Ecological Approaches to Understanding Post-Disaster Distress

描述（由申请人提供）：本研究的目的是评估环境因素（例如，社区层面的健康和社会资源，社区社会经济地位）在塑造灾后心理健康和恢复中的作用。社区特征是灾后功能的重要决定因素，这一概念在关于卡特里娜飓风的许多公共话语中得到了深刻的体现，这些话语广泛关注潜在的社会经济地位、资源可用性和准备工作在灾难发生后可能发挥的作用。据我们所知，这项拟议的研究将是第一个提供全面、严谨和基于理论的各种途径的研究，通过这些途径，社区层面的因素塑造了灾难后个人风险和社区精神病理学发病率以及不良行为结果。我们的主要目标是展示灾难恢复的生态概念的效用，重点关注个人的健康结果，如创伤后应激障碍（PTSD）的发生/严重程度、抑郁症状和慢性压力。为了实现这些目标，我们将收集二级和初级数据来描述(A)密西西比州各县在灾难发生前后的社区特征，以及(B)密西西比州1000名居民的社会人口统计学、事件暴露和心理健康。为了以不受回忆偏差影响的方式描述灾前社区资源，我们将从公共资源（如美国人口普查和密西西比州发展局）中收集上下文数据库。我们还将收集有关社区一级暴露情况和灾后社区资源的客观信息，包括对需求和联邦应急管理署拨款数额的估计。为了获得个人层面的信息，我们将从卡特里娜飓风造成的破坏程度形成的三个地理区域中随机抽取1000名成年人样本。使用多种抽样方式，我们将对飓风前一般人群中与其代表性成比例的人进行抽样，并包括因飓风而疏散和未疏散的人。关键假设将使用多层次层次模型和生态分析进行检验。

DESCRIPTION (provided by applicant): The purpose of this study is to assess the role that contextual factors (e.g., community-level health and social resources, community socioeconomic status) play in shaping mental health and recovery in the aftermath of a disaster. The notion that community characteristics are important determinants of post disaster functioning was dramatically brought home in much of the public discourse about Hurricane Katrina that focused extensively on the role that underlying socio-economic position, resource availability, and preparedness may have played in the aftermath of this disaster. The proposed research would be the first study, to our knowledge, to provide a full, rigorous, and theoretically-based test of the various pathways through which community-level factors shape individual risk and community rates of psychopathology and adverse behavioral outcomes after disasters. Our broad aim is to demonstrate the utility of an ecological conceptualization of disaster recovery, focusing on individuals' health outcomes such as the occurrence/severity of posttraumatic stress disorder (PTSD), depressive symptoms, and chronic stress. To achieve these aims we will collect both secondary and primary data to describe (A) community characteristics of Mississippi counties before and after the disasters, and (B) sociodemographics, event exposures, and mental health among 1,000 residents of Mississippi. To characterize pre-disaster community resources in ways that are not subject to recall bias, we will assemble a contextual database from publicly available sources, such as the US Census and the Mississippi Development Authority. We will also assemble objective information about community-level exposure and postdisaster community resources, including estimates of need and amounts of FEMA monies awarded. In order to obtain individual-level information, we will select a random sample of 1,000 adults from three geographic areas formed by levels of damage caused by Hurricane Katrina. Using multiple sampling modalities we will sample persons proportional to their representation in the general population before the hurricane and include both persons who were and those who were not evacuated as a result of the hurricane. Key hypotheses will be tested using multi-level hierarchical models and ecologic analyses.