Psychological sequela of Hurricane Hugo

Psychological sequela of Hurricane Hugo

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Psychological sequela of Hurricane Hugo an application of the conservation of resources model of stress
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Quick response research report ;
Shaw, Darlene L
University of Colorado, Boulder -- Natural Hazards Research and Applications Information Center
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Hurricane Hugo, 1989 -- Psychological aspects ( lcsh )
Post-traumatic stress disorder -- South Carolina ( lcsh )
Disasters -- Psychological aspects ( lcsh )
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Includes bibliographical references (p. 18).
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Also issued online as part of a joint project with the Louis de la Parte Florida Mental Health Institute (FMHI) Research Library’s disaster mental health initiative.
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by Darlene L. Shaw ... [et al.].

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Psychological sequela of Hurricane Hugo :
an application of the conservation of resources model of stress /
by Darlene L. Shaw ... [et al.].
[Boulder, Colo.] :
Natural Hazards Research and Applications Information Center,
18, [18] p. :
ill. ;
28 cm.
Quick response research report ;
v #45
Cover title.
Includes bibliographical references (p. 18).
Also issued online as part of a joint project with the Louis de la Parte Florida Mental Health Institute (FMHI) Research Librarys disaster mental health initiative.
Hurricane Hugo, 1989
x Psychological aspects.
Post-traumatic stress disorder
z South Carolina.
Psychological aspects.
1 700
Shaw, Darlene L.
2 710
University of Colorado, Boulder.
Natural Hazards Research and Applications Information Center.
4 856


HAZARD HOUSE COpy PSYCHOLOGICAL SEQUELA OF HURRICANE HUGO: AN APPLICATIONOF THE CONSERVATION OF RESOURCES HODEL OFSTRESSByDarleneL.Shaw,PatJarrell,JohnFreedy,andCherylBene FrI DepartmentofPsychiatryandBehavioralSciencesMedicalUniversityofSouthCarolinaCharleston,SouthCarolinaQUICK RESPONSE RESEARCH REPORT #45 1991This publication is partofthe Natural Hazards Research&Applications Information Center's ongoing Quick Response Research Report Series.


FinalReportPsychological SequelaofHurricane Hugo:AnApplicationofthe ConservationofResources ModelofStress* Darlene L Shaw,PatJarrell, John Freedy, and Cheryl Bene DepartmentofPsychiatryandBehavioral Sciences Medical UniversityofSouth Carolina Charleston, South Carolina *Funded by Grant #BP0044897 from ,the Natural Hazards Research and Applications Information Center, UniversityofColorado, Boulder, Colorado. Funding period 11/01/89 to 10/31/90.


I.StatementoftheProblemtobeStudiedOnSeptember21,1989, hurricane Hugo came ashoreatCharleston, South Carolina. A category V hurricane, Hugo ravaged the coastline with sustained winds of135mph and tidal surges15to 20 feet above high tide. Not only was Hugo oneofthe most powerful storms to hit the continental U.S., but also one of the largest. Hurricane force winds radiated 100 miles from its center, and tropical force winds extended 200 miles from the eye. Consequently, the damage causedbyHugo was unprecedented: approximately 3 million people were affected;26lives were lost; and343people were injured. Seventeen thousand people were left jobless; over 5,300 homes were destroyed; and another 18,000 homes were rendered uninhabitable. In the Charlestonareaalone, property damage estimates were in excess of$4billion. Although the estimated losses are impressive, the negative psychological effects of a disaster of this magnitude are more difficult to describe and understand. Some helpinthis regardisprovidedbythe Diagnostic and Statistical Manual of Mental Disorders Revised (DSM-III-R) which describes the psychological sequela of trauma and recognizes Post-traumatic Stress Disorder (PTSD)asa diagnostic category. In the DSM-III-R framework, PTSD symptomatology includes: recurrent and intrusive recollections of the traumatic event (e.g., recurrent dreams, flashbacks); avoidance of stimuli associated with the traumaornumbingofresponsiveness (e.g., inability/refusal to recall details of the event, diminished interest in significant activities); and increased arousal (e.g., sleep disturbances, irritability, inability to concentrate). Associated complications of PTSD include depression, anxiety, and increased substance use. Hence, following a disasteritseems important to monitor acute PTSD symptoms as well as identify groupsofpeople who are at increased risk for long-term problems stemming from the disaster. Although the DSM-III-R describes the psychological sequelaofdisasters, it does little to helpusunderstand these reactions. Indeed, most of the studies investigating psychological reactions to disasters (e.g., Lystad,1985;Hartsough, 1985) have been hamperedbythe absence of a conceptual model of how stress reactions occur. Moreover, this lack of an adequate conceptual model represents a seriousflawin the stress literatureinthat theoretical models provide an important framework to guide research, increase our conceptual understanding of clinical problems, and improve our ability to provide clinical services. Fortunately, this shortcominginthe stress literature has recently been addressedbyHobfoll (1988) who proposed a theoretical model for conceptualizing stress and stress reactions. The model, called the Model of ConservationofResources,isbased on the supposition that people strive to retain, protect, and build resources. The model identifies four types of resources: object resources (e.g., property, material belongings); conditions (e.g., marriage, job roles); personal characteristics (e.g., self-esteem, sense of control); and energies (e.g., time, money).Anevent or situationisdefined as stressful if these resources.


2are threatenedorlost. According to this model, the impact a stressful event has on an individualisrelated to the perceivedoractual loss of resources, how essential these resourcesarefor the individual's survival, and the individual's coping style. Because the Conservation of Resources Model proposed by Hobfoll represents an important advance in the stress literature, the proposed study applied this model in order to investigate the psychological sequelaofhurricane Hugo. Specifically, the project sought to determine whether hurricane-related losses suffered by the students and faculty of the Medical UniversityofSouth Carolina affected their reportsofPTSD symptomatology, depression, anxiety, alcohol and substance use, and other health-risk behaviors (e.g., diet and exercise) following Hugo.ll.Research Questions tobeAnswered The overall goal of this project was to generate empirical data which would allowusto evaluate the applicabilityofHobfoll's theoretical modelofstress for predicting psychological response to natural disasters. In order to accomplish this goal, the following specific objectives for the project were identified: A. To describe and quantify the symptoms of psychological distress experiencedbyour sample following hurricane Hugo.B.To describe and quantify the typesoflosses sufferedbyour sampleasa resultofHugo.C.To determine whether resource loss was correlated with psychological distress and/or coping behavior. D.Toidentify variables that were predictive of psychological distress following Hugo and determine which variables among resource loss, personal characteristics, and coping behaviors were most predictive of distress.E.Todetermine whether high resource loss compared tolowresource loss,wasassociated with greater prevalence of clinically significant psychological distress following hurricane Hugo. F.Todetermine which types of resource loss were most important in explaining psychological distress following hurricane Hugo. G. To determine the effect of gender on self-reported resource 19ss following Hugo.


3H.Todetermine whether psychological distress following hurricane Hugo was effected by genderorthe extentoflossofresources.I.Toprovide normative data about the patternsofalcohol and medication use by our sample after hurricane Hugo.J.Toidentify subject variables (e.g., gender and pre-Hugo drinking patterns) that were associated with increased useofalcohol and medications following hurricane Hugo.K..Tocollect normative data that documents changes in health habits following hurricane Hugo.L.Todetermine whether gender and the extentofloss of resources were associated with disruptioninhealth-related behaviors following Hugo.ill.Methodologyofthe Study A. Methods: Approximately eight weeks after hurricane Hugo struck Charleston, South Carolina, 1,200 facultyofthe Medical UniversityofSouth Carolina (MUSC) in Charleston were sent via the campus mail, a packetofassessment instruments. Included in the packet was a cover letter that explained the purpose of the study, insured confidentiality, and provided instructions on completing the questionnaires. Eight weeks after Hugo struck, the same packetofinformation was distributed to275MUSC students during their class time. Individuals who completed the survey were given the opportunity to enter a drawing for two gourmet dinners valued at $120. Return envelopes and an entry form for the drawing were also included in the packet.B.Assessment instruments (See Appendix I for a copyofeach assessment instrument.) :1.Demographic questionnaire. This questionnaire provided basic demographic information about the subjects including their sex, race, marital status, education level, and annual income.Italso provided information about previous exposuretoother natural disasters, dollar value of property lost as a result of the hurricane, and the respondent's whereabouts when the hurricane actually struck.2.Resource Loss Questionnaire. Hobfoll's original Resource Loss Questionnaire (RLQ) was modified to obtain a 52-item self-report


4inventory on which subjects useda4-point Likert scale to rate the extent to which Hugo resulted in the loss or threatened loss of 52 resources (e.g., property, money, self-esteem, and leisure time). Although the scale yields a separate score for each typeofresource identified by Hobfoll (i.e., Objects, Conditions, Personal Characteristics, and Energies), the total resource loss score (unless specified otherwise) was used in thedataanalyses.3.COPEQuestionnaire. This 60-item self-report inventory provides154-item scales (Carver, Scheler, and Weintraub, 1989). Subjects used a 4-point Likert scale to indicate the extent to which they had used, after the hurricane, each of the60coping behaviors listed. A ratingof0 indicated that they had not used that behavior "atall,"and a rating of 3 indicated they had used the behavior "a lot."Thesubjects' scores for each of the15scales were used as raw data for a principle component factor analysis with Varimax rotation to produce the three coping factors used in this study: problem-focused coping, emotion focused coping, and disengagement copying.4.Symptom Checklist-90 Revised (SCL-90-R). This 90-item self-report questionnaire devised by Derogatis (1983) was used by subjects to report on a 5-point Likert scale the extent to which they experienced90symptoms (e.g., headaches, feelingsofguilt, trembling, and feeling blue) following hurricane Hugo.TheGlobal Severity Index score from the SCL-90-R was used in the data analysesasa measure of overall psychological distress following hurricane Hugo.5.Health Habits Questionnaire.Wedeveloped this 52-item questionnaire to evaluate weight changes, food choices, eating patterns, exercise patterns, alcohol use, and prescription medication use following hurricane Hugo.N.Sample Characteristics A Faculty Sample1.Size of sample: 525; response rate=43%.2.Gender: 51% male; 49% female.3.Age: mean age=40.46 years; range=19to77years.


