Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey

BACKGROUND/OBJECTIVES

Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs.

DESIGN/METHOD

We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator.

RESULTS

In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time.

CONCLUSIONS

Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

A longitudinal investigation of risk perceptions and adaptation behavior in the US Gulf Coast

Climate change is occurring more rapidly than expected, requiring that people quickly and continually adapt to reduce human suffering. The reality is that climate change-related threats are unpredictable; thus, adaptive behavior must be continually performed even when threat saliency decreases (e.g. time has passed since climate-hazard exposure). Climate change-related threats are also intensifying; thus, new or more adaptive behaviors must be performed over time. Given the need to sustain climate change-related adaptation even when threat saliency decreases, it becomes essential to better understand how the relationship between risk perceptions and adaptation co-evolve over time. In this study, we present results from a probability-based representative sample of 2,774 Texas and Florida residents prospectively surveyed 5 times (2017-2022) in the presence and absence of exposure to tropical cyclones, a climate change-related threat. Distinct trajectories of personal risk perceptions emerged, with higher and more variable risk perceptions among the less educated and those living in Florida. Importantly, as tropical cyclone adaptation behaviors increased, personal risk perceptions decreased over time, particularly in the absence of storms, while future tropical cyclone risk perceptions remained constant. In sum, adapting occurs in response to current risk but may inhibit future action despite increasing future tropical cyclone risks. Our results suggest that programs and policies encouraging proactive adaptation investment may be warranted.

Can mindfulness-based interventions reduce PTSD symptoms? An umbrella review

Post-traumatic stress disorder (PTSD) is a debilitating, often chronic condition with substantial cross-national lifetime prevalence. Although mindfulness-based interventions (MBIs) may help reduce PTSD symptoms, efficacy results are inconsistent. Despite many systematic reviews (SRs) examining MBIs for PTSD, SR quality has been neither evaluated nor synthesized. We conducted an umbrella review to summarize and evaluate existing evidence regarding MBIs for PTSD, identifying 69 SRs (27 meta-analyses), consisting of 83 primary studies. Using AMSTAR2 (a valid SR quality assessment tool), we evaluated each SR on key domains relevant to methodological rigor and rated the confidence of inferences. Results found SRs were 65.2% non-rigorous, 27.5% likely rigorous, and 7.2% rigorous; common limitations included inadequate risk of bias assessment, extractions not completed in duplicate, and lack of pre-registration, highlighting the need for higher quality SRs. We then performed a meta-meta-analysis to estimate the efficacy of MBIs to reduce PTSD symptoms, yielding a medium effect size (SMD=0.41, p < .001), derived from 22 meta-analyses (with replicable data) and 35 unique articles. Analyses were consistent across control conditions and MBI type (first-generation/narrow [i.e., MBIs with well-established protocols]) versus broad (i.e., other MBI types), comparable with second-line treatments (e.g., pharmacotherapy). Findings were narratively synthesized; areas for methodological improvements in MBI research were identified.

Contrasting Objective and Perceived Risk: Predicting COVID-19 Health Behaviors in a Nationally Representative U.S. Sample

BACKGROUND

Individuals confronting health threats may display an optimistic bias such that judgments of their risk for illness or death are unrealistically positive given their objective circumstances.

PURPOSE

We explored optimistic bias for health risks using k-means clustering in the context of COVID-19. We identified risk profiles using subjective and objective indicators of severity and susceptibility risk for COVID-19.

METHODS

Between 3/18/2020-4/18/2020, a national probability sample of 6,514 U.S. residents reported both their subjective risk perceptions (e.g., perceived likelihood of illness or death) and objective risk indices (e.g., age, weight, pre-existing conditions) of COVID-19-related susceptibility and severity, alongside other pandemic-related experiences. Six months later, a subsample (N = 5,661) completed a follow-up survey with questions about their frequency of engagement in recommended health protective behaviors (social distancing, mask wearing, risk behaviors, vaccination intentions).

RESULTS

The k-means clustering procedure identified five risk profiles in the Wave 1 sample; two of these demonstrated aspects of optimistic bias, representing almost 44% of the sample. In OLS regression models predicting health protective behavior adoption at Wave 2, clusters representing individuals with high perceived severity risk were most likely to report engagement in social distancing, but many individuals who were objectively at high risk for illness and death did not report engaging in self-protective behaviors.

CONCLUSIONS

Objective risk of disease severity only inconsistently predicted health protective behavior. Risk profiles may help identify groups that need more targeted interventions to increase their support for public health policy and health enhancing recommendations more broadly.

Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness

People experiencing homelessness report increased exposure to traumatic life events and higher rates of depression, anxiety, and post-traumatic stress disorder as compared with the general population. Heart rate variability-biofeedback (HRV-BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV-BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV-BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (n = 40) were randomized to either the HRV-BF or an active HP control group and received eight weekly, 30-min sessions over two months, delivered by a nurse-led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8-week session, and/or 2-month follow-up. All intervention sessions were completed by 90% (36/40) of participants. Both the HRV-BF and HP interventions showed significant increases in HRV from baseline to 2-month follow-up, with no significant difference between the intervention groups. The HRV-BF programme revealed a somewhat greater, although non-significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV-BF and HP intervention.

Adaptation of a mindfulness-based intervention for trauma-exposed, unhoused women with substance use disorder

OBJECTIVE

Women experiencing homelessness (WEH) report exceedingly high rates of trauma exposure, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Mindfulness-based interventions including Mindfulness-based Stress Reduction (MBSR) may help lower traumatic stress-related symptoms and reduce SUD, but have been underexplored in community-based settings serving WEH with symptoms of PTSD and SUD.

METHOD

We used a mixed-method, community-engaged approach that implemented a Community Advisory Board and the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework, including intervention demonstrations, to adapt and refine MBSR for WEH experiencing symptoms of PTSD/SUD. Trauma-exposed WEH (N = 28) living at a drug treatment site provided perspectives and feedback on an MBSR demonstration via quantitative questionnaires and four focus groups.

RESULTS

Quantitative measures indicated high perceived acceptability and feasibility: Nearly all WEH reported MBSR activities (including yoga, meditation, body scans, class discussion, and home practice) would be at least "somewhat helpful"; between 71.43% to 89.29% reported each activity would be "a great deal helpful." Most reported the focus group sessions were useful for providing feedback relevant for improving program design and administration. Qualitative findings revealed four themes aligning with quantitative findings that provided useful suggestions to guide MBSR implementation with trauma-exposed WEH: (a) perception of feasibility and effectiveness of MBSR, (b) strategies for successful recruitment, (c) strategies for successful retention, and (d) characteristics of the MBSR trainer.

