National Poverty Center Working Paper Series
#09-03
January 2009
Religiousness and Psychological Distress of Women after
Hurricane Katrina
Christian S. Chan, University of Massachusetts, Boston
Jean E. Rhodes, University of Massachusetts, Boston
This paper is available online at the National Poverty Center Working Paper Series index at:
http://www.npc.umich.edu/publications/working_papers/
Any opinions, findings, conclusions, or recommendations expressed in this material are those of the author(s) and do
not necessarily reflect the view of the National Poverty Center or any sponsoring agency.
Religiousness and Psychological Distress of Women after Hurricane Katrina
Christian S. Chan
Jean E. Rhodes
Department of Psychology
University of Massachusetts Boston
Submitted to the National Poverty Center,
University of Michigan
December 2008
Please address correspondence to Christian S. Chan or Jean E. Rhodes, Department of
Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA
02125, USA; email: christian.chan@umb.edu or jean.rhodes@umb.edu
ABSTRACT
RELIGIOUSNESS AND PSYCHOLOGICAL DISTRESS OF WOMEN
AFTER HURRICANE KATRINA
This prospective study examined social support and optimism as protective
pathways of influence of general religiousness on post-disaster psychological distress of
women who survived Hurricane Katrina. Two questionnaires were administrated, one
before and one after the disaster. Participants were 386 low-income, single mothers,
predominantly Black. Results of structural equation modeling indicated that, controlling
for level of exposure to the hurricanes, pre-disaster physical health, age, and number of
children, pre-disaster religiousness contributed to better post-disaster psychosocial
resources, which in turn were predictive of less psychological distress.
2
ACKNOWLEDGMENTS
This study was funded by NIH grant R01HD046162, the National Science Foundation,
the MacArthur Foundation, the Center for Economic Policy Studies at Princeton
University, and the National Poverty Center at University of Michigan. We thank Alice
S. Carter and John E. Perez for their helpful comments on an earlier version of this
manuscript.
3
TABLE OF CONTENTS
ACKNOWLEDGMENTS....................................................................
3
LIST OF TABLES...............................................................................
5
LIST OF FIGURES.............................................................................
6
CHAPTER
Page
1. INTRODUCTION.............................................................
7
Background................................................................
8
Religiousness and Psychological Distress.................
11
Social Support as a Protective Factor........................
13
Optimism as a Protective Factor................................
14
2. THE PRESENT STUDY...................................................
Hypotheses..................................................................
Method.......................................................................
Results........................................................................
Discussion..................................................................
Conclusion.................................................................
17
18
19
24
29
35
REFERENCES....................................................................................
42
4
LIST OF TABLES
Table
Page
1. Selected characteristics of participants at Time 1 (pre-disaster)..........
36
2. Correlations, Means, and Standard Deviations of the Measured
Constructs in the Model.........................................................
37
3. Factor Loadings for the Measurement Model......................................
38
4. Correlations of Latent Variables in the Model.....................................
39
5
LIST OF FIGURES
Figure
Page
1. The hypothesized model predicting post-disaster distress...................
40
2. The final model predicting post-disaster distress................................
41
6
CHAPTER 1
INTRODUCTION
In 2005, Hurricanes Katrina and Rita devastated the Gulf South of the United
States. The two hurricanes have taken the lives of an estimated 1,900 people, displaced
approximately 1.5 million, and were responsible for near $90 billion in damage, making
them two of the deadliest and costliest hurricanes in history of the country.
The hurricanes were particularly devastating for the low-income and Black
residents of New Orleans (Elliot & Pais, 2006; Logan, 2006), many of whom were left
homeless and isolated from their social and community networks. Recent studies
documented elevated levels of psychological distress among survivors of Hurricane
Katrina, compared to normative samples (e.g., Galea et al., 2007; Kessler, Galea, Jones,
& Parker, 2006; Wang et al., 2007; Weisler, Barbee, & Townsend, 2006). It is important
to note, however, that there was considerable variation in the adaptive coping of
survivors. Indeed, declines in functioning following natural disasters are neither
consistent nor inevitable (Norris, Friedman, &Watson, 2002; Norris Friedman, Watson et
al., 2002), and researchers have identified a range of factors that may offset the risk
(Brewin, Andrews, & Valentine, 2000). Higher mental health functioning prior to the
storm and a supportive social network are among the most salient protective factors
(Brewin et al., 2000; Vernberg, La Greca, Silverman, & Prinstein, 1996). In addition,
7
religiousness has long been recognized as an important resource in many urban Black
communities (Taylor & Chatters, 1988), and might be particularly important during
traumatic events. The current study sheds light on whether religious involvement helps
vulnerable individuals cope with the additional stressors of Hurricane Katrina and its
aftermath.