54.Race: 92% white; 4% black; 4% other.5.Marital status: 68% married; 21% single; 10% separatedordivorced.6.Education (highest degree earned): 74% graduate; 11% bachelors; 12% technical degree.7.Annual household income: $10,000-$40,000 27%; $40,000-$50,000 14%; $50,000 or more 58%.B.Student Sample1.Sizeofsample:202;response rate=73.5%.2.Gender: 43.1% males; 56.9% females.3.Age: mean age=23.95years; range=19to49years.4.Marital status: 77.7% single; 19.8% married; 2.5% separated or divorced.5.Race: 87.6% white; 7.9% black; 4.5% other.6.Education (highest degree earned): 8.5% graduate; 57.5% bachelors; 12% associate degree; 17.5% high school; 4.5% other7.Annual household income: $10,000orless 56.2%; $10,000-$20,000 13.9%; $20,000-$30,000 10.8%; $30,000-$50,000 2.6%; $50,000 or more 7.7%.V.Results Because the data for the faculty sample were analyzed separately from the data for the student sample, the results for these sampleswillbe reported separately. The section detailing the data from the student populationwillinclude comparisonsofthe student data with the corresponding data from the faculty sample. The resultswillbereported in the same order used to list the specific objectives for the project (See pages 2 and 3 of this report.). In addition, for each result reported, the objective it addresseswillbe noted.


6AResults fortheFacultySample1.Objective A:Inordertoquantifythepsychological distressreportedbyourfaculty sample,themeanSCL-9Q-R profile formenandthemeanprofile forwomenwerecalculated as shown inthegraphpresentedinAppendixII. Inspectionofthisgraphshowsthatforboththemenandwomen,themeanT-scoresontheSCL-90-R clinical scales fell intherangeof50to63, with onlythemeanT -score forwomen(T-score=63)ontheObsessive compulsive scale approachingtherangeofscores which indicates clinically significant symptoms(T-score>65). AlthoughthemeanscoresontheSCL9O-Rscaleswerenotclinically elevated for malesorfemales, 9.9%offemalesand6.3%ofmales fell above a T-scoreof65onthe SCL-90-R Global Severity Index (GSI) fornonpatientnorms. This finding indicates a sizableproportionofthefacultysamplesuffered from clinically relevant psychological distress following hurricane Hugo.2.Objective A:Thefive SCL-90-R items whichweremost frequentlyendorsedbythefaculty samplearelisted below inTable1with thepercentageofthe totalgroupendorsingeachitem noted.Formoredetailed information regardingthe10 SCL-90-R items most frequentlyendorsedbythesampleandthepercentageofmalesandfemales endorsingeachofthese items, please see Appendix II. Examinationofthedatain Appendix II indicatesthatthesymptomsofdistress most frequentlyreportedontheSCL-90R were very similar for malesandfemales.Table11. easily annoyedorirritated Feeling low in energyorslowed down Feeling criticalofothers Worryingtoomuchaboutthings Feeling blocked in getting thingsdonePercentageofTotalGroupEndorsingItem41% 35% 33% 32% 30%3.ObjectiveB:Thefive resource loss(RLQ)items most frequentlyendorsedbyourfacultysamplearelisted below inTable2 with thepercentageofthetotal sample endorsingeachitemnoted.Formoredetailed informationaboutthe10 resource loss items most frequentlyendorsedbythemalesandfemales in this sample, pleaseseeAppendix II. Examinationofthedatain Appendix II indicatesthatmales'andfemales'reportsofresources lostwere vPrv<:irnihr


7Table Vegetation on your property Free time Daily routine Feeling that I am accomplishingmygoals Feeling thatmylifeispeaceful PercentofTotal Sample Endorsing Item 83% 65% 54% 50% 47%4.ObjectiveC:Bivariate correlations indicated that high psychological distress as indicatedbythe SCL-90-R GSI scores was associated with: high resource loss (r=.64,P <.01), high scores on disengagement coping (r=.60,p<.01), and high scores on emotion-focused coping (r=.24, P <.01). Gender (r=.29,P< .01) and marital status (r=.20,P< .01) were also significantly correlated with distress, with females and single people reporting greater distress. Higher incomewasassociated with lower distress (r=.15,P< .01). Correlations also revealed that high resource loss was associated with being female (r=.24,P< .01) and higher coping scores, especially higher ratesofdisengagement coping (r=.57,p<.01). A table detailing the correlationsamong resource loss, psychological distress, and coping variablesisshown in Appendix III.5.Objective D: A step-wise regression was used to determine the degree to which psychological distress, as measured by the SCL-90-R GSI scores, could be predicted based upon demographic variables, scores on the COPE, and resource loss. Approximately half (r =50.1 %) of the total varianceofpsychological distress could be accounted forinthis manner, with resource loss making the greatest contribution (r =38.8%). Other variables which entered into the regression equation at a statistically significant level were disengagement coping (r =7.8%), marital status (r =1.5%), problem focused coping (r =.9%), distance from Charleston during Hugo (r =.6%), and extent to which personal decisions placed others at risk (r =1.0%). Hence, resource loss, compared to demographic or coping variables, served as the best predictor of distress. Table 3 below provides the beta weights for this step-wise regression.


8Table3 PredictionofGeneral Severity Index Scores for the Faculty Sample by Personal Characteristics, Resource Loss, and Coping Behavior Predictor Variable beta RR2F dfPBlock1:Personal Characteristics Gender.035Marital Status.076*Household Income -.041 Prior Disaster Exposure .027 After Block 1.315.09910.57 4,385 .001 Block2:Resource Loss Aggregate Resource Loss .450** After Block 2 .661 .437 230.51 5,384.001Block3:Coping Behavior Problem Focused -.122*** Emotion Focused .044 Disengagement Focused .333**** After All Three Blocks .718 .516 20.66 8,381 .001**********Being single was associated with greater distress. Higher loss was associated with greater distress. Less problem focused coping was associated with higher distress. More disengagement coping was associated with higher distress.6.Objective E: Table 4 below presents the percent of males and females in the high and low resource loss categories (upper most quartilev.lowest quartile) who demonstrated scores on the General Severity Index (GSI) above the clinical cut off score (T -score>63) using nonpatient norms.Aspredicted, the prevalenceofclinically meaningful distress levels was significantly greater among people experiencing high resource loss compared to people experiencinglowresource loss. These significant differences held for both males and females.


9Table 4 Prevalenceofclinically significant psychological distress among high and low loss males and females. High Loss Low Loss (n=51) (n=155) 34.4% 4.5% [t(204) = 8.05, P <.001] Females High Loss Low Loss (n=52) (n=160) 44.2% 10.6%[t(21O)= 8.19, P <.001]7.Objective F: In order to determine which typesofresource loss best explained psychological distress following Hugo, a two-step hierarchical multiple regression was performed (See Table 5 below.).Thefirst step entered demographic variables that accounted for 9.5%ofpsychological distress variance.Thesecond step entered the four resource loss variables that accounted for an additional 39.3%ofthe psychological distress variance. Examinationofsignificant beta weights indicated that, in orderofvariance explained, these variables predicted high psychological distress: personal characteristic loss (b =.41, f(7,402) = 52.36, p<.OOl), social condition loss (b =.30,f(7,402) = 35.81, P< .001), and lower annual household income (b = -.09, F(7,402) = 4.64, P< .03). Hence, the lossofpsychological and social resources (personal characteristics and social conditions) were most important in explaining psychological distress in our sample following hurricane Hugo.


