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      Posttraumatic Stress Disorder and Community Collective Efficacy following the 2004 Florida Hurricanes


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          There is a paucity of research investigating the relationship of community-level characteristics such as collective efficacy and posttraumatic stress following disasters. We examine the association of collective efficacy with probable posttraumatic stress disorder and posttraumatic stress disorder symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Anonymous questionnaires were distributed electronically to all Florida Department of Health personnel nine months after the 2004 hurricane season. The collected data were used to assess posttraumatic stress disorder and collective efficacy measured at both the individual and zip code levels. The majority of participants were female (80.42%), and ages ranged from 20 to 78 years (median = 49 years); 73.91% were European American, 13.25% were African American, and 8.65% were Hispanic. Using multi-level analysis, our data indicate that higher community-level and individual-level collective efficacy were associated with a lower likelihood of having posttraumatic stress disorder (OR = 0.93, CI = 0.88–0.98; and OR = 0.94, CI = 0.92–0.97, respectively), even after adjusting for individual sociodemographic variables, community socioeconomic characteristic variables, individual injury/damage, and community storm damage. Higher levels of community-level collective efficacy and individual-level collective efficacy were also associated with significantly lower posttraumatic stress disorder symptom severity (b = −0.22, p<0.01; and b = −0.17, p<0.01, respectively), after adjusting for the same covariates. Lower rates of posttraumatic stress disorder are associated with communities with higher collective efficacy. Programs enhancing community collective efficacy may be an important part of prevention practices and possibly lead to a reduction in the rate of posttraumatic stress disorder post-disaster.

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          Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers.

          The events of Sept. 11, 2001, highlighted the importance of understanding the effects of trauma on disaster workers. To better plan for the health care of disaster workers, this study examined acute stress disorder, posttraumatic stress disorder (PTSD), early dissociative symptoms, depression, and health care utilization in disaster workers. Exposed disaster workers (N=207) and unexposed comparison subjects (N=421) were examined at 2, 7, and 13 months after an airplane crash. Exposed disaster workers had significantly higher rates of acute stress disorder, PTSD at 13 months, depression at 7 months, and depression at 13 months than comparison subjects. Those who were younger and single were more likely to develop acute stress disorder. Exposed disaster workers with acute stress disorder were 3.93 times more likely to be depressed at 7 months. Those with high exposure and previous disaster experience or who had acute stress disorder were more likely to develop PTSD. Similarly, those who were depressed at 7 months were 9.5 times more likely to have PTSD. Those who were depressed at 13 months were 7.96 times more likely to also meet PTSD criteria. More exposed disaster workers than comparison subjects obtained medical care for emotional problems at 2, 7, and 13 months. Overall, 40.5% of exposed disaster workers versus 20.4% of comparison subjects had acute stress disorder, depression at 13 months, or PTSD. Exposed disaster workers are at increased risk of acute stress disorder, depression, or PTSD and seek care for emotional problems at an increased rate.
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            First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Workers

            First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed.
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              Neighborhood residence and mental health problems of 5- to 11-year-olds.

              Little research has investigated possible effects of neighborhood residence on mental health problems in children such as depression, anxiety, and withdrawal. To examine whether children's mental health is associated with neighborhood structural characteristics (concentrated disadvantage, immigrant concentration, and residential stability) and whether neighborhood social processes (collective efficacy and organizational participation) underlie such effects. The Project on Human Development in Chicago Neighborhoods is a multilevel, longitudinal study of a representative sample of children aged 5 to 11 years in the late 1990s recruited from 80 neighborhoods. A community survey assessing neighborhood social processes was conducted with an independent sample of adult residents in these 80 neighborhoods and is used in conjunction with US census data to assess neighborhood conditions. A total of 2805 children (18.1% European American, 33.8% African American, and 48.1% Latino) and their primary caregivers were seen twice. Child Behavior Checklist total raw and clinical cutoff scores for internalizing behavior problems (depression, anxiety, withdrawal, and somatic problems). The percentages of children above the clinical threshold were 21.5%, 18.3%, and 11.5% in neighborhoods of low, medium, and high socioeconomic status, respectively. A substantial proportion of variance in children's total internalizing scores (intraclass correlation, 11.1%) was attributable to between-neighborhood differences. Concentrated disadvantage was associated with more mental health problems and a higher number of children in the clinical range, after accounting for family demographic characteristics, maternal depression, and earlier child mental health scores. Neighborhood collective efficacy and organizational participation were associated with better mental health, after accounting for neighborhood concentrated disadvantage. Collective efficacy mediated the effect of concentrated disadvantage. A large number of children in poor neighborhoods have mental health problems. The mechanism through which neighborhood economic effects operated was community social control and cohesion, which may be amenable to intervention.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                11 February 2014
                : 9
                : 2
                : e88467
                [1 ]Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
                [2 ]National Institute for Occupational Safety and Health, Office of the Director, Washington, D.C., United States of America
                [3 ]Department of Sociology, Harvard University, Cambridge, Massachusetts, United States of America
                Harvard Medical School, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: RJU CSF DBR. Performed the experiments: RJU CSF DBR. Analyzed the data: JBAM XL LW. Contributed reagents/materials/analysis tools: JBAM XL LW. Wrote the paper: RJU CSF RJS JBAM XL. Interpretation of data: RJU CSF JBAM XL RJS.

                Copyright @ 2014

                This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                : 21 August 2013
                : 7 January 2014
                Page count
                Pages: 9
                This study was supported by funds from the Centers for Disease Control and Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Research Article
                Clinical Research Design
                Cross-Sectional Studies
                Survey Research
                Mental Health
                Public Health
                Environmental Health
                Social and Behavioral Sciences
                Psychological Stress
                Social Psychology
                Social Networks
                Social Research
                Social Systems



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