Background
The detrimental effects of large-scale disasters on individual’s psychological
well-being have been documented extensively (e.g., Galea et al., 2007; Kessler et al.,
2006; Rubonis & Bickman, 1991; Sundin & Horowitz, 2003). Individuals exposed to
disasters are at risk for symptoms of posttraumatic stress disorder (PTSD), depression,
anxiety, somatization, substance abuse, and physical illness (Joseph, Yule, & Williams,
1994; Pfefferbaum & Doughty, 2001; Solomon & Green, 1992; Spurrell & McFarlane,
1993). Among longer-term effects, victims may develop a full-blown major depressive
disorder, PTSD, and other anxiety disorders (Norris et al., 2002; Norris, Friedman,
Watson et al., 2002).
Studies of hurricanes, in particular, revealed that as many as half of the
respondents have suffered from some form of disaster-related mental disorders (David et
al., 1996; Norris, Perilla, Riad, Kaniasty, & Lavizzo, 1999). Similar conclusions were
drawn from findings in studies of the survivors of Hurricane Katrina (Kessler et al., 2006;
Weens et al., 2007; Weisler, Barbee, & Townsend, 2006). Reports on the effects of
Hurricane Katrina suggest that the residents of New Orleans were exposed to a large
number of traumatic events and that the number of such events is associated with mental
health symptoms (Weems et al., 2007). Studying a representative sample of 1,043
8
residents in Alabama, Mississippi, and Louisiana, researchers have estimated prevalence
rates for mood disorder ranging from 31% (Wang et al., 2007) to 49% (Galea et al.,
2007), and the prevalence rate of PTSD was estimated at 30% (Galea et al., 2007).
Taken together, these studies suggest that the mental health impact of Hurricane
Katrina on mental health outcomes of survivors is likely to have been substantial.
Moreover, low-income Black women—the focus of this study—may have been at
particular risk for adverse consequences. First, research on natural disasters has
documented that women are at significantly greater risk than men for post-disaster
psychopathology, including post-traumatic stress, anxiety and depression (Brewin et al.,
2000; Solomon & Green, 1992; Steinglass & Gerrity, 1990). Second, women are also
relied upon more than men in the aftermath of natural disasters (Norris, Baker, Murphy,
& Kaniasty, 2005; Solomon, Smith, Robins, & Fischbach, 1987), which may leave them
less able to attend to their own psychological needs, putting them at greater risk of postdisaster psychological dysfunction. Third, while children can be a source of support and
comfort to parents after natural disasters, the presence of children seems to exacerbate the
risk of post-disaster psychopathology (Bromet, Parkinson, Schulberg, Dunn, & Gondek,
1982; Gibbs, 1989; Morrow, 1997) and single mothers seem to be at particular risk for
experiencing family-related stress (Morrow, 1997). Indeed, a recent study found that
compared to their male counterparts, Black female survivors of Hurricane Katrina
reported more PTSD and mental health symptoms (Chen, Keith, Airriess, Li, & Leong,
2007).
In addition, members of economically disadvantaged minority communities and
neighborhoods are at particularly high risk of poor physical and mental health (Blank,
9
2005; LeClere, Richard, & Kimberly, 1997). Census data indicated that the population of
the city of New Orleans before Katrina was 67% Blacks, about a third of whom lived
below the poverty line (U.S. Census Bureau, 2007). Consistent with media reports during
the aftermath of Katrina, researchers has documented that the hurricane had a greater
impact on Black communities than on White communities, particularly in the city of New
Orleans (Logan, 2006). Blacks were less likely to have an evacuation plan in place prior
to the storm (Spence, Lachlan, & Griffin, 2007), and were less likely to evacuate prior to
the hurricane (Eliot & Pais, 2006), increasing their risk of exposure to the storm. Racial
disparities in economic outcomes of Katrina survivors are also evident in unemployment
rates (Elliot & Pais, 2006), as well as in reports of difficulties accessing healthcare and of
general life disruption. Blacks reported greater levels of stress than Whites in the
aftermath of Katrina (Elliot & Pais, 2006), and greater levels of anger and depression
(White, Philpot, Wylie, & McGowen, 2007). In addition, previous research indicating
greater adverse effects on poor, Black communities after other hurricanes in recent
history (e.g., Kaniasty & Norris, 1999; Peacock, Morrow, & Gladwin, 1997; Perilla,
Norris, & Lavizzo, 2002) provide evidence that racial disparities after Hurricane Katrina
do not represent an isolated incident.
