Displacement, county social cohesion, and depression after a large-scale traumatic event

Abstract

Background Depression is a common and potentially debilitating consequence of traumatic events. Mass traumatic events cause wide-ranging disruptions to community characteristics, influencing the population risk of depression. In the aftermath of such events, population displacement is common. Stressors associated with displacement may increase risk of depression directly. Indirectly, persons who are displaced may experience erosion in social cohesion, further exacerbating their risk for depression. Methods Using data from a population-based cross-sectional survey of adults living in the 23 southernmost counties of Mississippi (N = 708), we modeled the independent and joint relations of displacement and county-level social cohesion with depression 18–24 months after Hurricane Katrina. Results After adjustment for individual- and county-level sociodemographic characteristics and county-level hurricane exposure, joint exposure to both displacement and low social cohesion was associated with substantially higher log-odds of depression (b = 1.34 [0.86–1.83]). Associations were much weaker for exposure only to low social cohesion (b = 0.28 [−0.35–0.90]) or only to displacement (b = 0.04 [−0.80– 0.88]). The associations were robust to additional adjustment for individually perceived social cohesion and social support. Conclusion Addressing the multiple, simultaneous disruptions that are a hallmark of mass traumatic events is important to identify vulnerable populations and understand the psychological ramifications of these events.

The impact of housing displacement on the mental health of low-income parents after Hurricane Katrina

“…Previous research provides mixed evidence for relationships between secondary stressors and posttraumatic stress. Some research finds such a linkage (e.g., Galea et al, 2008; Goto et al, 2006) and other research shows stronger associations of secondary stressors with stress and depression rather than posttraumatic stress (e.g., Lê, et al 2013; Wickrama & Wickrama 2008). There may be several explanations for our finding of no association.…”

“…Primary disaster stressors, i.e., stressors experienced during the disaster and its immediate aftermath, including injuries, lack of food, water, medical care, and bereavement, are consistently associated with poorer postdisaster mental health and posttraumatic stress (e.g., Norris et al, 2002). However, the losses produced by a disaster often produce chronic or secondary stressors, e.g., property loss and damage, poor living conditions, disruptions in employment, school, healthcare access, social supports, and routines, which are associated with elevated stress and depression (e.g., Lê, Tracy, Norris, & Galea 2013). Many of these losses occur when disaster survivors are displaced (Lock, et al, 2012; Porter & Haslam, 2005).…”

“…Displacement often disrupts the social support systems that mediate the mental health impacts of primary disaster stressors (e.g. Lê et al, 2013). Further, displacement alters regular routines associated with homes, jobs, physical activity, participation in social organizations, and healthcare access (Abramson et al, 2010).…”

Life Course Epidemiology of Trauma and Related Psychopathology in Civilian Populations

“…In the aftermath of mass trauma, disruption to a social environment frequently occurs in conjunction with the destruction of physical structures [95]. Community social cohesion, defined as willingness between individuals to cooperate with their community in the service of common values [76, 78], has been documented to affect mental health above and beyond individual-level characteristics [95-97]. As such, after traumatic events, community social cohesion is capable of both exacerbating mental illness risk in the presence of low social cohesion and encouraging recovery in communities characterized by high social cohesion [96].…”

“…For example, a socially cohesive community may be better positioned to mobilize post-trauma efforts to identify and assist those in need, disseminate information across the community, and advocate for outside aid [98, 99]. Conversely, displacement after trauma, which interferes with existing community social cohesion, has been associated with the development of psychopathology [95, 100]. …”