UC Berkeley

Disasters affect millions of people every year and the frequency of natural disasters, in particular, are increasing due to climate change. Exposure to natural disasters is associated with a variety of mental health consequences, and some of the most studied outcomes are post-traumatic stress disorder, major depressive disorder, and physical and mental health comorbidities. The burden of these outcomes have been well documented. There is limited literature on those who experience positive adjustment in the aftermath of a traumatic event. Only recently did we really begin to understand the long-term mental health impacts among those who experience disasters. Evidence from the small pool of longitudinal studies have found that symptoms of distress peak among survivors in the year following the disaster and then improve for some. For others, symptoms persist for months and even years. Because of this, there are several proposed response pathways. These pathways include chronic low well-being, resistant, and resilience. However, the literature on what contributes to these different pathways, especially those who experienced resilience in the long term, is limited. Psychological resilience is generally defined as the process of how individuals remain relatively stable levels of psychological and physical functioning after exposure to trauma. One of the main methodological barriers in addressing this gap is due to lack of longitudinal data among survivors. Understanding the impacts of long-term mental health and the contributing factors which bolster resilience may provide new and enhanced prevention and treatment strategies for communities exposed to emergencies and disasters, in addition to informing upstream disaster management and crisis response efforts among those who are most vulnerable. Another important aspect of post-disaster mental health is how place matters, particularly for those who experienced severe displacement. The Hurricane Katrina disaster in 2005 resulted in the largest internal displacement in the country since the Dust Bowl. The general literature on place and health is substantial, though more limited in the context of post-disaster mental health. Due to displacement, both forced and voluntary, survivors are forced to adapt in new neighborhoods. These neighborhoods themselves undergo changes and it is likely that these changes impact mental health both in the short- and long-term.

This dissertation is composed of three research studies that explore psychological resilience, post-disaster mental health trajectories, and the mental health impacts of neighborhood social and economic conditions among natural disaster survivors. The first paper is a systematic and qualitative synthesis of how psychological resilience has been conceptualized and measured in longitudinal studies conducted among natural disaster survivors. The literature search was conducted through four databases and guided by the Population, Intervention, Comparator, Outcome, and Study Design framework. Twelve studies were included in the synthesis which examined resilience following a range of natural disasters. Findings from the review were that most of the studies had clear conceptualizations of resilience and used data-driven methods to measure resilience. However, conceptualizations of resilience were not consistent across studies and limitations of methodological approaches were not addressed. The second paper is a quantitative analysis to identify which mental health trajectories emerged among a cohort of adult Hurricane Katrina survivors across 10 years of survey data. Using latent growth mixture modeling, we found three distinct trajectories which we characterized as recovery, resilience, and chronic. We also found that baseline predictors associated with trajectory membership were employment change, residential mobility, and having received financial resources. These results warrant future examination of contextual factors, specifically at the community-level. The third paper is a quantitative analysis which examines the association between neighborhood-level socioeconomic status and mental health among women survivors of Hurricane Katrina, a particularly vulnerable population. Findings from this study were that while increased neighborhood socioeconomic status was associated with increased mental health, this relationship differed by move status. Women who did not move or were able to return to their pre-disaster neighborhoods were predicted to have better mental health compared to women who relocated and did not return. This study’s findings revealed the importance of displacement patterns and how changing neighborhood social and economic conditions may be important for mental health among survivors over time.