Even among the most vulnerable populations, however, there is often
considerable variability in post-disaster functioning (Ferraro, 2003). While a number of
risk factors associated with post-disaster adverse mental health outcomes have been
documented, such as severity of exposure, female gender, low socioeconomic status,
member of a minority group (for reviews, see Norris et al., 2002; Young, 2006),
researchers have also identified a range of protective factors that might be associated with
10
better psychological well-being following disasters. In his review, Gibb (1989) cited
active coping, internal locus of control, low perception of threat, high socioeconomic
status, being male gender, and having a religious belief as potent protect factors.
Similarly, more recent studies have noted that personal faith and involvement in religious
communities are important resources for coping with traumatic events (Smith et al., 2000;
Weaver, Koenig, & Ochberg, 1996). This may be particularly true for Black American
communities, for which the mental health benefits of religious practice, affiliation, and
belief among have been widely documented (Levin, Chatters, & Taylor, 1995; Levin,
Markides, & Ray, 1996). Research has consistently demonstrated that Blacks have
greater levels of religiousness and spirituality as compared to other ethnic groups (e.g.,
Taylor, Mattis, & Chatters, 1999). For example, in a recent study, approximately 70% of
Black respondents reported attending church at least once a month (Chatters, Taylor, &
Lincoln, 1999), which is considerably higher than attendance in the general public (58%)
(Gallup Organization, 2006). A recent report indicates that, among the 1,043 respondents
of a survey of Hurricane Katrina survivors, only 9% claimed to be non-religious
(Hurricane Katrina Community Advisory Group, 2006). Similarly, Elliot & Pais, (2006)
conducted a study after Hurricane Katrina and reported that Black Americans were much
more likely than White Americans (2.6 times) to report relying on religious faith to cope
in the aftermath of the catastrophe. It is hence important to consider religiousness as a
protective factor in the context of Hurricane Katrina.
Religiousness and Psychological Distress
Many studies have provided evidence for a positive relationship between
religiousness and well-being (e.g., George, Ellison, & Larson, 2002; Koenig,
11
McCullough, & Larson, 2001, Miller & Thoresen, 2003). Seventy-nine percent of the
studies included in a comprehensive literature review on protective factors (Koenig et al.,
2001) included reports with at least one positive correlation between religious
involvement and measures of well-being (e.g., happiness, life satisfaction, morale,
positive affect). Religious attendance and involvement are also found to be strongly
related to physical health (e.g., Koenig et al., 1997), mental health (e.g., Ellison, 1995;
Smith, McCullough, & Poll, 2003), longevity (e.g., Hummer, Rogers, Nam, & Ellison,
1999; Koenig et al., 1999), and post-traumatic growth (Koenig et al., 1998; see also
Koenig et al., 2001; Milam, Ritt-Olson, & Unger, 2004; Tedeschi & Calhoun, 1996).
More specific to the impact of natural disasters, Smith et al. (2000) found that religious
factors—measured retrospectively—were strong predictors of the well-being of the
survivors of the 1993 Midwest flood.
Despite this consensus, the underlying processes through which religion
contributes to mental health remain unclear. Koenig et al. (2001) summarized the
literature to suggest that religious involvement promotes a number of behaviors and
attitudes that have a positive effect on well-being. Relative to non-religious people,
religious people tend to be more socially active and have higher levels of social support
(Oman & Reed, 1998). Religiousness is also associated with higher levels of optimism
and hope (see Koenig, 2001 for a review), both of which are characteristics of persons
with high well-being and life satisfaction (Gillham, Shatté, Reivich, & Seligman, 2001).
Therefore, the association between religiousness and well-being seems to be mediated by
both interpersonally-oriented psychosocial resources (e.g., social support) and
intrapersonally-oriented psychosocial resources (e.g., hope and optimism) (Ai, Park,
12
Huang, Rodgers, & Tice, 2007; Salsman, Brown, Brechting, & Carlson, 2005). Each of
these two processes will be described below.
Social Support as a Protective Factor
Two aspects of social support are considered: perceived social support and the
provision of social support. A number of studies have shown that those higher in
religiousness have higher levels of perceived social support (e.g., Krause, 2002; Krause,
Ellison, Shaw, Marcum, & Boardman, 2001). Perceived social support, in turn, appears to
partially mediate the effect of religion on physical health (Myer, 2000; Powell, Shahabi,
& Thoresen, 2003) and psychological well-being (Ai et al., 2007; Salsman et al., 2005).
