towards an understanding of the psychological impact of natural disasters: an application of the...

Journal of Traumatic Stress, Vol. 5, No. 3, 1992

Towards an Understanding of the Psychological Impact of Natural Disasters: An Application of the Conservation Resources Stress Model

John R. Freedy, 1 Darlene L. Shaw, 2 Mark P. Jarrell, 2 and Cheryl R. Masters 3

The current study employed the Conservation of Resources (COR) stress model as a template for understanding short-term adjustment following a natural disaster (Hobfoll, 1989). The following three hypotheses were supported: resource loss was positively related to psychological distress; resource loss was relatively more important in predicting psychological distress than personal characteristics and coping behavior; and, resource loss constitutes a risk factor for the development of clinically significant psychological distress. The theoretical importance of the current findings is discussed, particularly the tendency within disaster literature to confound crisis experiences (e.g., terror) with resource loss experiences (e.g., loss of possessions, loss of social support) when defining degree of disaster exposure. Also, the practical importance of considering resource loss in planning intervention services is highlighted.

KEY WORDS: disaster; resource loss; psychological distress; coping,

INTRODUCTION

On September 22, 1989, Hurricane Hugo devastated Charleston, South Carolina. Hugo was the costliest hurricane in United States history with damage estimates for the mainland at 7.5 billion dollars (B. Case,

1Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Ave., Charleston, South Carolina 29425 -0742.

2Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina 29425-0742.

3Admissions Division, Broughton Hospital, Morganton, North Carolina 28655.

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0894-9867/92/0700-0441506.50/0 © 1992 Plenum Publishing Corporation

442 Freedy et al.

National Hurricane Center, personal communication, January 1990). At time of landfall, it is estimated that sustained winds reached approximately 138 miles per hour. A storm surge of 10.4 ft above sea level coupled with almost 7 in. of rain produced serious flooding. Hugo accounted for 21 deaths in the United States, with 13 of these deaths occurring in South Carolina. Owing to adequate warning (18 hrs before storm) and an excel- lent community response to evacuation orders, the death toll was not higher (Lawrence, 1989).

Solomon (1989) contends that hurricanes and other disasters provide unique opportunities for theory development and intervention planning. Dis- asters allow for theory development because research questions can be tested with few confounds. Since disasters are extreme events occurring within a discrete time period, it is possible to identify and empirically test proposed linkages between stressor and outcome variables. Further, the confound between perception and psychological outcome may be minimized in disaster research since extreme events are unlikely to be mainly a function of perception. Concerning intervention planning, disaster research affords an opportunity to identify risk factors involved in the development of psychological distress. From this, preventative intervention efforts can be tar- geted at individuals at high risk based on disaster experiences.

UNDERSTANDING DISASTER IMPACT

Several factors call attention to the importance of understanding the link between disaster exposure and the increased prevalence of psychological distress. First, disasters are common events affecting large numbers of people. Recent estimates suggest that up to 2 million residents of the United States suffer injuries or property damage each year due to disasters (Solomon, 1989). Second, a broad range of psychosocial problems have been associated with exposure to various disasters, including: Post-traumatic Stress Disorder (PTSD), anxiety disorders, depression, psychosomatic complaints, substance abuse, brief reactive psychoses, domestic violence, and divorce (Gibbs, 1989; Rubonis and Bickman, 1991). Finally, although psychological distress can dissipate following disaster exposure (see Cook and Bickman, 1990; Rubonis and Bickman, 1991), significant adjustment difficulties can persist following disaster experiences. Representative findings include: increased prevalence of generalized anxiety, major depression, and PTSD up to 24 months following the Mt. St. Helens volcanic eruption (Shore et al., 1986), heightened distress among firefighters 29 months after exposure to a catastrophic brushfire (McFarlane, 1988), elevated distress levels up to 5 years following the Three Mile Island nuclear accident (Baum

Resource Loss and Psychological Distress Following Disaster 443

et al., 1983; Baum, 1987), and persistent distress 14 years following the dam collapse at Buffalo Creek (Green et aL, 1990).

