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Many disaster survivors suffer from postdisaster distress regardless of whether or not they meet criteria for specific psychiatric diagnoses. Cognitive Behavior Therapy for Postdisaster Distress (CBT-PD), a ten-session manualized intervention, was developed to address a range of cognitive, emotional, and behavioral reactions to disaster. Trained community-based therapists provided CBT-PD to adult survivors of Hurricane Katrina as part of InCourage, a program sponsored by the Baton Rouge Area Foundation. Participants ( n = 88) who were assessed at referral, pretreatment, intermediate treatment, and posttreatment showed significant and large improvements. The overall pre-post effect size was 1.4 in intention-to-treat analyses. Improvements were comparable for persons with more severe distress and persons with moderate distress at referral. Benefits were maintained at follow-up for the 66 adults who have been assessed. [ABSTRACT FROM AUTHOR]

Hurricane Katrina created the largest population of internally displaced persons in the history of the United States. Exceptions to Federal Emergency Management Agency’s (FEMA’s) usual eligibility requirements allowed states from across the nation to apply for Crisis Counseling Assistance and Training Program (CCP) grants to provide services to evacuees. Over a 16-month period, crisis counselors documented 1.2 million individual and group encounters across 19 CCPs. Most encounters (936,000, 80%) occurred in Presidential disaster-declared areas of Louisiana, Mississippi, and Alabama, but many (237,000, 20%) occurred in 16 smaller “undeclared” programs across the country. Programs showed excellent reach relative to external benchmarks provided by FEMA registrations for individual assistance and population characteristics. Programs varied widely in service mix and intensity. The declared programs reached more people, but the undeclared programs provided more intensive services to fewer people with higher needs. [ABSTRACT FROM AUTHOR]

The 2005 hurricane season was the worst on record, resulting in disaster declarations and the implementation of federally-funded crisis counseling programs in five states. As part of a larger cross-site evaluation of these programs, data from 2,850 participant surveys, 805 provider surveys, and 132,733 encounter logs (submitted from 3 weeks before to 3 weeks after the participant surveys) were aggregated to the county level ( N = 50) and used to test hypotheses regarding factors that influence program performance. County-level outcomes (aggregate ratings of participants’ perceived benefits) improved as service intensity, service intimacy, and frequency of psychological referrals increased and as provider job stress decreased. The percent of providers with advanced degrees was indirectly related to participants’ perceived benefits by increasing service intensity and referral frequency. The results yielded recommendations for achieving excellence in disaster mental health programs. [ABSTRACT FROM AUTHOR]

During January–April 2007, Project Recovery, a federally funded crisis counseling program implemented by Mississippi’s Department of Mental Health, piloted a new model of Specialized Crisis Counseling Services (SCCS) on the Mississippi Gulf Coast. In this team-based approach, a masters-level counselor trained in a variety of intervention techniques and a resource coordinator worked together with persons whose needs were relatively intense. Compared to regular program (RCCS) participants over the same interval ( n = 29,522), SCCS participants ( n = 281) were more likely to be female, middle-aged, and at greater risk for severe distress. In a participant survey conducted in both programs over the same week, SCCS participants reported significantly greater benefit than did RCCS participants. A subset of 129 SCCS participants provided pre- and post-participation assessments and showed large improvements in disaster-related distress. [ABSTRACT FROM AUTHOR]

An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3–18 months after Hurricane Katrina. Referrals for disaster relief were predicted by clients’ losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban–rural disparities in access to services. [ABSTRACT FROM AUTHOR]

Communities have the potential to function effectively and adapt successfully in the aftermath of disasters. Drawing upon literatures in several disciplines, we present a theory of resilience that encompasses contemporary understandings of stress, adaptation, wellness, and resource dynamics. Community resilience is a process linking a network of adaptive capacities (resources with dynamic attributes) to adaptation after a disturbance or adversity. Community adaptation is manifest in population wellness, defined as high and non-disparate levels of mental and behavioral health, functioning, and quality of life. Community resilience emerges from four primary sets of adaptive capacities—Economic Development, Social Capital, Information and Communication, and Community Competence—that together provide a strategy for disaster readiness. To build collective resilience, communities must reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, and plan for not having a plan, which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns. [ABSTRACT FROM AUTHOR]

