Home > Public Resources > Trauma Blog > 2016 - October > Residents of Economically Disadvantaged Communities at Risk for PTSD Symptoms in the Long-Term After Residents of Economically Disadvantaged Communities at Risk for PTSD Symptoms in the Long-Term Aftermath of Hurricane Sandy Sarah Lowe, PhD, Laura Sampson, Oliver Gruebner, and Sandro Galea, PHD October 7, 2016 In the past few decades, we have seen major natural disasters in the United States and beyond – Hurricane Katrina in 2005, the Sichuan earthquake in 2008, the Joplin tornado in 2011, to name a few. These events have brought to light the vulnerability of disadvantaged communities to both disaster-related exposures, such as housing damage, displacement, and financial losses, and longer-term adverse outcomes, including physical and mental health conditions. At the same time, it is also apparent that an outpouring of support and assistance often follows natural disasters. In addition to governmental responses, members of communities near and far rally together to donate money, goods, and time to assist persons in need and prevent long-term hardship. In our research, we sought to illuminate how these seemingly contradictory phenomena work together to influence mental health. We drew on two representative samples of New York City neighborhoods that were most severely affected by Hurricane Sandy – one assessed approximately 13-16 months after and the other 25-28 months after the hurricane. We hypothesized that living in an economically disadvantaged community would increase risk for posttraumatic stress disorder (PTSD) symptoms among disaster-exposed participants, but only in the later post-disaster period. Why Mental Health Risks Might Increase in Economically Disadvantaged Communities Over Time Our hypothesis was informed by two major theories in the disaster literature. First, in their social support deterioration desistence model, Krys Kaniasty, Distinguished University Professor in the Department of Psychology at Indiana University of Pennsylvania and Fran Norris, retired and most recently a Research Professor in the Department of Psychiatry at the Geisel School of Medicine at Dartmouth, have theorized that, although social support increases in the initial aftermath of disasters, it declines over time, increasing survivors’ vulnerability to mental health problems (Kaniasty & Norris, 2009). A loss of social support might hit particularly hard for survivors in need of ongoing assistance, especially as disaster relief from federal, state, and local agencies dwindles. Second, in his Conservation of Resources Theory, Stevan Hobfoll, Judd and Marjorie Weinberg Presidential Professor and Chairperson of the Department of Behavioral Sciences at Rush Medical College, has posited that mental health problems arise when there is a rapid loss of social, material, and personal resources, and further, that securing and maintaining such resources is tied the environmental conditions in one’s community (Hobfoll, 1989, 2012, 2014). In the context of a disaster, the impact of resource loss on the mental health of a person living in an economically disadvantaged community might initially be buffered by outside disaster assistance. As outside sources of assistance decrease, however, environmental conditions will matter more – and therefore disaster-affected residents of disadvantaged communities will be at increasing risk of mental health problems. The Community Resilience after Hurricane Sandy Study To test our hypothesis, we conducted telephone surveys with adult residents of New York City census tracts that were inundated with floodwaters in the aftermath of Hurricane Sandy, which struck the area on October 29, 2012. Participants reported on their exposure to disaster-related stressors, including housing displacement and damage, and prolonged loss of electricity, heat, or hot water, completed an inventory of PTSD symptoms, and provided their home address at the time of the hurricane. A total of 1,000 participants completed the survey, 500 at each time point. Our research team then mapped participant addresses onto census tracts, and collected data on unemployment – a marker of economic disadvantage – from the American Community Survey for the 482 tracts represented in our sample. The results of our analysis were consistent with our hypothesis. We found that living in a community with high levels of unemployment increased the risk for PTSD symptoms associated with disaster exposure. However, this effect was limited to participants assessed 25-28 months after Sandy, and was non-significant among those assessed at 13-16 months after Sandy. To shed further light on mental health risk in New York City, we created a map showing which census tracts had high levels of unemployment and participants reporting high disaster exposure. Although these tracts spanned New York City’s five boroughs, they tended to be concentrated in Southern Brooklyn and Queens, and Northeastern Staten Island – areas within the city that were most severely impacted by the storm surge, erosion, and coastal flooding (City of New York, 2016). Looking Ahead The results of our study suggest the need for ongoing assistance to residents of economically disadvantaged communities in the wake of disaster. Such assistance could include additional financial support to offset disaster-related damages and losses, and access to affordable mental health services. Future research could provide additional insight into disaster survivors’ changing needs over time, and examine whether the findings of our study apply in the aftermath of other disasters. Reference Article Lowe, S. R., Sampson, L., Gruebner, O. and Galea, S. (2016), Community Unemployment and Disaster-Related Stressors Shape Risk for Posttraumatic Stress in the Longer-Term Aftermath of Hurricane Sandy. Journal of Traumatic Stress. doi:10.1002/jts.22126 Discussion Questions Why might assistance to disaster-affected communities diminish over time? Other than the reduction of disaster assistance, are there any other explanations for why mental health risks in economically disadvantaged communities increase over time in the aftermath of disasters? How might practitioners and policymakers continue to support economically disadvantaged communities after disasters? Author Biographies Sarah R. Lowe is an Assistant Professor of Psychology at Montclair State University. Her research focuses on the mental health consequences of exposure to traumatic events, and how factors at different ecological levels, from genes to neighborhoods, shape outcomes over time. Laura Sampson is a doctoral student in the Department of Epidemiology at the Boston University School of Public Health. Her research interests include the mental health consequences of natural disasters and military deployment, as well as urban health. Oliver Gruebner is a health geographer and research fellow at the Robert Koch-Institute in Berlin, Germany. His research focuses on spatial epidemiological approaches to mental health and child health relating to urban contexts. Sandro Galea is Dean and Professor of Epidemiology at the Boston University School of Public Health. He is interested in the social production of health of urban populations, and his work explores innovative cells-to-society approaches to population health questions. References Cited City of New York (2013). A stronger, more resilient New York. Retrieved from http://www.nyc.gov/html/sirr/html/report/report.shtml Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513-524. doi:10.1037/0003-066X.44.3.513 Hobfoll, S. E. (2012). Conservation of resources and disaster in cultural context: The caravans and passageways for resources. Psychiatry, 75, 227-232. doi:10.1521/psyc.2012.75.3.227 Hobfoll, S. E. (2014). Resource caravans and resource caravan passageways: A new paradigm for trauma responding. Intervention, 12(S1), 21-32. doi:10.1097/wtf.0000000000000067 Kaniasty K., & Norris, F. H. (2009). Distinctions that matter: Received social support, perceived social support, and social embeddedness after disasters. In Y. Neria, S. Galea, & F. Norris, (Eds.), Mental health and disasters (pp. 175-202). New York: Cambridge University Press.