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The impact of uncertainty andcommunal coping on mental healthfollowing natural disastersWalid A. Afifi a , Erika D. Felix b & Tamara D. Afifi aa Department of Communication, University of California-SantaBarbara, Santa Barbara, CA, 93106-4020, USAb Gervitz Graduate School of Education, Center for School-BasedYouth Development, University of California-Santa Barbara, SantaBarbara, CA, 93106-9490, USAAccepted author version posted online: 07 Jul 2011.Version ofrecord first published: 01 Aug 2011.

To cite this article: Walid A. Afifi , Erika D. Felix & Tamara D. Afifi (2012): The impact ofuncertainty and communal coping on mental health following natural disasters, Anxiety, Stress &Coping: An International Journal, 25:3, 329-347

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The impact of uncertainty and communal coping on mental healthfollowing natural disasters

Walid A. Afifia*, Erika D. Felixb and Tamara D. Afifia

aDepartment of Communication, University of California-Santa Barbara, Santa Barbara, CA93106-4020, USA; bGervitz Graduate School of Education, Center for School-Based Youth

Development, University of California-Santa Barbara, Santa Barbara, CA 93106-9490, USA

(Received 21 December 2010; final version received 1 July 2011)

Feelings of uncertainty are a central feature of the disaster experience.Surprisingly, though, there is very little systematic quantitative research aboutthe impact of uncertainty on disaster survivors. Moreover, communal coping hasincreasingly received attention as a potential buffer of the negative effects ofstressors but that literature is also limited in its application to disasters. Thisinvestigation applies research in the domain of uncertainty, together with theTheoretical Model of Communal Coping to better understand the experience of acommunity exposed to three wildfires in a one year period. A random-digitdialing procedure was used to gather data from 402 individuals. Participantscompleted measures of mental health, uncertainty, and communal coping in thecontext of their experience with the most personally stressful of the threewildfires. All analyses were examined separately for those who were evacuatedand those who were not. Results support the negative impact of uncertaintyacross both evacuated and nonevacuated sub-samples and show a strongbuffering role for communal coping among those who evacuated. The implica-tions of these findings for the understanding of wildfire survivors’ experiences arenoted and future directions are proposed.

Keywords: uncertainty; communal coping; disasters; mental health; communica-tion; wildfires

The storm [Katrina] has united evacuees on both sides of the city’s formidable divide ofrace and class. What they share is uncertainty, which, like the mold in vacant houses, hasmushroomed in the nearly four months since the hurricane. (Harden, 2005, p. A1)

The experience of uncertainty dominates media accounts of individuals’ experiences

of community-wide trauma. Scholars have also written voluminously about

uncertainty in disaster-related models of risk (e.g., see Amendola, 2004) and in the

context of understanding organizational-level crisis management (e.g., see Seeger,

Sellnow, & Ulmer, 1998). However, despite some scholarly efforts to understand the

process of sensemaking among disaster survivors (e.g., Weick, 1993, 2010),

systematic, quantitative examinations of uncertainty’s role vis-a-vis survivor well-

being are few. Given the known consequences of uncertainty on psychological

distress (for reviews, see W.A. Afifi, 2009; Bland, O’Leary, Farinaro, & Trevisan,

*Corresponding author. Email: w-afifi@comm.ucsb.edu

Anxiety, Stress, & Coping

Vol. 25, No. 3, May 2012, 329�347

ISSN 1061-5806 print/1477-2205 online

# 2011 Taylor & Francis

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1996), the relative neglect to examine uncertainty’s effects on well-being in the

context of disasters is surprising.

A factor that may help buffer the expected negative consequences of uncertainty

is communal coping, especially given the communal experience of disasters.

Communal coping involves groups of people confronting a shared stressor as a

social unit, viewing the stressor as ‘‘our’’ problem and ‘‘our’’ responsibility (Lyons,

Mickelson, Sullivan, & Coyne, 1988). This orientation to coping may minimize the

negative impact of uncertainty by fostering a sense of security, resilience, and efficacy

(T.D. Afifi, Hutchison, & Krouse, 2006; Bonanno, Galea, Bucciarelli, & Vlahov,

2007). This investigation represents a focused effort to examine the consequences of

disasters on uncertainty and the moderating role of communal coping for recovery.

Data are presented from a random sample of individuals who were exposed to

multiple wildfires that occurred in relative succession and threatened thousands of

people in a coastal community in California.

Uncertainty

Uncertainty as a central feature of disasters

Uncertainty has attracted attention from researchers and practitioners across a wide

range of disciplines (for reviews, see T.D. Afifi & Afifi, 2009; Bammer & Smithson,

2008), and is a central feature in the literature on sensemaking, one of the most

commonly applied perspectives to understanding human responses to crises (for

reviews, see Dervin, 1998; Weick, Sutcliffe, & Obstefeld, 2005). The construct has

been variously defined, but, in this investigation, reflects a lack of confidence in one’s

ability to predict particular outcomes (Penrod, 2001). Our interests specifically lie in

individuals’ sense of unpredictability about the safety of self, others, and home.

Although uncertainty is not a central characteristic of all traumatic episodes,

conceptual reviews of natural disasters reveal it to be a critical experience of those

events (Bland et al., 1996). In fact, Seeger et al. (1998, p. 233) define such crises as

‘‘specific, unexpected, and non-routine event[s] or series of events that create high

levels of uncertainty and threaten or are perceived to threaten high priority goals

including security of life and property or the general individual or community well

being.’’ Consistent with this notion, Handmer and Dovers (2007) reference the

‘‘inevitability of uncertainty’’ following disasters, and Vyner (1988) articulates nine

types of uncertainty that may plague individuals potentially exposed to invisible

environmental contaminants (e.g., radiation spill; influenza viruses; natural gas leak).

Vyner’s typology ranges from uncertainty about the level of exposure to a lack of

confidence about the financial repercussions of such exposure.

Scholars who use a sensemaking approach have also offered detailed analyses of

the management of uncertainty in the wake of disasters, more broadly. Two

prototypical examples are Weick’s (1988, 2010) scrutiny of the 1984 explosion at a

pesticide plant in Bhopal, India (an event which continues to be one of the world’s

worst industrial disasters; Broughton, 2005) and his analysis of the Mann Gulch

disaster, a wildfire which killed 13 firefighters in the Helena National Forest of

Montana in 1949 (Weick, 1993). Both analyses examined ways in which groups of

people, bound within organizational settings, strive to make sense of uncertainty

amidst crisis situations. Recently, Hodgson (2007) also applied a sensemaking

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framework to understand the role of emotions in the face of disasters. As part of his

analysis, he described the many ways in which exposure to the threat from wildfires is

characterized by confusion and uncertainty. Other scholars have engaged the notion

of uncertainty as a central feature of the disaster experience outside the sensemaking

framework. For example, Boin, van Duin, and Heyse (2001) applied a crisis

management approach to explore public uncertainty following an airplane crash.

