Surviving Two Disasters: Does Reaction to the First Predict Response to the Second?

http://eab.sagepub.com/Environment and Behavior

http://eab.sagepub.com/content/35/5/637The online version of this article can be found at:

DOI: 10.1177/0013916503254754

2003 35: 637Environment and BehaviorJudith M. Siegel, Kimberley I. Shoaf, Abdelmonem A. Afifi and Linda B. Bourque

Surviving Two Disasters: Does Reaction to the First Predict Response to the Second?

Published by:

http://www.sagepublications.com

On behalf of:

Environmental Design Research Association

can be found at:Environment and BehaviorAdditional services and information for

http://eab.sagepub.com/cgi/alertsEmail Alerts:

http://eab.sagepub.com/subscriptionsSubscriptions:

http://www.sagepub.com/journalsReprints.navReprints:

http://www.sagepub.com/journalsPermissions.navPermissions:

http://eab.sagepub.com/content/35/5/637.refs.htmlCitations:

What is This?

- Sep 1, 2003Version of Record >>

at Afyon Kocatepe Universitesi on May 20, 2014eab.sagepub.comDownloaded from at Afyon Kocatepe Universitesi on May 20, 2014eab.sagepub.comDownloaded from

http://eab.sagepub.com/

http://eab.sagepub.com/content/35/5/637

http://www.sagepublications.com

http://www.edra.org/

http://eab.sagepub.com/cgi/alerts

http://eab.sagepub.com/subscriptions

http://www.sagepub.com/journalsReprints.nav

http://www.sagepub.com/journalsPermissions.nav

http://eab.sagepub.com/content/35/5/637.refs.html

http://eab.sagepub.com/content/35/5/637.full.pdf

http://online.sagepub.com/site/sphelp/vorhelp.xhtml



10.1177/0013916503254754ARTICLEENVIRONMENT AND BEHAVIOR / September 2003Siegel et al. / SURVIVING TWO DISASTERS

SURVIVING TWO DISASTERSDoes Reaction to the FirstPredict Response to the Second?

JUDITH M. SIEGEL is a professor of community health sciences in the UCLASchool of Public Health. Trained in social psychology and epidemiology, Siegelfocuses her research on the interplay between psychological factors and health—bothphysical and mental. More specifically, she is interested in the relationship betweenstress and health. Most recently, she has been studying the emotional consequences ofexposure to disaster-generated stress.

KIMBERLEY I. SHOAF is an adjunct assistant professor of community health sci-ences and an assistant director of the Center for Public Health and Disasters in theUCLA School of Public Health. Trained in community health sciences, Shoaf’sresearch focuses on the health impacts of disasters including both those caused bynature and by humans.

ABDELMONEM A. AFIFI is a professor of biostatistics and Dean Emeritus of theUCLA School of Public Health. Trained in mathematics and statistics, Afifi balanceshis research between methodological issues and applications to health—both physi-cal and mental. More specifically, he is interested in risk factor analysis and, mostrecently, has been applying multilevel models to various public health and health ser-vices research questions.

LINDA B. BOURQUE is a professor of community health sciences in the UCLASchool of Public Health where she teaches courses on research methods and surveydesign. Trained in sociology, her current research focuses on how communities pre-pare for and react to disasters and ophthalmic clinical trials.

ABSTRACT: Respondents (N= 414) studied after a California earthquake wererecontacted 4 years later to determine if their prior experience with a disaster impairedor enhanced their ability to deal with a second natural disaster—a slow-onset El Niñoweather pattern. Analyses addressed whether being emotionally injured in one disas-ter influences the extent to which one prepares for a future disaster, whether emotionalinjuries experienced in one disaster predispose individuals to emotional injury in a

637

ENVIRONMENT AND BEHAVIOR, Vol. 35 No. 5, September 2003 637-654DOI: 10.1177/0013916503254754© 2003 Sage Publications

at Afyon Kocatepe Universitesi on May 20, 2014eab.sagepub.comDownloaded from


subsequent disaster, and whether other disaster-related parameters (physical injuryand property damage) are similarly associated across two disasters. Emotional injuryboth facilitated preparedness, in terms of number of hazard-mitigation activities per-formed, and predisposed to a subsequent emotional injury. An unexpected findingemerged showing that emotional injury increased the chance of reporting damage in asecond disaster—a relationship that was maintained after controlling for emotionalinjury in the second disaster. The impact of self-reported emotional injury in twosequential disasters on what might be considered a more objective outcome—property damage in the second disaster—underscores the need for a comprehensiveassessment of disaster reactions in postdisaster research and across disasters, whenpossible.