10Table 5 Hierarchical Multiple Regression Predicting Psychological Distress Predictor Variable beta RR2FdfPStep1:Demographic Variables Gender .04 Marital Status.05Household Income.09*After Step 1 .308.09514.20 3,406.001Step2:Resource Loss Variables Personal Characteristics.41**Objects.03Social Conditions.30**Energies.03After Step 2 .699 .488 77.12 7,402.001***8.9.p<.03p<.001 Objective G: In order to determine the effect of gender on self-reported resource loss following Hugo, a t-test was conducted upon the total loss scores for the male and female groups. This t-test revealed that female faculty members reported significantly higher loss compared to their male counterparts (t( 478)=537,p<.001). A graph depicting this difference can be seen in Appendix II. The mean total loss score for males was 32 compared to a mean total loss scoreof45for females. Objective H: In order to determine whether psychological distress following hurricane Hugo was effectedbygender, a t-test was applied to the Global Severity Index (GSI) scores for the male and female faculty groups. The mean GSI T -score for the males was 49 whereas the mean GSI T -score for the females was 53. The t-test applied to these data revealed that females reported significantly more psychological distress following hurricane Hugo than males (t(514)=3.81,p<.0001). A graphic depictionofthese resultsispresented in Appendix II.


1110.Objective H:Todetermine whether psychological distress following hurricane Hugo was effectedbythe extentoflossofresources, a median split was performed on the Resource Loss Questionnaire total scores to define a high loss and low loss group. The mean GSI T -score for the low loss group was45whereas the mean GSI T -score for the high loss group was 57. A t-test applied to these data indicated that significantly more distress on the SCL-90-R was reportedbythe high loss group compared to the low loss group (t( 472)=14.03,p<.0001). A graph depicting this differenceisshown in Appendix II.11.ObjectiveI:Normative data summarizing the alcohol and medication use changes madebyour sample following Hugoarepresented in Appendix IV.Ofthe total faculty sample, 20.4% reported increasesinalcohol intake following hurricane Hugo.Asshown in Table 1ofAppendix IV, approximately the same proportion of the faculty sample was abstinent from alcohol both preand post-Hugo (23% to 25%).Thepercentageoffaculty who drank 1 to 7 drinksperweek declined from its pre-Hugo level (67%) to a post-Hugo levelof59%. In contrast to these findings, whereas only 10%ofthe faculty sample drank 8 or more drinksperweek prior to Hugo, a full 16% drank at that rate following Hugo. This increase in the proportion of the sample who drank 8 or more drinksperweek following Hugo held up across gender and loss group (See Table1,Appendix IV.).Ofthe total sample, 12% reported starting a prescription medication following hurricane Hugo, and 10.6% of the total sample reported increases in the use of prescription medication following Hugo. Increased use of over-the-counter pain medication was reported by 27.4%ofthe total faculty sample, and increased use of an over-the-counter cold medication was reported by 12%. Increased use following hurricane Hugoofover-the-counter antihistamines was reportedby16.3% of the total faculty sample.12.ObjectiveJ:Figures 1-7 showninAppendix IV provide information about subject variables (e.g., gender and pre-Hugo drinking patterns) thatareassociated with increased use of alcohol and medication following hurricane Hugo. For the analyses that examined the effectofresource loss on alcohol and medication use, a median split was performed on the Resource Loss Questionnaire scores to define a highlossand low loss group. The highlights from these figures include the following findings: a) Changesinalcohol intake after the hurricane were similar for males and females. b) A significantly greater percentageofthe high loss group reported increasesintheir alcohol intake compared to thelowloss group.


12c) Males who drank more than 8 drinksperweek prior to the hurricane reported a higher rateofincreased intakeofalcohol (47%) than any other group. d) A higher percentage of females compared to males reported starting a prescription medication following hurricane Hugo. e) A higher proportionofhigh loss females compared to other groups reported an increase in prescription medication use following Hugo.f)A higher proportionofhigh loss females compared to other groups reported an increase in over-the-counter pain medication and antihistamine use following the hurricane. g) Genderorloss group did not appear to affect increases in over-the counter cold medication use.13.ObjectiveK:Normative data which describe the health-related characteristicsofour faculty sample and the changes in health habits our sample made following hurricane Hugo are reported in Tables 1-5 in AppendixV.Perusalofthe data shown in these tables indicates that the entire sample displayed, on average, increases from preto post-hurricane in snacking (t(520)=7.4,p<.0001), fast food consumption (t(515)=12.1,p<.0001), and skipping meals (t(516)=2.5,p<.05). A significant decreaseinexercise frequency was also noted (t(513)=12.8,p<.0001).Ofthe total sample, 15.4% reported weight gains compared to 12.8% that reported weight loss. Over half of the entire sample reported a disruption in exercise routine, and the most commonly cited obstacle to regular exercise was lack of time, followedbylack of energy and indisposed exercise facilities.14.ObjectiveL:Inorder to determine whether the extent of loss of resources was associated with disruption in health related behaviors following Hugo, a median split was performed on the total scores from the Resource Loss Questionnaire to create a high and alowloss group. Tables 2-5 shown in Appendix V summarize the effects of gender and lossofresources upon health related behaviors following Hugo. Perusal of these tables reveals several highlightsofthe data: a) A series of two-way ANOVA's revealed that the high loss group reported significantly greater changes than the low loss group on snacking (F(1,452)=15.7,p<.0001), fast food consumption F(1,452)=32.9,p<.001), and exercise frequency (F(1,452)=21.5,p<.0001). There were no significant gender effectsorgenderbyloss interactions on these variables.


13b) Females reported greater weight changes than males (F(1,452)=20.9,p<.0001) and the high loss group reported greater changes than the low loss group (F(1,452)=11.2,p<.001) (See table 4.0, Appendix V.). No gender by loss interaction was found on these variables. In addition, 50%ofthe high loss females reported "moderate" weight changesof5ormore pounds, compared to 28%ofthe high loss males and 37%ofthe low loss females. c) High loss individuals showed a significantly greater decline in exercise than low loss persons (F(1,465)=22.5,p<0001). No genderorgender by loss interaction was found on the variableofexercise frequency (See Table 5.0, Appendix I).B.Results for the student sample compared to thoseofthe faculty sample.1.ObjectiveA:Ingeneral, the student and faculty groups reported similar levels of loss, distress, and health habit changes. The student and faculty groups were not different on the Global Severity Indexofthe SCL-90-R. Mean GSI scores for the student and faculty groups were .39 and.37,respectively. Seven of the10most frequently endorsed SCL-90-R items were the same for both groups, suggesting similar symptom patterns.2.ObjectiveB:With regard to scores oJ:.l the Resource Loss Questionnaire, the student and faculty groups reported comparable levelsofaggregate loss. On individual itemsofthe Resource Loss Questionnaire, 8ofthe10most frequently reported losses were the same for the faculty and student groups. For both groups, higher losswasassociated with greater distress.3.Objectives C,D,F, G, and H: A hierarchical multiple regression analysis was applied to the student data in ordertodetermine which variables among resource loss, personal characteristics, and coping behaviors were most predictiveofpsychological distress in this sample. Three blocks of variables were entered: demographic/experiential, resource loss, and coping behavior. The demographic/experiential variables were entered first as control variables (sex, marital status, household income, and prior disaster exposure). Aggregate resource loss was entered as the second predictor block. The following coping behaviors were entered as the third predictor block: problem focused coping, emotion focusedcoping, and disengagement focused coping. The resultsofthe hierarchical multiple regression are showninTable6.Please note that oneormore asterisks indicate a significant beta weight. Thisisimportant for two reasons: first, significant beta weights indicate which variables within each predictor block are accounting for dependent variable variance; and second, the absolute size of beta weights indicates


14which variables are most importantinpredicting the dependent variable. Table 6 PredictionofGeneral Severity Index for the Student Sample Using Personal Characteristics, Resource Loss, and Coping Behavior Predictor Variable Block1:Personal Characteristics Gender Marital Status Household Income Prior Disaster ExposureMerBlock 1 Block2:Resource Loss Aggregate Resource Loss After Block 2 Block3:Coping Behavior Problem Focused Emotion Focused Disengagement Focused After All Three Blocksbeta-.160* notsig..023-.025 .441**-088-038-366***RR2FdfP .358.128 5.78 4,157.001.687 .472 27.94 5,156.001.749 .562 24.49 8,153.001******Females were more distressed than malesGreaterloss was associated with more distressGreateruse of disengagement focused coping was associated with greater distress In order to ease comparison of the resultsofthe multiple regression equations conducted separately on the faculty and student samples, Table 7ispresented below. This table presents the percentageofthe GSI variance accounted forbyeach predictor block when the multiple regression equations were calculated separately for the faculty and student groups.