Relatedly, Lachlan, Westerman, and Spence (2010) acknowledged the preeminent

experience of uncertainty among disaster survivors and examined information-

seeking tendencies in these contexts.

Unfortunately, these detailed analyses of uncertainty have rarely involved

quantitative assessments of that experience. The exceptions to the rule often offer

indirect measures of the construct, with results that are typically overlooked in

subsequent analyses. For example, Goto, Wilson, Kahan, and Slane (2006) asked

evacuees from a volcanic eruption what they worried most about during the

evacuation. Eleven percent reported ‘‘uncertainty about future,’’ but other concerns

could also easily be conceptualized as states of uncertainty (e.g., concerns about

home and property [31%], or about family member’s health and well-being [13%]). In

a similar vein, Kinzie, Boehnlein, Riley, and Sparr (2002) examined the reaction of

southeast Asian refugees living in the USA to the 11 September 2001 terror attacks.

Among the measures in that study was an open-ended question about concerns

related to the attack, to which 31% of Vietnamese and 53% of Laotian participants

responded with what was coded as concerns with ‘‘uncertainty and insecurity.’’

It is impossible to understand the true experience of uncertainty and the related

consequences without more direct and systematic measures of the construct. This

scholarly oversight is especially surprising given the known negative influences of

elevated uncertainty states.

Negative impacts of uncertainty

Outside the context of disasters, the study of uncertainty has consistently shown

psychological distress as the primary outcome of uncertainty. In fact, Parsons (1980,

p. 145) went so far as to argue that ‘‘exposure to uncertainty is perhaps the most

important negative aspect of what many have considered to be the central feature of

human life.’’ Indeed, evidence of uncertainty’s negative impact cuts across diverse

methodologies and contexts. For example, studies from an experimental paradigm

have shown that uncertainty about shocks cause both self-reported and physiological

indicators of psychological distress (e.g., Badia, McBane, Suter, & Lewis, 1966;

Monat, Averill, & Lazarus, 1972). Health scholars have concluded that uncertainty is

‘‘probably the greatest single psychological stressor facing the patient with a life-

threatening illness’’ (Koocher, 1984, pp. 754�755; see also, Mishel, 1999). Finally, Lee

(2006) found uncertainty to be positively correlated with symptoms of posttraumatic

stress among adult childhood cancer survivors, and Bailey et al. (2009) found

uncertainty to be associated with depressive symptoms, quality of life, fatigue, and

pain among individuals diagnosed with chronic Hepatitis C.

In sum, although a strong empirical link has been established between

uncertainty and psychological distress, the examination of that association within

the important milieu of disasters has been ignored. Based on existing knowledge

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about these variables, we expect that the experience of uncertainty in the context of

natural disasters is positively associated with psychological distress (H1).

Communal coping

If natural disasters are expected to produce uncertainty, and uncertainty is positively

associated with distress, it is important that we examine factors that may buffer

uncertainty’s negative effects. One factor that has received increased attention is

community support/resources (e.g., Hobfoll, 1998). Indeed, several studies have

shown the benefits of strong community ties for recovery from disasters (for review,

see Bonanno, Brewin, Kaniasty, & La Greca, 2010), and community-based

interventions regularly include components that encourage community cohesion(e.g., Foa et al., 2005). Unfortunately, what has been mostly lacking from this

literature is attention to the interpersonal communication features that promote a

sense of communal bonding.

The Theoretical Model of Communal Coping (TMCC; T.D. Afifi et al., 2006)

combines a risk and resiliency approach with a systems approach by examining how

multiple individuals’ coping behaviors are integrally linked and affect each other in

positive and negative ways. The TMCC is the communal coping approach that most

directly reflects a communication lens.At a general level, TMCC proposes that people who communicate about their

uncertainty and stress as something they can solve together and overcome as a unit

should foster a sense of ‘‘mental hardiness’’ or resilience (see also Hobfoll, Briggs, &

Wells, 1994). Those messages may be communicated directly (e.g., ‘‘we can get

through this’’) or indirectly (e.g., through joint problem solving and mutual activities

that build collective resolve). In either case, they have been shown to enhance

people’s coping efficacy � the belief that they have the ability to cope with a stressor

(e.g., T.D. Afifi et al., 2006; Brashers, Haas, Klingle, & Neidig, 2000). Moreover,although the studies have been set outside the context of disasters, the existing data

suggest that communal coping has direct benefits for well-being. For example,

Koehly et al. (2008) found that communal coping among sisters in hereditary breast

and ovarian cancer families was significantly associated with lower psychological

distress and related somatization. In a similar vein, Rohrbaugh, Mehl, Shoham,

Reilly, and Ewy (2008) examined how 57 survivors of heart failure talked with their

spouses about their health problems. They found that when spouses used more ‘‘we’’

language when talking about the recovering spouse’s health problems, it predictedfewer heart failure symptoms and better general health of that spouse over the next

six months. Finally, Hobfoll, Schroder, Wells, and Malek (2002, Study 4) reported a

positive association between communal coping and improvements in the psycholo-

gical well-being of low-income women across a nine-month period.

Despite the few studies noted, quantitative tests of the benefits of communal

coping remain rare. If communal coping helps minimize the negative effects of joint

stressors, it could provide an important resource for families and communities

coping with collective uncertainty in the context of natural disasters. Specifically,communal coping should buffer the distressing effects of uncertainty by providing a

sense of trust that they can conquer events together as a group. To test the

applicability of TMCC to postdisaster recovery, we predict that positive communal

coping behaviors should moderate the association between uncertainty and

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psychological distress in the context of disasters, such that the effect of uncertainty

on distress weakens with increased reliance on positive communal coping strategies

(H2).

Role of evacuation

For several reasons, those who are evacuated from their residence due to the threat

from wildfires go through a qualitatively different experience of the disaster than

those who do not. First, evacuations orders are only given to those whose residence is

in particular danger of destruction (i.e., where the level of threat is very high).

Second, the process of evacuation, often done within a time-sensitive and chaoticatmosphere of high danger, is likely to heighten the degree of experienced stress.