CONCLUSIONS

Focus group recommendations could bolster intervention compliance, engagement, and completion for MBSR and community-based programs for WEH more generally. Results provide suggestions for implementing a trauma-sensitive approach when administering MBSR to trauma-exposed WEH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing Perception of Wildfires and Related Impacts among Adult Residents of Southern California

Major wildfires and their smoke pose a threat to public health and are becoming more frequent in the United States, particularly in California and other populated, fire-prone states. Therefore, it is crucial to understand how California residents view wildfires and engage in risk-reducing behaviors during wildfire events. Currently, there is a knowledge gap concerning this area of inquiry. We disseminated a 40-question cross-sectional survey to explore wildfire perception and knowledge along with related risk-reducing measures and policies among 807 adult residents in the fire-prone region of Orange County, California. Results demonstrated that nearly all (>95%) participants had (or knew someone who had) previously experienced a wildfire. Female gender, knowing a wildfire victim and reporting to have a general interest/passion for environmental issues were the three factors most strongly associated with (1) wildfires (and smoke) being reported as a threat, (2) participants' willingness to evacuate if threatened by a nearby wildfire, and (3) participants' willingness to support a wildfire-related tax increase (p < 0.05). The majority (57.4%) of participants agreed that the occurrence of wildfires is influenced by climate change, with the most commonly reported risk-reducing actions (by 44% of participants) being informational actions (e.g., tracking the news) rather than self-motivated physical safety actions (e.g., using an air purifier) (29%). The results of this study can help to inform decision- and policy-making regarding future wildfire events as well as allow more targeted and effective public health messaging and intervention measures, in turn helping to reduce the risk associated with future wildfire/smoke episodes.

Acute stress, worry, and impairment in health care and non-health care essential workers during the COVID-19 pandemic

OBJECTIVE

Health care and non-health care essential workers working in face-to-face interactions during the coronavirus disease 2019 (COVID-19) pandemic may be vulnerable to psychosocial distress. Limited empirical research on COVID-19-related psychosocial outcomes has utilized probability-based samples including both health care and non-health care essential workers.

METHOD

We surveyed a sample of 1,821 United States self-identified essential workers, collected using probability-based methods, working in face-to-face interactions during the early phase of the COVID-19 outbreak (March 18, 2020 through April 18, 2020), in three consecutive 10-day cohorts. We assessed acute stress, health-related worries, and functional impairment. Demographics, secondary stressors (lack of childcare or health care, lost wages), and pre-COVID-19 mental and physical health were examined as predictors of psychological outcomes.

RESULTS

Acute stress (β = .08, p = .001), health-related worries (β = .09, p = .001), and functional impairment (β = .05, p = .034) increased over time in the early weeks of the outbreak. Health care essential workers reported lower functional impairment (β = -.06, p = .009) and acute stress (β = -.06, p = .015) compared with non-health care essential workers. Across the sample, prior mental and physical health ailments, inability to obtain health care, lost wages, younger age, female gender, and Hispanic ethnicity were associated with acute stress (βs = -.14 to .15, ps ≤ .001), health-related worries (βs = -.09 to .14, ps ≤ .001), and functional impairment (βs = -.08 to .16, ps ≤ .006). Lack of childcare (β = .09, p < .001) was positively associated with acute stress.

CONCLUSION

Non-health care essential workers may be vulnerable to negative psychosocial outcomes. Targeted training and support may help facilitate coping with the effects of working in-person during the ongoing COVID-19 pandemic. Findings may help inform intervention efforts, critical as COVID-19 becomes endemic and society must learn to live with its evolving variants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological responses to U.S. statewide restrictions and COVID-19 exposures: A longitudinal study

OBJECTIVE

The COVID-19 pandemic has generated debate as to whether community-level behavioral restrictions are worth the emotional costs of such restrictions. Using a longitudinal design, we juxtaposed the relative impacts of state-level restrictions and case counts with person-level direct and media-based exposures on distress, loneliness, and traumatic stress symptoms (TSS) during the COVID-19 pandemic in the United States.

METHOD

From March 18, 2020 to April 18, 2020 and September 9, 2020 to October 16, 2020, a representative probability sample of U.S. adults (N = 5,594) completed surveys of their psychological responses and personal direct and media-based exposures to the COVID-19 pandemic. Survey data were merged with publicly available data on the stringency of state-level mitigation policies (e.g., school/business closures) during this period and longitudinal case/death counts for each state.

RESULTS

Three multilevel models (outcomes: distress, loneliness, TSS) were constructed. Measurements of dependent variables (Level 1) were nested within respondents (Level 2) who were nested within states (Level 3). State-level mitigation, cases, or deaths were not associated with any dependent variables (all p's > .05). However, person-level exposures, including having contracted COVID-19 oneself (distress b = .22, p < .001; loneliness b = .13, p = .03; TSS b = .18, p = .001), knowing others who were sick (distress b = .04, p < .001; loneliness b = .02, p < .001; TSS b = .05, p < .001) or died (distress b = .10, p = .001; loneliness b = .10, p = .003; TSS b = .16, p < .001), and exposure to pandemic-related media (distress b = .12, p < .001; loneliness b = .09, p < .001; TSS b = .16, p < .001), were positively associated with outcomes.

CONCLUSIONS

Personal exposures to COVID-19 are more strongly associated with psychological outcomes than statewide mitigations levied to stop disease spread. Results may inform public health response planning for future disease outbreaks. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Media exposure, threat processing, and mitigation behaviors in Gulf Coast residents facing the co-occurring threats of COVID-19 and hurricanes

The 2020 hurricane season threatened millions of Americans concurrently grappling with COVID-19. Processes guiding individual-level mitigation for these conceptually distinct threats, one novel and chronic (COVID-19), the other familiar and episodic (hurricanes), are unknown. Theories of health protective behaviors suggest that inputs from external stimuli (e.g., traditional and social media) lead to threat processing, including perceived efficacy (self- and response) and perceived threat (susceptibility and severity), guiding mitigation behavior. We surveyed a representative sample of Florida and Texas residents (N = 1846) between April 14, 2020 and April 27, 2020; many had previous hurricane exposure; all were previously assessed between September 8, 2017 and September 11, 2017. Using preregistered analyses, two generalized structural equation models tested direct and indirect effects of media exposure (traditional media, social media) on self-reported (1) COVID-19 mitigation (handwashing, mask-wearing, social distancing) and (2) hurricane mitigation (preparation behaviors), as mediated through perceived efficacy (self- and response) and perceived threat (susceptibility and severity). Self-efficacy and response efficacy were associated with social distancing (p = .002), handwashing, mask-wearing, and hurricane preparation (ps < 0.001). Perceived susceptibility was positively associated with social distancing (p = 0.017) and hurricane preparation (p < 0.001). Perceived severity was positively associated with social distancing (p < 0.001). Traditional media exhibited indirect effects on COVID-19 mitigation through increased response efficacy (ps < 0.05), and to a lesser extent self-efficacy (p < 0.05), and on hurricane preparation through increased self-efficacy and response efficacy and perceived susceptibility (ps < 0.05). Social media did not exhibit indirect effects on COVID-19 or hurricane mitigation. Communications targeting efficacy and susceptibility may encourage mitigation behavior; research should explore how social media campaigns can more effectively target threat processing, guiding protective actions.