Drawing upon literatures in several disciplines, Norris and colleagues (in press) concluded that the resilience of communities, and consequently the wellness of communities, rests upon a network of adaptive capacities, particularly Economic Development, Social Capital, Information and Communication, and Community Competence. There are numerous ways in which efforts to build community resilience might also achieve the five essential elements of mass trauma intervention explicated by Hobfoll and colleagues. Thus, it is argued here that efforts to reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, cultivate trusted and responsible information resources, and enhance decision-making skills will augment more specific intervention efforts to promote safety, calming, efficacy, hope, and connectedness in the aftermath of mass trauma. Many of these outcomes require systems and social changes that can be the target of intervention efforts before as well as after disasters. [ABSTRACT FROM AUTHOR]

Abstract: Consumption patterns and misuse of alcohol were examined in adults sampled from three cities in Mexico (n =1933). The sample was divided into groups of persons who abstained from alcohol, drank but endorsed no misuse, or drank and endorsed at least some misuse of alcohol. Half of the entire sample was categorized as drinkers (12 or more drinks in lifetime). Mexican men drank more per occasion and reported more problems with alcohol rather than did Mexican women. Low socioeconomic resources, not being married, and female gender were related to whether Mexicans abstained from alcohol rather than drank without misuse. Lifetime posttraumatic stress disorder (PTSD) or depression increased the likelihood of misusing alcohol versus drinking without misuse, as did greater amount of drinks consumed per occasion and male gender. Younger age and not being married were also related to misuse, although this was true mostly for women. The number of traumatic experiences in childhood and lower socioeconomic resources also predicted misuse, although mostly for men. Specific traumatic experiences and their relationship to alcohol use and misuse were also examined. [Copyright &y& Elsevier]

In this article, we present and illustrate cognitive-behavioral therapy for postdisaster distress. The treatment is for individuals who show more than normal transient stress after disaster and functions as an intermediate step between traditional crisis counseling and longer-term mental health treatments. Thus, it is one part of a larger mental health disaster response and is designed to be implemented no sooner than 60 days post disaster. A clinical case demonstrates its process and technique in a community practice setting. © 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session. [ABSTRACT FROM AUTHOR]

The article presents abstracts of political and social science research. They include "The Political Costs of Failure in the Katrina and Rita Disasters," "President Bush and Hurricane Katrina: A Presidential Leadership Study," "Metaphors Matter: Disaster Myths, Media Frames, and Their Consequences in Hurricane Katrina," "Weathering the Storm: The Impact of Hurricanes on Physical and Mental Health," and "Planning for Postdisaster Resiliency."

The Crisis Counseling Assistance and Training Program grants supplemental federal funding to states and territories for individual and community crisis intervention services in the aftermath of presidentially declared disasters. Little research has been conducted to evaluate the effectiveness of these services, and few data exist to guide policies and programs. A qualitative study of thirty-eight state program directors (representing 95 percent of all such programs over a five-year period) identified the numerous challenges that states experience when planning, applying for, implementing, maintaining, phasing out, and evaluating these federally funded programs. The results highlighted the importance of including mental health in state-level disaster plans, fostering collaborative relationships across institutions, clarifying program guidelines, sharing innovations across programs, and building state capacity for needs assessment and program evaluation. [ABSTRACT FROM AUTHOR]

Samples of adults representative of Teziutlán, Puebla, and Villahermosa, Tobasco, were interviewed 6, 12, 18, and 24 months after the devastating 1999 flood and mudslides. The interview contained multiple measures of social support that had been normed for Mexico. Comparisons between sample data and population norms suggested minimal mobilization of received support and substantial deterioration of perceived support and social embeddedness. Social support was lowest in Teziutlán, which had experienced mass casualties and displacement, and among women and persons of lower educational attainment. Disparities according to gender, context, and education grew larger as time passed. The results provide compelling evidence that the international health community must be mindful of social as well as psychological functioning when disasters strike the developing world. [ABSTRACT FROM AUTHOR]

