NJ Sandy Panel: Long-Term Toll on Mental Health

Contact:

DR. CHRISTINE HATCHARD,  732-614-5888, chatchar@monmouth.edu

PATRICK MURRAY, 732-263-5858 (office), 732-979-6769 (cell), pdmurray@monmouth.edu

Many New Jersey victims of Superstorm Sandy continue to suffer from psychological distress, including post-traumatic stress disorder (PTSD), five years year after the storm hit the state. This finding comes from the Monmouth University Poll’s Superstorm Sandy Panel study, which has been tracking   New Jersey residents who suffered significant property damage from the storm or were displaced from their homes. This year’s survey collected data from 432 panel members who updated Monmouth on their recovery. The survey finds that, despite some improvement overall, emotional health concerns have continued to trouble a significant number of these survivors since Monmouth first interviewed them in 2013.

Currently, 14% of panel participants say their life today is better than it was before Sandy hit while 45% say their life is about the same. About 4-in-10, though, say their life now is worse than it was before Sandy, including 25% who say it will never be the same, 7% who believe it is still possible to return to normal and 9% who are not sure what type of life is possible in the future. More than two thirds (71%) of panel participants who are still waiting to move back into their homes say their life is worse now than it was before Sandy. A majority (53%) of those who have permanently relocated because of the storm say the same. Among those who have been able to return to their Sandy-damaged properties, 34% say life today is still worse than it was before the storm.

On the mental health front, the panel results indicate fewer New Jersey Sandy victims are displaying psychological distress than in the immediate years after the storm hit. Overall, two-thirds (68%) of the Sandy panel participants now show no signs of emotional distress according to the Kessler-6 scale. This is an increase from 2013 when a smaller number (53%) of these same panel participants exhibited no signs of distress. At the other end of the scale, 15% of panel participants currently register serious distress, which is down from 25% for this same group four years ago. Another 17% exhibit mild to moderate distress compared to 22% in 2013. Despite these improvements, these Sandy survivors continue to exhibit signs of emotional distress at much higher rates than the state population as a whole. According to the 2012 statewide Behavioral Risk Factor Surveillance Survey, 4% of New Jersey adults exhibit signs of serious distress and 8% exhibit signs of mild to moderate distress.

“As expected, psychological distress has continued to improve for Sandy victims over time, however the overall rate of serious distress for Sandy victims as compared to the general population remains a cause for concern. Being in distress for long periods of time can increasingly have a negative impact on all areas of people’s lives, such as relationships and careers. This compounds the distress originally associated with Superstorm Sandy, and the directly related issues like being displaced from their homes or dealing with financial consequences,” said Dr. Christine Hatchard, Assistant Professor of Psychology and Director of the Clinical Psychology Research Center at Monmouth University.

Emotional distress is highly correlated with one’s housing status. Among those who have returned to their pre-Sandy home, just 10% display serious distress. This number goes up to 24% among those who have permanently relocated, and 40% among those who are still waiting to return home. Four years ago, 20% of those who had already returned to their pre-Sandy homes showed serious distress compared to 34% of those displaced at the time who showed the same level of distress.

The panel design of Monmouth’s study also allows for the examination of individual level changes. The survey finds that 42% of the Sandy panel participants show improvement in their Kessler-6 distress scores over the past four years while 14% have worse scores. Just over 4-in-10 (43%) have experienced little to no change in their individual stress scores. Examining these results by current housing status, half (50%) of those who have permanently relocated, just over 4-in-10 (42%) of those who have moved back into their pre-Sandy homes, and one-third (33%) of those who are still waiting to move back into their homes score better on the Kessler-6 distress scale than they did in 2013.

“This is the same thing we have seen since Monmouth launched this panel study. Getting people back in their homes is the single biggest positive factor for improving emotional health. Unfortunately, a significant number of Sandy survivors, about 1-in-10 in our panel, are still without a permanent residence,” said Patrick Murray, director of the Monmouth University Polling Institute.

The 2014 survey included the widely used PCL-5 index to identify potential symptoms of post-traumatic stress disorder (PTSD). At that time, more than 1-in-5 (23%) panel participants exhibited signs of a provisional diagnosis of PTSD according to this 20 question index. That number is down to 17% in the current survey. Just like emotional distress, provisional PTSD diagnoses are related to one’s housing status. Those most likely to exhibit PTSD signs are Sandy survivors still waiting to move back into their storm-damaged homes (40%) followed by those who have permanently relocated their homes (27%). Those who have been able to move back to their original properties are the least likely to exhibit provisional signs of PTSD (12%). These results are similar to the 2014 findings based on housing status at that time.

One-quarter of those surveyed (25%) report having received some type of counseling or therapy since Sandy hit. This is up from 18% who reported receiving counseling in 2014. However, the panel participants who currently report having received some type of counseling include just 37% of those with serious or moderate emotional distress and 34% of those with provisional signs of PTSD.

One-fifth (20%) of the Sandy survivors interviewed by Monmouth report that they currently need mental or emotional counseling. This number is basically unchanged from 23% who said the same in 2014. Three-in-ten (30%) of the panel participants say there was a time after Sandy when they did not get needed therapy or emotional support, which is unchanged from 30% who said the same three years ago. The need for mental health counseling today is significantly higher among those who are still displaced from their homes and those whose family income is less than $50,000 a year.