In addition, researchers have suggested a linkage between social support and better
adjustment after major life events (Ai et al., 2007; Brummett et al., 1998; Pirraglia,
Peterson, Williams-Russo, Gorkin, & Charlson, 1999), and natural disasters (Benight,
Swift, Sanger, Smith, & Zeppelin, 1999; Brewin, Andrew, & Valentine, 2000; Smith et
al., 2000), including Hurricane Katrina (Chen et al., 2007). In one study (Ferraro & Koch,
1994), social support was a significant mediator between religious involvement and
physical health for Black Americans, but not for White Americans.
Since religious institutions promote opportunities for socialization among
members and believers, they can provide a strong basis for social support. Greater
religious participation is related to greater emotional support from others in face of a
negative life event, such as the loss of a child (McIntosh, Silver, & Wortman, 1993). A
Gallup poll (2005) conducted soon after Hurricane Katrina indicated that many survivors
saw their religious faith and church-based social networks as important sources of
emotional support. This suggests that those who were more religiously involved might
13
have more access to social and emotional support from their faith and religious
congregations.
It has been established that people who both perceive social support and provide
social support tend to report more positive well-being (Maton, 1988). Because attending
religious activities might contribute to a higher degree of social connectedness,
reciprocity, and organized volunteerism, it may cultivate in its members a sense of
efficacy in interpersonal relationships. Consistent and meaningful reciprocal interactions
in the church setting provide opportunities for both receiving and providing social
support. This in turn could lead to a higher sense of social efficacy, the extent to which
one sees his or herself as capable in relating to other people (e.g., Patrick, Ryan, &
Kaplan, 2007) and an efficacious provider of social support. Similar to self-efficacy
(Bandura 1986), social efficacy refers more to a general perception of ability to maneuver
in the social world than an objective measure of social skills. It is thus important to
consider both perceived social support and social efficacy when studying the impact of
social support.
Optimism as a Protective Factor
In addition to the social benefits, religiousness is associated with a greater sense
of optimism (Koenig, 2001). Optimism is conceptualized as global, stable, and positive
expectations that good things will be plentiful in the future while bad things will be
scarce (Scheier & Carver, 1985, 1993). Religiousness is significantly and positively
related to optimism (Idler & Kasl, 1997; Salsman et al., 2005; Sethi & Seligman, 1993),
particularly among people who are encountering significant life stress (Koenig et al.,
2001). Studying a group of Muslim war refugees from Kosovo and Bosnia, Ai, Peterson,
14
and Huang (2003) suggested religiousness is associated with religious coping, which in
turn is associated with optimism. Optimism has also been shown to mediate between
religiousness and psychological well-being (Salsman et al., 2005). More generally,
researchers have demonstrated that optimism is related to better physical health
(Peterson, Seligman, & Vaillant, 1988), longevity (e.g., Seligman, 1991), as well as better
mental health (e.g., Giltay, Zitman, & Kromhout, 2006; Puskar, Sereika, Lamb, TusaieMumford, & McGuinness, 1999). Higher levels of optimism are associated with better
outcomes among patients of a chronic disease (for a review, see Andersson, 1996),
individuals who were exposed to the September 11 terrorist attacks (Ai, Evans-Campbell,
Santangelo, & Cascio, 2006), and is associated with post-traumatic growth (e.g., Davis,
Nolen-Hoeksema, & Larson, 1998; Evers et al., 2001). Explanations for such positive
effects include the notion that those higher in optimism tend to engage in adaptive
problem-focus coping, constructive thinking, and have greater acceptance of
uncontrollable situations than those who are less optimistic (Aspinwall, Richter, &
Hoffman, 2001; Aspinwall & Taylor, 1992).
A connection between optimism and post-disaster outcomes has also been
documented. A study reported that optimism was associated with less general distress,
both directly and indirectly through heightened self-efficacy, among survivors of the
1999 Marmara earthquake in Turkey (Sumer, Karanci, Berument, & Gunes, 2005).
Another study compared those who were and those who were not affected by a fireworks
disaster in the Netherlands in 2000 and concluded that pessimists in both groups were
more at risk for a number of psychological symptoms than optimists (van der Velden et
al., 2007). In their study of HIV-positive gay men after Hurricane Andrew, Cruess et al.