Contemporary disaster studies emphasize the importance of defining the nature of disasters. A global distinction has been made between natural (e.g., hurricanes, earthquakes, tornadoes) and technological (e.g., nuclear accidents, toxic spills) disasters. Further, characteristics such as powerful impact, predictability, controllability, threat, terror, and horror have been found to be associated with psychosocial outcome (Baum, 1987). In general, high levels of powerful impact, threat, terror, and horror coupled with low levels of predictability and controllability have been found to adversely af- fect community (e.g., basic services), social (availability of emotional and instrumental support), and individual functioning (psychological distress; (Baum, 1987; Gibbs, 1989).

A recent meta-analysis of controlled disaster studies (comparison group, pre to post design) provides a useful summary of the data concerning the relationship between specific elements of disaster exposure and individual psychological adjustment (Rubonis and Bickman, 1991). The authors concluded that controlled disaster literature indicates a 17% in- crease in the prevalence of' psychopathology following disaster exposure. However, the authors noted that few studies employed the available typo- logies that define disaster characteristics (e.g., terror, threat) thought to be determinants of negative psychological outcome. Therefore, the precise disaster elements responsible for increased psychopathology prevalence following disaster exposure remains unclear.

A CONCEPTUAL MODEL

The major goal for this study was to empirically test a conceptual model of natural disaster adjustment. Such tests are valuable because, as mentioned, the existing literature has been inconsistent in linking elements of disaster exposure to psychological outcome (Rubonis and Bickman, 1991). Further, existing definitions of disaster exposure primarily emphasize crisis-related variables such as exposure to threat, terror, or horror (Baum, 1987). Many natural disaster victims, particularly when given adequate warning, are not directly exposed to life threatening or other horrific experiences. However, most natural disaster victims do face a range of ad- versities involved in the post disaster period, such as: scarcity of food, damage to property, feelings of hopelessness, and disruption of normal rou- tines (Solomon and Canino, 1990). Accordingly, this study examined the theoretical and practical importance of a range of adverse experiences on individual adjustment following a natural disaster.

444 Freedy et al.

The Conservation of Resources (COR) stress model provides a useful framework to examine the impact of adverse experiences on individual functioning following natural disaster (Hobfoll, 1989). This model focuses on the extent to which individuals are able to maintain social (e.g., family roles, work roles) and personal (e.g., possessions, sense of optimism) characteristics that can be employed to achieve reinforcing goals. The model labels these social and personal characteristics as resources. Resources, then, are tools employed by an individual in achieving desirable states. The COR model proposes that the loss or threatened loss of resources results in diminished coping capacity and psychological distress. Further, the model implies that replenishing diminished resources should enhance coping capacity and reduce psychological distress (Hobfoll, 1988, 1989).

The breadth of the COR model makes it useful in conceptualizing adjustment to natural disasters. The model identifies four resource categories: object resources--which are possessions with either functional or status value such as, car, home, household items; condition resources--which include a variety of social roles such as, employment, marriage, and mem- bership in organizations; personal characteristic resources--which are self and world views such as, a sense of optimism, a sense of meaning/purpose, and feeling independent; and energy resources--such as time, money, and information, which are valued as tools in the acquisition of other resources (Hobfoll, 1988, 1989). The COR model implies that natural disasters re- strict coping options and produce psychological distress by producing loss within each resource category. Further, postdisaster interventions that target affected resources should enhance coping capacity and reduce psychological distress.

MEDIATING FACTORS

An accurate model of how disaster victims adjust is only possible when certain mediating variables are considered. The COR model proposes that the experience of resource loss is the primary factor in determining postdisaster psychological adjustment. It does not suggest, however, that the predisaster availability of resources (e.g., social support, money) or the postdisaster vulnerability to resource loss (e.g., loss of possessions, loss of employment) occurs randomly. Certain groups (e.g., single parents) may begin with fewer resources and remain more vulnerable to resource loss, coping impairment, and psychological distress following disasters or other stressful events (Hobfoll, 1989). The role of individual differences in resource availability and vulnerability to resource loss can be recognized by


including both personal characteristics and coping behaviors as predictors of post-disaster psychological distress.

Gibbs (1989) conducted a literature review that addressed the role of personal characteristics such as age, gender, previous psychopathology, and social class in determining post-disaster adjustment. This review reported that among adults it is unclear whether younger or older adults are most vulnerable to psychological distress. It was reported that several studies found heightened stress reactions among children. The review reported that findings of higher distress rates among females are confounded with type of pathology. When a full range of disorders are considered, overall rates of disorder typically do not differ by gender. The review concluded that few findings support a connection between premorbid adjustment and postdisaster outcome. Finally, Gibbs (1989) reported that higher education and income levels are associated with lower levels of postdisaster psychological distress. It may be that such individuals have access to greater social and personal resources to meet demands created by a disaster.