Keywords: natural disaster; emotional reaction; preparedness; property damage

Natural disasters tendto be quantified on the basis of their physical parame-ters, their financial impact, and the number of injuries and deaths caused bythe event. Much less rigor has been devoted to estimating the emotional com-ponents of natural disasters and their sequelae. The survey reported hereinvestigated the extent to which psychological distress from a natural disaster(an earthquake) affected response to a subsequent natural disaster (an El Niñoweather pattern). In this research, psychological distress was captured by theconstructemotional injury—a question asked in the context of queries aboutphysical injuries and that referred to emotional reactions that resulted fromthe disaster. This research addresses two questions: (a) whether being emo-tionally injured in one disaster influences the extent to which one prepares fora future disaster and (b) whether emotional injuries experienced in one disas-ter predispose individuals to another emotional injury in a later disaster.

A unique opportunity to study natural disasters occurred when extremeweather conditions, because of an El Niño pattern, were predicted in Califor-nia for the winter of 1997-1998. Several years prior, a telephone survey was

638 ENVIRONMENT AND BEHAVIOR / September 2003

AUTHORS’NOTE: The authors express their gratitude to the anonymous reviewerswho provided valuable feedback on an earlier version of this manuscript and toWilliam G. Cumberland, Ph.D., for his advice regarding the analyses. Data for theNorthridge and El Niño studies were collected and processed with funds fromthe National Science Foundation (Nos. CMS-9416470, CMS-9411982, & CMS-9810681) and from the Los Angeles County Department of Health Services (PurchaseOrder R41867 & Award No. 953124). Data for both studies were collected by the Sur-vey Research Center at UCLA’s Institute for Social Science Research, Eve P. Fielder,Dr.P.H., Director. Address correspondence to Judith M. Siegel, UCLA School of Pub-lic Health, Box 951772, Los Angeles, California, 90095-1772.



fielded in Los Angeles County after the 1994 Northridge, California, earth-quake. The El Niño was an anticipated slow-onset disaster, which was wellpublicized. Concrete recommendations were made regarding preparednessactivities residents could (and should) do. By recontacting the respondentsthat were studied after the Northridge earthquake, it was possible to deter-mine if their prior experience with a disaster impaired or enhanced their abil-ity to prepare for the El Niño.

To the extent that the emotional injury from the earthquake was disabling,the symptoms of the injury (anxiety and distress) could have hampered theability to attend to and perform the necessary El Niño hazard mitigationbehaviors. Thus, it was plausible that respondents who were emotionallyinjured as a result of the Northridge earthquake would have been less pre-pared for the El Niño winter. Alternatively, emotional injury could have stim-ulated activity both via heightened sensitivity to messages prescribingmitigation behaviors and via reduced anxiety that might have followed per-formance of these behaviors. Both the conservation-of-resources stressmodel (Hobfoll, 1989) and the warning and response model (Lindell & Perry,1992) are compatible with this hypothesis and have been applied in naturaldisaster situations (Freedy, Shaw, Jarrell, & Masters, 1992; Kaiser, Sattler,Bellack, & Dersin, 1996; Sattler, Kaiser, & Hittner, 2000).

In the context of the current study, the conservation-of-resources modelemphasizes the motivation to reduce resource loss, which is perceived asstressful, through disaster preparation. Both models suggest that experienceacquired in one disaster provides an opportunity for resource gain. Resourcegain occurs because respondent knowledge about how to minimize lossincreases and, thus, their ability to master a situation substantially improves.From the perspective of these theories, it was anticipated that respondentswho were emotionally injured in a prior natural disaster would be more pre-pared for a subsequent disaster, especially when concrete recommendationsfor mitigating hazards were widely disseminated.

A study of preparation for a series of hurricanes provided some support forthe notion that emotional reactions to one disaster enhance preparedness for afuture disaster (Sattler et al., 2000). In this investigation, psychological dis-tress, but not property damage, was retained in a multivariate model predict-ing preparation for a hurricane 4 years after the initial disaster, but neithervariable had an impact on preparation 7 years later. Another investigationfound that the level of fear during an earthquake and frequent thoughts of theearthquake were related to higher levels of postearthquake preparedness(Russell, Goltz, & Bourque, 1995).

Siegel et al. / SURVIVING TWO DISASTERS 639



Less directly relevant is research on the social construction of illness.Recognition of and attention to symptoms of illness are heightened amongthose with past illness experience (Cockerham, 2001). Anxiety is known tofacilitate illness behavior leading to the description of theworried well—aphysically healthy subset of the population who make extensive use of medi-cal services. By extrapolation, it is suggested that emotionally injuredrespondents would be more attentive to hazard mitigation recommendations.Thus, for the first question this study addressed, it was anticipated thatrespondents who were emotionally injured by the Northridge earthquakewould do more to prepare for El Niño. Self-reported worry about the El Niñoand respondents’ rating of their levels of preparedness relative to others wereexamined as possible mediators of an observed association between emo-tional injury and preparedness activities.