Priming close social contact protective behaviors enhances protective social norms perceptions, protection views, and self-protective behaviors during disasters

Many people do not make choices that minimize risk in the face of health and environmental threats. Using pre-registered analyses, we tested whether a risk communication that primed perceptions about health-protective preparation and behavior of close social contacts promoted protection views and protective behaviors. From December 10-24, 2020, we fielded a 2 (threat vignette: wildfire or COVID-19) x 3 (social contact prime: control, inaction, or action) experiment to a representative sample of 1,108 California residents facing increased COVID-19 cases/deaths, who had recently experienced the most destructive wildfire season in California history. Outcome variables were protection views and protective behavior (i.e., information seeking). Across threat conditions, stronger social norms, efficacy, and worry predicted greater protection views and some protective behaviors. Priming social-contact action resulted in greater COVID-19 information-seeking compared to the control. In the wildfire smoke condition, priming social contact action and inaction increased perceived protective behavior social norms compared to the control; social norms partially mediated the relationships of priming with protection views and protective behaviors; and having existing mask supplies enhanced the relationship between priming inaction and greater protection views compared to priming action or the control. Findings highlight the importance of social influence for health protection views and protective behaviors. Communications enhancing social norms that are sensitive to resource contexts may help promote protective behaviors.

A multi-method exploration of mindfulness as a coping tool: Perspectives from trauma-exposed, unhoused women residing at a drug treatment facility

This multi-method study examined perspectives on mindfulness and coping strategies used by trauma-exposed women experiencing homelessness (WEH), residing in a state-funded residential drug treatment site in Southern California (United States). Questionnaires and in-depth focus group interviews were utilised to examine traumatic experiences over the lifespan, probable-posttraumatic stress disorder (PTSD), and coping strategies. Mindfulness was explored as a potential way to improve coping; potential benefits and challenges associated with implementing a mindfulness-based intervention (MBI) with trauma-exposed WEH were also investigated. A Community Advisory Board (CAB) was formed to identify key issues experienced by WEH and to develop a semi structured interview guide (SSIG). Using the SSIG, women participated in one of four focus groups (total N = 28; n = 7 per group). Quantitative data on demographic indicators, probable-PTSD, and trauma exposure were collected. Almost 90% of women met criteria for probable-PTSD; trauma exposure was exceedingly high; most women had experienced multiple traumas throughout their lives. Four main themes emerged from qualitative analyses, which drew from Grounded Theory and used open, selective, and axial coding: (1) ways of coping with trauma; (2) perspectives on mindfulness; (3) prior experiences with mindfulness; and (4) challenges for conducting a mindfulness programme. Overall, WEH used a variety of coping techniques to deal with their trauma, had some familiarity with mindfulness, and were optimistic an MBI would be helpful, despite identifying several challenges to implementation. MBIs may be helpful adjuncts to traditional care for trauma-exposed, WEH, recovering from substance use disorder. Population-specific considerations may improve implementation and participation.

Distortions in time perception during collective trauma: Insights from a national longitudinal study during the COVID-19 pandemic

OBJECTIVE

During the protracted collective trauma of the COVID-19 pandemic, lay of distorted perceptions of time (e.g., time slowing, days blurring together, uncertainty about the future) have been widespread. Known as "temporal disintegration" in psychiatric literature, these distortions are associated with negative mental health consequences. However, the prevalence and predictors of temporal disintegration are poorly understood. We examined perceptions of time passing and their associations with lifetime stress and trauma and pandemic-related secondary stress as COVID-19 spread across the United States.

METHOD

A probability-based national sample (N = 5,661) from the NORC AmeriSpeak online panel, which had completed a mental and physical health survey prior to the pandemic, completed two surveys online during March 18-April 18, 2020, and September 26-October 16, 2020. Distorted time perceptions and other pandemic-related experiences were assessed.

RESULTS

Present focus, blurring weekdays and weekdays together, and uncertainty about the future were common experiences reported by over 65% of the sample 6 months into the pandemic. Half of the sample reported time speeding up or slowing down. Predictors of temporal disintegration include prepandemic mental health diagnoses, daily pandemic-related media exposure and secondary stress (e.g., school closures, lockdown), financial stress, and lifetime stress and trauma exposure.

CONCLUSION

During the first 6 months of the COVID-19 pandemic, distortions in time perception were very common and associated with prepandemic mental health, lifetime stress and trauma exposure, and pandemic-related media exposure and stressors. Given that temporal disintegration is a risk factor for mental health challenges, these findings have potential implications for public mental health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life, a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Media exposure, risk perceptions, and fear: Americans' behavioral responses to the Ebola public health crisis

We examined media exposure, psychological fear and worry, perceptions of risk, and health protective behaviors surrounding the 2014 Ebola virus outbreak in a probability-based, representative, national sample of Americans (N = 3447). Structural equation models examined relationships between amount (hours/day) and content (e.g., graphic images of dead bodies) of media exposure and counts of self-reported health protective behaviors that participants performed or would perform if Ebola spread to their community. Ebola-related risk perceptions and fear and worry were potential mediators. Greater total hours and more graphic media exposure positively correlated with more fear and worry; greater total hours of media exposure also positively correlated with higher perceived risk. Higher risk perceptions were associated with more health protective behaviors performed and intended. Greater fear and worry were associated with more behaviors performed. Amount and content of media exposure exhibited indirect effects on behaviors performed; amount of media exposure had indirect effects on intentions. Media may help promote health protective behaviors during public health threats; the amount and content should be congruent with threat to minimize distress and maximize resources.