15Table 7 PercentofGSI Variance Accounted forbyEach Predictor Block Contained In the Hierarchical Multiple Regression Analyses for the Faculty and Student Data. Predictor Block Faculty Group Student Group Demographic/Experiential 9.5% 12.8% Resource Loss 34.1% 34.4% Coping Behavior 7.9% 8.9% Total Variance Accounted for 51.5% 56.1% InspectionofTable 7 indicates that for both the faculty and student groups, resource loss was the single best predictor of psychological distress. In addition, demographic/experiential variables accounted for approximately the same amount of variance in GSI scores for the faculty and student groups. Moreover, the total amountofGSI variance accounted for in the hierarchical multiple regression was approximately the same for the two groups (faculty and students) under study.4.Objective E: To assess the role of resource loss as a risk factor for clinically significant psychological distressinthe student group, we used level of resource loss (high, low) as a grouping variable and scores on the General Severity Index (GSI) as a dependent variable. Given known gender differences for SCL-90-R scores, separate analyses were conducted for male and female student participants. Specifically, participants were assigned to the high resource loss group for their gender if their resource loss score was in the uppermost 25.0% of the distribution for their gender. Conversely, the low resource loss groups consistedofindividuals with resource loss scores fallinginthe lowest quartile of the distribution for their gender. Among male students, the high loss group reported significantly greater levelsofpsychological distress (t(68)=3.24,p<.002). Using non-patient norms for the General Severity Index, 21.1% of high loss student males exceeded a cutoff score indicative of clinical distress (t-score>63).Bycontrast, only6.1% oflowloss males exceeded the cutoff. Among female students, the high loss group, compared to thelowloss group, reported significantly higher


16psychological distress (t(102)=-5.25,p<.001). Using nonpatient norms for the General Severity Index, 50.09% of high loss female students exceeded the T-score cutoffof63.A more modest 18.4%oflow loss females exceeded the clinical cutoff. Comparisonofthe student data presented in the preceding paragraph with the corresponding data for the faculty sample (See page 9ofthis report.), reveals that for both groups high resource lossisassociated with significantly higher levelsofclinically relevant psychological distress. Further examinationofthe percentageofhigh versuslowloss students and faculty who exceed clinical cutoff scores suggests loss has a particularly strong effect within the faculty sample.5.Objectives I andJ:Students and faculty reported similar patternsofchange in alcohol and medication usage following Hugo. High loss and high distress were associated with greater increases in alcohol and medication use for both groups(p<.05). A higher percentageofthe female student group, compared to all other groups, increased their useofmedications.6.ObjectiveK:The students reported health related characteristics (% overweight, smoking status, exercise frequency, etc.) almost identical to the faculty. The only differencebeing that fewer students regarded themselves as "regular exercisers." Students' food consumption patterns after the hurricane were in the same direction as the faculty's reports. Consumption of "healthy" foodstuffs declined, whereas the consumption of those foods considered tobeunhealthy in large quantities increased.7.ObjectiveL:Consistent with the faculty data, female students and students who reported higher levels of loss displayed significantly more change in health behaviors(p<.05). These changes generally were in the unhealthy direction.Aswith the faculty, greater change to "unhealthy" food choices was seen in the female and high loss students. Snacking behavior did not change for students, whereasitshowed a significant increase for high loss faculty(p<.01). Compared to low loss students, high loss students reported skipping significantly more meals(p<.05), whereas this was not different for the faculty.


17Both students and faculty with higher losses reported increased consumptionoffast food and a decrease in exercise. Snacking behavior, fast food consumption, skipping meals and changes in exercise were not different between males and females for either the studentorthe faculty populations. Small differences in weight change patterns were noted for both the faculty and students. Across all groups (male versus female and low versus high loss), the mean weight changeinthe student and faculty groups was identical(x=2.3Ibs.). The absolute weight change for male students in the high and low loss groups (2.5Ibs.,2.1Ibs.) was roughly equivalent to high andlowloss faculty (2.8Ibs.,1.71Ibs.). However, in the high loss group, a higher percentage of students reported weight losses (23.5%) than gains (11.7%). This trend was reversed in the faculty data with 16% reporting losses and 21.3% reporting gains. Roughly 20%ofthe low loss males in both populations reported weight gain; 9.1%oflow loss males noted a loss, whereas only 2.9%oflowloss faculty reported a loss. Thus, it appears that male students are more susceptible to losing weight than their older faculty counterparts who were more likely to gain. Female students and female faculty in the high loss groups showed nearly identical patterns of weight change. Fifty-one percentinboth groups reported weight gains, and 18% reported losses. Low loss female students showed smaller absolute weight changes (1.8 Ibs.) than low loss female faculty (3.2 Ibs.). Only 19% oflowloss female students reported weight gains compared to 34.8% of thelowloss female faculty. The most frequently reported obstacles to an exercise routine for both students and faculty were1)lack of time and 2) lack of facilities. Summarizing the comparison of student and faculty data about health related issues, the experience of hurricane Hugo appeared to have affected students and faculty similarly. Unhealthy changes in food consumption, weight, and exercise patterns were noted in both groups. In general, females and high loss persons displayed greater changes. The most notable differences, which couldbeexplained by age, were directionofweight change.


18VI.ReferencesCarver, C.S., Scheler, M.F., and Weintraub, J.K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267-283. Derogatis, L.R. (1983). SCL-90-R: Administration, scoring, and procedures manual-II (2nd ed.). Baltimore, MD: Clinical Psychometric Research. Hartsough, D.M. (1985). Disaster work and mental health: prevention and control of stress among workers. U.S. Department of Health and Human Services Publication No. (ADM) 85-1422. Lystad,M.(Ed.). (1985). Innovations in mental health services to disaster victims. U.S. DepartmentofHealth and Human Services Publication No. (ADM) 85-1390. Hobfoll, S.E. (1988). The ecology of stress. Washington, DC: Hemisphere.


MEDICAL UNIVERSITYOFSOUTH CN{OUNA StudentLifeCenter Dean otStudent Ute (S031 792-4402StudentSupportServices (S031 792-4334Counseling and PSychOlogical Services {S03, 792-4930 StudenrJ\VennessCenter 18031792Human Performance Labofarory {S031792 StudentHeallhService lS03/ 792Student and Activities 18031792 StudentFinancial Aid Services (8031792 Studenr Dormitory18031 792-4141 171Ashley AvenueCharleston.SouthCarolina November 13, 1989TO:FROM:SUBJECf:MUSCFaculty, Staff, and StudentsDarleneL Shaw, Ph.D. Director, Counseling&Psychological services Psychological EffectsofHurricane Hugo Hurricane Hugo has had a major effect on our lives. Help us understandthepsychological aftennathofthe storm and become eligible to win oneoftwo free dinners for twoatRobert'sRestaurantbycompleting the attached survey.Thedrawing will be heldintheStudent Wellness Center Classroom at noononDecember15.Youneed not be present to win.TheNational Hazard Center in Boulder, Colorado awarded a grant to Counseling and Psychological services to study the effectsofHugoonthe MUSC community. As partofthatgrant we are conducting the enclosed survey. Please be totally honestasyou complete the survey. Alloftheinformation you provide will be absolutely confidential.Toparticipate andbeeligible foroneofthe free dinners for two, please dothefollowing:1.Detach the survey from this cover letter. Complete the survey.Donot put your nameonthesurvey! This will ensure your anonymity. Place completed survey in the large pre-addressed envelope provided. 2 Complete this cover letterbyfilling in your name, department, and phone extensioninthe spaces provided below. This servesasyour entry form for the drawing. Place the letterinthe small pre-addressed envelope provided. 3.Dropboth envelopes in campus mail.Ifyou have any questions about the survey, please call 792-4930.Thankyou for taking the time to complete the survey.Theresultsofthe surveywillbepublishedinthe Catalyst and professional journals. Name---------------Phoneextension----Department. _"An equalc;:Jpcr;uOl:ry mit aiflfrr.a[lve acnonemployer' \._------------------------------


General Background Questionnaire Indicate your responsesonthis questionnaire. When a question requires a brief answer, do so in the space provided (e.g., age). When a question requires choosing alternatives, circle the answer that most accurately reflects your life.l. Sex: MF3.Race:a.asianb. blackc.hispanicd.native americane.whitef.other5.Highest Education:a.High schoolgraduateb.Associates degreec.Bachelors degreed.Graduate degree e.other7.Annual personal incomea.SOto10,000b.S1O,OOIto20,000c.S20,001to30,000d.S3O,001to40,000e.S4O,001to50,000f.overS50,0019.Living arrangements prior to Hugo:a.owned residenceb.rented residencec.lived with parentsd.other2.Age (today):4.Marital Status:a.single b. marriedc.separatedd.divorcede.widowed6.Affiliation atMUSe:a. student b. faculty/ staffd.professional staff (nurses, social workers, etc.) staff (clerical, etc.)f.other_8.Annual household incomea.$0to10,000b.S10,001to20,000c.S20,001to30,000d.$30,001to40,000e. $40,001 to50,000f.over$50,00110.Numberofpeople living in household prior to Hugo (include self): I2345678ormore11.Numberofdependents living in household prior to Hugo (include self, children, older relatives): 12345678ormore