Third, the perceived risk to self that comes with the processing of threat information

related to wildfires of close proximity undoubtedly produces a level of acute

uncertainty about personal safety that is unmatched among those who do not

evacuate. Fourth, evacuees’ absence from their residence during the period of

elevated threat to the property is likely to make them especially uncertain about its

safety. Fifth, the sometimes-lengthy stay away from the primary residence adds layers

of distress and uncertainty (e.g., when will normalcy return?) that other residentsexposed to wildfire do not experience. Finally, the process of evacuation and its

immediate aftermath, including the location to which individuals may evacuate (e.g.,

Red Cross centers), is likely to encourage bonds among the evacuated communities

in ways that heightens the impact of communal coping. As a result of the difference

in these experiences, we examined the effect of evacuation, with the expectation that

both hypotheses would find stronger support among those who were evacuated than

those who were not.

Method

Participants and procedure

Between July 2008 and May 2009, residents of Santa Barbara, CA, and surrounding

communities experienced three highly destructive wildfires. Together, the fires burned

roughly 20,000 acres, destroyed over 200 homes, and led to evacuation of

approximately 50,000 residents, some more than once (see Wildfire Maps, 2009).The services of Social Science Survey Research Center (SSSRC) at the University of

California-Santa Barbara were retained five months after the third wildfire � the one

that resulted in the largest number of evacuees (:30,000; see Independent Staff,

2009). A random-digit dialing procedure was used to complete phone surveys with

402 residents. All were informed of their rights as participants and consented. The

SSSRC was responsible for all aspects of sampling and data collection, including the

sampling of telephone numbers, the recruitment and training of bilingual inter-

viewers, and the calling and surveying of respondents. Three hundred and thirty-seven participants completed all measures of interest for this investigation and served

as the sample for these analyses (n�337).

The sample included more females (61%) than males, was predominantly

Caucasian (70%) or Latino/Latina (11%), and included a wide range of ages

(range �18�94; M�55.39, SD �14.95). The sample generally reflected the income

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distribution of residents in the affected areas. Of those who responded to the income

question, the median household income category was $60,000�80,000 and the mode

(41% of respondents) was over $100,000; 8% had annual household incomes below

$20,000. The sample was highly educated, with 62% having completed an under-

graduate or graduate degree.

The sample’s experience with the wildfires was of high intensity. Forty-two

percent (n�142) of participants were evacuated at least once across the three fires

(13% two or more times) and 8% reported damage to property as a result of the fires.

Participants reported the degree of stress associated with each of the three fires on

10-point scales (i.e., ‘‘On a scale of 1-10 with 10 being the highest, how stressful was

the ____ fire for you?’’; Gap Fire (July 2008) �4.64, SD �3.02; Tea Fire (November

2008) �5.20, SD �2.93, Jesusita Fire (May 2009) �6.24, SD �2.81;

F(2,672) �37.93, pB.001), then completed the remainder of the survey with the

most stressful of the three fires in mind. Those who were evacuated reported on the

wildfire for which they were evacuated. In cases where two wildfires received equally

high stress ratings or where participants were evacuated during more than one

wildfire, the most recent of the two wildfires was used as the target wildfire. That

decision tree resulted in 64% reporting on the Jesusita fire, 18% on the Tea fire, and

18% on the Gap fire. The average level of stress for the target wildfire was high

(M�7.33, SD �2.50). As would be expected, evacuees reported greater stress from

the wildfire on which they focused (M�8.01, SD �2.26) than did nonevacuees

(M�6.83, SD �2.56), t(335) �4.40, pB.001.

Bilingual translators who worked with the SSSRC relied on well-accepted

translation and back-translation procedures to develop a Spanish version of the

survey. All interviewers were bilingual, and 6% of respondents completed the Spanish

version. The survey averaged approximately 10 minutes for completion.

Measures

Psychological distress

Participants were asked to think back to the period of the wildfire and complete the

short version of the Mental Health Inventory, a measure of psychological distress

and well-being (Stewart, Hays, & Ware, 1988; Veit & Ware, 1983). The MHI-5 is a

five-item measure that has repeatedly been shown to have strong psychometric

properties and to perform more effectively than many other related measures (for

reviews, see Berwick et al., 1991; Kelly, Dunstan, Lloyd, & Fone, 2008). Participants

were asked to reflect back to ‘‘the period of the fire’’ and to indicate how often they

experienced a set of emotions, some positive (e.g., ‘‘. . .you were calm and peaceful’’)

and others negative (e.g., ‘‘. . .you were a very nervous person?’’). Although the scale

in the original measure spans six points ranging from ‘‘all of the time’’ to ‘‘none of

the time,’’ concerns about participants’ ability to cognitively manage distinctions

across six points in a phone survey led to the adoption of a three-point scale (‘‘all of

the time,’’ ‘‘some of the time,’’ and ‘‘none of the time’’). Consistent with the original

measure, positive items were recoded such that higher scores on the summed scale

(theoretical range �5�15) indicated better health. As a result of that coding and the

interpretation of high scores on the measure, along with the conceptual overlap

between mental health and psychological distress, references to data from this

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measure will hereafter be labeled ‘‘mental health,’’ as opposed to psychological

distress. The measure showed acceptable psychometric properties (a�.77,

M�11.47, SD �1.99).

Uncertainty

The measurement of uncertainty was adapted from prior studies of uncertainty (e.g.,

W.A. Afifi & Weiner, 2006) and included three items, each assessing different targets

of potential uncertainty experienced by participants during the period of the fire:

uncertainty about their home’s safety (M�2.45, SD �1.36), about their own safety

(M�1.50, SD�.95), and about the safety of their family and/or friends (M�2.16,

SD �1.26). Participants were asked to think back to their thoughts ‘‘during theheight of the fire’’ then asked ‘‘how uncertain were you that __[target uncer-

tainty]__?’’). A five-point scale followed, ranging from ‘‘very certain’’ to ‘‘not at all

certain.’’ Higher scores indicated greater uncertainty. Because each item was

intended to capture a different aspect of uncertainty and because empirical analyses

confirmed their relative independence (a�.48, average r�.26), each of the three

items was examined separately in the analyses.

In addition to those three items, participants who indicated being uncertain

about the safety of their home were asked to estimate the number of days that theuncertainty lasted (for purposes of analyses, all others were assigned a score of 0 days

for that question). The number of days of uncertainty ranged from 0 to 30, with an

average of about 1 day (M�1.04, SD �2.68).