A second goal of this study was to determine whether emotional injuriesexperienced in one disaster predisposed individuals to emotional injury in asubsequent disaster. In earlier analyses confined to the earthquake (Siegel,2000), the analytic strategy was to examine the correlates of a quake-inducedemotional injury controlling for generalized psychological distress as mea-sured by the Global score on the Brief Symptom Inventory (BSI) (Derogatis& Spencer, 1982). Several correlates of emotional injury were identified withthe covariate (BSI Global score) accounting for the most variance in the out-come measure—self-reports of emotional injury from the earthquake. Theseprior analyses support the notion that psychologically vulnerable people(e.g., those who are previously psychologically distressed) are more prone tosuffer emotional injury after a natural disaster. This conclusion is concordantwith other research on disasters (Carr et al., 1997; Schuster et al., 2001;Shore, Tatum, & Vollmer, 1986).

The current analyses examined whether an observed association betweenemotional injury in Northridge and emotional injury in El Niño was com-pletely accounted for by global psychological state as measured by the BSI.In other words, if enduring psychological state (BSI) explained away anyassociation of emotional injury as reported after two different disasters, thiswould suggest that emotional injury is not specific to a disaster experiencebut is, instead, a proxy measure for poor mental health. Alternatively, if emo-tional injury in one disaster predicted emotional injury in a second disasterindependently of underlying psychological state, the likelihood is increasedthat experience with the first disaster has a measurable impact on one’s abilityto cope with a second disaster.




METHOD

SAMPLE

The sample for the El Niño study was a panel drawn from a series of 3cross-sectional probability samples selected by random-digit dialing afterthe Northridge earthquake of January 17, 1994. Data for the three studieswere collected in the fall of 1994 for Wave 1 (n= 506), in the late summer andfall of 1995 for Wave 2 (n= 96), and between late summer of 1995 and springof 1996 for Wave 3 (n= 1,247) (see Bourque, Shoaf, & Nguyen, 1997, for adetailed description of the sample). In total, 1,849 respondents interviewedfollowing the Northridge earthquake were considered eligible for the El Niñostudy.

At the end of the interview for the Northridge surveys, respondents wereasked to provide their address in case the research staff wished to contactthem in the future. For the 1,849 potential respondents from the 3 indepen-dent samples, address information was provided by 73% (n= 1,353). Amongthe respondents who provided contact information for potential follow-up,721 were unavailable (i.e., number disconnected, number belonged toanother household, respondent deceased, etc.). Of the remaining 632 house-holds, 414 agreed to participate in the El Niño study to yield a response rate of65.5% for this study or 22.4% of those originally interviewed. Taking intoaccount the 2000 Census data (U.S. Census Bureau, 2000) showing that 30%of renters and 10% of owners in the Southern California population move inany given year, the overall success of recontacting potential study partici-pants was consistent with expectations.

Successfully reinterviewed respondents had a demographic profile con-sistent with residential stability. Compared to those who were not reinter-viewed, they tended to be older, White, married/living with a partner, well-educated, home owners who were longtime residents of California, and bornin the United States. Respondents did not differ from nonrespondents in gen-der composition or work status. Respondents also were more likely to reportdamage from the Northridge earthquake and to live in areas that experiencedmore shaking, whether measured by Modified Mercalli Intensity (MMI) orpeak ground acceleration.

INTERVIEW AND QUESTIONNAIRE

Interviews were conducted in the spring and early summer of 1999 utiliz-ing computer-assisted telephone interviewing (CATI) at the UCLA Institutefor Social Science Research’s Survey Research Center. Interviews, averaging




30 minutes in length, were completed in either English or Spanish at therequest of the respondent.

Many of the items included in the El Niño questionnaire replicated thosefrom the Northridge earthquake study. New items were developed to assessthe extent to which the respondents knew about the El Niño event, the sourcesof such information, their judgment of the accuracy/reliability of that infor-mation, the extent to which they engaged in preparation activities specific tothe El Niño, and the extent to which they worried about the El Niño, other nat-ural disasters, or other concerns such as crime and personal health.

Information collected after the earthquake. The demographic attributesanalyzed included gender, age, race/ethnicity (African American, Hispanic,White, or other), language of interview (English or Spanish), householdincome (categorized as below $40,000, $40,000 to $70,000, and above$70,000), education (12 years or less compared to 13 or more), employmentstatus (working, full- or part-time, compared to not currently working), homeownership (own or rent), and dwelling type (house or other).

The 53-item BSI (Derogatis & Spencer, 1982) administered after bothdisasters measured 9 dimensions of current psychological symptomatology(e.g., anxiety, depression) and yielded several different summary scores. Theglobal severity index (GSI) utilized in the present analyses is considered thebest, single summary measure from the BSI (Derogatis & Melisaratos,1983), combining information on number of symptoms and intensity ofperceived distress. Reliability and validity data for the scale are adequate(Derogatis & Melisaratos, 1983).