12.Where did you stay during hurricane Hugo? a. own residence b. residenceofa family memberorfriendc.a shelterd.a hoteVmotel e.atworkf.other_13.Whowaswith you during hurricane Hugo? (circle only one) one, membersorclose friendsc.acquaintancesorco-workersd.other_14.How far from Charleston (the peninsula)wasyour placeofrefuge?a.lessthan25milesb.26 to 100 milesc.101to 150 milesd.over151miles15.Towhat extent did you fear for your safety duringhurricane Hugo? 1 notatall23moderately 45extremely16.To what extent did you sustain physical harmorinjury due to Hugo?1notatall23moderately45extremely17.Towhat extent did your decisions regarding hurricane Hugo place youatrisk for harm? (e.g., where to stay, whenorif to leave, etc.)1not at all23 moderately45extremely18.To what extent did your decisions regarding hurricane Hugo place other peopleatrisk for harm?1not at all 23moderately45extremely19.To what extent didotherpeople make decisions regarding Hugo that placed you at risk for harm? (e.g., job/partner required you to stay) 1 notatall 23moderately 45extremely


20.Howsoon after Hugo did you see your residence?a.immediatelyb. 1to3daysc.4to6daysd.greater than6days21.Estimatethefinancial costofrepairing damage to your primary residence? (includes structure and contents) a.nocost b. less thanSS,OOOc.SS,001to$20,000d.$20,001to$50,000e.SSO,OOIto$100,000f.over$100,00022How long were you displaced from your primary residence due to Hugo?a.IwasnotdisplacedataUb.less than3daysc.3to7daysd.8to14dayse.15to30daysf.31daysormore, but I am back inmyprimary residenceg.31daysormore and I am not back inmyprimary residence23.How soon after the storm did you return to your placeofemployment? (school for students)a.1to3daysb. 4to 7daysc.greater than 7days24.Have you ever personally experienced a natural disaster prior to Hugo? (hurricane, tornado,flood,earthquake, etc.) Yes__No25.Areyou a nativeofthe Charleston area?Yes__No26.How long have you lived in the Charleston area?a.less than 1 yearb.1 to 5 yearsc.6 to15yearsd.over15years


RESOURCES QUESTIONNAIREInstructions: Listed below are a numberofthings which make life easier and/or enjoyable. Since hurricane Hugo you may have experienced a lossofmanyofthese resources. Carefully consider each resource and rate theextent to which you have experienced a lossofthat resource since Hugo. Rate [he extentofloss for each resourceonthe following scale:o=no loss 1=a little bitof loss 2=a moderateamountof loss 3=quitc a bitofloss 4= extremc amountof loss 1.Personal transportation2.Homecontents3.Time for adequate sleep4.Sentimental possessions (photo albums, etc.)5.Clothing6.Feeling valuable to others7.Family stability8."Free time"9.Pets10.Vegetation on your property (trees, shrubs, etc.)11.Intimacy with oneormore family members12.Time for work13.Feeling that I am accomplishingmygoals14.A good relationship withmychildren15.Time with loved ones16.Necessary tools for work17.Stamina/endurance18.Adequate food19.A daily routine20.Personal health 21. Sense of optimism22.Necessary appliances for home


L Height:__ft.__in. HEALTH HABITS2.Weight:__3.How much has your weight changed since Hugo? (circleone&indicate amount) no change gained/1ost__Ibs. 4. Which statement best describes your weight loss effortsBEFOREthehurricane: (chooseone)a. trying toeatfewer caloriesb. trying toexercisemorec.botha and bd.attending a formal weight loss program e.not trying tolose weight 5. Which describes yourCURRENTweight loss efforts (choose one)a. trying toeatfewer caloriesb. trying to exercise morec.botha and bd.attending a formal weight loss programe. Iamnottrying to lose weightHowmany timesper week did/do you eat fast foods 6.BEFOREthe hurricane: 7. SINCE the hurricane:o12345678910ormoreo12345678910ormoreHowmanymealsperweekdid/do you skip (brea.kfast included) 8.BEFOREthe hurricane 9. SINCE the hurricaneo12345678910ormoreHowmany snacks did/do you eatperday10.BEFOREthe hurricaneo1234ormoreo12345678910ormore 11. SINCE the hurricaneo1234ormore Usingthefollowing scale,desafbeyourintake ofeachofthefollowing foodsSINCEthehurricane:12much less12._redmeat13. -poultry/fish 14._vegetables15._breads/starches16._fruit17._milklyogurt18._cheese19._chips/crackers/pretzels34no change5much more20. _desserts (ice cream, cookies, cake, etc.)21.chocolates/candies22. _fast foods (burgers, chicken, french fries) 23. pizza 24. fried foods 25. beverages with caffeine (coffee, soda)


26.Do you consider yourself a regular exerciser?12notatall34somewhat5very much so ZT. Ifyou exercise regularly, whattypeofexercise do you engage in most often: (circle one) not a regular exerciser walking running swimming aerobic dance cycling weight trainingother(please specify) About howmany timesper weekdid/doJOuCIeIdse28. BEFOREthe hurricane 19. SINCE the hurricaneD1234567 8910ormoreD1234567 8910ormore30.Whichofthe following has contributed the most to changes in your exercise SINCE the hurricane: (pick one)a.myexercise has not changedb.not enough time to exercisec.not enough energy to exercised.exerciseisnotasimportant to mee.lackofexercisefacilityf.lackofexercise partnerg.other The net several questions ask aboutalmholmnsumption.-A drink" referstoa beer, wine moler, 407..of wine, or drink: mntaining 1oz.ofliquor.3LUsing the following scale, describe your intakeofalcohol SINCE the hurricane. Have you had alcohol:12much less34no change5much more HOw many drinks ofalmholdid/do JOu usually have per week 32.BEFOREthe hurricane 33. SINCE the hurricanea.Da.Db.1-3b.1-3c.4-7c. 4-7 d.8-12d.8-12e.13-16e.13-16f.17or moref.17ormore During the last twoweeks, howmanytimes haeJOu had 34. 1 or 2 drinks 35. 3or4 drinks on one occasion on one occasion (but no more) (but no more)a.nonea.noneb.onceb.oncec.twicec.twiced.3-5timesd. 3-5 timese.6ormoree.6ormore36.5ormore on one occasiona.noneb.oncec.twiced.3-5timese.6ormore


37. Describe your cigarette smokingSINCEthe hurricane.12much less34nochange5muchmore 38. Which describesyourcigarette smoking in the past30 days? a.havenotsmokedb.1-5cigarettesperdayc.aboutonehalfpack adayd.abouta pack a daye.about11/2packs a dayf.2ormorepacks a day 39. Which describes your cigarette smokingBEFOREthe hurricane?a.didnotsmokeb.1-5cigarettesperdayc.aboutonehalf pack a dayd.abouta pack a day e.about1112packs a dayf.2ormorepacks a day 40. Usingthefollowing scale,descnbeyouruseofprescription medicationsSINCEhurricaneHugo?12much less34no change5much more Usingthefollowing scale, desaJ.beyour intakeofeachofthefollowing medicationsSINCEthehurricane:12 much less34nochange5 much more4L_ pain relievers (aspirin, Tylenol, Nuprin, etc.)42_ cold medications (Nyquil, Contac, etc.) 43. antihistamines (Dimetapp, Sudafed, Aetifed, etc.) 44. anti-acids (Turns, Maalox, etc.) 45. laxatives (Ex-lax, Correetol, etc.) 46. diuretics (Aquaban, Pamprim, etc.) 47. diet pills (Dexatrim, Control, etc.) 48. stimulants (No-doz, Vivarin, etc.) 49. nose sprays(ACrin,Neo-synephrine, etc.)SO.other_5LPlease list any prescription medications that you have started takingSINCEthe hurricane: 52. Using the following scale, describe your seat beltuseSINCEthehurricane.12much less34no change5much more


COPEHurricane Hugo produced challenges for eachofus.Weare interested in what you have done to cope withthechallenges createdbyHugo. Your responses should reflect your efforts to cope from immediately after the hurricane until today. Respond to each item according to the scale below. Your response for each item should be written in the spaa corresponding to the item. 1=I have not donethisat all2=I have done this a little bit3=I have donethisa medium amount4=I have donethisa lot1.I have tried to growasa personasaresult of the experience.2.I have turned tomyworkorother substitute activities to takemymind off things.3.I have gotten upset and letmyemotions ouL4.I have tried to get advice from someone about what to do.5.I have concentratedmyefforts on doing something aboutthe challenges.6.I have said tomyself"this isn't real. W 7.I have putmytrustinGod.8.I have laughed aboutthe situation.9.I have admitted tomyselfthat I can't deal with the challenges and quit trying.10.I have restrainedmyselffrom doing anything too quickly.11.I have discussedmyfeelings with someone.12.I have used alcohol or drugs to make myselffeelbetter.13.I have gottenusedto the idea that the hurricane happened.14.I have talked to someone to find out more aboutthe situation.15.I have keptmyselffromgetting distractedbyother thoughts or activities.16.I have daydreamed about things other than this.17.I have gotten upset, and am really aware ofmyfeelings.18.I have sought God's help.19.I have made a plan of action.20.I have made jokes about the situation.21.I have accepted that the hurricanehashappened and that it can't be changed.22.I have held off doing anything about the challenges until the situation permits.23.I have tried to get emotional supportfromfriends or relatives.24.Ihavejustgivenuptrying to reachmygoals.25.I have taken additional action to trytoget rid of the problems.26.Ihavetried to losemyselffor a whilebydrinking alcohol or taking drugs.27.I have refused to believe that Hugohashappened.28.I have letmyfeelingsouL29.I have tried to see Hugo in a different light, to make it seem more positive.30.I have talked to someone who coulddosomething concrete about the challenges.31.I have slept more than usual.32.I have tried to comeupwith a strategy about what to do.33.I have focused on dealing with the challenges, and if necessary let other things slide a little.34.I have gotten sympathy and understandingfromsomeone.35.I have drank alcohol or taken drugs,inorder to think aboutthe situationless.36.I have kidded around about Hugo.