Coping behavior is a second factor that can mediate between disaster impact and psychological outcome. Gibbs (1989) reviewed the com- plex role of coping behavior following disaster and concluded that behavior resulting in a sense of control, sense of meaning, or emotional relief was beneficial. The COR model suggests that coping behavior re- duces psychological distress to the extent that the behavior replenishes diminished resources (Hobfoll, 1989). For example, when disaster related resource loss allows for instrumental control (e.g., repairing home damage, activism concerning toxic exposure) active coping strategies aimed at problem solving have produced positive outcomes (Gibbs, 1989). Conversely, if the postdisaster environment does not allow for instrumental control, active coping strategies may be less effective in replenishing resources. Consistent with this prediction, Baum, Fleming, and Singer (1983) suggested that self-blame and emotion focused coping reduced psychological distress following the Three Mile Island nuclear accident by replenishing a sense of personal control.

RESEARCH QUESTIONS

These statements reflect the research questions for this study: 1. Resource loss is a critical element in defining the impact of a natu-

ral disaster. Therefore, loss will be positively related to psychological distress.

2. Resource loss will be one of several variables impacting psychological distress. However, in relative terms, resource loss will assume pri-

446 Freedy et ai.

mary importance and account for more variance than mediator variables (personal characteristics and coping behavior).

3. Resource loss will constitute a risk factor in defining clinical level of psychological distress. Higher levels of resource loss will be associated with clinically significant levels of distress.

METHOD

Sample

Questionnaire sets were mailed to 1200 faculty and professional staff of the Medical University of South Carolina in Charleston, South Carolina, 8 weeks after Hurricane Hugo. A total of 490 individuals re- turned the survey within 4 weeks for a 40.8% return rate. Incomplete responses required the deletion of 72 questionnaire sets. Therefore, current analyses are based on the responses of 418 participants returning usable questionnaires sets (34.8% of all questionnaire mailed).

Among the 418 participants providing usable data, 49.3% were male and 50.7% were female. Participants' mean age was 40.2 years (SD = 10.4) with a range from 19 to 68. Regarding race, 93.5% of the sample was Cau- casian. Concerning marital status, 69.4% of the participants were married. A bachelors degree or higher professional degree was held by 87.1% of participants, while 87.3% reported an annual household income greater than $30,001.

Measures

Consistent with research questions, three variable sets were assessed: resource loss, mediator variables (personal characteristics and coping behavior), and psychological distress.

Resource Loss

The loss of resources was assessed with a 52-item Resources Ques- tionnaire. This scale is a modification of a 74 item scale developed to measure resource loss. Preliminary evidence indicates adequate test- retest reliability and acceptable construct validity (Hobfoll et aL, 1991).

A revised 52-item scale was created to ensure a scale appropriate to resource loss following natural disaster while still sampling the resource categories proposed by the COR model. Participants rated the extent of


loss of each resource since the occurrence of the hurricane (0 = no loss to 4 = extreme amount of loss). Five resource loss scores were created based on average loss scores: object loss, condition loss, personal characteristic loss, energy loss, and total loss. High correlations (r = 0.68 to 0.92) between the total resource loss scale and four component loss scales led to the decision to use only the total resource loss score (52 items) in additional analyses.

Mediator Variables

Two categories of mediator variables were assessed. The first category included a range of personal characteristics, including: gender, age, race, marital status, education, annual household income, and previous experience with natural disaster. Homogeneity within the current sample led to the decision to delete race (93.5% Caucasian) and education (87.1% at least a bachelors degree) as variables in data analysis.

Coping behavior was the second mediator variable assessed for this study. The COPE inventory was employed to assess coping behavior (Carver et al., 1989). This 60 item inventory consists of 15, four-item scales, including: active coping, planning, seeking instrumental social support, seeking emotional social support, suppression of competing activities, re- ligion, positive reinterpretation and growth, restraint coping, acceptance, focus on and venting of emotions, denial, mental disengagement, behavioral disengagement, alcohol/drug use, and humor. Carver et al. (1989) reported evidence of adequate reliability (internal consistency and test-retest), con- vergent validity, and discriminant validity.