Damage (property or personal) was assessed from a series of questionsand summarized as present or absent. Damage was considered if repairs wereneeded or if the damaged entity was no longer usable. Physical injuriesincluded “any physical injuries—even minor cuts and bruises—as a result ofthis earthquake.” Following the questions on physical injuries, respondentswere asked, “What aboutemotional injuries? Would you say that you had anyemotional injuries as a result of this earthquake?” It should be noted thatreports of damage and injuries were stable across the 3 cross-sectional prob-ability samples. Chi-square analyses of the sample by each of these earth-quake parameters were nonsignificant, showing that the percentage ofrespondents who reported damage or injury (physical or emotional) acrossthe 3 samples was the same. This suggests that time elapsed since the earth-quake did not influence response and supports the reliability of the measures.An indirect test of the validity showed that all three indices (physical injury,emotional injury, and property damage) were significantly associated withMMIs1 (government estimates of shaking in the area and the amount and type




of damage sustained by major structures, e.g., roads, freeways, buildings):t(1729) = 23.33,p < .001 for damage;t(1727) = 11.40,p < .001 for physicalinjury; and t(1724) = 9.02,p < .001 for emotional injury. The Governor’sOffice of Emergency Services (1994) maps zip codes by MMIs.

Information collected after the El Niño winter. The identical questions ondamage, physical injuries, and emotional injuries were asked with the wordsEl Niñosubstituted forearthquake.

In regard to preparedness, respondents were asked about “preparationsuggestions that have been made by various agencies and groups who areconcerned with disaster preparedness.” The six activities were (a) makerepairs to your roof (endorsed by 33%), (b) clean out your rain-gutters (45%),(c) clear vegetation around your house (41%), (d) get sandbags (9%), (e) keepyour gas tank full in case of a disaster (34%), and (f) keep extra cash on handin the house (44%). A preparedness score, ranging from 0 to 5, was calculatedby summing the number of activities that the respondent endorsed (excludingsandbags because of the low frequency of this activity).

Respondents were asked to make two comparative judgments about theirlevel of preparedness (e.g., “Compared to most people you know, how pre-pared are you to cope with an El Niño condition in the future?”) and worry(e.g., “Compared to most people you know, how much do you worry about ElNiño?”). Responses were assessed on a 4-point scale and ranged frommuchless prepared (or worried) than most peopleto much better prepared (moreworried) than most people.

ANALYTIC PLAN

The relationship between emotional injury after the earthquake and prepa-ration for the El Niño disaster was examined first. The possibility thatobserved relationships were accounted for by demographic variables or gen-eralized psychological distress was tested, and a potential mediator (worryabout El Niño) of the observed relationship was also considered. Actual pre-paredness activities and perceptions of level of preparedness relative to oth-ers were both included in these analyses.

The second set of analyses assessed whether emotional injuries experi-enced as a result of the Northridge earthquake predisposed individuals toemotional injuries from the El Niño. The concordance rate between emo-tional injuries from the two disasters was established, and the possibility thatthis relationship was mediated by preparedness activities was explored. Theinterrelationships between disaster parameters (financial, physical, emo-tional)withineach disaster was determined, as it was expected that emotional




response would covary with severity of impact. These parameters were thenexaminedacrossdisasters using binary logistic regression to isolate the neteffect of emotional injury on subsequent emotional injury, physical injury,and reports of damage. Last, the analyses were repeated substituting a globalmeasure of psychological distress for emotional injury from the earthquaketo determine if emotional injury was a proxy for poor mental health.

RESULTS

Emotional injury and preparedness. The demographic characteristics andother relevant variables for the 414 respondents in this study are presented inTable 1. Three variables that tapped the financial (sustaining damage as aresult of the quake), physical (being physically injured by the quake), andemotional parameters (being emotionally injured by the quake) of theNorthridge earthquake experience were examined as predictors of El Niñopreparedness activities. Of the three, only emotional injury was related toperforming the recommended actions. Those who were emotionally injuredby the earthquake did more to prepare for El Niño than those who were notemotionally injured by the quake, with a mean of 2.20 versus 1.86,t(412) =2.29,p< .05. Preparedness for the El Niño did not vary with reports of physi-cal injury or financial loss. The possibility that the relationship between emo-tional injury in Northridge and preparedness for El Niño might be a functionof respondent demographics was subsequently tested. Living in a house com-pared to a multiple unit, owning rather than renting one’s dwelling, andincreasing age were each associated with performing more preparednessactivities, whereas gender, race/ethnicity, language, employment status, edu-cation, and income were not related to preparedness activities. To determineif these associations accounted for the relationship between emotional injuryand El Niño preparations, dwelling type, home ownership, and age wereincluded as covariates in analyses of covariance with emotional injury inNorthridge as the independent variable and preparedness as the outcome. Therelationship between emotional injury and preparedness was maintained,F(1, 400) = 6.78,p < .01, when controlling for dwelling type, home owner-ship, and age.