Continue to answer each item with these response choices: 1=I have not donethisatall2=I have done this a little bit3=I have donethisa medium amount4=I have donethisa lot 37. I have given up the attempt to get what I wanL 38. I have looked for something good in whatishappening. 39. I have thought about how I might best handle the challenges.40.I have pretended that the hurricane hasn't really happened.41.I have made sure not to make matters worsebyacting too soon.42.I have tried hardtoprevent other things from interfering withmyeffortsatdealing with this.43.I have gone to moviesorwatched TV, tothinkabout the situation less.44.I have accepted the realityofthe fact that Hugo happened.45.I have asked people who have had similar experiences what they did.46.I have felt a lotofemotional distress and I found myself expressing those feelings a lot.47.I have taken direct action to get around the challenges.48.I have tried to find comfort inmyreligion.49.I have forced myself to wait for the right time to do something. 50. I have made funofthe situation. 51. I have reduced the amountofeffortPmputting into solving the challenges.52.I have talked to someone abouthowIfeel.53.I haveusedalcoholordrugstohelp me get through the challenges.54.I have learned to live with the hurricane.55.I have put aside other activitiestoconcentrate onthis.56.I have thought hard about what steps to take. 57. I have acted as though it hasn't even happened.58.I have done what has tobedone, one stepata time.59.I have learned something from the experience.60.I have prayed more than usual.


IAGE IOJ;1.5 lOCATlON:_EDUCATION: VISITNUMBER:_! __._.d.__ SEXMALEo 1"0"1 HOWMUCHWEREYOUDISTRESSEDBY:1.Headaches1232.Nervousnessorshakinessinside2233.Repeatedunpleasantthoughtsthatwon'tleaveyourmind3234.Faintnessordizziness4235.Lossofsexualinterestorpleasure52,36.Feelingcriticalofothers6237.Theideathatsomeoneelsecancontrolyourthoughts7238.Feelingothersaretoblameformostofyourtroubles8239.Troublerememberingthings92310.Worriedaboutsloppinessorcarelessness10I2311.Feelingeasilyannoyedorirritated11123I12.Painsinheartorchest121I2313.Feelingafraidinopenspacesoronthestreets132314.Feeling low inenergyorsloweddown14 23 \.' 15.Thoughtsofendingyourlife15.J2316.Hearingvoicesthatotherpeopledonot hear 16 ; 02317.Trembling1702318.Feelingthatmostpeoplecannotbetrusted18 G 2319.Poorappetite1902320.Cryingeasily2002321.Feelingshyoruneasywiththeoppositesex2102322.Feelingsofbeingtrappedorcaught2202323.Suddenlyscaredfornoreason2302324.Temperoutburststhatyoucouldnotcontrol2402325.Feelingafraidtogooutofyourhousealone2502326.Blamingyourselfforthings2602327.Painsinlowerback2702328.Feelingblockedingettingthingsdone2802329.Feelinglonely29I02330.Feelingblue30I02331.Worryingtoomuchaboutthings31 I02332.Feelingnointerestinthings321 G i 2333.Feelingfearful3302334.Yourfeelingsbeingeasilyhurt340 3 L 35.Otherpeoplebeingawareofyourprivatethoughts35023PleasecontinueonthefollowingpageiNSTRUCTIONS:Belowisalistofproblemspeoplesometimeshave.Pleasereadeachonecarefully.andcirclethenumbertotherightthatbestdescribesHOWMUCHTHATPROBLEMHASDISTRESSEDORBOTHEREDYOUDURINGTHEPAST7DAYSINCLUDINGTODAY.Circleonlyonenumberforeachproblemanddonotskipanyitems.Ifyouchangeyourmind.eraseyourfirstmarkcarefully.Readtheexamplebelowbeforebeginning,andifyouhaveanyquestionspleaseaskaboutthem.EXAMPLEHOWMUCHWEREYOUDISTRESSEDBY:1.Bodyaches


TIle RelationshipBetweenLossofResourcesandClinicalSymptomatologyAmongSurvivorsofaNaturalDisaster:AClinicalApplicationoftheConservationofResourcesModelDarleneShaw,Ph.D.;JohnFreedy,M.A.;PatJarrell,M.A.andCherylBene,M.A.DepartmentofPsychiatIyandBehavioralSciencesMedicalUniveristyofSouthCarolinaCharleston,SouthCarolina Ten Rcsour""LosslI.auM .... Froqucntl1EndonodT:.n6cWKd"'Ctc1hoK...id1rnpondcnuQte:d,1.1" I Ofh"h(, on a l..ilc:nacaIcnnpiActo.0 to4....... ..u .. ....... ... _-.,-__ ...-...... -'1LSI'-.-..--... u .. "" "., .. u., ......21" ,.It-....-.-...-....---.-......U.......6StfIto..,......14.)t_-.w-c.,.... "1t ., ...0JI)1'-.........")'.--............."""' .. ""$Cl..90--a.icWJIII.bthc...""">--""'-... r... .......;.""",d'lollTUr",Ih,:n .. ucffc.ocdbylmodelOfItIcc.&lena01Iou.01fUOUt'CC.LII 11 Oc:W'nnOtwIN:eReo01rcndc-r on loud rollo ...."'=11,,;0bDacribcandq_il,b:lypcaelkMla",lJuUIbramp":u .c....."oil It.. ,o.Purpose.._A._oIl1lCWJUw-.tpo:rwai'lIIl.-..a.C_IlO....'"$u.Ie&,.ca-.edSampleFot....Iea.theIi.'"nNcIIlI__......puIOftIJraidmoc:....)S"cn6onin&iLs.......... 6. Tbct)'pCel"*"dCI..-acwerr.......for....1nII.........4.1\rc"....,.....ol4Uual__......_Iirdart.-Im"'lC-aIa.. 2. Jok-.KOfa tOl -.alaMdkmaIa_.-.cSCLJO.ItWIbdookdftctJ-"t.'J........-...b. t.""'")IftdIIhchi&:h...(now.....1au'l9Wp) .). Fa-lalClDftlllllipil'K*Id,hip"'ln&b.dICI4COI"t1 01 h:0t0baI1tdu.$cUe(OSf)ollhcSCJ.,..l;lO., SummaryI. __IWXIfCI_sa.,.9O-.1CIJa;_\IU)'.-a.rlGr...... ......"'T ............GM4MI"""......fOIIQ.......L.-................... 'tcnI.,.....-,..,..T............(QSI)....WM................r...uea.w.i&f""........__....for-".__)n.cndorIinc.fw'-Mc:a,..-.cdahUInwUd.....tocecIhinpl6anc.owictI.....-'enillck..'-' Ten SCL-90RlI.msMoslFr.qu'DtI,Endo .... d ---...........-..I.ooI..OatwoId*'-........--.......... ... ... II ........... "..I .....I.-o............. " .. '''''''"'''c......,.... '" .. ).w-,.Mc_........... " .. ..............1................."".......-" "n ........ _ .,.. .. '" II" ..." "1ST............"It"'"sa-p...,,--........" II" ""E.IICIonoQac.. _uIhoIcwt.CIMOdu-..cdaaIety(1)lWWdG_'IIaknncinctro-O104 -.b..1J..---. ...-.-ol)'OW-..dc:.I'''-'-cd ...... 1CIIlb,........,.,1ftCIL.......Ianob.l<,.-......-.........""01....__hquond,.aA,aM Uann; r.loWS.D._10..IJ....."'172,.,........'HM'NffJI'SDOQDt!TlhCf,.,.0.."""'"

