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      Self-Reported and FEMA Flood Exposure Assessment after Hurricane Sandy: Association with Mental Health Outcomes


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          Hurricane Sandy caused extensive physical and economic damage; the long-term mental health consequences are unknown. Flooding is a central component of hurricane exposure, influencing mental health through multiple pathways that unfold over months after flooding recedes. Here we assess the concordance in self-reported and Federal Emergency Management (FEMA) flood exposure after Hurricane Sandy and determine the associations between flooding and anxiety, depression, and post-traumatic stress disorder (PTSD). Self-reported flood data and mental health symptoms were obtained through validated questionnaires from New York City and Long Island residents (N = 1231) following Sandy. Self-reported flood data was compared to FEMA data obtained from the FEMA Modeling Task Force Hurricane Sandy Impact Analysis. Multivariable logistic regressions were performed to determine the relationship between flooding exposure and mental health outcomes. There were significant discrepancies between self-reported and FEMA flood exposure data. Self-reported dichotomous flooding was positively associated with anxiety (OR adj: 1.5 [95% CI: 1.1–1.9]), depression (OR adj: 1.7 [1.3–2.2]), and PTSD (OR adj: 2.5 [1.8–3.4]), while self-reported continuous flooding was associated with depression (OR adj: 1.1 [1.01–1.12]) and PTSD (OR adj: 1.2 [1.1–1.2]). Models with FEMA dichotomous flooding (OR adj: 2.1 [1.5–2.8]) or FEMA continuous flooding (OR adj: 1.1 [1.1–1.2]) were only significantly associated with PTSD. Associations between mental health and flooding vary according to type of flood exposure measure utilized. Future hurricane preparedness and recovery efforts must integrate micro and macro-level flood exposures in order to accurately determine flood exposure risk during storms and realize the long-term importance of flooding on these three mental health symptoms.

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          Post-traumatic stress disorder following disasters: a systematic review.

          Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.
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            The development of instruments to measure the work disability assessment behaviour of insurance physicians

            Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.
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              Modeled impact of anthropogenic warming on the frequency of intense Atlantic hurricanes.

              Several recent models suggest that the frequency of Atlantic tropical cyclones could decrease as the climate warms. However, these models are unable to reproduce storms of category 3 or higher intensity. We explored the influence of future global warming on Atlantic hurricanes with a downscaling strategy by using an operational hurricane-prediction model that produces a realistic distribution of intense hurricane activity for present-day conditions. The model projects nearly a doubling of the frequency of category 4 and 5 storms by the end of the 21st century, despite a decrease in the overall frequency of tropical cyclones, when the downscaling is based on the ensemble mean of 18 global climate-change projections. The largest increase is projected to occur in the Western Atlantic, north of 20 degrees N.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                27 January 2017
                : 12
                : 1
                : e0170965
                [1 ]Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
                [2 ]Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine, Manhasset, New York, United States of America
                Columbia University, UNITED STATES
                Author notes

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

                • Conceptualization: BL RMS ET.

                • Data curation: WLC.

                • Formal analysis: WLC BL RMS ET.

                • Funding acquisition: ET.

                • Investigation: WLC SS RMS.

                • Methodology: BL RMS ET.

                • Project administration: RMS ET.

                • Resources: RMS, ET.

                • Supervision: BL RMS ET.

                • Validation: WLC.

                • Visualization: WLC BL ET.

                • Writing – original draft: WLC.

                • Writing – review & editing: WLC BL SS RMS ET.

                Author information
                © 2017 Lieberman-Cribbin et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                : 23 August 2016
                : 14 January 2017
                Page count
                Figures: 4, Tables: 1, Pages: 15
                Funded by: funder-id http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
                Award ID: U01-TP000573-01
                Funded by: Office of the Assistant Secretary for Preparedness and Response
                Award ID: HITEP150029-01-00
                This work was supported by the The Centers for Disease Control and Prevention under award number U01-TP000573-01 (Emanuela Taioli, http://www.cdc.gov/grants/), and the Office of the Assistant Secretary for Preparedness and Response under HITEP150029-01-00 (Emanuela Taioli, http://www.phe.gov/about/aspr/pages/default.aspx), as well as a private donation given to Northwell Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Research Article
                Earth Sciences
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Neuropsychiatric Disorders
                Anxiety Disorders
                Post-Traumatic Stress Disorder
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Anxiety Disorders
                Post-Traumatic Stress Disorder
                People and places
                Geographical locations
                North America
                United States
                New York
                Earth Sciences
                Natural Disasters
                People and Places
                Research and Analysis Methods
                Research Design
                Survey Research
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