Objective: We examined the lifetime prevalence of violence in Mexico and how different characteristics of the violent event effect the probability of meeting criteria for lifetime post-traumatic stress disorder (PTSD).Method: We interviewed a probability sample of 2,509 adults from 4 cities in Mexico (Oaxaca, Guadalajara, Hermosillo, Mérida) using the Composite International Diagnostic Interview (CIDI).Results: Lifetime prevalence of violence was 34%. Men reported more single-experience, recurrent, physical, adolescent, adulthood, and stranger violence; women more sexual, childhood, family, and intimate partner violence. Prevalence was generally higher in Guadalajara, though the impact was greater in Oaxaca compared to other cities. Of those exposed, 11.5% met DSM-IV criteria for PTSD. Probabilities were highest after sexual and intimate partner violence, higher for women than men, and higher in Oaxaca than other cities.Conclusions: It is important to consider the characteristics and the context of violence in order to develop effective prevention and intervention programs to reduce the exposure to and impact of violence. [ABSTRACT FROM AUTHOR]

Samples of adults representative of Tezuitlán, Puebla and Villahermosa, Tobasco (combined N = 561), were interviewed 6, 12, 18, and 24 months after the devastating 1999 floods and mudslides in Mexico. Current DSM-IV PTSD and major depressive disorder (MDD) were assessed with the Composite International Diagnostic Interview. At Wave 1, PTSD was highly prevalent (24% combined), especially in Tezuitlán (46%), which had experienced mass casualties and displacement. Both linear and quadratic effects of time emerged, as PTSD symptoms initially declined but subsequently stabilized. Differences between cities lessened as time passed. Comorbidity between PTSD and MDD was substantial. The findings demonstrate that the international health community needs to be prepared for epidemics of PTSD when disasters strike developing areas of the world. [ABSTRACT FROM AUTHOR]

Discusses the biological, psychological and social aspects of human response to terrorism. Link of traumatic stress to terrorism response; Human biopsychosocial reactions to extreme events; Impact of terrorism on economic health.

We describe in this study the various ways that survivors may experience social support and conflict after a disaster. Using unstructured interviews, 25 Mexicans/Mexican Americans (14 women, 11 men) were asked to recount the ways that they received support, as well as the ways they experienced conflict. Interviews occurred across three cities: Guadalajara, Jalisco (n = 9), Homestead, Florida (n = 6), and Puerto Angel, Oaxaca (n = 10). Recurrent themes were found for both support and conflict. Survivors reported more support from informal sources (family, neighbors) than formal sources (government) and far more tangible (food, shelter) than emotional or informational support. Conflict themes were different for each city. In Mexico, reports of conflict were more likely to involve abuses by government officials while in Homestead conflict involved abuses by residents. Theoretical and practical implications for future disaster research in developing countries are discussed. © 2003 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This article provides a brief overview of the field of disaster research, summarizing what is known at present about the prevalence of disasters, the range of stressors and outcomes experienced, and sample-, event-, and individual-level risk factors for poor health and mental health outcomes. Prior research does not suggest that an urban context either enhances or reduces risk for individual survivors. It is argued, however, that the influence of extraindividual exposure, ethnic diversity, and support deterioration may be especially salient for understanding urban disasters. Investigators of urban disasters are especially well situated to expand knowledge of ecological and collective aspects of disaster response and recovery. [ABSTRACT FROM AUTHOR]

Examines the normative data regarding the levels of psychological distress following criminal victimization in the general population. Symptom profile; Total effects of crime and time; Unique effects of crime over time.