AppendixIII RHIRINeup.ychologloal dl,tl"l"(. g., prOVidingnorm.llv. ihlOf'lMlionoono.mlngplychologlcal '''C1lonl, ...urlnoe) 3. Coping bthblot,wh.therfocvNd on probllm.,.motlonl,0' dl .. lllouid rldUOI PlYehologlcol dl.Ir...10the txl."t'hllthecoping .. rvll toflpl.nllh ( .g.finding.h.'I." ,.....t.bll.hlng .ool.III.. Cllnla.1 wort ....m.y bI mo.1 helpful by .noourlgl"gcopingIhltadd,..... Ih.,.eourc. n.tdeof Ihe nalural dl..,t., vwUm..-.L (1M?\. '............,. .... __-....AV...-'" I 'A.111)....Ct'Mhw' "a' ar......tnrte ......................,..,....................#IIJI..a.u.................. .. ............, tnn=, ..'"1'1,. 'M'" ..,'" ",..... .-...--"'" '__.. _11" ...........LAI''0"" 'tt' _... to' NMdUI'"MOIc.-....,..............,..,--. -'O"M.,VlIof't.C."..,......-"..................... 9"W=Mn1, __.._ ......-...--.CIII_ ...... 1 ..f4(1L.,................LLI'.......... "..-........ ........................u.f1wn......-...___ 1M _nee II'eC W....Itl(11.._ EMPIRICAL TESTF.mel..C.AN High LOI.LowLOll (n-12)(n.flO) U.211o10.1110(1(2'0),'.18, P . 00')Mil..SUMMARYOFKEY HighLOllLow I.0Il(noll) (n.ll1) 31101110(1(20.),'.01, p .0011rlbll' P ...v.l.nOl or.llnlcolly .Ignlfloonl p.yehologle.1 dl.I,.... Imonohigh endlow10.. mil ...ndl.m.I...Tlbl' 3p""add,. ..l"g thlIhlrdhypothlil. .bov. 1110 olinlo.1 cuIon100 ... (1013)."A. prodlClod,1110prov.len ..01.lInlo.11y mllnlng'uldl.I,... IonllgnlllconUy ... lIt""ongpoopl.npo,l.nelnghigh01I0OI10 .. oomporld 10 poopl porl.nelng low....ou10... TIlIgnllloonl dln .... _. h.kllo, bolh milInd'.m.r..1. lubllqUlftllonolU,,1dl_lIt,1no .... 1Id1IV11. 0' "'IourotJo .. I,..poalUvtly.INCIIIed withIncr.....In bolh p'Y0hologlcol dl....... IftdDOping behavlo,. 2.Po'l ""twal dJ .....,adlu,lrntnloanbeviewed III ..In whlokInvlrof\JMnIa''lctO,..(I.g ,.,oure.toN).remore'mportanllMnplf"80nellaclon, g., beh.vlor) In I. High tn.1. 0' rnouroela...... l.. oolll.cfwIththlellnloolly 1IV11. 01Cllnlctllmpllctllon.01K.yFInding.1. In_tlon .n_ .houklll,glllndlYldu.l.'.plrlln.lnghigh !IvI1. or ... IOU"," lollII Il1011IndlYldu.r vvlnOflblllo poyehologlcll dl.I......2. TIl.1ypII 01 "'lOUroo loII"'por1od con guld.lh. .hould rod_poychologlcll dl.I...... Whlnhigh" 11,.. OUtOft.,.,"tot" (.. g .. Nnae o'oonltol)Ih. mllUng ofIh... MId, m., r9qul ... I dlN,renl Ipprolch10 rMluce FINDINGS DI_V_ ..... M.......:11-':='=::'DlNtWAcItuMltnl..''..., . '..... T.bI y.".bIt 1I :I t '._lMo&--.......... & __ CopInfoW .111..__ CopInf,so' "_CopInf.17' .Tlbl'I ".Mnllbtv ...'e,.oor,.lllIon tll'Ylnl '0Ih. oplng .lyl... figure 2lummlrlze.dillconcemlnG Ih. retltlY Import._ oflleh.... ou"'"loll,d.mog .. phlocherac1erlltlo., and GOplnglMh.vlora Inlcoountlnglor ..... nOlIn poychologlcol dl.I.... (hypolh ..l. TIl.ngu ...I. b.Nd uponI hl.rarchlcal mulllpl' reg..... lon equIUon. blookanl_ In Ih.followingontor, _Ing 10nOIIon glldlng1",,1y e.ulll lIqu.noIng:d.mog ... phlo bloo_ (g.nd ..mlrllli.IIIU .. hou .. hokl Inoom.),.... 0""'" 10.. blook; .ndDOping blhlVlot bloo ... InlOlli, 1110propo.ed mocl.1... ounled lot 11.1110 01 peyohologlo., dl.t .....vafllnot. AI pr9dletecf, ""ouroe'0" (7.'110). METHOD 10.7110 I.m.'., 48.3110 m.l.m'.n "'0.2v-.ra; ..d10.4;r.ngl.1 .....n.llIowhll.;1.3110AI,lconlA.I.nlHl.p.nlei Nillvi American ANDPSYCHOLOGICALDISTRESS: OF A THEORETICAL MODEL 1,2 Freedy, J.R., Shaw,D.Jarrell, M.P.,andBene,Department of Psychiatry and Behavioral Sciences Medical UniversityofSouth Carolina Charleston, South CarolinaCOPINGTabl.1 .umm.rb:1IChlf'llettrllUCI".o1"I.II N.411;,..t% felurnrei.Dernographlo Qutlnonnel,.R..ou .... Qu.lllonn.l.... 12 h.""" Ipolnl Uk."ace",.nglng ,. .. xtrem.amount of10.. ;modified 'rom Hob'oll;me.tu'"::0.;'.7: loll (molft 0112111m.) e;.lnInJUb, 1 n8): polnl Uk." ...1. lrom 0.1hIVe nGt donhl.IIIUlo .. havt donhlllot; ...4 l1.mICile. wereuHd II rrwdill forIprlnclpl.componenl.f.elo, .n.lyIl.wllh..rI"",. rolilion10procluc. Ih.3 ooplng f.Clo ... ulld In Ihl Iudy:probllmfoculldcoping, mol/on locu.J coping, .nddl ."g_g.",.",ooplng.SClIo-R GlobalS.verllyIndn;Derog.U"1auAg'l0_.,:_:18 110m.nled 1 U% .Ingl., n.v.,momed10.1110 .Ingl.,p'lYlou.1y m.rrled Hlgllo., Educ.tlon: 71.4110g ...du.l.d.g, ..11.7110 d.g ... 1lIr11.1JAnnUli Houllhold .110.00018.3110 In.olftl' "0.000 110.00021.0110"30,0001.1110 Appro.lm.I.lywllk lon,louth C.,ollnl, qu.. Uonntll..... I, we...mallid1110followtng: LOSS,HYPOTHESES INTRODUCTIONRESOURCE ,. 10..will,.lIltd 10 ...,..:hologicil dllt"..andcoping beh.vlor. .., lluource lOllw111.oooun'lor mol'l : ,(chologICiI dlltr ........ rllnc.lh.n dtmogrephlo'ollabJeI orcoping blhtvlor."). il...ourci10..will be ert.k fector 'or ,".(thologICiIdlltrllLHigh....ource 1011will be'uoc"ttd wlthag"III' prev.I,nct 0'clinically ,iunlUcanlplychologlctldlltrttloompeted '0 low &',Juret loIS. 1!." .t_m.nlttlptlMntlh. hypothl ..,Inthle Ilu.!;: I; I,tl,pUN"1 to undtf'ltan4lndlvlduI'"JUlt"...",10111......11,..., . lurl' dl ... .....LU.ra'urIrev'"tndlcl'" thl' .:lIP';'."l! I ... n.lurlldl'II'"t lIrmlnvty' common(Blum, 111,,;;.";::.''''.nil'. MOl' tmpo"lnllomen'" h.alth pl ..I ,I...... l dl...terllpotU,. GinprodUOIbolh twI,and .. 1 JI.ychologle.1dl",. .. (OrM",Lindy, O,.Cl., ..,. .. ".l.,d. Korol,Wlngt', uta;Mld.hlre,.II0'0,;_ .. 1""'1). Ambiguity III."WI d.flnltlone ofdIN.I.r Uf'(,."'v.,.llh mol'definition, ""philbin". mil01 1tOU11 ('. 1:_,..,,: .nd ongoIng (I.g., tdvtnltlllin ChI pottdla."h"j"\"tlod)tv'nl.(M.d.tllmO"8rteft,1881).ThllIh.lo" I.i,,' jll" .mblgul1l.. bypropotlngand .mplriOlUy J"":4.1 orIndlvldul.ldlullm.nlfollowingnllural 1'" ('tilluN.tlon 0'Rllourc.. (COR)....... mod.1 pt