The possibility was also considered that generalized emotional distress, asopposed to emotional injury specific to the Northridge quake, was related toincreased preparedness behavior. An additional analysis of covariance wasperformed, this time substituting the GSI from the BSI as the covariate. TheGSI is considered the best, single summary measure from the BSI (Derogatis





TABLE 1Selected Sample Characteristics

Characteristic n %

AgeBelow 35 118 28.435 to 49 164 39.850 and older 132 31.8

GenderMale 186 44.9Female 228 55.1

Race/ethnicityWhite 212 51.3Hispanic 141 34.1African American 34 8.2Other 26 6.3

Household incomeBelow $40,000 179 43.2$40,000 to $69,000 82 19.9$70,000 and above 153 36.9

Education12 years or less 162 39.213 years or more 251 60.8

Language of interviewEnglish 338 80.9Spanish 79 19.1

Marital statusMarried or living as married 855 49.3Other 863 49.7

Employment statusCurrently working 1131 65.6Not working 594 34.4

Home ownershipOwn 271 66.1Rent 139 33.9

DwellingHouse 278 67.1Other 136 32.9

Damage from Northridge quakeNo 240 58.0Yes 174 42.0

Physical injury from Northridge quakeNo 372 89.9Yes 42 10.1

Emotional injury from Northridge quakeNo 270 65.2Yes 144 34.8

(continued)



& Melisaratos, 1983) combining information on number of symptoms andintensity of perceived distress. The analysis showed that the relationshipbetween emotional injury and preparedness activities was maintained whencontrolling on the GSI measured after the quake,F(1, 386) = 4.44,p < .05.Furthermore, GSI was not related to subsequent preparedness activities.

Given that emotional injury in one disaster predicted preparedness in asubsequent disaster, it is likely that concerns aroused by the experience withthe first disaster are facilitating these preparation behaviors. In the El Niñoquestionnaire, one item asked respondents for a comparative assessment ofhow much they worry about a future El Niño relative to others, and one itemasked about preparedness for future El Niños relative to others. As antici-pated, those who were emotionally injured in the Northridge quake indicatedthey worried more than most people about future disasters, but emotionalinjury remained a predictor of preparedness even when controlling for worryabout future El Niños,F(1, 406) = 4.47,p < .05. The covariate, worry aboutfuture El Niños, was marginally related to preparedness,F(1, 406) = 3.20,p=.08. In terms of perceptions of preparedness, emotional injury in Northridgewas not related to perceptions of preparedness for El Niño. Despite the factthat the emotionally injured were actually more prepared than other respon-dents, they did not perceive themselves to be prepared,p > .46. It should benoted that perceptions of preparedness and actual preparedness were relatedin a linear fashion: respondents who felt much less prepared than most per-formed 1.47 activities compared to 2.58 for respondents who were much bet-ter prepared than most,F(4, 406) = 4.52,p< .001. In sum, emotional injury inNorthridge increased the likelihood that county residents prepared for ElNiño, and this was not completely mediated via worry about future disasters.


Damage from El NiñoNo 352 85.3Yes 61 14.7

Physical injury from El NiñoNo 405 97.8Yes 9 2.2

Emotional injury from El NiñoNo 372 89.9Yes 42 10.1

Table 1(continued)

Characteristic n %



Emotional injury across disasters. The second goal in the analyses was todetermine if emotional injury in Northridge predisposed respondents to anemotional injury in a second disaster. A cross-classification of emotionalinjury after the Northridge quake with emotional injury from El Niño yieldeda strong concordance,χ2(1) = 8.23,p < .005, with the rates of emotionalinjury in El Niño being twice as high for respondents who had an emotionalinjury from the Northridge event (16%) compared to those who did not (7%).The effect size for the chi-square is 0.28 (Dennis, Lennox, & Foss, 1997).Neither damage in Northridge nor physical injury in Northridge predisposedrespondents to an emotional injury in El Niño.

As respondents with a prior emotional injury did more to prepare for ElNiño (noted above), the possibility was tested that preparation activitiesmoderated the likelihood of reporting an emotional injury in El Niño. That is,emotionally injured respondents who prepared for El Niño might have beenless likely to sustain a second emotional injury as a result of El Niño. Two-way ANOVAs, with preparation activities (dichotomized) and emotionalinjury in Northridge as the predictor variables, showed that respondents whowere emotionally injured in Northridge were more likely to be emotionallyinjured in El Niño,F(1, 420) = 8.08,p< .005, regardless of the number of pre-paredness activities they performed (interactionns,p > .65). Preparednessactivities did not predict emotional injury in El Niño.