A probability sample of 1,429 adults aged 55 and older was interviewed in their homes three times at six-month intervals. Measures of symptoms, social support, and education were obtained before measures of life-event stress. A LISREL analysis of three waves and two intervals of data yielded a goodness of fit of .989 between the data and the model. For both intervals, increases in stress led to increases in symptoms, which supported the Dohrenwend hypothesis of a normative stress reaction. This reaction typically did not persist beyond six months unless there was high stress over both intervals. Contrary to Dohrenwend's resource mediation hypothesis, social support and education did not influence either the reaction to or the recovery from stress. Symptoms were very stable over the one-year period. Overall, the results depict older adults as quite consistent and resilient. Because life events were correlated over time and were predicted by person characteristics, they should not be considered as independent of person factors. [ABSTRACT FROM AUTHOR]

Using data from a five-wave panel study of older adults, this study examined the potential for attrition to affect relationships among study variables. There were few differences between those respondents who completed all five waves and those who did not in either their initial matrices of correlations or in the equations that best predicted their wave 2 health and depression. Relationships among variables also did not differ between respondents and persistent nonrespondents, between respondents and four specific attrition types, or between the original sample and various multiwave samples. In discussing the findings, the limited effects that attrition has on relationships between variables are contrasted to the stronger effects that attrition appears to have on mean levels of those variables, showing that the former does not necessarily follow from the latter. The findings support recent conclusions in the literature that the threat posed by panel loss is not as great as typically assumed. [ABSTRACT FROM PUBLISHER]

As part of a larger panel study, interviews were obtained from 63 older adults who had experienced the death of a spouse, parent, or child, and from 387 older adults who had not been bereaved. Three interviews were conducted before the death, one after. The study found that: (a) bereavement itself did not affect health; (b) family stress increased as the time of death approached but diminished thereafter; (c) before the death, family stress was associated with worsening health; (d) after the death, health worsened if there had been no family stress preceding the death, but otherwise it improved; (e) after the death, however, psychological distress increased sharply, regardless of the level of prebereavement stress. Implications of the study for conceptualizations of grief and for understanding the life experiences of older adults are discussed. [ABSTRACT FROM PUBLISHER]

This study examines attrition from a large probability sample of older adults over five waves of data collection, each 6 months apart. Respondents to all five waves and groups differing in the wave or reason they dropped out were compared on initial psychological, health, social, demographic and life event measures. For men, in general, the better their initial conditions, the greater the number of interviews. For women, however, differences among groups participating for different lengths of time were nonlinear. For both men and women, these differences were accounted for by changing sources (types) of attrition across waves, plus strong differences among attrition types. In general, respondents to all five waves initially had better conditions than persons who died, became ill, or were not found at a later wave, but had equal or worse conditions than persons who lost interest in the study. [ABSTRACT FROM PUBLISHER]

Testing effects have been obtained on attitudinal and cognitive variables in studies typically conducted on college students in which the pretest-posttest interval usually was several days or weeks. In an effort to expand our knowledge of testing effects, an assessment of testing was incorporated into a panel study of the mental health, social and psychological resources, and stressful life events of older persons. Conceivably, prior assessment of life events might produce greater subsequent recollection of events in the pretest-posttest interval. Also, the rapport established in the initial interview together with previous discussion of possible physical and mental health symptoms might yield greater disclosures of illness in a subsequent interview. In a multistage sample survey, seven out of eight dwellings in the selected segments were randomly assigned to be in the panel group; the eighth dwelling was assigned to the control group. A total of 2,042 persons 55 years and older living in the panel dwellings were interviewed on Wave 1 and reinterviewed with the same instruments six months later on Wave 2; 248 persons in the control group were interviewed only on Wave 2. Comparisons between the two groups on six measures of mental health, several measures of physical health, self-esteem and social support scales, and five measures of life events found no evidence for testing effects. [ABSTRACT FROM PUBLISHER]

This study examined the predicted utility of the Nonverbal LearningDisabilities syndrome (NLD) (Rourke, 1995) for characterizing neurocognitiveand psychosocial outcomes in 123 children with brain tumors. Children withbrain tumors were found to be at high risk of having a specific academic deficit,particularly in arithmetic. Children with arithmetic deficit evidenced a higherrate of impairment on nonverbal tasks than on verbal tasks, whereas childrenwith reading deficit evidenced a higher rate of impairment on verbal tasksthan on nonverbal tasks. However, significant differences between childrenwith arithmetic and reading deficits were not found for all of the componentfeatures of the NLD syndrome, and arithmetic deficit was not related to treatmentwith irradiation. [ABSTRACT FROM AUTHOR]