15
(2000) found that higher levels of optimism were related to lower levels of depression,
distress, PTSD symptoms, and better cellular immunologic control over several herpes
viruses. Therefore, optimism seems to be a protective factor against the negative effects
of disaster.
Taken together, the above literature suggests that religion might serve as a
protective resource against the negative psychological effects of natural disasters through
its positive influence on survivors’ social support and sense of optimism.
16
CHAPTER 2
THE PRESENT STUDY
Because disasters are mostly unpredictable, most disaster outcomes studies lack
pre-disaster data (over 95%; Norris & Elrod, 2006). One advantage of having pre-disaster
data is that it allows researchers to better clarify the temporal order of the event and
outcome variables, as well as to control for pre-existing level of psychological health. In
the current prospective study, data collected both before and after Hurricane Katrina are
used.
In this study, it is anticipated that those survivors who were more engaged in
religious activities before the disaster will have lower levels of distress after Hurricane
Katrina and that this relationship will be mediated by higher perceived levels of social
support. That is, those who attended religious services more frequently are expected to
have higher levels of social support, which, in turn, can help mitigate the psychological
distress caused by and related to Hurricane Katrina. In addition to the perception of the
availability of social support, the perception of oneself as engaged in providing support to
others is expected to be another aspect of social support that plays a protective role
against the Hurricane Katrina-related stressors. It is further anticipated that optimism will
mediate the benefits of religiousness on survivors’ post-disaster outcomes. The questions
whether religiousness is associated with optimism after the storm and whether optimism
17
is associated with better psychological outcomes will thus be examined.
Researchers have consistently shown that high severity of exposure is associated
with more mental health symptoms (Palinkas, Downs, Petterson, & Russell, 1993;
Thompson, Norris, & Hanacek, 1993). Recent reports on the effects of Hurricane Katrina
confirm this relationship, showing that the residents of New Orleans were exposed to a
large number of traumatic events and that the number of such events is associated with
mental health symptoms (Weems et al., 2007). Therefore, level of exposure is included in
this study as a predictive factor of post-disaster psychological distress and is statistically
controlled for to more accurately investigate the relationships in question. Similarly, predisaster psychological functioning is repeatedly found as a robust predictor of postdisaster mental health (Norris, Friedman, & Watson, 2002). In the current study, it is
expected that pre-disaster psychological distress will be predictive of post-disaster
psychological distress. In addition, two demographic variables, age and number of
children, are included and statistically controlled for, given findings that younger age
(e.g., Brewin et al., 2000) and the presence of children (Bromet et al., 1982; Gibbs, 1989;
Morrow, 1997) exacerbate risk for post-disaster psychopathology.
Hypotheses
In summary, based on the literature reviewed above, the following hypotheses are
specified. Among a sample of women hurricane survivors:
1. Higher levels of exposure will be associated with more severe levels of psychological
distress. Although this relationship has been consistently demonstrated in previous
studies, this study will be the first to incorporate and control for pre-disaster data in the
context of Hurricane Katrina.
18
2. Religiousness will be associated with lower levels of psychological distress and that
this relationship is mediated by social support and optimism, after controlling for predisaster levels of distress and levels of exposure to the disaster.
Method
Sample and Procedure
The sample consisted of residents in the greater New Orleans region who survived
Hurricanes Katrina and Rita. This study consists of three waves of data. The baseline
(T0) data were collected from 1,019 students in two community colleges in New Orleans.
These students were enrolled in Opening Doors, an education intervention program
(Brock & Richburg-Hayes, 2006). The participants provided information on sociodemographic characteristics, family background, and participation in transfer programs.
Participants also reported their physical and mental health, including, but not limited to,
health conditions that limit activities, height and weight, tobacco use and symptoms of
stress and psychological distress. In this study, the demographic data from this survey of
was used.
The Pre-Katrina survey (T1) was administered to 492 of the 1,019 New Orleans
respondents a year after T0 and months before the arrival of Hurricane Katrina. It was
designed to study the effects of the Opening Doors program. The survey included
questions on religiousness; economic and social resources (e.g., educational attainment,
employment, and income; information on support received from family and friends, as
well as social networks, social trust and civic engagement); physical health (e.g.,
difficulties with activities of daily living and obesity), and mental health (e.g.,
psychological distress, stress, substance use, and risky sexual behaviors). The survey also
19
contained measures of optimism, social support and social efficacy. The collection of
data was interrupted by Hurricane Katrina, by which point 492 respondents had
completed the survey.