A situational form of the COPE inventory was administered prefaced by the following instructions:

Hurricane Hugo produced challenges for each of us. We are interested in what you have done to cope with the challenges created by Hugo. Your responses should reflect your efforts to cope from immediately after the hurricane until today.

Participants responded to each item on a 4 point scale regarding the fre- quency of their behavior (1 = I have not done this at all to 4 = I have done this a lot). Scale scores were derived by calculating the mean fre- quency of each type of coping response.

Carver et al. (1989) proposed grouping scales from the COPE inventory into three distinct coping styles: problem focused coping, emotion focused coping, and self-limiting strategies. Accordingly, a principle components factor analysis with varimax rotation was conducted using the 15 scale means as raw data. Three factors (eigenvalue > 1.00) accounting for 55.8% of inventory variance emerged and are used in subsequent analy-

448 Freedy et ai.

Table I. Correlations Among Resource Loss, Personal Characteristics, Coping, and Psychological Distress Variables

Variable 1 2 3 4 5 6 7 8 9 10

1. General Severity - - Index

2. Resource Loss 0.64 a - - 3. Gender 0.29 a 0.24 a - - 4. Age -0.07 -0.02 -0.28 a - - 5. Marital Status 0.20 a 0.09 0.30 a -0.17 ° - - 6. Household

Income -0.15 a 0.01 -0.24 a 0.43 a 0.41 a - - 7. Prior Disaster

Exposure 0.10 b 0.07 0.11 b -0.23 a 0.06 -0.13 a 8. Problem

Focused Coping 0.11 b 0.28 a 0.02 0 .05-0 .01 0.14 a 9. Emotion

Focused Coping 0.24 a 0.24 a 0.24 a -0.16 a 0.10 b -0.17 a 10. Disengagement

Coping 0.60 a 0.57 a 0.28 a -0.14 a 0.16 a -0.12 b

0.04

0.06 0.46 a - -

0.09 0.26 a 0.35 a

Note. N = 418. p < 0.01.

< 0.05.

ses. T h e f a c t o r s a n d c o m p o n e n t s c a l e s a r e as fo l lows: problem focused coping, p l a n n i n g , a c t i v e c o p i n g , s u p p r e s s i o n o f c o m p e t i n g ac t iv i t i e s , a n d a c c e p -

t a n c e ; emotion focused coping, s e e k i n g e m o t i o n a l soc ia l s u p p o r t , r e l i g ion ,

a n d h u m o r ; disengagement coping, b e h a v i o r a l d i s e n g a g e m e n t , d e n i a l , a l co -

h o l / d r u g use , a n d m e n t a l d i s e n g a g e m e n t .

Psychological Distress

P s y c h o l o g i c a l d i s t r e s s w a s a s s e s s e d w i t h t h e S C L - 9 0 - R ( D e r o g a -

t i s , 1 9 8 3 ) . T h i s 9 0 - i t e m s c a l e a s s e s s e s t h e i n t e n s i t y (1 = n o t a t a l l t o

5 = e x t r e m e l y ) o f p s y c h o l o g i c a l a n d s o m a t i c s y m p t o m s w i t h i n t h e p a s t

w e e k . A h i g h m e d i a n c o r r e l a t i o n b e t w e e n t h e G l o b a l S e v e r i t y I n d e x

( G S I ) a n d t h e n i n e s y m p t o m d i m e n s i o n s ( e .g . , d e p r e s s i o n , a n x i e t y ) ( r

= 0 . 8 5 ) l e a d t o t h e s e l e c t i o n o f t h e G S I as t h e d i s t r e s s m e a s u r e f o r

t h i s s t u d y .

R E S U L T S

T a b l e I p r e s e n t s c o r r e l a t i o n s a m o n g r e s o u r c e loss, p e r s o n a l c h a r a c -

t e r i s t i c , c o p i n g , a n d p s y c h o l o g i c a l d i s t r e s s v a r i a b l e s . T h e a s s o c i a t i o n o f e a c h

Resource Loss and Psychological Distress Following Disaster

Table lI. Prediction of General Severity Index (Psychological Distress) by Personal Characteristics, Resource Loss, and Coping Behavior

449

Predictor Variable beta R R 2 F df p

Block 1: Personal Characteristics Gender 0.037 Marital Status 0.076 Household Income -0.044 After Block 1