Association Between Repeated Exposure to Hurricanes and Mental Health in a Representative Sample of Florida Residents

IMPORTANCE

During the past century, more than 100 catastrophic hurricanes have impacted the Florida coast; climate change will likely be associated with increases in the intensity of future storms. Despite these annual threats to residents, to our knowledge, no longitudinal studies of representative samples at risk of hurricane exposure have examined psychological outcomes associated with repeated exposure.

OBJECTIVE

To assess psychosocial and mental health outcomes and functional impairment associated with repeated hurricane exposure.

DESIGN, SETTING, AND PARTICIPANTS

In this survey study, a demographically representative sample of Florida residents was assessed in the 60 hours prior to Hurricane Irma (wave 1: September 8-11, 2017). A second survey was administered 1 month after Hurricane Irma (wave 2: October 12-29, 2017), and a third survey was administered after Hurricane Michael (wave 3: October 22 to November 6, 2018). Data were analyzed from July 19 to 23, 2021.

EXPOSURE

Hurricanes Irma and Michael.

MAIN OUTCOMES AND MEASURES

The main outcomes were posttraumatic stress symptoms (PTSS), global distress, worry about future events (generalized worries), and functional impairment. Path models were used to assess associations of individual-level factors (prior mental health, recent adversity), prior storm exposures (loss and/or injury, evacuation), and direct, indirect, and media-based exposures to hurricanes Irma and Michael with those outcomes. Poststratification weights were applied to facilitate population-based inferences.

RESULTS

Of 2873 individuals administered the survey in wave 1, 1637 responded (57.0% completion rate) (894 [54.6%, weighted] women; mean [SD] age, 51.31 [17.50] years); 1478 in wave 2 (90.3% retention from wave 1) and 1113 in wave 3 (75.3% retention from wave 2) responded. Prior mental health ailments (b, 0.18; 95% CI, 0.07-0.28), prior hurricane-related loss and/or injury (b, 0.09; 95% CI, 0.02-0.17), hours of Hurricane Irma-related media exposure (b, 0.03; 95% CI, 0.02-0.04), being in an evacuation zone during Hurricane Irma and not evacuating (b, 0.14; 95% CI, 0.02-0.27), and loss and/or injury in Hurricane Irma (b, 0.35; 95% CI, 0.25-0.44) were positively associated with PTSS after Hurricane Irma; most associations persisted and were associated with responses to Hurricane Michael. Prior mental health ailments (b, 0.10; 95% CI, 0.03-0.17), hours of Hurricane Michael-related media exposure (b, 0.01; 95% CI, 0.003-0.02), hurricane Irma-related PTSS (b, 0.42; 95% CI, 0.34-0.50), recent individual-level adversity (b, 0.03; 95% CI, 0.005-0.05), being in an evacuation zone during Hurricane Irma and evacuating (b, 0.10; 95% CI, 0.002-0.19), and direct (b, 0.36; 95% CI, 0.16-0.55) and indirect (b, 0.12; 95% CI, 0.05-0.18) Hurricane Michael-related exposures were directly associated with Hurricane Michael-related PTSS. After Hurricane Michael, prior mental health ailments (b, 0.17; 95% CI, 0.06-0.28), and PTSS related to hurricanes Irma (b, 0.11; 95% CI, 0.001-0.22) and Michael (b, 0.58; 95% CI, 0.47-0.69) were associated with respondents' functional impairment. Analogous analyses using global distress and generalized worries as mediators of functional impairment yielded a similar pattern of results.

CONCLUSIONS AND RELEVANCE

In this survey study, repeated direct, indirect, and media-based exposures to hurricanes were associated with increased mental health symptoms among Florida residents who experienced hurricanes Irma and Michael, suggesting that people were sensitized to respond with more psychological symptoms over time. These results may inform targeted public health intervention efforts for natural disasters.

Hurricane adaptation behaviors in Texas and Florida: exploring the roles of negative personal experience and subjective attribution to climate change

Understanding motivation to adopt personal household adaptation behaviors in the face of climate change-related hazards is essential for developing and implementing behaviorally realistic interventions that promote well-being and health. Escalating extreme weather events increase the number of those directly exposed and adversely impacted by climate change. But do people attribute these negative events to climate change? Such subjective attribution may be one cognitive process whereby the experience of negative climate change-related events may increase risk perceptions and motivate people to act. Here we surveyed a representative sample of 1,846 residents of Florida and Texas, many who had been repeatedly exposed to hurricanes on the Gulf Coast, facing the 2020 Atlantic hurricane season. We assessed prior hurricane negative personal experience, climate change-related subjective attribution (for hurricanes), risk appraisal (perceived probability and severity of a hurricane threat), hurricane adaptation appraisal (perceived efficacy of adaptation measures and self-efficacy to address the threat of hurricanes), and self-reported hurricane personal household adaptation. Our findings suggest that prior hurricane negative personal experiences and subjective attribution are associated with greater hurricane risk appraisal. Hurricane subjective attribution moderated the relationship between hurricane negative personal experiences and risk appraisal; in turn, negative hurricane personal experience, hurricane risk appraisal, and adaptation appraisal were positively associated with self-reported hurricane personal adaptation behaviors. Subjective attribution may be associated with elevated perceived risk for specific climate hazards. Communications that help people understand the link between their negative personal experiences (e.g., hurricanes) and climate change may help guide risk perceptions and motivate protective actions, particularly in areas with repeated exposure to threats.

Risk perceptions and health behaviors as COVID-19 emerged in the United States: Results from a probability-based nationally representative sample

Understanding psychosocial correlates of engaging in health-protective behaviors during an infectious disease outbreak can inform targeted intervention strategies. We surveyed a national probability-based sample of 6,514 Americans, with three separate, consecutive representative cohorts between March 18, 2020 and April 18, 2020, as the U.S. COVID-19 epidemic began. Americans adopted many health-protective behaviors (e.g., hand hygiene, social distancing) early, performing them, on average, "most of the time," with frequency increasing over time. In covariate-adjusted models, self-reported female gender (β = .16, p < .001), older age (β = .13, p < .001), more COVID-related secondary stressors (β = .17, p < .001), and greater perceptions of the risks of catching (β = .07, p = .001) and dying (β = .09, p < .001) from Coronavirus were associated with greater frequency of social-distancing behaviors. Wearing face masks and/or gloves was positively associated with female gender (β = .07, p < .001), older age (β = .14, p < .001), Black (β = .14, p < .001) and Hispanic (β = .07, p = .002) ethnicity, personal-COVID-19 exposure (β = .06, p < .001), reporting secondary stressors (β = .11, p < .001), and higher perceived risk of dying from Coronavirus (β = .13, p < .001). Participants in Cohorts 2 and 3 (compared to Cohort 1) wore face masks and gloves and engaged in social distancing more frequently. Overall, early in the U.S. COVID-19 outbreak, despite the novelty and uncertainty, Americans were responsive to guidelines, adopting them early and following them frequently. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Differences in childhood adversity, suicidal ideation, and suicide attempt among veterans and nonveterans

