The psychosocial consequences of natural disasters have been
studied extensively. When Norris and colleagues (2002) reviewed
this literature, they found a wide range of effects. About a third
of these studies found effects that were quite severe, meaning that
a high percentage of study participants exhibited clinically
significant distress or diagnosable disorders. The most frequently
reported condition was PTSD, followed by depression, and then other
anxiety disorders. Many survivors also reported nonspecific
distress, health problems, chronic problems in living, and resource
loss. Within the adult samples, risk factors for adverse outcomes
included more severe exposure, female gender, middle age, ethnic
minority group membership, secondary stress, prior psychiatric
problems, and weak or deteriorating psychosocial resources.
Consistent support has been found for the importance of coping
self-efficacy in predicting psychological outcomes from a variety
of disasters, including but not limited to hurricanes (Benight
& Bandura, 2004).
In some of these studies, participants were interviewed more
than once so that the disaster's effects could be studied over
time. Most often, people improved as time passed. However, almost
all studies included a minority of participants who did not improve
but, for whatever reason, continued to be distressed or impaired
long after the event. As the authors of these studies often
remarked, these particular people who do not recover on their own
are especially important to understand and serve.
Quite a few studies have been conducted
specifically on the effects of hurricanes, including such major
events as Hurricane Hugo, Hurricane Andrew, and Hurricane Mitch.
Norris and colleagues (2002) described Hurricane Andrew as a good
example of a "high impact disaster." In one study of 400 highly
exposed residents of southern Dade County, 25% of the sample met
study criteria for PTSD 6 months after the hurricane. Symptoms of
depression and avoidance remained high as late as 30 months after
the hurricane struck (Norris et al., 1999). Lasting
symptoms were especially likely when people experienced other
forms of life stress in addition to the hurricane or had poor
self-esteem or weak social ties. Long after Hurricane Andrew,
many people felt less positive about the quality of their social
relationships than they had felt before the disaster (Norris
& Kaniasty, 1996), suggesting that perceptions of social
support are also harmed by disaster experience.
In this study, the effects of Hurricane
Andrew appeared to be more severe for Latinos, especially less
acculturated Latinos, than for non-Hispanic Whites and Blacks
(Perilla and colleagues, 2002). To a degree, this finding was
explained by Latinos' greater exposure, but it was also partially
explained by Latinos' higher levels of fatalism (external
control) and acculturative stress (discomfort in dealing with
members of other ethnic groups). The mediating role of fatalism
is consistent with a large literature showing that low perceived
control is a risk factor for poor psychological outcomes.
Acculturative stress might have hindered help-seeking or
exacerbated the effects of other stressors.
Altogether, the evidence from this study
of Hurricane Andrew, as well as from other disaster studies,
suggests that the long-term emotional consequences of disaster
follow strongly from survivors' thoughts or beliefs. Adults at
risk for mental health problems think that they (a) are uncared
for by others, (b) have little control over what happens to them,
or (c) lack the capacity to manage stress.
These hurricane-specific findings are
consistent with findings from research on other forms of trauma
that have examined the factors predicting whether or not a person
develops chronic PTSD. Two of the strongest factors influencing
recovery are subsequent life stress and social support from
others. The most recent research with survivors of assaults
and motor vehicle accidents has consistently shown that the
presence of negative social support impedes recovery (Dunmore,
Clark, & Ehlers, 2001; Ullman & Filipas, 2001; Zoellner,
Foa, & Brigidi, 1999). Family members' critical comments
about the length of time taken for recovery seem to stand in the
way of trauma victims' recovery in treatment for PTSD.
by Fran H. Norris, Dartmouth Medical School
and National Center for PTSD
More detailed information on the mental
health impact of disasters is found in this article which is
posted on the Research Education in Disaster Mental Health
(REDMH) Web site.