Estimates of the natural distribution of environmental demands on older adults are provided here. Frequencies of occurrence over a one-year period for 54 life events relevant to older adults are reported for a sample of 1102 men and 1758 women representative of the population aged 55 and older in Kentucky. Estimates of the absolute number of noninstitutionalized Kentucky older adults who would experience selected events in a year are thus made possible. In addition, older adult judgments as to the desirability or undesirability of each event are also reported. These data could be used, with some qualifications, to establish normative weights or desirability classifications for these events for older adults. The following selected classes of events are evaluated in terms of their impact, based on the desirability ratings and previous research: health, death, family conflict, and rewards. Program implications suggested by considering both the prevalence and impact data are: (a) mental health interventions should be closely tied to physical health events; (b) death of spouse would be an event important for prevention programs; (c) other forms of marital disruption would be too in- frequent to justify programs; (d) retirement would appear to have too little impact to justify adjustment programs; and (e) the very desirable impact of reward events found here would justify programs promoting these events for older adults. [ABSTRACT FROM AUTHOR]

A "QOL-Contribution" model for resource allocation decisions is proposed that integrates concepts and values from community psychology, need assessment, and quality of life (QOL) studies. QOL is taken as the criterion for establishing the goodness-of-fit between a population and its environment. It is assumed that the characteristics of a given human group interact with the resources and the stressors of its environment, with its level of QOL as the result. The utility and the implications of the model for resource decisions are demonstrated with data from a statewide need assessment. In this application, different life domains, and different program targets within life domains, are prioritized according to their relative contributions to QOL. The findings for mental health and employment illustrate the specificity of the model's application. The model is then restated as the general task, and a unifying theme, for community psychology. [ABSTRACT FROM AUTHOR]

As participants in a panel study, over 200 older adults were interviewed both before and after each of two floods that occurred in southeastern Kentucky in 1981 and 1984. The present study examined the impact of flood exposure on the physical health of this sample over five follow-up interviews. The major findings were as follows: first, flood exposure was related to modest health declines in this sample. Second, symptomatic reactions to the less severe flood appeared to be seasonal, peaking in the first spring after the incident, decreasing by that fall, then increasing to a lesser degree the following spring. This seasonal trend was found only for those who had experienced both high personal losses and high community destruction in the floods. It was not a general seasonal health trend among the older adult sample. Third, the persistence of health effects was related directly to flood intensity. [ABSTRACT FROM AUTHOR]

1,402 older adults were interviewed twice with a six month interval. The direct, indirect, and interactive relationships of resources, life events, global stress, and depression were examined using multiple regression procedures to isolate the unique contributions of six hypothesized functions of resources: (1) stronger resources did not reduce undesirable events; (2) stronger resources did reduce the degree to which one experienced global stress: (3) stronger resources reduced depressive symptoms; (4) strong resource persons had less global stress than weak resource persons at low levels of events, but this advantage disappeared as level of events increased (opposite of prediction); (5) the traditional buffer hypothesis was not supported; the advantage of strong resource persons over weak resource persons held at all levels of events; (6) strong resource persons had less change in depression than weak resource persons only at the higher levels of global stress. This form followed the buffer effect previously attributed to events. [ABSTRACT FROM AUTHOR]

Using a prospective design with five follow-up intervals, the study addressed questions regarding the timing of onset, duration, course, and nature of psychological reactions to natural disaster. As participants in a statewide panel study, more than 200 older adults were interviewed both before and after two distinct floods occurred in southeastern Kentucky in 1981 and 1984. Exposure to these incidents, which differed in overall intensity, was assessed at both the individual and community levels. Personal loss was associated with short-term increases in negative affect, limited to one year postflood. Longer-term effects were more dependent on the level of community destruction. Exposure to high levels of community destruction was related to decreased positive affect up to two years postdisaster, whereas exposure to high levels of both community destruction and personal loss was predictive of increased negative affect for two years. [ABSTRACT FROM PUBLISHER]