Adverse childhood experiences (ACEs) are robustly associated with physical and mental health problems over the life span. Relatively limited research has examined the breadth of ACEs among military veteran populations, for whom ACEs may be premilitary traumas associated with suicidal ideation and attempt. Using data from the Comparative Health Assessment Interview Research Study, a large national survey sponsored by the U.S. Department of Veterans Affairs, this investigation examined the prevalence of 22 self-reported potentially traumatic experiences before the age of 18 (i.e., ACEs) among veterans and nonveterans and estimated the association of ACEs with suicidal ideation and attempt at age 18 or older. All analyses were weighted to account for complex sampling design and stratified by gender. The study sample included 9,571 veteran men, 3,143 nonveteran men, 5,543 veteran women, and 1,364 nonveteran women. Veteran men reported greater average frequency of ACEs than nonveteran men (2.7 ACEs vs. 2.3 ACEs, respectively, p < .001); 11.1% of veteran men indicated >6 ACEs compared with 7.3% of nonveteran men (p < .001). Veteran women reported greater average frequency of ACEs than nonveteran women (3.1 ACEs vs. 2.4 ACEs, respectively, p < .001). Among women, more veterans than nonveterans reported >6 ACEs (14.9% vs. 8.6%, respectively, p < .001). The strongest correlate of suicide attempt at age 18 or older for veteran men was having >6 ACEs (adjusted odds ratio, aOR = 4.20, 95%CI = 2.72-6.49); for veteran women, the strongest correlate was suicidal ideation or attempt before age 18 (aOR = 5.37, 95%CI = 4.11-7.03). Suicide prevention research, policy, and practice should address ACEs among veterans as salient premilitary risk factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Media Exposure and Post-traumatic Stress Symptoms in the Wake of the November 2015 Paris Terrorist Attacks: A Population-Based Study in France

The intense mass media coverage of the Paris terrorist attacks on November 13, 2015 exposed a majority of the French population to the attacks. Prior research has documented the association between media exposure to terrorism and post-traumatic stress symptoms (PTSS). The present study replicated and extended these findings in a French sample. A population-based sample (N = 1,760) was drawn from a national web-enabled panel in June 2016. Hours of attack-related media exposure (i.e., TV-watching, viewing internet images, engaging in social media exchanges) in the 3 days following the attacks were assessed. Multivariate regression models, adjusting for gender, age, direct exposure (i.e., witnessing in person or knowing someone injured or killed), residential area, social support, pre-attack mental health service utilization, and other adverse life events, examined the association between media exposure and PTSS (assessed using the self-report PCL-5). Compared to those reporting less than 2 hours of daily attack-related television exposure, those reporting 2-4 hours (β = 3.1, 95% CI = 0.8-5.3) or >4 hours (β = 4.7, 95% CI = 2.0-7.4) of media exposure reported higher attack-related PTSS. This finding was replicated with social media use: those with moderate (β = 3.2, 95% CI = 0.9-5.5) or high (β = 6.8, 95% CI = 1.9-11.7) use reported higher PTSS than those reporting no use. Subanalyses demonstrated that media exposure and PTSS were not associated in those directly exposed to the attacks. Results highlight the potential public health risk of extensive mass media exposure to traumatic events.

National Opinions on Death Penalty Punishment for the Boston Marathon Bomber Before vs. After Sentencing

Humans seek consistency between their internal thoughts and the outside world. Thus, when legal authorities make decisions, people are likely to accept and obey these decisions in order to remain consistent with the societies in which they live. Few studies have explored these biases in an applied context. We examined the relationship between the sentencing of Dzhokhar Tsarnaev (the Boston Marathon bomber) and Americans' opinions about his punishment in a natural quasi-experiment. We expected that Tsarnaev's sentencing would be associated with increased support for his death penalty sentence, in a manner consistent with the legitimization literature. A survey of a representative U.S. national sample (N=3,341; 78.13% total response rate) was conducted between April 29 and June 26, 2015. We assessed views about Tsarnaev's sentencing (i.e., whether he should receive the death penalty), political party, demographics, and psychological indicators; 81.77% of our sample completed the survey prior to Tsarnaev's sentencing and 18.23% completed the survey afterwards. Multiple logistic regression analyses indicated that those who completed the survey after Tsarnaev was sentenced to death were more likely to support a death penalty sentence than were those who took the survey prior to the sentencing (OR=1.48, p=.007; 95% confidence [1.11, 1.96]). These results remained significant after adjusting for significant covariates, including male gender, White race, Protestant-Christian religious affiliation, Boston residency, beliefs in a just world, and Republican political party identification. Results of this quasi-experiment suggest that people adjust their opinions to be consistent with the fait accompli, particularly once the outcome is widely known.

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States

The COVID-19 (coronavirus disease 2019) pandemic is a collective stressor unfolding over time; yet, rigorous empirical studies addressing its mental health consequences among large probability-based national samples are rare. Between 18 March and 18 April 2020, as illness and death escalated in the United States, we assessed acute stress, depressive symptoms, and direct, community, and media-based exposures to COVID-19 in three consecutive representative samples from the U.S. probability-based nationally representative NORC AmeriSpeak panel across three 10-day periods (total N = 6514). Acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the United States. Preexisting mental and physical health diagnoses, daily COVID-19-related media exposure, conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. Results have implications for targeting public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time.

Correlates of depression and anxiety among homeless adults with latent tuberculosis infection

Homeless persons have disproportionate rates of latent tuberculosis infection (LTBI). LTBI treatment can prevent and reduce active tuberculosis spread. We examined associations between mental health, social support, and perceptions of general health in 50 LTBI-positive, homeless adults enrolled in LTBI treatment. Depression and anxiety prevalence were 40% and 48%, respectively. Depression was negatively associated with general health, positive social interaction, and tangible, emotional/informational, and total social support, and positively associated with severe substance use (ps < 0.05). Anxiety was negatively associated with emotional/informational, tangible and total social support, and positively associated with severe substance use (ps < 0.05). Mental health services may help improve LTBI interventions.