Block 2: Resource Loss Aggregate Resource Loss After Block 2

0.451

Block 3: Coping Behavior Problem Focused -0.121 Emotion Focused 0.044 Disengagement Focused 0.334 After All Three Blocks

0.308 0.095 13.46 3,386 0.001

0.660 0.436 74.40 4,385 0.001

0.718 0.515 57.95 7,382 0.001

predictor variable with psychological distress (GSI) is presented in column 1. Relevant to the first research question, resource loss demonstrates a robust positive association with psychological distress (r = 0.64, p < 0.01). GSI was also significantly correlated with personal characteristics, including: gender (r = 0.29, p < 0.01), marital status (r = 0.20, p < 0.01), and annual household income (r = -0.15, p < 0.01). As personal characteristic variables were coded, these correlations indicate that higher psychological distress was associated with being female, single, and having lower income. All coping categories were positively associated with psychological distress. Disengagement coping demonstrated a particularly robust effect (r = 0.60, p < 0.01).

The correlations between predictor variables and resource loss is presented in Column 2. Among personal characteristics, only gender was correlated with resource toss (r = 0.24, p < 0.01) indicating that being female was associated with higher levels of resource loss. Concerning coping behavior, resource loss was associated with more coping. While the correlations between resource loss and problem focused coping (r = 0.28, p < 0.01) and resource loss and emotion focused coping (r = 0.24, p < 0.01) were modest, the correlation between disengagement coping and resource loss was substantially larger (r = 0.57, p < 0.01).

Hierarchical multiple regression was used to address the second research question concerning the relative importance of resource loss in predicting psychological distress. Table II presents these results. Predictor

450 Freedy et al.

Table III. Prevalence of Clinically Significant Psychological Distress Among High and Low Loss Males and Females

Males Females

High Loss Low Loss High Loss Low Loss (n = 51) (n = 155) (n = 52) (n = 160)

34.4% 4.5% 44.2% 10.6% [t(204) = 8.05, p < 0.001] [t(210) = 8.19, p < 0.001]

variables were entered in three blocks, consistent with theoretical notions of the likely causal sequencing of events. The personal characteristic block consisted of demographic/experiential characteristics demonstrating a significant bivariate correlation with psychological distress. The resource loss block consisted of participant scores on the aggregate measure of resource loss. The coping block consisted of participant scores on the three coping factors.

Examination of Table II reveals that altogether the three predictor blocks accounted for 51.5% of the variance, F(7,382) = 57.95, p < 0.001. The personal characteristic variable block accounted for 9.5% of the variance, F(3,386) = 13.46, p < 0.001. The resource loss block accounted for an additional 34.1% of the variance, F(4,385) = 232.94, p < 0.001. The coping behavior block accounted for 7.9% of the variance, F(7,382) = 20.74, p < 0.001.

The relative importance of variables in each predictor block was de- termined by examining significant beta weights. Beta weights provide an appropriate criterion since unlike the percentage of variance (R2), beta weights do not change when the order of predictor blocks changes. Psy- chological distress was associated with being single, F(1,388) = 3.44, p < 0.06, B = 0.08; higher resource loss, F(1,388) = 102.42, p < 0.001, B = 0.45; less frequent problem focused coping, F(1,388) = 8.21, p < 0.004, B = -0.12; and more frequent disengagement focused coping, F(1,388) = 53.58, p < 0.001, B = 0.33. The relative sizes of the beta weights suggest that resource loss is the most powerful predictor followed by disengagement focused coping.

Table III presents data addressing the third research question concerning resource loss as a risk factor for developing psychological distress. The percentage of males and females in high and low resource loss categories (upper quartile vs. lower quartiles) who demonstrated scores on the general severity index above the non-patient clinical cutoff score (t = 63) are displayed. As predicted, the prevalence of clinically meaningful distress levels was significantly greater among participants experiencing high resource loss compared to participants experiencing low resource loss. Sig-


nificant differences held for both males (t[204] = 8.05, p < 0.001) and females (t [210] = 8.19, p < 0.001).

DISCUSSION

This preliminary study provided clear support for the proposed hypotheses. First, resource loss had a strong positive relationship to psychological distress. Second, resource loss was the most important of several predictors in determining psychological distress. Third, the experience of intense resource loss was associated with an increased prevalence of clinically significant psychological distress.