Despite extensive data from randomized controlled trials supporting the efficacy of evidence-based treatments (EBTs), the adoption of these interventions in the Department of Veterans Affairs (VA) and the Department of Defense has been markedly slow. Qualitative interviews were conducted with a nationally representative sample of 38 directors of specialized posttraumatic stress disorder outpatient programs in VA medical centers about implementation of two EBTs. Every director confirmed that EBTs, specifically prolonged exposure and cognitive processing therapy, were provided in their program. It was nearly universal, however, for these treatments to be preceded by preparatory groups. The consensus among directors was that these groups improve readiness for trauma-focused EBTs, help veterans to make informed decisions about their treatment plans, improve coping skills and symptom management, and decrease the likelihood of no-shows for scheduled EBTs. The concept of readiness for trauma-focused EBTs guided program development and flow throughout the programs. Implications for increased implementation of EBTs include developing and disseminating standardized ways of explaining their rationale and expected outcomes. Future research directions, such as empirically identifying veterans who are willing to participate in and benefit from these EBTs, are also noted. [ABSTRACT FROM AUTHOR]

Abstract: This study examined the nature and determinants of longitudinal trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms in older persons affected by a large-magnitude disaster. Two hundred six adults age 60 or older (mean = 69, range = 60–92) who resided in the Galveston Bay area when Hurricane Ike struck in September 2008 completed telephone interviews an average of 3-, 6-, and 15-months after this disaster. Latent growth mixture modeling was employed to identify predominant trajectories of disaster-related PTSD symptoms over time; and pre-, peri-, and post-disaster determinants of these trajectories were then examined. A 3-class solution optimally characterized PTSD symptom trajectories, with the majority (78.7%) of the sample having low/no PTSD symptoms over all assessments (i.e., resistant); 16.0% having chronically elevated symptoms (i.e., chronic); and 5.3% having a delayed onset course of symptoms (i.e., delayed-onset). Lower education, greater severity of Hurricane Ike exposure (i.e., Ike-related physical illness or injury and high level of community destruction), and greater number of traumatic and stressful life events after Hurricane Ike, particularly financial problems, were associated with a chronic PTSD trajectory. Greater number of traumatic and stressful life events, particularly financial problems after Hurricane Ike, was also associated with a delayed-onset trajectory. These findings suggest that there are heterogeneous trajectories of disaster-related PTSD symptoms in older adults and that these trajectories have common and unique determinants. They also underscore the importance of prevention efforts designed to mitigate the deleterious effects of post-disaster stressors, most notably financial distress, in older persons affected by disasters. [Copyright &y& Elsevier]

Abstract: Objective: To examine the prevalence and correlates of disaster-related posttraumatic stress disorder (PTSD), depression, and needs for psychological care in older persons affected by Hurricane Ike. Method: A total of 193 adults aged 60 or older who resided in the Galveston Bay area were interviewed 2–5months following Hurricane Ike. Pre-, peri-, and post-disaster variables hypothesized to be related to PTSD and depressive symptoms, and perceived needs for psychological care were assessed. Results: Weighted prevalences of past-month Ike-related PTSD and depression were 7.6% and 8.6%, respectively. Risk factors for Ike-related PTSD symptoms were predominantly peri-disaster in nature, with greater hurricane exposure, and peri-event dissociative and autonomic activation symptoms associated positively with these symptoms. Risk factors for depressive symptoms were predominantly pre-disaster in nature, with being married/living with partner associated negatively, and prior disaster exposure and pre-disaster PTSD or depression associated positively with these symptoms. 27.2% of the sample endorsed at least one of the perceived needs for psychological care assessed. A history of PTSD or depression, greater peri-event autonomic activation, and Ike-related PTSD and depressive symptoms were associated with greater need for psychological care. Limitations: This study is limited by its cross-sectional design and employment of psychiatric screening instruments. Conclusions: A substantial proportion of older adults may have PTSD and depression, as well as perceived needs for psychological care, after a disaster. Assessment of disaster exposures, and peri-event dissociative and autonomic symptoms may help identify older adults at risk for disaster-related psychopathology. Older adults with a history of PTSD or depression, and greater peri-event autonomic activation and PTSD symptoms may be more likely to have needs for psychological care. [Copyright &y& Elsevier]