Home is not always a haven: The domestic violence crisis amid the COVID-19 pandemic

The novel coronavirus (SARS-CoV-2) and the associated disease it causes, COVID-19, have caused unprecedented social disruption. Due to sweeping stay-at-home orders across the United States and internationally, many victims and survivors of domestic violence (DV), now forced to be isolated with their abusers, run the risk of new or escalating violence. Numerous advocates, organizations, and service centers anticipated this: Upticks in domestic violence were reported in many regions soon after stay-at-home directives were announced. In this commentary, we delineate some of the recent events leading up to the reported spike in DV; review literature on previously documented disaster-related DV surges; and discuss some of the unique challenges, dilemmas, and risks victims and survivors face during this pandemic. We conclude with recommendations to allocate resources to DV front-liners and utilize existing DV guidelines for disaster preparedness, response, and recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure

The 2019 novel coronavirus (COVID-2019) has led to a serious outbreak of often severe respiratory disease, which originated in China and has quickly become a global pandemic, with far-reaching consequences that are unprecedented in the modern era. As public health officials seek to contain the virus and mitigate the deleterious effects on worldwide population health, a related threat has emerged: global media exposure to the crisis. We review research suggesting that repeated media exposure to community crisis can lead to increased anxiety, heightened stress responses that can lead to downstream effects on health, and misplaced health-protective and help-seeking behaviors that can overburden health care facilities and tax available resources. We draw from work on previous public health crises (i.e., Ebola and H1N1 outbreaks) and other collective trauma (e.g., terrorist attacks) where media coverage of events had unintended consequences for those at relatively low risk for direct exposure, leading to potentially severe public health repercussions. We conclude with recommendations for individuals, researchers, and public health officials with respect to receiving and providing effective communications during a public health crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations between exposure to childhood bullying and abuse and adulthood outcomes in a representative national U.S. sample

BACKGROUND

Negative childhood experiences are associated with poor health and psychosocial outcomes throughout one's lifespan.

OBJECTIVE

We examined associations between childhood bullying and maltreatment and several adulthood outcomes: psychological distress, functional impairment, generalized fear, and physician-diagnosed mental and physical health ailments. The potential mediating role of recent negative life events was also explored.

PARTICIPANTS AND SETTING

Data were collected through web-based surveys of a U.S. representative national sample of adults.

METHODS

At Wave 1 (N = 3,598), participants reported exposure to negative childhood experiences; at Wave 2 (N = 3,497), physician-diagnosed mental and physical health ailments were provided; at Wave 3 (N = 2,906), participants reported exposure to recent negative life events and psychosocial outcomes.

RESULTS

Of the sample, 26.29% (weighted n = 946) reported childhood bullying, 15.02% (weighted n = 540) reported physical abuse, 15.56% (weighted n = 560) reported witnessing parental violence, 11.42% (weighted n = 411) reported sexual abuse, and 8.64% (weighted n = 311) reported parental neglect. Respondents who reported bullying, physical abuse, or sexual abuse during childhood reported greater distress, functional impairment, and fear of the future in adulthood, as mediated through recent negative life events, compared to those who did not (ßs: 0.04-.06). Those reporting bullying, neglect, physical abuse, or sexual abuse in childhood reported more mental health ailments in adulthood (IRRs: 1.44-1.66) compared to those who did not. Those reporting bullying or sexual abuse in childhood reported more physical health ailments (IRRs: 1.25-1.39).

CONCLUSIONS

Specific negative childhood experiences have unique links with poor outcomes in adulthood. Recent negative life events partially mediate these associations.

Exposure to prior negative life events and responses to the Boston marathon bombings

OBJECTIVE

The objective of the study was to explore how type and timing of prior negative life experiences (NLEs) may be linked to responses to subsequent collective trauma, such as a terrorist attack.

METHOD

Using a longitudinal design, we examined relationships between prior NLEs and responses to the 2013 Boston Marathon bombings (BMB). Shortly after the BMB, a representative sample, compiled from metropolitan Boston (n = 846), New York (n = 941), and the rest of the United States (n = 2,888), reported BMB exposure and acute stress symptomatology. Six months later, we assessed prior NLEs, BMB-related posttraumatic stress symptoms, ongoing fear about future terrorism, and functioning. NLEs were classified by Diagnostic and Statistical Manual of Mental Disorders, fifth edition, criteria for traumatic events and other stressful experiences and by occurrence in childhood, adulthood (pre-BMB), and recent (past 6 months).

RESULTS

Cumulative exposure to events, delineated by type and timing of occurrence, were contrasted; analyses adjusted for demographics, BMB-related exposure, and residential region. Post-BMB acute stress was associated with childhood (b = 0.88, 95% confidence interval [CI: 0.14, 1.61]) and adulthood (b = 0.83, 95% CI [0.21, 1.45]) trauma exposure. Exposure to childhood, adulthood, and recent traumatic events, as well as recent stressful events, was associated with higher BMB-related posttraumatic stress (ps < .05). Greater exposure to adulthood (b = 0.06, 95% CI [0.01, 0.11]) and recent (b = 0.30, 95% CI [0.01, 0.58]) trauma was associated with higher fear about future terrorism. Exposure to childhood (b = 0.17, 95% CI [0.07, 0.27]) and adulthood (b = 0.15, 95% CI [0.05, 0.25]) trauma and recent stressful events (b = 0.45, 95% CI [0.24, 0.66]) was associated with poorer functioning.

CONCLUSION

Prior trauma may sensitize negative responses to collective trauma; recent stressors may exacerbate effects. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Predictors of treatment initiation, completion, and selection among youth offered trauma-informed care

OBJECTIVE

Few studies have investigated determinants of trauma-informed care (TIC) in vulnerable youth populations. The purpose of the present study was to investigate factors associated with initiation, completion, and selection of type of TIC treatment among a sample of 128 treatment-seeking youth who experienced crime or violence.

METHOD

This retrospective medical record review study used data collected through routine clinical care at an outpatient, no-cost community mental health clinic.

RESULTS

We found that 69.5% of treatment-seeking youth (n = 89) initiated treatment, defined as attending at least 1 TIC session. Among youth who initiated treatment, 61.8% (n = 55) completed a TIC treatment. Predisposing and need characteristics were not significantly associated with initiating or completing treatment in adjusted models. Youth assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) were more likely to complete treatment compared with those assigned to child-centered therapy (CCT) approaches (odds ratio [OR] = 4.48, 95% CI [1.35, 14.91], p = .014). Logistic regression analyses suggested therapists were less likely to select TF-CBT for children with higher externalizing symptoms (OR = 0.92, 95% CI [0.85, 0.99], p = .035).