Whereas physical injury and damage from the quake was not associatedwith emotional injury from El Niño, physical injury and damage were corre-lated with emotional injury within disasters for both Northridge—r(414) =0.24,p < .01 (for physical injury) andr(414) = 0.22,p < .01 (for damage)—and El Niño—r(414) = 0.17,p < .01 (for physical injury) andr(414) = 0.22,p< .01 (for damage). Damage in the Northridge event did not predict damagefrom El Niño, but emotional injury in the Northridge event was associatedwith reporting damage in the El Niño event,r(414) = 0.14,p< .01. This corre-lation matrix is presented in Table 2.

It is possible that the relationship between emotional injury in Northridgeand damage in El Niño was due to the variance shared by emotional injury inEl Niño with both damage in El Niño and emotional injury in Northridge. Inother words, emotional injury in Northridge and damage in El Niño onlyappear to be related because they are each associated with a third variable:emotional injury in El Niño. This possibility was explored with binary logis-tic regression. Damage in El Niño was regressed on emotional injury inNorthridge, emotional injury in El Niño, and their interaction. With all vari-ables in the model, emotional injury in Northridge—beta = .68;p< .05; oddsratio (OR) = 1.98; 95% confidence interval (CI) = 1.05, 3.72—and emotionalinjury in El Niño each made independent contributions to reports of damage




TABLE 2Intercorrelations of Emotional Injury, Physical Injury, and Damage Across Two Natural Disasters

and Preparedness in the Second Disaster ( N = 414)

Emotional InjuryEQ

Physical InjuryEQ

DamageEQ

Emotional InjuryEN

Physical InjuryEN

DamageEN

PreparednessEN

Emotional injury EQ — .24** .22** .14** –.01 .14** .11*Physical injury EQ — — .27** .07 –.05 .09 .05Damage EQ — — — –.06 .04 .02 –.02Emotional injury EN — — — — .17** .22** .03Physical injury EN — — — — — .03 .00Damage EN — — — — — — .08Preparedness EN — — — — — — —

NOTE: *p < .05. **p < .01.EQ = Northridge earthquake; EN = El Niño

648

at Afyon K

ocatepe Universitesi on M

ay 20, 2014eab.sagepub.com

Dow

nloaded from


from El Niño—beta = 1.47;p < .01; OR = 4.35; 95% CI = 1.51, 12.48. Theinteraction of the two emotional injury variables did not contribute to themodel (p> .84). The full model is presented in Table 3.

A second binary logistic regression was computed that included all of therelevant damage and injury variables. Specifically, damage in El Niño wasregressed on damage, physical injury, and emotional injury in Northridge andboth physical and emotional injury in El Niño. The two predictors thatemerged were emotional injury in Northridge—beta = .59;p < .05; OR =1.80; 95% CI = .99, 3.28—and emotional injury in El Niño—beta = 1.36;p<.001; OR = 3.90; 95% CI = 1.87, 8.12. The full model is presented in Table 3.

These logistic regressions showed that emotional injury in El Niño con-tributed to reports of damage in El Niño, but an independent relationshipremained between reporting emotional injury in Northridge and reportingdamage in El Niño, suggesting that emotional injury acted to increase theprobability of reporting damage. Last, the possibility was tested that overallpsychological health, as opposed to the earthquake-specific emotional injury,might be accounting for these findings. The above analysis was repeated,substituting the GSI from the BSI (dichotomized at the median) for emo-tional injury in Northridge. In previous analyses of psychological response tothe Northridge quake (Siegel, 2000), the GSI was highly associated with theprobability of reporting an emotional injury in response to the Northridgequake. The analyses performed here show that the global assessment of men-tal health is not related to reports of damage in El Niño (p> .54) (data notshown). It appears, then, that emotional injury in Northridge is not a proxyvariable for poor mental health.

DISCUSSION

Residents of Los Angeles County—survivors of two natural disasters—were studied to determine the extent to which experiences with one disasteraffected preparation for and emotional response to a second disaster. The firstdisaster, an earthquake, was unpredictable and fairly devastating in regard toloss of life, injuries, and property damage. The second disaster, an El Niñoweather condition that occurred more than 3 years later, was a predicted,slow-onset disaster, which was ultimately more minor in impact than whathad been anticipated. Two specific questions were initially addressed by thisresearch: Does being emotionally injured in one disaster influence the extentto which one prepares for a future disaster, and does emotional injury experi-enced in one disaster predispose individuals to another emotional injury in a