“The one-year prevalence of PTSD is only around 3.5% for the general population, so the rate of PTSD in our sample is relatively high. For those who are still in distress, counseling for symptoms related to PTSD is recommended and effective, although a combination of counseling and continued logistical support to rebuild their lives produces the best outcomes for those recovering from natural disasters,” said Dr. Hatchard.

About Monmouth University’s NJ Sandy Recovery Panel:

This release marks the twelfth installment of findings from Monmouth University’s tracking panel of New Jersey residents who were hit the hardest by Superstorm Sandy. Results from the first wave of the panel were released in October 2013. The initial study was made possible by a New Jersey Recovery Fund grant from the Community Foundation of New Jersey and the Geraldine R. Dodge Foundation. Results from subsequent waves of the panel were released annually in October of each year. Monmouth has also released five polls to assess statewide opinion of the recovery’s progress over the past five years as well as a separate survey of New Jersey coastal residents’ views of rebuilding policies after the storm. Monmouth’s previous Sandy reports can be found at www.monmouth.edu/polling .

Methodological Note:

The Monmouth University Polling Institute conducts the Sandy Recovery Survey online and by telephone with New Jersey residents who were “hard-hit” by the storm, i.e. were displaced from their homes for a month or more or sustained $8,000 or more in damage to a primary home due to Superstorm Sandy. The results presented in this report are based on 432 interviews completed in September and October 2017. This survey is part of a panel study designed to track the experiences of New Jersey residents who continue to be impacted by the storm. The initial wave of this study was conducted between September 2013 and January 2014, the first follow up survey was conducted between July and October 2014, the second was conducted between August and September 2015, and the third was conducted between August and September 2016.

The results presented in this report are based on 432 New Jersey residents who participated in both the initial wave of the panel study and the most recent wave. Because survey respondents were recruited using a variety of non-probability methods, the survey results cannot be statistically projected to the larger population of all Sandy victims in the state (i.e. a sampling margin of error cannot be calculated). The value of these survey findings rests in comparisons over time among the same group, or panel, of residents to better understand individual-level recovery progress as well as examining variations in the recovery experience among different groups within this cohort (e.g. comparing those who remain displaced with those who are back in their homes).

Survey Questions

Kessler-6 Psychological Distress Scale

15%     Serious

17%     Mild to moderate

68%     None

Kessler-6 INDIVIDUAL LEVEL CHANGE SINCE 2013

19%     Much better

23%     Somewhat better

43%     Little to no change

10%     Somewhat worse

4%     Much worse

PCL-5 Post-Traumatic Stress Disorder [PTSD] Scale

17%     Provisional diagnosis

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Kessler-6* Psychological Distress  scale is based on the responses to six different items (see below).  Each question response is scored from 0 to 4 (0 = none of the time) (4 = all of the time) and each respondent’s answers are totaled (range = 0 – 24).  Serious Psychological Distress is a score of 13 or more; Mild to Moderate Psychological Distress is a score from 8 to 12; and No Psychological Distress is a score of 7 or less.

For more information:  http://dhds.cdc.gov/guides/demographics/core?i=PsychologicalDistress

Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., Howes, M.J, Normand, S-L.T., Manderscheid, R.W., Walters, E.E., Zaslavsky, A.M. (2003). Screening for serious mental illness in the general population  Archives of General Psychiatry . 60(2), 184-189.

Kessler-6 scale items: The following questions ask about how you have been feeling during the past 30 days. For each question, please select the option that best describes how often you had this feeling. During the past 30 days, about how often did you feel…[nervous / hopeless / restless or fidgety / so depressed that nothing could cheer you up / that everything was an effort / worthless] – none of the time, a little of the time, some of the time, most of the time, all of the time?

PCL-5 Post-Traumatic Stress Disorder [PTSD] Scale  is based on the responses to 20 items (see below).  A provisional PTSD diagnosis can be made by treating each item rated as 2 = “Moderately” or higher as a symptom endorsed, then following the DSM-5 diagnostic rule which requires at least: 1 B item (questions 1-5), 1 C item (questions 6-7), 2 D items (questions 8-14), 2 E items (questions 15-20).

PCL-5 scale items:  Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one and indicate how much you have been bothered by that problem in the last month – not at all, a little bit, moderately, quite a bit, extremely?

1. Repeated, disturbing, and unwanted memories of the stressful experience
2. Repeated, disturbing dreams of the stressful experience
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)
4. Feeling very upset when something reminded you of the stressful experience
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
6. Avoiding memories, thoughts, or feelings related to the stressful experience?
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)
8. Trouble remembering important parts of the stressful experience
9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)
10. Blaming yourself or someone else for the stressful experience or what happened after it
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame
12. Loss of interest in activities that you used to enjoy
13. Feeling distant or cut off from other people
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)
15. Irritable behavior, angry outbursts, or acting aggressively
16. Taking too many risks or doing things that could cause you harm
17. Being “super alert” or watchful or on guard
18. Feeling jumpy or easily startled
19. Having difficulty concentrating
20. Trouble falling or staying asleep

Click on pdf file link below for full methodology and results by key demographic groups.