Objective: Cognitive-behavioral therapy for postdisaster distress (CBT-PD) is a transdiagnostic intervention that has been used following major disasters such as the 9/11 terrorist attacks and Hurricane Katrina. In this study, we report findings from a community-based treatment program that offered CBT-PD to individuals who experienced Hurricane Sandy., Method: Eight trained community therapists delivered CBT-PD to 342 adults who had been exposed to Hurricane Sandy. Participants were assessed at referral, pretreatment, intermediate treatment, posttreatment and 5-month follow-up., Results: The overall prepost effect size was 1.41, indicating large improvement pre to posttreatment. Gains were maintained at follow-up. Timing of the intervention did not affect outcome. Participants who received the intervention early (i.e., 10 to 15 months after Sandy) had the same improvement as those who received it later (i.e., 21 to 26 months after Sandy). Similarly, there was no difference in outcome between individuals with severe as compared with moderate distress at pretreatment., Conclusions: Results suggest that CBT-PD is appropriate for a range of individuals with moderate to severe distress and that it has benefit both early on as well as two years postdisaster. Findings add to growing literature that CBT-PD should be considered as one important component of a larger disaster response system. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Objective: Because findings on the mental health status of Holocaust survivors' offspring have been inconsistent, we aimed to identify factors that place some offspring at greater risk for developing mood or anxiety disorders., Method: Using a web-based survey and structured clinical interviews with adult children of survivors, we attempted to predict disorders from offspring's circumstances, perceptions of parents' posttrauma adaptational styles, and self-reported reparative adaptational impacts. Posttrauma adaptational styles encompass intrafamilial and interpersonal psychological, social and behavioral coping, mastery, and defense mechanisms used by each parent. Reparative adaptational impacts reflect the offspring's self-reported insecurity about their own competence, reparative protectiveness, need for control, obsession with the Holocaust, defensive psychosocial constriction, and immature dependency., Results: Of the disorders studied, generalized anxiety disorder was most frequent, followed by major depressive episode and posttraumatic stress disorder (PTSD). Only 2 variables independently predicted these disorders: participants' age and reparative adaptational impacts. Parents' styles were correlated with the presence of disorder, but had no effect when the child's reparative impacts were controlled. The age effect was consistent with epidemiologic research showing lower prevalence of psychological disorder in older cohorts. The severity of participants' reparative impacts was unequivocally the most important (OR = 5.3) or at least the most proximal precursor to the development of psychological disorders. When reparative impacts were low, frequency of disorder was low (8%); when reparative impacts were high, frequency of disorder was high (46%)., Conclusion: Reparative adaptational impacts could guide clinicians in treating children of survivors. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