TABLE 3Binary Logistic Regression of Damage From El Niño on

Emotional Injury From El Niño and From a Previous Disaster (Model 1)and on Emotional Injury From Two Disasters, Physical Injury From Two Disasters, and Damage From the First Disaster (Model 2)

(N = 414)

Variable Beta p Value Odds Ratio95% Confidence

Interval

Model 1Emotional injury, El Niño 1.47 .01 4.34 1.51, 12.48Emotional injury, Northridge .68 .05 1.98 1.05, 3.72Interaction –.17 .81 .84 .21, 3.48Constant –2.24 — — —

Model 2Emotional injury, El Niño 1.36 .00 3.90 1.87, 8.12Physical injury, El Niño –.03 .97 .97 .17, 5.60Emotional injury, Northridge .59 .05 1.80 .99, 3.28Physical injury, Northridge .40 .37 1.49 .62, 3.55Damage, Northridge –.03 .92 .97 .52, 1.79Constant –2.24 — — —

650

at Afyon K

ocatepe Universitesi on M

ay 20, 2014eab.sagepub.com

Dow

nloaded from


later disaster? A third question, which arose from the analyses, assessedwhether emotional injury after the earthquake had a net effect on physicalinjury and reports of property/personal damage from the El Niño once emo-tional injury after the El Niño was taken into account.

In regard to preparedness for El Niño, specific activities (e.g., cleaninggutters) recommended by government and service agencies were widelypublicized in the months leading up to the El Niño winter. Compatible withboth the conservation-of-resources stress model (Hobfoll, 1989) and thewarning and response model (Lindell & Perry, 1992), respondents whoreported after the Northridge earthquake that they were emotionally injuredby the quake performed more of the recommended preparedness activitiesthan did respondents who had not reported an injury independent of demo-graphic characteristics. Neither physical injury nor property damage inNorthridge had an impact on El Niño preparedness activities—a finding con-sistent with a study of hurricane preparedness (Sattler et al., 2000) . Althoughemotionally injured respondents did acknowledge being more worried aboutEl Niño, these worries did not mediate the association between injury andpreparedness activities. Furthermore, respondents who were emotionallyinjured by the quake did not perceive themselves to be especially preparedrelative to other people they knew.

This constellation of findings is consistent with the notion that self-perceived emotional injury, which likely reflects anxiety and depression,fuels a heightened sensitivity to messages about an impending disaster, even3 years past the initial event. Given that this outcome is independent of demo-graphic characteristics, it cannot be explained by an antecedent variable, noris it a function of generalized psychological distress. One means of managinganxiety about an impending disaster is to prepare. Thus, from this perspec-tive, emotional injury facilitated appropriate preparation.

In contrast, data relevant to our second question did not support afacilitative role for emotional injury in coping with a disaster. Respondentswho were emotionally injured by the Northridge earthquake were twice aslikely to report an emotional injury from El Niño than those with no quake-related emotional injury, although the percentages in both cases were small.Sustaining a first emotional injury does not in any way immunize peopleagainst a second injury, nor does it appear to lead to effective strategies foravoiding a subsequent injury. Furthermore, reporting an emotional injuryafter the quake increased the likelihood of perceiving property damage fromthe El Niño. Despite the high concordance for emotional injuries in the twodisasters, this effect was not explained by emotional injury in El Niño. Inother words, emotional injury from the quake influenced reports of damagein a subsequent disaster—an effect that is not solely mediated by emotional




injury in one disaster predicting emotional injury in a second disaster. It isnotable that neither physical injury nor property damage in Northridge had animpact on reports of damage in El Niño, suggesting that it is somethingunique to emotional responses that is contributing to this effect.

One possibility is that individuals with high levels of psychological dis-tress overall are more prone to experience emotional injuries from disastersand perceive high levels of property damage. According to this interpreta-tion, distress could be feeding a wide range of negative perceptions. If thiswere the case, substituting psychological distress for emotional injury in themodel should produce the same relationship with reports of property dam-age. Subsequent analyses showed that this was not the case. A global assess-ment of mental health status was not related to reports of damage. One cantentatively conclude, therefore, that reports of emotional injury in response toa natural disaster are more than a proxy variable for poor mental health. Pos-sibly, experiences in one disaster sensitize some people such that the thresh-old at which they perceive themselves to be vulnerable to and affected bysubsequent disasters is lowered.

This study had a number of strengths, most notably, the population-basedsample and the data points following two natural disasters—the second ofwhich was an anticipated disaster. As a result, this was a particularly appro-priate setting for studying disaster preparedness. The inclusion of a standard-ized instrument for the assessment of generalized psychological distress aswell as a measure of distress specific to the disaster added to our understand-ing of the emotional impact of disasters despite the latter being a single-itemindex. The pairing of the question on emotional injury with the question onphysical injury induced some level of common understanding among respon-dents regarding what was meant by an emotional injury. The study also hadsome weaknesses, primarily in regard to the crudeness of the assessment ofdamage. Respondents were asked to report on the nature of the damage andestimate its dollar value, but these variables were no more informative in theanalyses than using the dichotomous indicator of damage versus no damage.Because there was no independent verification of the damage, it was impossi-ble to assess the accuracy of the damage estimates. Still, this method of col-lecting data on damage is common practice in disaster research therebylending more importance to our finding that estimates of damage are influ-enced by emotional injury in a previous disaster.