Communal coping

A two-item measure of communal coping was adapted from T.D. Afifi et al. (2006)

and captured the extent to which individuals engaged in positive communal copingwith the wildfire threat. Participants were asked to identify from a list ‘‘who [they]

would consider to be the [their] primary source of emotional support during times of

stress’’ and were restricted to a single choice. The most common response was their

spouse/partner (57%), followed by their friends (16%), their extended family (14%),

and their children (8%). With that person/those people in mind, participants were

then asked the extent to which they agreed with the statement that they ‘‘saw this

stressful period as something that was ‘our issue’ that we faced together’’ and that

they ‘‘had a real feeling that we were going to work through this period together,whatever the outcome.’’ A five-point Likert-type scale followed, ranging from

‘‘strongly agree’’ to ‘‘strongly disagree.’’ All items were recoded such that higher

scores indicated more communal coping. The measure achieved acceptable reliability

(a�.74, M�4.46, SD�.68).

Analytic strategy

Preliminary analyses preceded the tests of the hypothesis. As such, we first conductedindependent samples of t-tests to compare the evacuated and nonevacuated groups

on uncertainty, communal coping, and mental health. Significant differences between

the evacuated and nonevacuated groups would suggest the need to test the

hypotheses separately for each group. Next, several variables were examined for

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their role as possible statistical controls. Those that were significant predictors of our

outcome of interest (mental health) were included as control variables in the primary

analyses.

The two hypotheses were then tested in the following manner. The firsthypothesis predicted that uncertainty related to the wildfire would be positively

associated with distress. A hierarchical regression analysis was used to test the

prediction, with participants’ recollection of their mental health during the period of

the fire as outcome, the control variables entered in the first step, and the three types

of uncertainty (about the home’s safety, about personal safety, and about the safety

of family and friends) entered simultaneously as predictors in the second step.

The second hypothesis predicted that communal coping would buffer the

negative effects of uncertainty, such that the influence of uncertainty on psycholo-gical distress would be weaker to the extent that individuals engaged in communal

coping. To allow for unique moderating roles related to each type of uncertainty,

three separate regression analyses were conducted, one for each type of uncertainty.

Hierarchical regression analyses were again used, with the participants’ report of

their mental health during the period of the fire as the outcome. The first step

included the control variables. The second step included the main effect term for

both the level of communal coping and a particular type of uncertainty, and the final

step included the interaction term between the two main effects found in the firststep. Significant interaction terms signaled the presence of a moderating relationship

and were followed up with analysis of the slope of the simple regression line

(reflecting the association between the predictor and mental health) at three levels of

the moderator (communal coping): one standard deviation below the mean, at the

mean, and one standard deviation above the mean (see Aiken & West, 1991; Frazier,

Tix, & Barron, 2004). An SPSS macro (MODPROB), developed by Hayes and

Matthes (2009), was used to perform the follow-up simple regressions. All predictors

were mean-centered.

Results

Preliminary analyses

As expected, individuals who were evacuated differed significantly from those who

were not evacuated on nearly all variables of interest. Specifically, they experiencedgreater uncertainty about the safety of their home, less uncertainty about the safety

of close others, more stress from the target wildfire, and a greater reliance on

communal coping (see Table 1). In addition, the mean difference between the two

groups approached significance on mental health. As a result of these group

differences, all hypothesis tests were conducted separately across level of evacuation

(yes/no).

In the interest of controlling for variables that may affect the recovery process

but were not the theoretical focus of these analyses, we first examined theassociation between nine separate control variables and mental health: participant

sex (dummy-coded; 0 �male, 1 �female), age, ethnicity (dummy-coded;

0 �Caucasian, 1 �non-Caucasian), primary language (dummy-coded; 0 �English;

English; 1 �Spanish), the wildfire on which they were reporting (dummy-coded

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into two variables), and their primary support provider (dummy-coded into three

variables). Participant sex (r �.22, pB.001) and age (r�.15, pB.01) were the only

variables that were significantly associated with mental health, suggesting that older

women experienced the least distress. All subsequent analyses controlled for sex and

age. Correlations among variables in the hypotheses are reported in Table 2.

Impact of uncertainty on mental health (H1)

The first hypothesis predicted that uncertainty is negatively associated with mental

health. Results supported the prediction for both those who were not evacuated,

Fchange(3, 182) �26.09, pB.001, R2change�.27, and those who were evacuated,

Fchange(3, 132) �4.68, pB.01, R2change�.09. A closer examination revealed that

all three types of uncertainty were associated with lower mental health scores for

those who were not evacuated, while only two types (safety of the home and safety

of close others) were linked to mental health for those who were evacuated (see

Table 3).

Moderating role of communal coping (H2)

Those who were not evacuated

Analyses for those who were not evacuated failed to support the moderating role of

communal coping for any of the uncertainty types. Specifically, the regression step

containing the interaction term did not contribute significantly to variance in mental

health in the analysis of uncertainty about the home, Fchange(5, 182)�.40, p�.05,

uncertainty about personal safety, Fchange(5, 182) �1.58, p�.05, or uncertainty

about others, Fchange(5, 182)�.14, p�.05.

Table 1. Effects of evacuation on variables of interest.

Evacuated

(n�142)

Not evacuated

(n�195)

M SD M SD t

Uncertainty � home safety 2.95 1.43 2.09 1.19 6.04**

Uncertainty � personal safety 1.49 .92 1.51 .97 �.21

Uncertainty � others’ safety 1.85 1.11 2.38 1.32 �3.86**

Duration of uncertainty 1.32 2.10 .83 3.02 1.67

Communal coping 4.68 .47 4.29 .76 5.39**

Mental health 11.23 2.06 11.65 1.92 �1.92*

Stress about fire 8.06 2.26 6.74 2.65 5.10**

Notes: ‘‘Duration of uncertainty’’ reflects the self-reported duration of uncertainty regarding the safety ofparticipants’ home.df �335; *pB.06; **pB.001.

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Table 2. Correlations table.

