Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian Americans

A Home Disaster Preparedness Intervention Study with Korean American Residents in New York City

This study investigated the effectiveness of the Nurses Taking on Readiness Measures (N-TORM) intervention in improving disaster preparedness of Asian immigrant residents in New York City. N-TORM is an innovative, nurse-led, household disaster preparedness educational intervention provided to community members to help them create their disaster-related evacuation and communication plans, build disaster supply kits, and understand community resources available to assist residents before, during, and after disasters. The aims of this controlled before-after intervention study were to (a) pilot test the Korean translation of the Household Emergency Preparedness Instrument (K-HEPI), (b) evaluate the effectiveness of N-TORM to increase household disaster preparedness knowledge and behavior, and (c) describe the factors most necessary to maintain and expand N-TORM. Participants in the experimental group (N = 200) demonstrated significantly greater pre-to-post improvement in disaster preparedness compared to those in the control group (N = 199), as measured by the K-HEPI (effect on total General Preparedness scores, β = 1.66, SE = 0.105, p < .001). The Korean community organization that was involved in this study continues to offer N-TORM to its members, demonstrating the intervention's sustainability. Further testing of the K-HEPI and the intervention in longitudinal studies is recommended to explore potential associations between disaster preparedness and outcomes such as survival without rescue, prevention of injury, or acute exacerbations of chronic illnesses. Replicating the intervention across different immigrant populations is essential, and data from these studies can inform policy development to better address the needs of immigrant communities before, during, and after disasters. ClinicalTrials.gov Identifier: NCT0554478. Hunter College of City University of New York Protocol Record 2022-0542-Hunter, Korean Translation and Validation of the K-HEPI by a Phase 1 Feasibility Study in NYC, is registered and posted on the ClinicalTrials.gov website.

Experiences of Immigrants During Disasters in the US: A Systematic Literature Review

As a vulnerable population, immigrants can be disproportionately affected by disasters. Because of their legal and migratory status, immigrants may have different challenges, needs, and possibilities when facing a disaster. Yet, within disaster studies, immigrants are rarely studied alone. Instead, they are often considered part of the large heterogeneous group of racial and ethnic minorities in the United States. This racial classification points to a gap in the literature and in our understanding of how disadvantaged groups may cope with disasters. To address this gap, the current study hypothesizes that: (1) Immigrants have unique experiences and disaster impacts compared to the broader aggregated category of racial and ethnic minorities in the U.S. and (2) There are variations in disaster experiences and impacts across different types of immigrant subgroups beyond refugees. To explore these hypotheses, a study of the literature across six databases from 2018 to 2023was conducted. The review identified a total of 17 articles discussing immigrant experiences during disasters. Major cross-cutting themes on immigrant disaster experiences include fear of deportation, restrictive immigration status, excessive economic burden and labor exploitation, employment rigidity, adverse health outcomes, limited informational resources and limited social capital, selective disaster relief measures, and infrastructural challenges as regards to housing and transportation. Many of the themes identified are unique to immigrants, such as the fear of deportation, restrictive immigration status and visa policies, and selective disaster relief measures.

The Epidemiology and Geographic Patterns of Natural Disaster and Extreme Weather Mortality by Race and Ethnicity, United States, 1999-2018

OBJECTIVES

The adverse effects that racial and ethnic minority groups experience before, during, and after disaster events are of public health concern. The objective of this study was to examine disparities in the epidemiologic and geographic patterns of natural disaster and extreme weather mortality by race and ethnicity.

METHODS

We used mortality data from the Centers for Disease Control and Prevention from January 1, 1999, through December 31, 2018. We defined natural disaster and extreme weather mortality based on International Classification of Diseases, 10th Revision codes X30-X39. We calculated age-adjusted mortality rates by race, ethnicity, and hazard type, and we calculated age-adjusted mortality rate ratios by race, ethnicity, and state. We used geographic mapping to examine age-adjusted mortality rate ratios by race, ethnicity, and state.

RESULTS

Natural disasters and extreme weather caused 27 335 deaths in the United States during 1999-2018. Although non-Hispanic White people represented 68% of total natural disaster and extreme weather mortality, the mortality rate per 100 000 population among non-Hispanic Black people was 1.87 times higher (0.71) and among non-Hispanic American Indian/Alaska Native people was 7.34 times higher (2.79) than among non-Hispanic White people (0.38). For all racial and ethnic groups, exposure to extreme heat and cold were the 2 greatest causes of natural disaster and extreme weather mortality. Racial and ethnic disparities in natural disaster and extreme weather mortality were highest in the South, Southwest, Mountain West, and Upper Midwest.

CONCLUSIONS

Racial and ethnic minority populations have a greater likelihood of mortality from natural disaster or extreme weather events than non-Hispanic White people. Our study strengthens the current knowledge base on these disparities and may inform and improve disaster preparedness and response efforts.

Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry

The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design.

Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

Perceived Decrease in Workplace Security Since the Beginning of the COVID-19 Pandemic: The Importance of Management Styles and Work-Related Attitudes

The coronavirus disease 2019 (COVID-19) pandemic has reduced the sense of security of people in everyday life. The efforts of managers in the workplace to minimize the health risks and economic damage, however, can provide the employees with a greater sense of security. The aim of this study was to identify the types of workplace responses to the pandemic outbreak with respect to the characteristics of employees and their employers accomplishing the differences in subjective sense of workplace security before the pandemic and during the outbreak. Three hundred and thirty-seven Polish employees completed an online survey during the first 2 weeks of the COVID-19 pandemic in March 2020. Using the cluster analysis, we identified four subgroups of employees differing in their sense of workplace security, work-related psychological factors, and perceived management styles of their supervisors. Employees led by developers and executive managers sustained a high sense of work security and positive attitude to work, while those led by compromisers and deserter managers suffered from the highest drop of subjective security. In this study, we proposed how employees can be protected from overreactions and unnecessary panic in a time of global crisis by virtue of the psychological competences of their supervisors and employers.

Psychological outcomes for young adults after disastrous events: A mixed-methods scoping review

RATIONALE

Young adulthood (18 to 34) is a time of transitional change where individuals can be highly susceptible to mental health concerns. Despite similar vulnerabilities to their adolescent counterparts, the psychological outcomes for young adults following disasters are not well understood.

OBJECTIVE

This scoping review aimed to explore the literature on the psychological outcomes for young adults after disaster events.

METHODS

A systematic search of the literature was conducted in seven electronic databases, including PsycINFO, Medline, CINAHL, PILOTS, EMBASE, Scopus, and ProQuest dissertations and theses global. In total, 91 reports from 15 countries were included.

RESULTS

Findings suggested that young adults experience a range of psychological consequences after disasters, including posttraumatic stress symptoms, depression, anxiety, and other psychological outcomes, such as general/non-specific psychological distress. Pre-disaster, peri-disaster, and post-disaster factors were also found to influence the degree of psychological outcomes experienced by young adults, including prior psychological functioning and disaster exposure, among a host of other factors.

CONCLUSION

Future research is recommended to better understand young adults' psychological outcomes, experiences, and service needs following disasters.

Americans' distress early in the COVID-19 pandemic: Protective resources and coping strategies

OBJECTIVE

The rapid emergence of the coronavirus disease 2019 (COVID-19) pandemic in the United States has dramatically altered daily life and taken a toll on Americans' physical, mental, social, and financial well-being. Based on previous widespread disasters, future high prevalence of short- and long-term adverse mental health consequences are anticipated. Studies of COVID-19 outside the United States indicated moderately high levels of distress, but we have little information regarding Americans' distress nor the factors associated with relative distress or adjustment during this unprecedented time. This study represents the first national view of Americans' distress during the massive disruption of COVID-19 and identifies levels of stress exposure, protective psychosocial resources, and coping strategies.

METHOD

Data were collected April 7-9, 2020 from an online platform, using best practices for ensuring high-quality data; 1,015 completed respondents are included ([53.9%] women; average age = 38.9 years; mostly White [82.4%] and non-Hispanic [91.5%]). Respondents' locations ranged across the United States, from 18.5% in the Northeast to 37.8% in the South.

RESULTS

Fairly high levels of stress exposure and peritraumatic and general distress (depression, anxiety, and stress) were reported. Emotion regulation skills along with active and distraction coping emerged as the strongest predictors of lower distress levels.

CONCLUSIONS

These results identify potential targets for online mental health interventions-focusing on engaging in adaptive emotion regulation and coping (e.g., through telehealth mental health first aid)-during the pandemic to offset the likely rise in distress over the months ahead. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature

Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.

The Impact of Job Loss on Posttraumatic Stress Disorder Among Asian Americans: 11-12 Years After the World Trade Center Attack

Adversities following disasters are associated with the delayed onset and persistence of post-traumatic stress disorder (PTSD). In the wake of the World Trade Center attack, a sizeable group of Asian Americans being directly exposed to the disaster had endured job loss during the decade afterwards. Yet, no studies to date have examined the relationship between job loss and long-term PTSD in this group. This study examined the 10-11-year prevalence of probable PTSD (≥ PCL score of 44) among Asian (n=1,712) and Caucasian American (n=25,011) participants of the World Trade Center Health Registry who had completed three waves of survey studies (2003-04, 2006-08, 2011-12). Logistic regression was used to model the relationship between job loss since the disaster and probable PTSD for the two racial groups separately while controlling for sociodemographics, disaster exposure, post-disaster traumatic/stressful events exposure, lower respiratory symptoms, PTSD history since 911, and mental health service use. The long-term prevalence of probable PTSD was 15.1% for Asian Americans and 14.4% for Caucasian Americans, with no significant difference. For both groups, having job loss since 911 was a significant risk factor for probable PTSD (Asian Americans: AOR=1.80; 95% CI=1.19, 2.71; Caucasian Americans: AOR=1.73; 95% CI=1.56, 1.93). While job loss was an important risk factor, employment opportunities were more restricted for Asian Americans given the cultural and language limitations. Current findings highlight the importance of improving employment as part of post-disaster assistance.