Within a year after Hurricane Katrina, telephone follow-ups with those who
completed the pre-Katrina survey (T1) were conducted by trained interviewers. Four
hundred and two (81.7%) of the 492 respondents who participated in T1 were
successfully contacted and completed the post-Katrina survey (T2). Data collection for
T2 began in May 2006, nine months after the hurricane, and ended in March 2007. In
addition to the questions in T1, the T2 survey included a detailed set of questions about
experiences during and after the hurricane (e.g., the timing of evacuation, traumatic
experiences during and shortly after the hurricane, property damage, and sources of
formal and informal support).
The focus of the current study was on the psychological functioning and
psychosocial resources of women after Hurricane Katrina as it related to their
religiousness before the storm. The final sample consisted of 386 women who completed
interviews at all three-time points. At baseline, most participants were unmarried and had
one or two children. Many participants were financially disadvantaged: approximately
70% received some type of government assistance (e.g., food stamps) at the time they
enrolled in the study (T0). At the time of enrollment, the average monthly income of the
participants was low (mean = $1,617; SD = $1,092). The demographic characteristics of
the participants who completed all three waves of survey were not different from the
overall group at baseline. To determine whether those who completed the post-disaster
interview differed from those who did not, t tests were conducted on all variables
20
assessed before Hurricane Katrina (i.e., T1). Results indicated no differences in any of
the variables included in this study between the two groups. Table 1 presents the
demographic information of the participants included in the current study.
Measures
A series of surveys containing questions concerning health resources and social
resources were administered in both waves of the study. Below are the descriptions of the
questions asked that were included in this study. The internal consistency for each scale
is reported.
Psychological Distress. Two indicators were used to measure pre-Katrina distress:
the K6 scale (Kessler et al., 2002) and the Perceived Stress Scale (PSS; Cohen, Kamarck,
& Mermelstein, 1983; Cohen & Williamson, 1988). The K6 scale is a 6-item measure of
nonspecific psychological distress and has been shown to have good psychometric
properties (Furukawa, Kessler, Slade, & Andrews, 2003). It includes items such as
“During the past 30 days, about how often did you feel so depressed that nothing could
cheer you up?” Respondents answered on a 5-point Likert-type scale ranging from 1 (all
the time) to 5 (none of the time). Previous validation study (Kessler et al., 2003) suggests
that a score of 0 to 7 can be considered as probable absence of mental illness, a score of 8
to 12 can be considered as probable mild or moderate mental illness and a score of 13 or
greater can be considered as probably serious mental illness. Cronbach’s alpha of the K6
scale in this study was .76 for T1 and .82 for T2. The PSS is a four-item stress measure
that assesses whether the individual feels overwhelmed by current life events in the past
month. It has been widely used in studies of the effects of stress on health outcomes. An
example of the items is “In the last month, how often have you felt difficulties were
21
piling up so high that you could not overcome them?” Participants answered on a 5-point
Likert-like scale ranging from 0 (never) to 4 (very often). Cronbach’s coefficient alpha
was .74 for T1 and .82 for T2.
Religiousness. Religiousness was measured with two single-item questions
inquiring about the frequency of attending religious services and the importance of
religion to the participant. Report of religious attendance was based on a 5-point Likerttype scale ranging from 1 (never) to 5 (several times per week). Religious importance
was measured with an item asking participants to rate the level of importance of religion
in his or her life using a 5-point scale to indicate the degree of importance. Responses
ranged from 1 (not at all important) to 5 (very important). Cronbach’s alpha was .60 for
T1.
Social support was assessed using questions from the Social Provisions Scale
(SPS; Cutrona & Russell, 1987) and a measure of social efficacy. Eight items from the
SPS were asked, including questions asking whether participants have people in their
lives who value them and on whom they can count. Response options were given in a 4point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).
Cronbach’s alpha was .82 for T2. Social efficacy was measured using a scale developed
by the MacArthur Network on Transitions to Adulthood for the evaluation of the
Opening Doors program (Brock & Richburg-Hayes, 2006). It contains five items on a 5point Likert scale (e.g., “You feel that you are important, that you ‘matter,’ to other
people;” “People often seek your advice and support.”) Response options were given in a
4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).
Cronbach’s alpha was .72 for T2.
22
Optimism. The Life Orientation Test-Revised (LOT-R) is a self-report measure of
optimism that consists of six items (Scheier, Carver, & Bridges, 1994). Each item was
rated on a 4-point Likert scale that ranges from strongly disagree to strongly agree. Three
of the six items were framed positively (e.g., “I am always optimistic about my future”),
and the remaining three were framed negatively (e.g., “If something can go wrong for
me, it will”). Cronbach’s alpha was .70 in T2.