1 2 3 4 5 6 7 8

1. Age � �.05 .14 .05 �.09 �.09 �.08 �.01

2. Sex �.03 � .26*** �.11 �.06 �.11 �.21** �.05

3. Mental health .19* .17* � �.21** �.50*** �.44*** �.28*** �.44***

4. Communal coping �.07 �.09 �.06 � .17* �.03 �.10 .07

5. Uncertainty � home safety �.30*** �.06 �.26*** .13 � .51*** .21** .52***

6. Uncertainty � personal safety �.18* �.08 �.11 �.10 .25** � .32*** .41***

7. Uncertainty � other’s safety �.19* �.07 �.28** �.02 .13 .30*** � .19**

8. Duration of uncertainty �.19* �.17* �.21** �.01 .73*** .23** .19* �

Notes: The correlations above the diagonal reflect results for those who were not evacuated (n�195); the correlations below the diagonal reflect results for those who wereevacuated (n�142).*pB.05; **pB.01; ***pB.001.

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Those who were evacuated

In contrast, communal coping played the predicted moderating role for the

uncertainty � mental health association for two of the three types of uncertainty

among those who were evacuated: uncertainty about the home, Fchange(5,

132) �8.73, pB.01, and uncertainty about personal safety, Fchange(5, 132) �5.48,

pB.05. Communal coping did not play the predicted moderating role in the case of

uncertainty about others, Fchange(5, 132)�.09, p�.05.

Consistent with our predictions, the follow-up analysis for uncertainty about the

home revealed that its association with mental health was significant at low,

b��.75, SE�.20, t(137) ��3.73, pB.001, and moderate levels, b��.36,

SE�.12, t(137) ��2.87, pB.001, of communal coping, but not at high levels,

b�.03, SE�.16, t(137)�.22, p�.05. The follow-up analyses associated with

uncertainty about personal safety showed it to be negatively associated with mental

health at low levels of communal coping, b��.59, SE�.23, t(137) ��2.13,

pB.05, but did not significantly impact mental health at either moderate, b��.10,

SE�.19, t(137) ��.52, p�.05, or high levels of communal coping, b�.28,

SE�.28, t(137) �1.02, p�.05. Graphical representations clarify the moderating

role of communal coping on the association between uncertainty and mental health

(see Figures 1 and 2). Specifically, the figures show that communal coping seems to

buffer the negative effects of uncertainty on mental health, as predicted.

Table 3. Regression of uncertainty types on mental health.

b SE b b t

Not evaluated

Step 1

Age .02 .01 .15 2.13*

Sex 1.03 .28 .26 3.76***

Step 2

Age .01 .01 .09 1.47

Sex .78 .24 .20 3.28**

Uncertainty � home safety �.53 .11 �.33 �4.73***

Uncertainty � personal safety �.48 .14 �.24 �3.34**

Uncertainty � others’ safety �.13 .09 �.09 �1.44

Evaluated

Step 1

Age .03 .01 .20 2.40*

Sex .75 .35 .18 2.17*

Step 2

Age .02 .01 .10 1.19

Sex .59 .34 .14 1.75

Uncertainty � home safety �.25 .12 �.17 �2.01*

Uncertainty � personal safety .01 .19 .01 .07

Uncertainty � others’ safety �.47 .16 �.25 �2.94**

Note: *pB.05; **pB.01; ***pB.001.

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Supplementary analyses: duration of uncertainty

To examine the role played by the duration of uncertainty about the home’s safety,

we tested the strength of its association with mental health (using a second-order

correlation, with sex and age of participant controlled) and the moderating role of

communal coping, applying the same procedure used to test H2.

Consistent with the general pattern shown in tests of H1, results for the impact of

extended uncertainty experiences showed a strong association between the duration

of uncertainty and mental health for those who did not evacuate, r(184) ��.43,

pB.001, but not for those who did, r(134) ��.13, p�.05. Results for the

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9.5

10

10.5

11

11.5

12

12.5

13

Men

tal H

ealth

Low CopingModerate CopingHigh Coping

Low Uncertainty - Home safety High Uncertainty - Home safety

Figure 1. Moderating role of communal coping: home safety.

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9

9.5

10

10.5

11

11.5

12

12.5

13

Low Uncertainty - Personal safety High Uncertainty - Personal safety

Men

tal H

ealth

Low CopingModerate CopingHigh Coping

Figure 2. Moderating role of communal coping: personal safety.

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moderating role of communal coping also approximated the results from the

hypothesis tests. Specifically, the regression coefficient for the interaction term

approached statistical significance for those who evacuated, Fchange(5,132) �3.65,

p�.06, but not for those who did not, Fchange(5,182) �2.65, p�.05. Follow-up

analyses again supported the predicted moderating role of communal coping: the

association between the number of days of uncertainty was significantly negative

associated with mental health at low levels of communal coping, b��.34, SE�.14,

t(137) ��2.46, pB.05, but not at moderate, b��.15, SE�.10, t(137) ��1.52,

p�.05, or high levels of communal coping, b�.05, SE�.14, t(137)�.34, p�.05 (see

Figure 3).

Discussion

The purpose of this investigation was twofold: (1) to examine the influence of

uncertainty resulting from natural disasters on mental health and (2) to better

understand the role of communal coping as a buffer of uncertainty’s predicted

negative effects. Results from an investigation of a community exposed to multiple

wildfires support the predicted negative association between uncertainty and

psychological well-being, as well as the predicted role of communal coping in the

recovery process.

Since evacuations are tied to heightened threat and come with a unique set of

experiences, those who evacuated (42% of the sample) were first compared to those

who did not (58%) on the variables of interest. Those who evacuated experienced

more uncertainty about their home’s safety, less uncertainty about the safety of

family and friends, and engaged in more communal coping than those who did not

evacuate. Statistical trends also suggested that evacuation was associated with more

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9

9.5

10

10.5

11

11.5

12

12.5

13

Men

tal H

ealth

Low Communal CopingModerate Communal CopingHigh Communal Coping

Low Uncertainty - Duration High Uncertainty - Duration

Figure 3. Moderating role of communal coping: uncertainty duration.

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psychological distress. As a result of these differences across the two groups, all

subsequent analyses were tested separately for those who evacuated and those who

did not.

The impact of uncertainty

This investigation offers one of the first systematic, quantitative examinations of the

influence of uncertainty on mental health in the context of natural disasters. Three

targets of uncertainty were assessed: uncertainty about the home’s safety, uncertainty

about personal safety, and uncertainty about the safety of friends and/or family.

Results supported the prediction that heightened levels of uncertainty associated

with exposure to wildfires are negatively associated with mental health. Supplemen-tary analyses showed that the duration of uncertainty about the home’s safety (not

just the level of uncertainty) was also associated with lower mental health.

