Russell T. Jones

Mental illness and suicidality after Hurricane Katrina

OBJECTIVE To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey. METHODS The National Comorbidity Survey-Replication, conducted between February 2001 and February 2003, interviewed 826 adults in the Census Divisions later affected by Hurricane Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the same area before the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of personal growth that resulted from the trauma (for example, increased closeness to a loved one, increased religiosity). Outcome measures used were the K6 screening scale of serious mental illness and mild-moderate mental illness and questions about suicidal ideation, plans and attempts. FINDINGS Respondents to the post-Katrina survey had a significantly higher estimated prevalence of serious mental illness than respondents to the earlier survey (11.3% after Katrina versus 6.1% before; chi(2)1= 10.9; P < 0.001) and mild-moderate mental illness (19.9% after Katrina versus 9.7% before; chi(2)1 = 22.5; P < 0.001). Among respondents estimated to have mental illness, though, the prevalence of suicidal ideation and plans was significantly lower in the post-Katrina survey (suicidal ideation 0.7% after Katrina versus 8.4% before; chi(2)1 = 13.1; P < 0.001; plans for suicide 0.4% after Katrina versus 3.6% before; chi(2)1 = 6.0; P = 0.014). This lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma (faith in ones own ability to rebuild ones life, and realization of inner strength), without which between-survey differences in suicidality were insignificant. CONCLUSION Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.

Psychological impact of fire disaster on children and their parents.

Six weeks following a major wildfire, children’s psychosocial functioning was examined. Employing a multimethod assessment approach, the short-term mental health consequences of the fire were evaluated. Individual adjustment was compared between families who reported high levels of loss as a result of the fire (high-loss group) and families who reported relatively low levels of loss resulting from the fire (low-loss group). Standardized assessment procedures were employed for children and adolescents as well as their parents. In general, high-loss participants reported slightly higher levels of post-traumatic stress disorder (PTSD) symptoms and significantly higher scores on the Impact of Events Scale. PTSD symptoms reported by parents were generally significantly correlated with (but not concordant with) PTSD symptoms reported by their children. The high-loss group scored significantly higher on the Resource Loss Index than did the low-loss group. Preexisting and comorbid disorders and previous stressors are described. A methodological framework for future studies in this area is discussed.

Trends in Serious Emotional Disturbance Among Youths Exposed to Hurricane Katrina

OBJECTIVE To examine patterns and predictors of trends in DSM-IV serious emotional disturbance (SED) among youths exposed to Hurricane Katrina. METHOD A probability sample of adult pre-hurricane residents of the areas affected by Katrina completed baseline and follow-up telephone surveys 18 to 27 months post-hurricane and 12 to 18 months later. Baseline adult respondents residing with children and adolescents (4-17 years of age) provided informant reports about the emotional functioning of these youths (n = 576) with the Strengths and Difficulties Questionnaire (SDQ). The surveys also assessed hurricane-related stressors and ongoing stressors experienced by respondent families. RESULTS SED prevalence decreased significantly across survey waves from 15.1% to 11.5%, although even the latter prevalence was considerably higher than the pre-hurricane prevalence of 4.2% estimated in the US National Health Interview Survey. Trends in hurricane-related SED were predicted by both stressors experienced in the hurricane and ongoing stressors, with SED prevalence decreasing significantly only among youths with moderate stress exposure (16.8% versus 6.5%). SED prevalence did not change significantly between waves among youths with either high stress exposure (30.0% versus 41.9%) or low stress exposure (3.5% versus 3.4%). Pre-hurricane functioning did not predict SED persistence among youths with high stress exposure, but did predict SED persistence among youth with low-moderate stress exposure. CONCLUSIONS The prevalence of SED among youths exposed to Hurricane Katrina remains significantly elevated several years after the storm despite meaningful decrease since baseline. Youths with high stress exposure have the highest risk of long-term hurricane-related SED and consequently represent an important target for mental health intervention.

Teaching children how and when to make emergency telephone calls

The present study examined a behavioral procedure which was designed to teach young children how and when to make emergency phone calls. Experiment 1 compared the effectiveness of three conditions — behavioral training, teacherdevised training and no training — in teaching children how to make emergency calls. The conditions were administered to six classes in two different preschool programs. The behavioral training program resulted in significantly greater improvements in emergency dialing skills relative to teacher-devised and no-training conditions. Experiment 2 examined a discrimination training procedure with selected subjects from Experiment 1 to ensure that the children not only knew how to make the emergency phone calls but also knew when to make them, i.e., in what situations. In a multiple baseline design across children, the discrimination training procedure was shown to improve performance in identifying when to apply the emergency dialing skills.

