare for disasters: moving beyond personal benefits. AGEING & SOCIETY 2016; 36:2117-2140. [PMID: 30013285 DOI: 10.1017/s0144686x15000914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the United States of America (USA), older adults in rural areas are at increased risk for adverse outcomes of disasters, partly due to medical needs, limited or long geographic distances from community resources, and less knowledge and motivation about preparedness steps. Older residents and ageing service providers in a rural community in the USA were interviewed regarding their perceptions about disasters and preparedness, and their reactions to the preparedness training programme using the concepts of the Extended Parallel Process Model. Participants generally indicated low motivation to engage in preparedness behaviours despite perceptions of personal risk and beliefs that preparedness behaviours were easy and could improve disaster outcomes. A theme of social relationships emerged from the data, with participants identifying social relationships as resources, barriers and motivators. People surrounding older adults can support or deter their preparedness behaviours, and sometimes elicit a desire to protect the wellbeing of others. Findings suggest two potential strategies to facilitate preparedness behaviours by moving beyond personal benefits: highlighting older adults' increased ability to protect the wellbeing of younger generations and their community by being prepared themselves, and engaging family, friends and neighbours in preparedness programmes to enhance the resilience of their social groups. Older adults in many cultures have a desire to contribute to their society. Novel and effective approaches to increase preparedness could target their social groups.
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Ron P. The Relationship Between Background Characteristics and Death Anxiety in Times of War: A Comparison Between Three Generations Arab and Jewish Families in Israel. Community Ment Health J 2016; 52:1123-1132. [PMID: 27272324 DOI: 10.1007/s10597-016-0021-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
(a) To compare the levels of death anxiety between the Jewish and Arab population in Israel after the Second Lebanon War and the Casting Lead Operation. (b) To compare the levels of death anxiety between three families' generations: elderly parents, their adult children and their adult grandchildren and (c) to learn about the relationship between background characteristics and death anxiety in times of war. The sample included 172 trios of elderly parents (ages 65 and up), their middle aged children (ages 41-64) and, their young adult children (ages 20-40) living at the northern and southern of Israel. Three quarters of the participants were Jews and the others were Arabs (including Muslims, Christians and Druze). Participants answered a self-report questioner. Death anxiety levels were measured by the Carmel and Mutran's instrument (1999). In general, the highest levels of death anxiety were found among the elderly parents (p < 0.01). Regarding the nationality and the gender variables, the highest levels of death anxiety were found among the adult Jewish daughters' group (p < 0.001). Nationality was found to be the most contributive variable for predicting death anxiety levels among the three generations; the sense of mastery was the second contributor, to predict death anxiety levels among the three generations' participants. Elderly population, Arab population and women, are at high risk to suffer from high levels of death anxiety in times of war in Israel. Special attention should be given to this population groups.
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Affiliation(s)
- Pnina Ron
- School of Social Work, University of Haifa, Mount Carmel, 31905, Haifa, Israel.
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Challenges Faced and Support Received: Older Adults' Perceptions of Hurricane Sandy. Disaster Med Public Health Prep 2016; 11:39-47. [PMID: 27739379 DOI: 10.1017/dmp.2016.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Individuals exposed to natural disasters are at risk for negative physical and psychological outcomes. Older adults may be particularly vulnerable; however, social support can act as a resource to help individuals respond to severe stressors. This study explored the challenges older people faced before, during, and after Hurricane Sandy in October 2012 and the people they turned to for support. METHODS Semi-structured interviews were conducted with 20 older adults in New Jersey drawn from the ORANJ BOWL (Ongoing Research on Aging in New Jersey - Bettering Opportunities for Wellness in Life) research panel, who experienced high levels of primary home damage during Hurricane Sandy. Content analysis of interview transcripts classified older adults' perceptions on how they "made it" through-the challenges they faced and the support they received. RESULTS The findings suggested that older adults experienced emotional, instrumental, social, and financial challenges before, during, and after the storm. However, by relying on family and friends, as well as neighbors and community networks, older people were able to respond to stressors. CONCLUSIONS Our findings carry implications for ensuring that older adults are connected to social networks before, during, and after disasters. The role of neighbors is particularly important when disasters strike. (Disaster Med Public Health Preparedness. 2017;11:39-47).
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Cohen JR, Adams ZW, Menon SV, Youngstrom EA, Bunnell BE, Acierno R, Ruggiero KJ, Danielson CK. How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults. J Affect Disord 2016; 202:102-9. [PMID: 27259082 PMCID: PMC4947444 DOI: 10.1016/j.jad.2016.05.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/13/2016] [Accepted: 05/22/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The present study's aim was to provide the foundation for an efficient, empirically based protocol for depression screening following a natural disaster. Utilizing a Receiver Operating Characteristic (ROC) analytic approach, the study tested a) what specific disaster-related stressors (i.e., property damage, loss of basic services) and individual-related constructs (i.e., PTSD symptoms, trauma history, social support) conveyed the greatest risk for post-natural disaster depression, b) specific cutoff scores across these measures, and c) whether the significance or cutoff scores for each construct varied between adolescents and adults. METHODS Structured phone-based clinical interviews were conducted with 2000 adolescents who lived through a tornado and 1543 adults who survived a hurricane. RESULTS Findings suggested that in both adolescents and adults, individual-related constructs forecasted greater risk for depressive symptoms following a natural disaster compared to disaster-related stressors. Furthermore, trauma history and PTSD symptoms were particularly strong indicators for adolescent depressive symptoms compared to adult depressive symptoms. Adolescents and adults who reported vulnerable scores for social support, trauma history, and lifetime PTSD symptoms were approximately twice as likely to present as depressed following the natural disaster. LIMITATIONS Findings from the present study were limited to post-disaster assessments and based on self-reported functioning 6-12 months following the natural disaster. CONCLUSIONS The present study synthesizes the extensive body of research on post-disaster functioning by providing a clear framework for which questions may be most important to ask when screening for depression following a natural disaster.
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Affiliation(s)
- Joseph R. Cohen
- Department of Psychology, University of Illinois, Champaign, IL,Corresponding author. Department of Psychology, University of Illinois Urbana-Champaign, 603 E. Daniel St., Champaign, IL 61820. Charleston, SC 29425; Tel.: (843) 792 0259. Electronic mail may be sent to
| | - Zachary W. Adams
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC
| | | | | | - Brian E. Bunnell
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC
| | - Carla Kmett Danielson
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC
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