FOLLOWINGANATURALDISASTERMarkP.Jarrell, CherylR.Bene, John Freedy&Darlene ShawDepartmentofPsychiatry and Behavioral Sciences Medical UniversityofSouth Carolina Charleston, South Carolina JS IIFigure1Percentofloss/gendergroupsreportingIncreases In alcohol IntakeTABLE I PERCENT OF GENDERANDLOSSGROUPS REPORTING0,1,ORI.DRINKS PER WEEK PREANDPOSTHURRICANEhighlOll ',mal .. u12 iowlonJ.m.ln ISnigh lOll mal .. low 1011 mal,. 2. 2320 17 IS 12 I.-11Hott 12% 0' (ht 10LIIumpll upOl11dInc" ....In oVlt,lh..-counlll cold medicillon use IS20 10Figure 7 Percent loss/gender groups reporting Increases In over-the-counter anl/hlstamlnr : .'e Figure 6 Percentofloss/gendergroups reporting Increases In over-the-counter cold medIcation use hlgP'llon I. mal .." low 1011r,mal.. 13 highloti INt ..lowton malts Nol.: 12% 01the10111.ampl. raponedIlal1lng prnorpllon medlcallon, Figure 4 Percentofloss/gendergroupsreportingIncreases Inprescriptionmedicationuse IS 10Figure 3 Percentof10ss/genderJjroups startingprescriptionme cations1 20i1120.530 1220o DrlnkJl.... k 1,7 DrlnkJlwka.DrlnkJlwk Samplt Pro POll Pro POll Pro PoslTOlall).J24.7 67.1 19.3 9.616.1 Malt 19.219.2 66.6 19.3 10 11.6 Frmalt 27330.3 67.9 $9.$ 4.7 10.3HI Loss 19921.170.1 62.$ 10.016.'LoLou27.2 29.0 63.1 16.7 9.6 1031IS30 2.METHOD K.rtet thehumcane. 1200wttT.\CnlViolcampuim;aillo!.hefacuhyoIndpfo(culOnllllaHII Ihe MedicalUnlvtrJuy ofSoulh CarnlrnJ .1 Cllaflulon. Soulh Carohna INTRODUCTIONIt IiECn<:nllyl&rtcd....n;uuroallianiliclnllythe1"l$)'cholaCtClI(uoclia"'"1andhcNvinr of ilJ....i(lim)., Whilein(omution conccmina therucliofU 10 dilUtCDhuac",rr-ed in recenl year$.....clylillie u knnwn .heNt(hep.ncmA01 alcohol at'Id mcdicilllM (ollowIn, diu.(ICn Nonnative: m(onnllion of lhutypeU(nlicllm Older10 undcn.undthereApen"""andmeet the needl of nllunldluucrvictim$..Funhtr. ifvari.blescould N:prcdicl ,mups'l hlthmil. (Ot increa""" in ;Jlcohol ilnd mce,lic,;uu')f\inlcrvcnuon1> cnuhJbe: deliveredmort cfr!cll:mly 10 Ihc!oCl.flcl,roup" On SCf'lcmht, 21. 19"9,hurricane 11ul0 tuncuhot't II Ch:ulcnnn. South Carolina Ac3lcl01')'ShUrricane.HUJof:lV' lhe coaMlincwi!.h,"u"laincd of 135 mphInd ud.31Wf,n15 III 2'1(CCI.hovehi,hlide. Nol only WI"humclncnne nf themoMpowerful 10hillhe cOnlincnul U.S.. bulaha oneof lhe'Iltge.u. lIumclne(orce windsfldialed 100 miles(tomIh<: eyeo(Ihe r;IOrm.Conr;cqucnlly.thedamage caur;cdby lhe IIOtTTlwasunpn:cedenled: apptOlim.1lely ) millIon peoplewCtta((ecled: 26 livesWCttlosl;and hundreds o( peopleWCftKnlludyinjured. Sevenletnlhouund people Wett leftJobleH;OVCfhomuWertdemoyed; lndInothet 19RJXXJhomeswen:ttndcl'td uninhabilable,In theO'lltlellonIttl.Ione.pmpcnydllml,eulimalcswert' In tlce,"1 of 4billiondollatS. Hal.: 20.4% 01Ih.lolalumpl. Itport.oInett ....In aleohollnlaktUN highlou l.m.l" 10"",10"l'/'NI"nigh loum.I low 10" mal ..hlOhloll "mllnlow 10.. '.mal ..highlOll mil ..lowIon INI ..10high1011 l.mal ..10 .. 1011 lamal"high Ion mal .. low 1011 INI ..10A ('ovct Icllct upl,lInedthe orIhc cnnrllknlialilY. andJIVC on compklin,lhcqvcillnnnllre.'SliNeyJlI;llt'O;,bIllfllnk'dOUI,..((Il\l\llIl:llft I h:::thhIlahib (JucMiMnJin: Resourcc LouQueilionn;ai,c (1Inhroll' Presentedatthe24thAnnualConventionoftheAssociationfortheAdvancementofBehavior Sample SUMMARY These dill JUllellmilO('((tCU (OtCtndtt and lou ..... Ith In r .... .. '1'I(t1"'AVI .1'1 u'\10.000+14% \40.000 14'1> \.10.000 11% \0.10.000 Rm.while4'10black EduCitlon lenlcnudalc12%b3chdor decrees12%degree12%N.sU06725ft(cmale),0"-rile A medi3nIrhlwupcrfomn:don the LouQUUlionn.u"r,"coru 10 define ahilhlouandlowInu ,roup.0,1.Ire pn:M:nled by,ender.ndlou ,roup.Inclividuah complellll'th<:iu""ey wert 'Iven lheopponuOlly IncntetI dr,lwin, ror2 ,nutnlel dinnenvalued alSI20,00.Rtlum and an rnlty ronn(0 "hedt1winJwere included.


AppendixVTheDisruptionofHealthMaintenanceBehaviorsFollowingTraumaticStress:ImplicationsforClinicalIntelVentionBene,C.R,Jarrell,P.M., Shaw,D.1.,Freedy, J. RInstituteofPsychiatryandBehavioral SciencesMedicalUniversityofSouth Carolina Charleston,SC oaoursIII-.)9.1]A.......lU'o.:l.......0.'-IU..1 ......._ola....-.--...ra..... 10 ,heF .........,.ol_FoIlowIoclIocIhn1ca..b'.......GcN.r_.""""DOCUAnIIlCUASI......e--I,""""".......... ........................................."-l<, --......-)1.1IU 1l.1 .... L......-v'LI ..,'.1 I),)1......ol......,,,-' ,0., 14.1 I. 0U IU ... 1).9T&Wc1.1 ... a.-..R......,....O""p)"-p<.aJO Sl,pU'.-.bwi""......F-Ia.,"...,.....-............__.,..."cbw""'.......oo()t.wWtl6oc...........&& or Fladlap.ncW'U\adoI.mcWbwo.IIt7'-=*tlOlll"D'&Ul"riacfarihn . -..1 _10.-...,....., .o.-a.__oo4__ ._ a......-tJIIIH-.. nc-.I.....,&cr ...&colCOl--.o-.......wnc-c.loupa.toIM......,....e::a-.,...low_f'C"O"&.v............-.". M__....w-...AWP..-.."'t-'-w"t......................,.,................1\oI;.....-pdoII.......,..__.._ol.......-..,'-W-O.......,.,.Iolq<__ py,November1-4,1990in T&Wc1.1"""""to-""'"T.btcU_....ol""ld"",Gco4a'u4"7t...e.Table...UlUM",UJr,!Tllo.. 1.1, 1.)1 fI."1.11 ........." 1.101..11 F 1.1,I.U ....-"L>t1.1) 1.<71.".-" ...Ut I.",-"t"-: __ ...-..,..-...;..-p..........,................ c .. FnqtH-.c7elHcaflJlR..daWId.a...wn"1l..e.-(-eaa.toIMbc1"'"pet'..-cd)'", .....11.''10LeI-.I.llb&.LK"-'-..... '..1'"11..1 .51.1'"...e-1.1...III'10)oUt.. o-cc 10 ol_lldolH....rionb,e-krI"'""""-ol.............,....-)T&Wc1.t r ..........ol .. Itq>ortl"Ca..... 10 ....e..... IMol''''FoIlowiartcw1aiGa.........-.dIc..."-.-..lrr..............j.D).n......-Ir..".,......-.. ..-:&._L.:t.... (_T j.l). T .....UA--..1.-,./J4OVA'I-...J.Itr.Ip'-............-.'-...--..ctiacOl(I.W)-IJ.'.,..e..:Dl.1_---...-QlICI..u.I)-J1.'.r<""'l.....-.....-.lI'l',-<. I. ...dl.-.pI.'-I*......."'"-.Results......--b.... ___........ .. _.I....,.."...-"'-c'-.i1......o.__......,...,.-.........w......wMt .. .,.......,....aodoo.cpc-.""-'-e:tr-t---rMaw,........_..,---,K-oI.._.-IW::I"r--'-'-c..............,to.-bIu.........,......-TM.... ....-_004_...........................,......,.--.........,......-=W--."'-..wIrJ.1IC.A..................W--r'l ........__................,.,.-.._ ..,._..........r-..,..aI----.a:.r-.J,..od*"-.M"r"a..-1..-...."..SQ.AQ,__.....Aplrae-d,<.D:Il:...xp<..OOl).r-&......_'-(fI(1.47I)ooU....p<.O::O)UIIf...,.........................-.f"d;lIII.wII .. ...----",..,......-_......->-1-.__........ItC)....... ( .. T .....].Q. r ....l.IJ_CI'WIIIlI1.........-.ld.wfr:tJlwpw"-..."...,.--'OO'.....rpaoi(oodL


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