Physical Symptoms. Participants were asked to indicate if they have had any of
the following physical symptoms over the year before T1: 1) an episode of asthma or an
asthma attack, 2) trouble with back, 3) trouble with digestion, such as stomach ulcers,
frequent indigestion or stomach upset, 4) trouble with frequent headaches or migraines,
and 5) diagnosed or treated for anemia. For all questions, responses were coded as “Yes”
= 1, and “No” = 0. Total “physical symptoms” was the number of items endorsed.
Cronbach’s alpha was .44 in T1.
Hurricane exposure. Participants were asked to indicate if they experienced any
of the following as a result of the hurricanes: 1) no fresh water to drink, 2) no food to eat,
3) felt their life was in danger, 4) lacked necessary medicine, 5) lacked necessary medical
care, 6) had a family member who lacked necessary medical care, 7) lacked knowledge of
safety of their children, 8) lacked knowledge of safety of their other families members,
and 9) whether there was any death among family and friends. Participants were asked
these questions for both Hurricanes Katrina and Rita. In addition, participants were asked
whether they had lost a house, a vehicle (e.g., car, motorcycle), and whether a family pet
had died or been lost due to the hurricanes and their aftermath. For all questions,
responses were dichotomous (“Yes” = 1 and “No” = 0). A composite score (possible
23
range = 0 to 20) was created with the count of affirmative responses to these items.
Cronbach’s alpha was .82 in T2.
Demographic characteristics. Demographic questions were collected at all three
time points. In this study, participants’ reported age and race at T0 and number of
children at T1 were utilized.
Data Analysis
First, the normality of the data was examined to determine whether the
assumptions of multivariate statistical estimations used in the study were met. All
measured continuous variables were examined for departure from normality in terms of
skewness and kurtosis. Zero-order correlations were used to examine bivariate relations
among the variables in the theoretical model. Second, structural equation modeling
(SEM) was employed to evaluate 1) the adequacy of the measurement model that
consisted of four latent variables (i.e., religiousness, social support, and pre- and postdisaster distress) and 2) the structural regression model that related the latent and
measured variables (i.e., religiousness, social support, optimism, and pre- and postdisaster distress, level of exposure, along with age, age of children, and physical health)
(Figure 1). Third, bootstrapping was used to test the significance of mediated effects in
the model.
Results
Missing Data Analysis
Although not missing completely at random (Little’s MCAR test: χ2 [1405] =
1602.27, p < .001), missing data analysis indicated that none of the variables had more
24
than 3% of missing variables. Due to the low missing rate, unless otherwise specified,
missing data were handled with pairwise deletion.
Descriptive Results
A large majority of the participants were religious. Only 2.0% of the participants
rated religion as not at all important or not too important, while most participants
(76.2%) reported that religion is very important in their lives. Similarly, most participants
(72.1%) claimed to attend religious services at least once to twice per month.
Distress levels increased from pre-disaster to post-disaster. The average on the K6
scale increased by 1.08, which was statistically significant, t(382) = -4.00, p < .001.
Similarly, the average on the PSS increased by 1.05, which was also statistically
significant, t(381) = 5.27, p < .001. The results of the K6 scale indicated that the fraction
of the sample with probable mild or moderate mental illness rose from 16.1% to 23.4%,
whereas the fraction with probable serious mental illness increased from 6.5% to 14.0%.
The post-disaster prevalence rates are comparable to those reported by other researchers
studying the mental health of survivors of Hurricane Katrina (e.g., Galea et al., 2007,
Wang et al., 2007).
Correlations Among Religiousness, Social Support, Social Efficacy, Optimism, and
Psychological Distress
With the exception of the importance of religion, variables showed no violations
of normal distribution in the hypothetical model. Importance of religion data displayed
relatively high degree of skewness (= -2.15) and kurtosis (= 4.38) and was not normally
distributed. For the SEM analyses, square root transformation of the variable was used.
Table 2 shows the zero-order correlations among the raw scores of the variables,
25
including their sample sizes, means, and standard deviations. The size of zero-order
correlations among indicators of the four latent factors were moderate to high, ranging
from .47 to .69.
The two indicators of religiousness were moderately correlated with each other.
Pre-disaster frequency of religious service attendance was negatively correlated with predisaster levels of perceived stress, mood and anxiety symptoms, as well as post-disaster
levels of perceived stress. It also correlated positively with post-disaster optimism.
Importance of religion was correlated negatively with pre-disaster levels of perceived
stress and positively with post-disaster optimism.