CONCLUSIONS

Findings suggest among youth who called in for treatment, many successfully initiated treatment, and of those who initiated, most completed treatment. Empirically supported treatments such as TF-CBT may further promote treatment completion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depression, social support, and stigma as predictors of quality of life over time: results from an Asha-based HIV/AIDS intervention in India

Quality of life (QOL) is associated with better outcomes in HIV/AIDS populations. We explored predictors of improved QOL over time in 600 Women Living with HIV/AIDS (WLH/A) in India [mean age = 34.31, SD = 6.97], enrolled in a nurse-led-Asha (Accredited Social Health Activist) intervention. Trained local interviewers ascertained self-report data at baseline and six-month follow-up (post-intervention). Latent Class Analysis (LCA) identified constellations of responses on psychosocial indicators (depression, social support, internalized stigma and stigma fears); their relationship with QOL over time was examined. We identified three classes: Class 1) Highest Social Resources/Lowest Depression; Class 2) Some Social Resources/Highest Depression; and Class 3) Lowest Social Resources/Higher Depression. At baseline, Class 3 reported the lowest QOL (M = 0.25, SD = 0.26); Class 1 reported the highest (M = 0.37, SD = 0.33). Class 2's QOL did not differ from Class 3's QOL, likely due to the potent effects of high depression. At six-month follow-up, all groups reported improved QOL; class membership no longer predicted variability (contrast between Class 2 and 1 = -0.05, 95% CI = -0.14, 0.04; contrast between Class 3 and 1 = 0.01, 95% CI = -0.03, 0.05; contrast between Class 3 and 2 = 0.07, 95% CI = -0.02, 0.16). Psychosocial indicators are important predictors of QOL; an Asha-supported approach may have broad applicability to improve QOL in WLH/A in India.

Randomized controlled trial of a community-based intervention on HIV and nutritional outcomes at 6 months among women living with HIV/AIDS in rural India

OBJECTIVE

To assess the impact of nurse-led Asha (Accredited Social Health Activist)-support behavioral and nutritional intervention among women living with HIV/AIDS (WLH/A) in rural India.

DESIGN

Cluster randomized controlled trial.

METHODS

Sixteen Primary Health Centers serving WLH/A in Andhra Pradesh were grouped into four regional clusters that were randomly allocated into one of four arms. All four groups included Asha-support and consisted of: Asha-support only (control group); nutrition education; nutrition supplementation; and the combination of supplementation and education. Differences between baseline and 6-month follow-up for key physiological outcomes (BMI, CD4 cell count) were analyzed using factorial mixed models that accounted for geographic clustering.

RESULTS

At 6 months, all groups improved CD4 cell count: Asha only [mean difference score (D) = 343.97, standard deviation (SD) = 106.94], nutrition education (D = 356.15, SD = 0.69), nutrition supplement (D = 469.66, SD = 116.0), and nutrition supplement and education (D = 530.82, SD = 128.56). In multivariable models, Asha-support and nutrition, and Asha-support and nutrition supplement interventions demonstrated independent significant improvements in CD4 cell count; the interaction term was significant [estimate = 529.9; 95% confidence interval (CI) 512.0, 547.8; P = 0.006]. BMI also increased for all groups: Asha only (D = 0.95, SD = 0.82), Asha and nutrition education (D = 1.28, SD = 0.53), Asha and nutrition supplement (D = 2.38, SD = 0.60), nutrition supplement, and nutrition supplement and education (D = 2.72, SD = 0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (estimate = 0.27; 95% CI = 2.5, 2.7; P = 0.80).

CONCLUSION

Interventions supported by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.

Acute stress and subsequent health outcomes: A systematic review

OBJECTIVE

To systematically review the relationship between acute posttraumatic stress symptoms (<1 month) and subsequent physical and mental health outcomes other than posttraumatic stress disorder (PTSD).

METHODS

A systematic search of electronic databases (PubMed, PsycINFO, CINAHL, and Web of Science) was conducted to identify longitudinal studies examining the link between acute posttraumatic stress and physical and mental health. Inclusion criteria required assessment of acute posttraumatic stress (<1 month post-event) and at least one follow-up assessment of a physical or mental health outcome (not PTSD).

RESULTS

1,051 articles were screened; 22 met inclusion criteria. Fourteen studies examined physical health outcomes and 12 examined non-PTSD mental health outcomes. Early psychological responses to trauma were associated with a variety of short- (<1 year) and long- (≥1 year) term physical and mental health outcomes. Physical health outcomes included poor general physical health, increased pain and disability, lower quality of life, and higher risk of all-cause mortality. Significant psychological outcomes included more cumulative psychiatric disorders, depression, and anxiety. Significant psychosocial outcomes included increased family conflict.

CONCLUSIONS

Methodologically rigorous longitudinal studies support the utility of measuring acute psychological responses to traumatic events as they may be an important marker of preventable trauma-related morbidity and mortality that warrants long-term monitoring and/or early intervention.

Aftermath of Terror: A Nationwide Longitudinal Study of Posttraumatic Stress and Worry Across the Decade Following the September 11, 2001 Terrorist Attacks

Research conducted in the early years after the September 11, 2001 (9/11) terrorist attacks in New York, Pennsylvania, and Washington, DC demonstrated adverse psychological outcomes among residents of the United States who were exposed to the attacks both directly and indirectly via the media. However, less is known about the impact of this collective trauma over time. Beginning at the end of December 2006, a longitudinal study of a nationally representative sample of U.S. residents (Cohort 2, N = 1,613) examined the long-term effects of 9/11, with annual assessments administered every year for 3 years. We assessed rates of 9/11-related posttraumatic stress (PTS) annually during the first 2 years of the study; during the second and third years of the study, we assessed fear and worry regarding future terrorism. Rates of PTS among participants were compared with those assessed annually in a nationally representative sample between 2002 and 2004 (Cohort 1); results indicated a relatively stable pattern of 9/11-related PTS symptoms for 6 years following the attacks. Five to six years after 9/11, we found an association between 9/11-related PTS and both direct, B = 8.45, 95% CI [4.32, 12.59] and media-based (live television), B = 1.78, 95% CI [0.90, 2.65] exposure to the attacks. Six to 7 years post-9/11, fear and worry regarding future terrorism were predicted by 9/11-related PTS symptoms that had been reported approximately 5 years after the attacks, B = 0.04, 95% CI [0.03, 0.05]. The psychological legacy of 9/11 was perceptible among many U.S. residents throughout the decade that followed.

