Dana Rose Garfin

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.

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.

Exposure to rapid succession disasters: a study of residents at the epicenter of the Chilean Bío Bío earthquake

We examined cumulative and specific types of trauma exposure as predictors of distress and impairment following a multifaceted community disaster. Approximately 3 months after the 8.8 magnitude earthquake, tsunami, and subsequent looting in Bío Bío, Chile, face-to-face interviews were conducted in 5 provinces closest to the epicenter. Participants (N = 1,000) were randomly selected using military topographic records and census data. Demographics, exposure to discrete components of the disaster (earthquake, tsunami, looting), and exposure to secondary stressors (property loss, injury, death) were evaluated as predictors of posttraumatic stress (PTS) symptoms, global distress, and functional impairment. Prevalence of probable posttraumatic stress disorder was 18.95%. In adjusted models examining specificity of exposure to discrete disaster components and secondary stressors, PTS symptoms and global distress were associated with earthquake intensity, tsunami exposure, and injury to self/close other. Increased functional impairment correlated with earthquake intensity and injury to self/close other. In adjusted models, cumulative exposure to secondary stressors correlated with PTS symptoms, global distress, and functional impairment; cumulative count of exposure to discrete disaster components did not. Exploratory analyses indicated that, beyond direct exposure, appraising the tsunami and looting as the worst components of the disaster correlated with greater media exposure and higher socioeconomic status, respectively. Overall, threat to life indicators correlated with worse outcomes. As failure of government tsunami warnings resulted in many deaths, findings suggest disasters compounded by human errors may be particularly distressing. We advance theory regarding cumulative and specific trauma exposure as predictors of postdisaster distress and provide information for enhancing targeted postdisaster interventions.

Distress, Worry, and Functioning Following a Global Health Crisis: A National Study of Americans’ Responses to Ebola

The 2014 Ebola crisis received unprecedented media attention in the United States, despite low risk of transmission. We examined theoretically derived correlates of psychological response to the crisis, including Ebola-related media exposure, prior mental health history, and stress response to a recent prior collective trauma (the 2013 Boston Marathon bombing, BMB). A national probability sample completed a survey 2–4 weeks post-BMB; 18 months later, the same sample reported responses to the Ebola crisis (N = 3,447). History of mental health diagnoses, acute stress response to the BMB, and Ebola-related media exposure were associated with greater psychological distress and functional impairment. Prior acute stress and Ebola-related media exposure were also associated with Ebola-related worry; individuals with higher BMB-related acute stress who consumed more Ebola-related media were more worried about contracting Ebola. Media coverage of the Ebola public health crisis was associated with negative psychological outcomes, even among individuals at low risk for contracting the disease.

Responses to Natural Disasters

Many individuals experience natural disasters including earthquakes, tornadoes, hurricanes, tsunamis, and wildfires; residents of developing nations experience greater/more severe risk. While many individuals display resilience post-disaster, deleterious physical and mental health problems are also common and correlate with disaster characteristics, demographic indicators, socioeconomic status, and pre-disaster mental health. Post-disaster responses have been examined less frequently among children; detrimental effects may persist for decades. Longitudinal assessments post-disaster are relatively uncommon, although critical for understanding long-term adaptation. Logistical difficulties generate challenges for disaster research and marked variability in methodologies has hindered cross-study comparisons. Improved designs may enhance current knowledge, improving outreach services.

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

ABSTRACT This study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.

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

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.

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.

Emotion Coregulation Processes between Mothers and their Children With and Without Autism Spectrum Disorder: Associations with Children’s Maladaptive Behaviors

A dyadic microanalysis approach was used to examine emotion coregulation processes in mother–child interactions in relation to children’s maladaptive behaviors. Seventy-two mother–child dyads (46 children with Autism Spectrum Disorder (ASD); 26 neurotypical children) were previously videotaped in a semi-structured play procedure at home and mothers reported on children’s internalizing and externalizing behaviors. Mother-child interactions were reliably coded in 5-second intervals and analyzed using Space State Grid software. Regression analyses supported moderation, whereby greater dyadic flexibility and more mutual-positive engagements were significantly associated with lower levels of maladaptive outcomes for children with ASD. Results have implications for initiating positive interactions and promoting effective parenting that help improve behavior in young children with ASD.

Terrorism and Health

Terrorist attacks target innocent civilians, spreading fear and anxiety throughout the population. Postattack, many people exhibit resilience, yet deleterious physical and mental health outcomes are also common. Directly exposed individuals may experience significant physical, mental, and/or social injury. Indirect exposure (i.e., media-based) diffuses events well beyond their immediate geographic proximity and predisposes individuals to negative outcomes similar to those experienced by directly exposure individuals. Longitudinal studies suggest that these health effects may persist over time. Physiological reactions and coping strategies may help explain outcome variability. Clarifying predictors of adaptive and maladaptive responses may advance theory and facilitate improved postattack services.