The pattern of results suggests important theoretical and practical implications. In terms of theory, the results support broadening current con- cepts regarding the nature of disaster impact and adjustment. Past disaster research has emphasized the role of acute stressful experiences (e.g., terror, horror) in the development of psychological distress (Baum, 1987; Gibbs, 1989). The current findings suggest that resource loss extending beyond the acute impact of a hurricane or other natural disaster also plays a critical role in determining coping capacity and subsequent psychological adjustment. Future definitions of disaster exposure should delineate both horrific experiences and resource loss to gain a greater understanding of the relative importance of these risk factors.

The results concerning resource loss and coping behavior have practical implications. Since resource loss appears to be an important risk factor for developing clinical levels of psychological distress, post-disaster interventions should target the replenishment of resources in order to minimize psychological distress. Conceptualizing the functional value of resources for adjusting to the postdisaster environment provides useful guidelines for intervention planning. An initial intervention priority should be replenishing resources basic to survival (e.g., food, shelter, information concerning loved ones/property) since such resources provide a bedrock for human functioning (Maslow, 1968). A natural extension to bolstering basic resources would be providing a range of information, advice, and assistance in order to enhance resources pertaining to the ability to control and predict the postdisaster environment. Typical interventions directed at these resources include: information concerning normative reaction, advice on how to cope, advice on how to assist children, and so forth (Peuler, 1988).

Results suggest that decreased problem solving behavior and increased disengagement behavior may represent a normative coping pattern in the initial months following a natural disaster. Conventional wisdom might suggest that prolonged coping of this type might fail to replenish

452 Freedy et al.

resources, resulting in psychological distress. Alternatively, as noted in the introduction, increased emotion focused and disengagement focused behavior can lead to an increased sense of control and less psychological distress, particularly when resource loss in the postdisaster environment is not ame- nable to personal control (Baum et aL, 1987). Ultimately, the type and extent of resource loss experienced may be a critical factor to consider in determining the most optimal coping strategies, initially and over time. Al- though current results suggest a normative coping pattern, future longitudinal studies are needed to definitively identify the causal links among resource loss, coping, and psychological distress.

As with any study, these results must be considered in the context of methodological issues. This was a cross sectional study based on retrospective self-report measures. One concern is the role of perceptual distortions such as negative response set or selective memory on the results. Certain factors may have limited, to some degree, the impact of perceptual factors. First, as with any extreme event, it is unlikely that a causal sequence extending from disaster impact (resource loss) to outcome (psychological distress) is mostly a function of perceptual distortion (Solomon, 1989). Also, the relatively brief retrospective period may have minimized the development of perceptual distortions. A second concern is how generalizable the results are to other samples. In this regard, the sample size is a strength of the study. Although the modest response rate could impact generalization, the response rate is acceptable given the chaotic nature of the postdisaster environment. Finally, replication with less affluent populations is necessary to bolster confidence in generalization to other populations.

Common method bias constitutes another potential confound in in- terpreting the relationship between resource loss, coping, and the development of psychological distress. This confound cannot be entirely dismissed although several factors may have lessened the impact of common method bias. First, both the resource loss and coping questionnaires inquire about experiences across the entire postdisaster period (approximately 8 weeks) while the SCL-90-R inquires about distress in the past 7 days. The relatively independent time frames specified in questionnaire instructions should have encouraged the reporting of separate, although interdependent experiences. Second, the differing content of the measures of resource loss, coping, and psychological distress should have encouraged the reporting of separate experiences. The measures of resource loss and coping contained a large number of items concerning a relatively objective event or action. Conversely, the SCL-90-R largely concerns subjective ratings of subjective experiences.

Overall, this study provides preliminary data suggesting a set of variables with significant theoretical and practical importance. As with any sin-


gle study, methodological issues serve to caution against any temptation to consider these results as definitive. However, the large amount of psychological distress variance captured by both resource loss (34.1%) and coping behavior (7.9%) blocks, attests to the relatedness of project variables. At- tempts to replicate these findings are essential given the robust, provocative nature of the results. Ideally, replication attempts will involve different disasters, different populations, longitudinal designs, and appropriate control groups.

ACKNOWLEDGMENTS

The authors wish to acknowledge Heidi S. Resnick and Dean G. Kil- patrick for their helpful comments on earlier versions of this manuscript. This study was supported by a grant from the National Hazards Research and Applications Information Center, University of Colorado, Boulder, Colorado (Grant No. P0044897).

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