A comprehensive valid behavioral measure for assessing multidimensional multigenerational impacts of massive trauma has been missing thus far. We describe the development of the Posttrauma Adaptational Styles questionnaire (Part I of the three-part Danieli Inventory of Multigenerational Legacies of Trauma), a self-report questionnaire of Holocaust survivors' children's perceptions of each parent and their own upbringing (60 items per parent). The items were based on literature and cognitive interviewing of 18 survivors' offspring. A web-based convenience sample survey was designed in English and Hebrew and completed by 482 adult children (M age = 59; 67% women) of Holocaust survivors. Exploratory factor analyses were conducted by using maximum likelihood extraction with Geomin rotation to examine the factor structure of the original 70 items for each parent. Conducted hierarchically, the analysis yielded three higher-order factors reflecting intensities of victim, numb, and fighter styles. The 30-item Victim Style Scale (α = .92-.93) and 18-item Numb Style Scale (α = .89) had excellent internal consistency; the consistency of the 12-item Fighter Style Scale (α = .69-.70) was more modest. English-Hebrew analyses suggested good-to-excellent congruence in factor structure (φ = .87-.99). Further research is needed to evaluate the validity of the measure in other samples and populations., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The impacts of the Holocaust on children of survivors have been widely investigated. However, consensus is limited, and no validated measures have been tailored with or to them. We aimed to develop and validate a scale that measures these specific impacts (Part II of the Danieli Inventory of Multigenerational Legacies of Trauma). We studied 484 adult children of survivors who participated in a cross-sectional web-based survey in English or Hebrew; of these, 191 participated in a clinical interview. Exploratory factor analyses of 58 items to reduce and refine the measure yielded a 36-item scale, Reparative Adaptational Impacts, that had excellent internal consistency (α = .91) and congruence between English and Hebrew versions (φ ≥ .95). Associations between impacts and SCID-based diagnoses of major depressive episode, posttraumatic stress disorder, and generalized anxiety disorder were moderate to strong (ds = 0.48-0.89). Strong associations also emerged between severity of offspring's reparative adaptational impacts and intensity of their parents' posttrauma adaptational styles (Multiple R = .72), with intensity of victim style, especially the mother's, having the strongest effect (β = .31-.33). Having both research and clinical relevance for assessing Holocaust survivors' offspring, future studies might investigate the scale's generalizability to other populations affected by mass trauma., ((c) 2015 APA, all rights reserved).)

Positive and negative religious coping are related to positive and negative psychological adjustment, respectively. The current study examined the relation between religious coping and PTSD, major depression, quality of life, and substance use among residents residing in Mississippi at the time of Hurricane Katrina. Results indicated that negative religious coping was positively associated with major depression and poorer quality of life and positive religious coping was negatively associated with PTSD, depression, poorer quality of life, and increased alcohol use. These results suggest that mental health providers should be mindful of the role of religious coping after traumatic events such as natural disasters.

Background: The majority of disaster survivors suffering from psychological symptoms do not receive mental health services. Research on barriers to service use among disaster survivors is limited by a lack of longitudinal studies of representative samples and investigations of predictors of barriers. The purpose of this study was to address these limitations through analysis of a three-wave population-based study of Hurricane Ike survivors (N = 658)., Methods: Frequencies of preference, outcome expectancy, resource, and stigma barriers among participants with unmet mental health needs were documented and logistic regression using a generalized estimating equations approach explored predisposing (e.g., age), illness-related (e.g., posttraumatic stress) and enabling (e.g., insurance coverage) factors as predictors of each type of barrier., Results: Preference barriers were most frequently cited at each wave, whereas stigma barriers were least frequently cited. Older age and higher emotional support predicted preference barriers; being a parent of a child under 18-years old at the time of the hurricane, higher generalized anxiety, and lack of insurance predicted resource barriers; and higher posttraumatic stress predicted stigma barriers., Conclusions: These findings suggest that postdisaster practices targeting subpopulations most likely to have barriers to service use may be indicated.

Background: Depression is a common and potentially debilitating consequence of traumatic events. Mass traumatic events cause wide-ranging disruptions to community characteristics, influencing the population risk of depression. In the aftermath of such events, population displacement is common. Stressors associated with displacement may increase risk of depression directly. Indirectly, persons who are displaced may experience erosion in social cohesion, further exacerbating their risk for depression., Methods: Using data from a population-based cross-sectional survey of adults living in the 23 southernmost counties of Mississippi (N = 708), we modeled the independent and joint relations of displacement and county-level social cohesion with depression 18-24 months after Hurricane Katrina., Results: After adjustment for individual- and county-level socio-demographic characteristics and county-level hurricane exposure, joint exposure to both displacement and low social cohesion was associated with substantially higher log-odds of depression (b = 1.34 [0.86-1.83]). Associations were much weaker for exposure only to low social cohesion (b = 0.28 [-0.35-0.90]) or only to displacement (b = 0.04 [-0.80-0.88]). The associations were robust to additional adjustment for individually perceived social cohesion and social support., Conclusion: Addressing the multiple, simultaneous disruptions that are a hallmark of mass traumatic events is important to identify vulnerable populations and understand the psychological ramifications of these events.