Natural Hazards and Mental Health among US Gulf Coast Residents

BACKGROUND: Individuals affected by disasters are at risk for adverse mental health sequelae. Individuals living in the US Gulf Coast have experienced many recent major disasters, but few studies have explored the cumulative burden of experiencing multiple disasters on mental health. OBJECTIVE: The objective of this study was to evaluate the relationship between disaster burden on mental health. METHODS: We used data from 9,278 Gulf Long-term Follow-up Study participants who completed questionnaires on perceived stress, anxiety, depression, and post-traumatic stress disorder (PTSD) in 2011-2013. We linked 2005-2010 county-level data from the Spatial Hazard Events and Losses Database for the United States, a database of loss-causing events, to participant’s home address. Exposure measures included total count of loss events as well as severity quantified as property/crop losses per capita from all hazards. We used multilevel modeling to estimate odds ratios (OR) and 95% confidence intervals (CI) for each exposure-outcome relationship. RESULTS: Total count of loss events was positively associated with perceived stress (OR(Q4):1.40, 95% CI:1.21-1.61) and was inversely associated with PTSD (OR(Q4):0.66, 95% CI 0.45-0.96). Total duration of exposure was also associated with stress (OR(Q4):1.16, 95% CI 1.01-1.33) but not with other outcomes. Severity based on cumulative fatalities/injuries was associated with anxiety (OR(Q4):1.31, 95% CI 1.05-1.63) and stress (OR(Q4):1.34, 95% CI 1.15-1.57), and severity based on cumulative property/crop losses was associated with anxiety (OR(Q4):1.42, 95% CI:1.12-1.81), depression (OR(Q4):1.22, 95% CI:0.95-1.57) and PTSD (OR(Q4):1.99, 95% CI:1.44-2.76). SIGNIFICANCE: Higher natural hazard burden above and beyond individual disasters may increase risk for multiple adverse mental health outcomes.