Taken together, these findings are supportive of the notion that the emo-tional response to a disaster is an important parameter and should be studiedwith the same rigor as other traditional indicators of disaster impact. Whenasked in the context of physical injuries, respondents are able to assess theemotional effects of a disaster and seem to be calling upon a reaction that is




not identical to a general level of distress that is not specific to a source. Thefinding that emotional reactions in one disaster influenced reports of whatmight be considered an objective outcome (property damage) in anotherdisaster underscores the need for a comprehensive assessment of disasterreactions in postdisaster research. Such assessments might also aid in target-ing appropriate areas for disaster-related social services.

NOTE

1. The scale calculations are based on reports from U.S. postal employees. These individualsare asked to estimate the amount of shaking in their area and the type of damage sustained bymajor structures. The scale ranges from I (no damage) to XII (catastrophic damage). In theNorthridge earthquake, scores ranged from VI to IX.

REFERENCES

Bourque, L. B., Shoaf, K. I., & Nguyen, L. H. (1997). Survey research.International Journal ofMass Emergencies and Disasters,15, 71-101.

Carr, V. J., Lewin, T. J., Kenardy, J. A., Webster, R. A., Hazell, P. L., Carter, G. L., et al. (1997).Psychosocial sequelae of the 1989 Newcastle earthquake: III. Role of vulnerability factors inpost-disaster morbidity.Psychological Medicine, 27, 179-190.

Cockerham, W. C. (2001).Medical Sociology(8th ed.). Upper Saddle River, NJ: Prentice-Hall.Dennis, M. L., Lennox, R. D., & Foss, M. A. (1997). Practical power analysis for planning sub-

stance abuse prevention and services research. In K. J. Bryant, M. Windle, & S. G. West(Eds.),Recent advances in prevention research methodology: Lessons from alcohol and sub-stance abuse research(pp. 367-405). Washington, DC: American PsychologicalAssociation.

Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductoryreport.Psychological Medicine, 13, 595-605.

Derogatis, L. R., & Spencer, P. M. (1982).Administration and procedures: BSI Manual—I.Baltimore: Clinical Psychometric Research.

Freedy, J. R., Shaw, D. L., Jarrell, M. P., & Masters, C. R. (1992). Towards an understanding ofthe psychological impact of natural disasters: An application of the conservation ofresources stress model.Journal of Traumatic Stress,5, 441-454.

Governor’s Office of Emergency Services. (1994).Briefings of January 17, 1994, NorthridgeEarthquake. Pasadena, CA: OES.

Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress.Amer-ican Psychologist,44, 513-524.

Kaiser, C. F., Sattler, D. N., Bellack, D. R., & Dersin, J. (1996). A conservation of resourcesapproach to a natural disaster: Sense of coherence and psychological distress.Journal ofSocial Behavior and Personality, 11, 459-476.




Lindell, M. K., & Perry, R. W. (1992).Behavioral foundations of community emergency plan-ning. Washington, DC: Hemisphere.

Russell, L. A., Goltz, J. D., & Bourque, L. B. (1995). Preparedness and hazard mitigation actionsbefore and after two earthquakes.Environment and Behavior, 27, 744-770.

Sattler, D. N., Kaiser, C. R., & Hittner, J. B. (2000). Disaster preparedness: Relationships amongprior experience, personal characteristics, and distress.Journal of Applied Social Psychol-ogy, 30, 1396-1420.

Schuster, M. A., Stein, B. B., Jaycox, L. H., Collins, R. L., Marshall, G. N., Elliott, M. N., et al.(2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks.New England Journal of Medicine, 345, 1507-1512.

Shore, J. H., Tatum, E. L., & Vollmer, W. M. (1986). Psychiatric reactions to disaster: The MountSaint Helens experience.American Journal of Psychiatry, 143, 590-595.

Siegel, J. M. (2000). Emotional injury and the Northridge California earthquake.Natural Haz-ards Review, 1, 204-211.

U.S. Census Bureau. (2000).Profile of selected housing characteristics: 2000. Year structurebuilt and year householder moved into unit: 2000(Summary File 3, Geographic area: LosAngeles County, Tables DP-4 and QT-H7). Los Angeles: Author.




Documents

Surviving Two Disasters: Does Reaction to the First Predict Response to the Second?