These associations held regardless of evacuation status. Interestingly, though, the

effect of uncertainty was nearly three times stronger for the nonevacuated

participants compared to those who evacuated (as assessed by the size of the R2

change). Most likely, that difference reflects the more limited role played by

uncertainty in affecting mental health among evacuees compared to nonevacuees.

In other words, the amount of variance in mental health for which uncertainty canaccount is probably greater among the nonevacuated group than the evacuated

group. Yet, the data also suggest another possibility. Although the two groups did

not differ in the amount of self-reported uncertainty about their personal safety (see

Table 1), the experience of that uncertainty differed (see Table 3). For the

nonevacuated group, it was strongly associated with psychological distress, while

for the evacuated group, it had no impact. So, what accounts for that difference in

the same level of uncertainty, about the same issue (personal safety)? Perhaps, the

answer lies in the fact that the gestalt experiences of uncertainty about personalsafety ‘‘during the period of the fire’’ (as our survey instructions read) differed for the

two groups. The evacuated group may have felt acute levels of uncertainty on that

front until the evacuation, after which personal safety was no longer in question. In

contrast, the nonevacuated group may have continued to have some question about

their personal safety (albeit less peaked and more stable over time) throughout the

length of the wildfire threat. In other words, a snapshot rating of uncertainty about

personal safety over a period of time suggests that the two groups’ experience on that

front was the same, but a more microscopic lens within that time period may revealshifting states of uncertainty that account for its differing impact on psychological

distress. Future research would benefit from a more fluid assessment of uncertainty

states. Moreover, the heightened impact of uncertainty in the nonevacuated group

suggests the need to better understand the role of evacuation in disaster recovery.

More broadly, this evidence that uncertainty is associated with psychological

distress in the context of wildfires supports the position that successful management

of uncertainty should be a primary goal for disaster response agencies (e.g.,

Rodrıguez, Dıaz, Santos, & Aguirre, 2006). Unfortunately, even when acknowledged,such uncertainty-management efforts often fail because of the often-held, yet

inaccurate belief that the provision of information is the antidote to uncertainty

(see W.A. Afifi, 2009). In fact, information holds a complex relationship to

uncertainty, sometimes increasing it and at other times decreasing it. W.A. Afifi

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and Burgoon (2000) argued that one explanatory mechanism underlying whether

information increases or decreases uncertainty is the information’s consistency with

previously held information. In the context of wildfires, learning that a wildfire which

was believed to be weakening has, in fact, weakened is likely to reduce uncertainty

about its danger, whereby hearing that it has suddenly strengthened is likely to

increase uncertainty about its danger. Alternatively, information may serve to

decrease one type of uncertainty but increase another. Consider the discovery that a

wildfire is heading rapidly in the direction of one’s house. That information reduces

uncertainty about the location of the fire but dramatically increases uncertainty

about personal and property safety. Better understanding of the information�uncertainty association is central to successful efforts at disaster management

and, as this investigation has shown, has direct implications for population-wide

well-being.

The role of communal coping

Results also support the prediction that communal coping reduces the negative

effect that uncertainty can have on recovery. Specifically, the negative effect of

uncertainty on mental health was buffered by reliance on communal coping.

Importantly, this benefit of communal coping only occurred among those who were

evacuated.

The strength of the moderating role of communal coping is worth noting. First, it

emerged across three of four uncertainty measures: degree of uncertainty about the

home, length of uncertainty about the home, and degree of uncertainty about personal

safety. The breadth of its effect shows the robustness of the benefits of communal

coping. Second, the strength of the benefit is worth noting (see Figures 1�3). The

impact is especially noteworthy because it occurred in a sample where the overall level

of communal coping was very high (M�4.68 on a five-point scale among the

evacuated sample). In other words, there were not many people who reported low

levels of communal coping. It is possible that a sample with greater variance on

communal coping would show an even stronger buffering effect.

These findings are important for several reasons. First, they add to a growing

body of research, showing the benefits of communal coping. As noted earlier, Koehly

et al. (2008) found it to be negatively associated with anxiety about illness, and T.D.

Afifi et al. (2006) have shown that it buffers against the negative effects of divorce.

This investigation adds to the list of contexts in which communal coping has been

shown to play a positive role. Second, the research on uncertainty and communal

coping guides agencies toward directions in which they can facilitate postdisaster

efforts. Public service announcements (PSAs), news programs, and disaster

preparedness and recovery programs that successfully create awareness to the

strength and challenges of coping in social networks or that educate community

members about positive support messages should produce benefits in terms of

population well-being. Indeed, Psychological First Aid (Brymer et al., 2006)

emphasizes building and using social support to cope with disaster-related stress.

Integrating effective communal coping strategies into disaster prevention and

recovery programs could further improve the health of individuals, families, and

larger communities.

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Limitations and future directions

As with all studies, there are aspects to this investigation that limit the size of its

contribution. First, we did not measure the strategies that individuals used to

manage their uncertainties. Future efforts should closely examine the roles of both

media and interpersonal channels in shaping individuals’ uncertainty experiences

leading up to, during, and following, community-wide trauma. Second, the focus of

this investigation was on acute uncertainty following an event. Future studies should

also consider the effects of chronic uncertainty that result from disasters or other

traumatic community-wide events. For example, the prolonged uncertainty that

haunts long-term evacuees is likely to take a particularly strong toll on their well-

being. In fact, recent discoveries related to the neurological correlates of uncertainty

(Platt & Huettel, 2008) suggest the possibility of long-term neurological implications

associated with chronic uncertainty. Third, the data are cross-sectional and retro-

spective and thus do not allow for causal claims about either the associations

between uncertainty and mental health, or about the impact of communal coping.

Fourth, our design cannot separate the impact of evacuation itself from that of the

heightened exposure and trauma resulting from the conditions that lead to the

evacuation. Finally, experts in telephonic survey administration strongly encouraged

hard caps in the number of items due to concerns with respondent fatigue. One of the

consequences was that our assessment of communal coping only captured positive

forms of that coping. Importantly, TMCC (T.D. Afifi et al., 2006) notes situations in

which communal coping could exacerbate stress, not reduce it. For example,

individuals who disclose too much about their own uncertainty regarding the natural

disaster may inadvertently produce stress contagion, thereby weakening both their

own and the other person’s protective abilities (T.D. Afifi et al., 2006). In another

vein, Cline et al. (2010) examined a community’s struggle with negligence from a

mining company and the resultant widespread exposure to asbestos, a cancer-causing

agent. Their analysis brought attention to the potentially destructive aspects of

communal orientations to disaster recovery. Specifically, residents who were

diagnosed with cancer or those activists against the contamination found themselves

shunned by community members who blamed them for pushing the company out of

the town and destroying the infrastructure of the community. These studies

emphasize the need to better understand the process of communal coping and to

account for cases where communal orientations may impede, as oppose to facilitate,

the recovery process.

