Cumulative Trauma and the Long-Term Health and Recovery of Disaster Survivors

Abstract

Natural disasters significantly impact the mental health of those who survive them, a group that is growing as natural disasters increase in frequency and intensity due to climate change. Although research indicates significant differences in vulnerability to mental health outcomes such as post-traumatic stress disorder (PTSD) after a natural disaster, there is limited research examining how key factors, such pre-disaster trauma, contribute to these differences. This dissertation investigated the extent to which pre-disaster traumas shape both the experience of disasters, and long-term mental health and recovery of disaster survivors, to clarify processes that produce vulnerability and resilience to disasters.Manuscript 1 examined the extent to which pre-Katrina traumas predict the number and severity of Katrina-related traumatic events. Results indicate that experiencing traumatic events prior to Hurricane Katrina was associated with greater Katrina-related trauma exposure. Specifically, women who experienced more traumatic events prior to Hurricane Katrina reported a greater number of Katrina-related traumas and had a greater risk for specific Katrina-related traumatic events. Manuscript 2 evaluated the extent to which pre-Katrina traumatic experiences explain differences in long-term trajectories of Katrina-specific PTSD among survivors with similar levels of Katrina-related trauma. After adjusting for Katrina-related trauma, pre-Katrina trauma exposure had little impact on probability of Katrina-specific PTSD trajectory. Of the various types of trauma exposure examined, Chronic-High PTSD was most strongly influenced by cumulative trauma exposure and Katrina-related trauma. Using qualitative interview data, Manuscript 3 examined sources of resilience identified by Katrina survivors with a history of prior trauma as key to their recovery from Hurricane Katrina. Three main factors that women with a history of pre-Katrina trauma perceived as influencing their recovery were identified. These factors included the availability of new opportunities post-Katrina that facilitated recovery, relying on religion and using prayer as an important coping strategy, and gaining housing and job stability after the disruption and destruction of Katrina.