Public Understanding of Ebola Risks: Mastering an Unfamiliar Threat

Ebola was the most widely followed news story in the United States in October 2014. Here, we ask what members of the U.S. public learned about the disease, given the often chaotic media environment. Early in 2015, we surveyed a representative sample of 3,447 U.S. residents about their Ebola-related beliefs, attitudes, and behaviors. Where possible, we elicited judgments in terms sufficiently precise to allow comparing them to scientific estimates (e.g., the death toll to date and the probability of dying once ill). Respondents' judgments were generally consistent with one another, with scientific knowledge, and with their self-reported behavioral responses and policy preferences. Thus, by the time the threat appeared to have subsided in the United States, members of the public, as a whole, had seemingly mastered its basic contours. Moreover, they could express their beliefs in quantitative terms. Judgments of personal risk were weakly and inconsistently related to reported gender, age, education, income, or political ideology. Better educated and wealthier respondents saw population risks as lower; females saw them as higher. More politically conservative respondents saw Ebola as more transmissible and expressed less support for public health policies. In general, respondents supported providing "honest, accurate information, even if that information worried people." These results suggest the value of proactive communications designed to inform the lay public's decisions, thoughts, and emotions, and informed by concurrent surveys of their responses and needs.

Factors associated with gerontological career choice: The role of curriculum type and students’ attitudes

Background and objective: Caring for a growing aging population presents a challenge in contemporary health care. This study aims to identify factors associated with nursing student’s career choice in older adult care and predictors of attitudes toward older adults. Such information is critical to inform effective gerontological nursing education.Methods: Undergraduate nursing students (N = 411) from three nursing schools in California participated in a cross-sectional, web-based survey.Results: In covariate-adjusted analyses, students who had prior experiences taking gerontology-related courses, working with older adults, living with older adults, being confident in providing older adults care, and having lower negative attitudes toward older adults were more likely to consider a future career in gerontological nursing. Students’ confidence in older adult care was negatively correlated with negative attitudes towards older adults.Conclusions: To increase students’ career choice in gerontology, nursing schools should provide more gerontology content in nursing curricula and explore avenues to increase student confidence in older adult care. 

Evacuation from Natural Disasters: A Systematic Review of the Literature

Research on evacuation from natural disasters has been published across the peer-reviewed literature among several disparate disciplinary outlets and has suggested a wide variety of predictors of evacuation behavior. We conducted a systematic review to summarize and evaluate the current literature on demographic, storm-related, and psychosocial correlates of natural disaster evacuation behavior. Eighty-three eligible papers utilizing 83 independent samples were identified. Risk perception was a consistent positive predictor of evacuation, as were several demographic indicators, prior evacuation behavior, and having an evacuation plan. The influence of prior experiences, self-efficacy, personality, and links between expected and actual behavior were examined less frequently. Prospective, longitudinal designs are relatively uncommon. Although difficult to conduct in postdisaster settings, more prospective, methodologically rigorous studies would bolster inferences. Results synthesize the current body of literature on evacuation behavior and can help inform the design of more effective predisaster evacuation warnings and procedures.

Media Use and Exposure to Graphic Content in the Week Following the Boston Marathon Bombings

Traditional and new media inform and expose the public to potentially distressing graphic content following disasters, but predictors of media use have received limited attention. We examine media-use patterns after the Boston Marathon bombings (BMB) in a representative national U.S. sample (n = 2888), with representative oversamples from metropolitan Boston (n = 845) and New York City (n = 941). Respondents completed an Internet-based survey 2-4 weeks post-BMB. Use of traditional media was correlated with older age, prior indirect media-based exposure to collective traumas, and direct BMB exposure. New media use was correlated with younger age and prior direct exposure to collective traumas. Increased television and online news viewing were associated with exposure to more graphic content. The relationship between traditional and new media was stronger for young adults than all other age groups. We offer insights about the relationship between prior collective trauma exposures and media use following subsequent disasters and identify media sources likely to expose people to graphic content.

Cumulative exposure to prior collective trauma and acute stress responses to the Boston marathon bombings

The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metropolitan Boston (n = 846) and New York City (n = 941) completed Internet-based surveys shortly after the Boston Marathon bombings. Cumulative direct exposure and indirect exposure to prior community trauma and acute stress symptoms were assessed. Acute stress levels did not differ between Boston and New York metropolitan residents. Cumulative direct and indirect, live-media-based exposure to 9/11, Superstorm Sandy, and the Sandy Hook shooting were positively associated with acute stress responses in the covariate-adjusted model. People who experience multiple community-based traumas may be sensitized to the negative impact of subsequent events, especially in communities previously exposed to similar disasters.

A national study of health care service utilization and substance use after the 2010 Chilean earthquake

OBJECTIVE

A national epidemiological survey in Chile assessed adaptive (health care utilization) and maladaptive (substance use) postearthquake behaviors.

METHODS

Three months after the 8.8-magnitude 2010 Bio-Bio earthquake, face-to-face interviews were conducted with a representative sample of 2,108 adults. Logistic regression analyses examined predictors of health care service utilization and substance use.

RESULTS

Few participants utilized available government- and community-based psychosocial resources (16.6%). A minority reported increased substance use (13.2%). Lower self-efficacy was correlated with increased health care utilization (odds ratio [OR]=.92, 95% confidence interval [CI]=.88-.96) and use of tranquilizers, illicit and psychotropic drugs, and alcohol (OR=.95, CI=.91-.99); this pattern was not limited to residents of areas with the heaviest impacts.

CONCLUSIONS

Self-efficacy beliefs elucidate variability in survivors' behaviors postdisaster and may provide an avenue to encourage salubrious responses. Postdisaster interventions should broadly target the population; those less heavily affected may need, and be as likely to use, available resources.

Internally displaced "victims of armed conflict" in Colombia: the trajectory and trauma signature of forced migration

While conflict-induced forced migration is a global phenomenon, the situation in Colombia, South America, is distinctive. Colombia has ranked either first or second in the number of internally displaced persons for 10 years, a consequence of decades of armed conflict compounded by high prevalence of drug trafficking. The displacement trajectory for displaced persons in Colombia proceeds through a sequence of stages: (1) pre-expulsion threats and vulnerability, (2) expulsion, (3) migration, (4) initial adaptation to relocation, (5) protracted resettlement (the end point for most forced migrants), and, rarely, (6) return to the community of origin. Trauma signature analysis, an evidence-based method that elucidates the physical and psychological consequences associated with exposures to harm and loss during disasters and complex emergencies, was used to identify the psychological risk factors and potentially traumatic events experienced by conflict-displaced persons in Colombia, stratified across the phases of displacement. Trauma and loss are experienced differentially throughout the pathway of displacement.