Conclusion

This investigation offers support for the notion that individuals’ experience of

uncertainty following natural disasters may negatively impact mental health, and

that communal coping plays an important role in recovery. Findings suggest the need

for disaster response units to devote considerable more attention to the association

between information and uncertainty, encourage the development of PSAs and

interventions focused on effective uncertainty reduction strategies and on communal

coping benefits, and lay out several possibilities in the effort to advance this area of

research.

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Acknowledgements

This research was partly funded through a grant from the Social Science Survey Center (SSSC)Central Coast Survey Award and by the Institute for Social, Behavioral, and EconomicResearch (ISBER) at the University of California-Santa Barbara.

References

Afifi, W.A. (2009). Uncertainty and information management in interpersonal contexts. InS. Smith & S.R. Wilson (Eds.), New directions in interpersonal communication (pp. 94�114).Thousand Oaks, CA: Sage.

Afifi, T.D., & Afifi, W.A. (Eds.). (2009). Uncertainty, information management, and disclosuredecisions: Theories and applications. New York, NY: Routledge.

Afifi, W.A., & Burgoon, J.K. (2000). Behavioral violations in interactions: The combinedconsequences of valence and change in uncertainty on interaction outcomes. HumanCommunication Research, 26, 203�233.

Afifi, T.D., Hutchinson, S., & Krouse, S. (2006). Toward a theoretical model of communalcoping in post-divorce families and other naturally occurring groups. CommunicationTheory, 16, 378�409.

Afifi, W.A., & Weiner, J.L. (2006). Seeking information about sexual health: Applyingthe Theory of Motivated Information Management. Human Communication Research, 32,35�57.

Aiken, L.S., & West, S.G. (1991). Multiple regression: Testing and interpreting interactions.Newbury Park, CA: Sage.

Amendola, A. (2004). Management of change, disaster risk, and uncertainty: An overview.Journal of Natural Disaster Science, 26, 55�61.

Badia, P., McBane, B., Suter, S., & Lewis, P. (1966). Preference behaviour in an immediateversus variably delayed shock situation with and without a warning signal. Journal ofExperimental Psychology, 72, 847�852. doi: 10.1037/h0023867

Bailey, D.E., Jr., Landerman, L., Barroso, J., Bixby, P., Mishel, M.H., Muir, A.J., . . . Clipp, E.(2009). Uncertainty, symptoms, and quality of life in persons with chronic Hepatitis C.Psychosomatics, 50, 138�146. doi:10.1176/appi.psy.50.2.138

Bammer, G., & Smithson, M. (Eds.). (2008). Uncertainty and risk: Multidisciplinaryperspectives. London: Earthscan.

Berwick, D.M., Murphy, J.M., Goldman, P.A., Ware, J.E. Jr., Barsky, A.J., & Weinstein, M.C.(1991). Performance of a five-item mental health screening test. Medical Care, 29, 169�176.doi:10.1097/00005650-199102000-00008

Bland, S., O’Leary, E., Farinaro, E., & Trevisan, M. (1996). Long-term psychological effects ofnatural disasters. Psychosomatic Medicine, 58, 18�24.

Boin, A., van Duin, M., & Heyse, L. (2001). Toxic fear: The management of uncertainty in thewake of the Amsterdam air crash. Journal of Hazardous Materials, 88, 213�234.doi:10.1016/S0304-3894(01)00268-0

Bonanno, G.A., Brewin, C.R., Kaniasty, K., & La Greca, A.M. (2010). Weighing the costs ofdisaster: Consequences, risks, and resilience in individuals, families, and communities.Psychological Science in the Public Interest, 11, 1�49. doi: 10.1177/1529100610387086

Bonanno, G.A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychologicalresilience after disaster? The role of demographics, resources, and life stress. Journal ofConsulting and Clinical Psychology, 75, 671�682. doi: 10.1037/0022-006X.75.5.671

Brashers, D.E., Haas, S.M., Klingle, R.S., & Neidig, J.L. (2000). Collective AIDS activism andindividuals’ perceived self-advocacy in physician-patient communication. Human Commu-nication Research, 26, 372�402.

Broughton, E. (2005). The Bhopal disaster and its aftermath: A review. Environmental Health:A Global Access Science Source, 4(6). doi:10.1186/1476-069X-4-6

Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., . . . Watson, P. (2006)Psychological first aid field operations guide (2nd ed.). Los Angeles, CA: National ChildTraumatic Stress Network and National Center for PTSD. Retrieved from www.nctsn.organd www.ncptsd.va.gov.

Anxiety, Stress, & Coping 345

Dow

nloa

ded

by [

Uni

vers

ity o

f Su

ssex

Lib

rary

] at

14:

38 1

5 M

arch

201

3

Cline, R.J.W., Orom, H., Berry-Bobovski, L., Hernandez, T., Black, C.B., Schwartz, A.G., &Ruckdeschel, J.C. (2010). Community-level social support responses in a slow-motiontechnological disaster: The case of Libby, Montana. American Journal of CommunityPsychology, 46, 1�18. doi:10.1007/s10464-010-9329-6

Dervin, B. (1998). Sense making theory and practice: An overview of user interests inknowledge seeking and use. Journal of Knowledge Management, 2(2), 36�45. doi: 10.1108/13673279810249369.

Foa, E.B., Cahill, S.P., Boscarino, J.A., Hobfoll, S.E., Lahad, M., McNally, R.J., &Solomon, Z. (2005). Social, psychological, and psychiatric interventions following terroristattacks: Recommendations for practice and research. Neuropsychopharmacology, 30, 1806�1817. doi:10.1038/sj.npp.1300815

Frazier, P.A., Tix, A.P., & Barron, K.E. (2004). Testing moderator and mediator effects incounseling psychology research. Journal of Counseling Psychology, 51, 115�134.doi:10.1037/0022-0167.51.1.115

Goto, T., Wilson, J.P., Kahan, B., & Slane, S. (2006). PTSD, depression and help-seekingpatterns following the Miyake Island volcanic eruption. International Journal of EmergencyMental Health, 4, 157�171.

Handmer, J., & Dovers, S. (2007). The handbook of disasters and emergency policies andinstitutions. London: Earthscan.

