Natural disasters rack up post-traumatic stress symptoms (PTSS) and functional decline in people, whether they are affected directly, indirectly due to concern for friends or family, or even through media coverage, an analysis found. based on a survey of two hurricanes.
The strongest association with PTSS after Hurricane Irma in 2017 was for direct loss or injury (non-standard b coefficient 0.35, P<0.001), Dana Rose Garfin, PhD, of the Sue & Bill Gross School of Nursing at the University of California Irvine, and their coauthors reported in JAMA Open Network.
But prior hurricane-related losses or injuries, prior mental health ailments, not evacuating from an evacuation zone, and even hurricane-related media exposure were also associated with a linear increase in PTSS after Hurricane Irma ( b 0.03-0.18).
“It may seem small, but this is on average over 1,600 people,” Garfin noted, so some people had more substantial impacts.
Hurricane Irma-related PTSS was positively associated with PTSS and functional decline after Hurricane Michael 1 year later, independent of demographics, socioeconomics, life events, physical loss due to hurricanes, and mental health prior to the hurricane.
In short, people who experienced repeated direct or indirect exposure to hurricanes had more mental health symptoms, suggesting they were more susceptible to psychological symptoms with each disaster, the group concluded.
“As we are exposed to an escalation of climate-related disasters (many of them will become more severe and frequent due to climate change), we can expect a mental health crisis, because our study shows that over time, people get used to the effects of these disasters. They have additive effects,” said Garfin medpage today. “The more people who experienced these events, the worse their mental health is.”
Study participants experienced global distress (a combination of depression, anxiety, and somatization), as well as ongoing fear and worry. Garfin noted that these symptoms increased over time and correlated with functional decline, suggesting that these experiences affected their daily social life.
in a comment Masaki Nakabayashi, PhD, accompanying the article, suggested that these findings could be broadly applied to many other types of disasters, such as cyclones in Southeast Asia and typhoons in East Asia, as well as global health pandemics like COVID-19. He noted that these findings could form the basis for a more comprehensive analysis of the effect of these disasters on populations, which, in turn, could lead to “more practical policy implications for mitigating damage.”
Nakabayashi also added that the research could inform studies of whether “recurrent waves of COVID-19 and increased numbers of infections may be similarly associated with adverse mental health outcomes.”
Garfin’s group surveyed 2,873 Floridians before Hurricane Irma made landfall in South Florida between September 8 and 11, 2017. They received 1,637 responses (57.0%) from that first wave of surveys. They sent follow-up surveys to respondents a month later and achieved 90% retention from Cycle 1. Another follow-up survey was sent between October 22 and November 2. 6, 2018, after Hurricane Michael, which hit the Florida Panhandle. They received 1,113 responses to that survey (75.3% retention from Cycle 2; 66.7% retention from Cycle 1).
Surveys took 15-20 minutes to complete with responses on a 5-point scale, depending on the target information.
Among the initial 1,637 respondents in Cycle 1, the median age was 51 years and 55% were women. Overall, 83.6% of participants reported no prior mental health diagnosis, 11.4% reported either a depression or anxiety diagnosis, and 5% reported both diagnoses.
Respondents reported being exposed to media related to Hurricane Irma for an average of 7.9 hours, including 3.8 hours of television, radio, and print news; 2.2 hours of online news; and 1.9 hours of social networks.
The survey was one that Garfin and a colleague had long awaited the opportunity to administer. So, as Hurricane Irma prepared to make landfall in South Florida, they quickly secured grant funding and ethics approval to run the first wave of the survey in just days.
In light of the quick response, Garfin said the team was surprised by the response rate of study participants. He noted that a much lower response rate might have been expected, given the circumstances of the participants.
“In fact, I think it speaks to the fact that people are interested in taking surveys and responding to things that are important to them,” Garfin said. “I think that’s why we were also able to maintain a strong following, because this is something that is important to people. They wanted to share their experiences with us.”
Disclosures
The study was funded in part by grants from the National Science Foundation.
Garfin reported receiving grants from the National Science Foundation and the National Institute on Minority Health and Health Disparities. Coauthors reported grants from the National Science Foundation.
Nakabayashi reported no disclosures.
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