Programming Maintenance as a Major Component of a Community-Centered Preventive Effort: Escape from Fire.

The present study investigated maintenance of responding by severely to moderately mentally retarded subjects following behavioral training of socially validated methods of exiting from a burning house. Four subjects in a community living arrangement were taught methods of exiting the house in fire emergency situations via a multiple baseline design across subjects. Training included instructions, modeling, behavioral rehearsal, social and tangible external reinforcement, and self-reinforcement. To facilitate maintenance, all children received (a) isolated followed by simultaneous presentation of situations, and those children who met certain criteria received (b) fading of reinforcement and (c) alteration from external to self-reinforcement. To increase the likelihood of generalization to an actual fire, children were taught in their own home and were presented with simulated cues. Generalization to a second room, a secondary focus, was trained to those children who met designated criteria via fading of reinforcement, self-reinforcement, and training in a third room. The procedure was effective in both training and maintaining emergency exiting skills in the simulated setting. Generalization probe data indicated the need to either program generalization or train children in their own rooms. The results were socially validated through presentation of a questionnaire to firefighters.

Elaborative and behavioral rehearsal in the acquisition of fire emergency skills and the reduction of fear of fire

Two training procedures (behavioral rehearsal and elaborative rehearsal) were assessed for relative effectiveness in the acquisition of fire emergency skills, and for reducing fear associated with being in fires. Both trained groups were also compared to untrained controls. We predicted that behavioral and elaborative rehearsal would lead to comparable skill acquisition, but that elaborative practice would decrease fear more than behavioral rehearsal. The subjects were 46 third-grade children, randomly assigned to conditions, whose behavioral performance and fear level were assessed before and immediatly after training. Significant performance gains were found for both trained groups but not for the controls. Elaborative rehearsal brought significantly more fear reduction than did behavioral rehearsal — which did not surpass that of controls. The results affirmed the value of elaborative rehearsal in reducing childrens fear of responding and in improving actual performance.

A follow-up to training emergency skills

This investigation represents a follow-up assessment of childrens responses 9 months after termination of a multifaceted behavioral procedure designed to teach how to exit a burning house. In the initial program, five children were trained in socially validated methods of responding to several simulated home emergency fire situations. Marked changes were attained with training, and improvements were socially validated. A 5-month follow-up on the five children indicated that emergency exiting skills were maintained at moderate levels when compared to original baseline levels. However, behavior was below levels required for safe exiting from fires. High levels of responding were quickly reestablished in the four children who received remedial training. Follow-up assessment 9 months after termination of the original training (and 4 months after retraining) revealed that behavior had again fallen below levels required for safety, although to a lesser degree. The results of this study indicate the need to ensure continued levels of high responding after withdrawal of interventions for adaptive skills.

The Psychological Effects of Hurricane Andrew on Ethnic Minority and Caucasian Children and Adolescents: A Case Study.

The impact of Hurricane Andrew on 212 African American, Caucasian, and Hispanic elementary and middle school children was examined at 6 months postdisaster. Using self-report instruments, this case study examined the predictive utility of several hypothesized mediators of childrens reactions to disaster. Results showed higher levels of intrusive symptomatology for girls and for elementary school children as compared with their middle school counterparts. No differences were found with reference to race. The lack of findings concerning race is addressed, as well as implications for future studies.

The Integration of Mental and Behavioral Health Into Disaster Preparedness, Response, and Recovery

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

Risk Factors for Psychological Adjustment Following Residential Fire: The Role of Avoidant Coping

SUMMARY Although a growing number of investigations have targeted technological and natural disasters involving children and adolescents (e.g., kidnappings, shootings, accidents, wars, fires, hurricanes), little is known about the influence of specific risk factors on functioning post-disaster. A number of basic questions are yet to be fully addressed, including: How do children and adolescents cope with technological and natural disasters? What are the most salient risk factors for children and adolescents, prior to, during, and following disasters? How do these risk factors interact in predicting psychological adjustment? And what is the relative role of risk factors on psychological adjustment over time? In fact, these and related questions hold the potential to move this important area of inquiry forward in a variety of meaningful ways.