Harden, B. (2005, December 29). A shared uncertainty: Hurricane unites evacuees on bothsides of New Orleans’s divide of race and class. The Washington Post, A1.

Hayes, A.F., & Matthes, J. (2009). Computational procedures for probing interactions in OLSand logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41,924�936. doi:10.3758/BRM.41.3.924

Hobfoll, S.E. (1998). Stress, culture, and community: The psychology and philosophy of stress.New York, NY: Plenum.

Hobfoll, S.E., Briggs, S., & Wells, J. (1994). Community stress and resources: Actions andreactions. In S.E. Hobfoll & M.W. deVries (Eds.), Extreme stress and communities: Impactand intervention (pp. 137�158). Dordrecht: Kluwer.

Hobfoll, S.E., Schroder, K.E.E., Wells, M., & Malek, M. (2002). Communal versusindividualistic construction of sense of mastery in facing life challenges. Journal of Socialand Clinical Psychology, 21, 362�399. doi:10.1521/jscp.21.4.362.22596

Hodgson, R.W. (2007). Emotions and sense making in disturbance: Community adaptation todangerous environments. Human Ecology Review, 14, 233�242.

Independent Staff (2009, May 14). Santa Barbara endures its most threatening natural disasterever. Retrieved from http://www.independent.com/news/2009/may/14/santa-barbara-en-dures-its-most-threatening-natural/

Kelly, M.J., Dunstan, F.D., Lloyd, K., & Fone, D.L. (2008). Evaluating cutpoints for the MHI-5 and MCS using the GHQ-12: A comparison of five different methods. BMC Psychiatry, 8,10. doi:10.1186/1471-244X-8-10

Kinzie, J.D., Boehnlein, J.K., Riley, C., & Sparr, L. (2002). The effects of September 11 ontraumatized refugees: Reactivation of posttraumatic stress disorder. The Journal of Nervousand Mental Disease, 190, 437�441. doi:10.1097/01.NMD.0000022443.69161.0A

Koehly, L.M., Peters, J.A., Kuhn, N., Hoskins, L., Letocha, A., Kenen, R., . . . Greene, M.H.(2008). Sisters in hereditary breast and ovarian cancer families: Communal coping, socialintegration, and psychological well-being. Psycho-Oncology, 17, 812�821. doi:10.1002/pon.1373

Koocher, G.P., (1984). Terminal care and survivorship in pediatric chronic illness. ClinicalPsychology Review, 4, 571�583. doi:10.1016/0272-7358(84)90045-X

Lachlan, K.A., Westerman, D.K., & Spence, P.R. (2010). Disaster news and subsequentinformation seeking: Exploring the role of spatial presence and perceptual realism.Electronic News, 4, 203�217. doi:10.1177/1931243110387092

Lee, Y.L. (2006). The relationships between uncertainty and posttraumatic stress in survivorsof childhood cancer. Journal of Nursing Research, 14, 133�142. doi:10.1097/01.JNR.0000387571.20856.45

346 W.A. Afifi et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f Su

ssex

Lib

rary

] at

14:

38 1

5 M

arch

201

3

Lyons, R.F., Mickelson, K., Sullivan, J.L., & Coyne, J.C. (1998). Coping as a communalprocess. Journal of Social and Personal Relationships, 15, 579�607. doi:10.1177/0265407598155001

Mishel, M.H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17,269�294.

Monat, A., Averill, J., & Lazarus, R. (1972). Anticipatory stress and coping reactions undervarious conditions of uncertainty. Journal of Personality and Social Psychology, 24, 237�253.doi:10.1037/h0033297

Parsons, T. (1980). Health, uncertainty, and the action situation. In S. Fiddle (Ed.),Uncertainty: Behavioral and social dimensions (pp. 145�162). New York, NY: Praeger.

Penrod, J. (2001). Refinement of the concept of uncertainty. Journal of Advanced Nursing, 34,238�245. doi:10.1046/j.1365-2648.2001.01750.x

Platt, M.L., & Huettel, S.A. (2008). Risky business: The neuroeconomics of decision makingunder uncertainty. Nature Neuroscience, 11, 398�403. doi:10.1038/nn2062

Rodrıguez, H., Dıaz, W., Santos, J., & Aguirre, B. (2006). Communicating risk anduncertainty: Science, technology, and disasters at the crossroads. In H. Rodriguez,E.L. Quarantelli, & R. Dynes (Eds.), Handbook of disaster research (pp. 476�488).New York: Springer.

Rohrbaugh, M.J., Mehl, M.R., Shoham, V., Reilly, E.S., & Ewy, G.A. (2008). Prognosticsignificance of spouse we talk in couples coping with heart failure. Journal of Consulting andClinical Psychology, 76, 781�789. doi:10.1037/a0013238

Seeger, M.W., Sellnow, T.L., & Ulmer, R.R. (1998). Communication, organization, and crisis.Communication Yearbook, 21, 231�275.

Stewart, A.L., Hays, R.D., & Ware, J.E., Jr. (1988). The MOS Short-form General HealthSurvey: Reliability and validity in a patient population. Medical Care, 26, 724�735.Retrieved from http://www.jstor.org/stable/3765494

Veit, C.T., & Ware, J.E., Jr. (1983). The structure of psychological distress and well-being ingeneral populations. Journal of Consulting and Clinical Psychology, 51, 730�742.doi:10.1037//0022-006X.51.5.730

Vyner, H.M.(1988). The psychological dimensions of health care for patients exposed toradiation and the other invisible environmental contaminants. Social Science and Medicine,27, 1097�1103. doi:10.1016/0277-9536(88)90304-8

Weick, K.E. (1988). Enacted sensemaking in crisis situations. Journal of Management Studies,25, 305�317.

Weick, K.E. (1993). The collapse of sensemaking in organizations: The Mann Gulch disaster.Administrative Science Quarterly, 38, 628�652.

Weick, K.E. (2010). Reflections on enacted sensemaking in the Bhopal disaster. Journal ofManagement Studies, 47, 537�550. doi:10.1111/j.1467-6486.2010.00900.x

Weick, K.E., Sutcliffe, K.M., & Obstefeld, D. (2005). Organizing and the process ofsensemaking. Organization Science, 16, 409�421. doi 10.1287/orsc.1050.0133

Wildfire Maps (2009). Wildfire Maps in Santa Barbara County-Individual Fire AnimatedMaps. Retrieved from htp://www.countyofsb.org/itd/default.aspx?id�19662

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