The two indicators of post-disaster social support were positively correlated with
each other and with optimism. Social efficacy also correlated positively with pre-disaster
frequency of religious service attendance. Both social efficacy and perceived social
support correlated negatively with pre- and post-disaster perceived stress, and postdisaster symptoms of mood-anxiety disorders. Perceived social support also negatively
correlated with severity of exposure.
Post-disaster perceived stress and symptoms of mood-anxiety disorders were
positively correlated with each other and were also positively correlated with level of
exposure. In addition, both variables were positively correlated with pre-Katrina stress
and symptoms of mood-anxiety disorders. The two demographic variables, age and
number of children, were positively correlated with each other and with level of
exposure. Number of children also negatively correlated with post-disaster perceived
social support and positively with post-disaster optimism. Physical health symptoms
correlated positively with both pre- and post-disaster perceived stress and mood and
26
anxiety symptoms.
Measurement Model
Prior to testing the hypothesized model, confirmatory factor analysis was
conducted to examine the fit of the measurement model. In this study, the measurement
model was estimated using the maximum-likelihood method in the AMOS 16.0 program
(Arbuckle, 2007). Model fit statistics suggest that the measurement model fit the data
well, χ2 (14, N = 386) = 42.33, p < .001, CFI = .96, RMSEA = .073 (90% confidence
interval [CI]: .048, .098; PCLOSE = .06). The factor loadings for the measurement model
are presented in Table 3. As the table shows, parameter tests for all factor loadings were
significant at p < .001. Thus, all the latent variables appear to have been adequately
operationalized by their respective indicators. Correlations among the latent variables are
presented in Table 4.
Structural Model Fit
With the exception of the importance of religion variable, which was transformed
(see above), raw scores were used in estimating the hypothetical model (Figure 1). The
initial estimation of the model with AMOS resulted in an acceptable fit to the data, χ2 (33,
N = 386) = 86.80, p < .001, CFI = .95, RMSEA = .065 (90% CI: .049, .082; PCLOSE =
.07). As a second step, insignificant paths (p > .10) were trimmed. The trimmed structural
model presented in Figure 2 represents a good fit to the data, χ2 (45, N = 386) = 103.00, p
< .01, CFI = .95, RMSEA = .058 (90% CI: .043, .073; PCLOSE = .18). The difference of
fit between the original model and the trimmed model was not statistically significant, df
= 12, CMIN = 16. 20, n.s., indicating that the more parsimonious model was not worse
fit. The trimmed model accounted for 40.1% of the variance in post-disaster distress.
27
Major Pathways to Post-disaster Distress
Significant paths are shown in Figure 2. The significant paths were partially
consistent with the hypothetical model. Confirming the first hypothesis, post-disaster
distress was found to be associated with severity of exposure to the hurricanes. Predisaster distress predicted both level of exposure and post-disaster distress. Although no
direct effects were found between the two demographic variables and post-disaster
distress, they predicted level of exposure.
The second hypothesis was only partially supported. No direct effect of
religiousness on post-disaster distress was found. However, significant pathways from
pre-disaster religiousness to pre-disaster social support and optimism were indicated.
Results also showed that post-disaster distress was also predicted by lower levels of
social support and optimism.
Indirect Effects
In order to test the magnitude and significance of mediation effects in predicting
post-disaster distress in the hypothesized model (Figure 1), a bootstrap procedure was
used. Because bootstrapping does not permit missing data, data imputation was first
conducted. Item means (rounded to their integer value) were substituted for missing
responses if a participant omitted one item on the multi-item scales. No imputation was
used when more than one item was missing on the scale; rather, these participants were
dropped. After this imputation approach, 18 participants (4.7%) were omitted from the
analyses because of missing data. Consequently, the sample of 386 was reduced to 368.
Bootstrapping was conducted with AMOS, following the guidelines offered by
Shrout and Bolger (2002). First, 1,000 bootstrap samples were formed using the imputed
28
dataset (N = 368). Second, the path coefficients of the final model (Figure 2) were
estimated 1,000 times. Third, the estimates of each path coefficient were used to calculate
mean and standard error of the indirect effects across the 1,000 bootstrap samples.
According to Shrout and Bolger (2002), if the 95% confidence interval (CI) of the mean
indirect effect does not include zero, it can be considered that the indirect effect is
statistically significant at the .05 level. The results indicated two statistically significant
indirect effects: the indirect effect of age on post-disaster distress (p < .05) and of predisaster distress on post-disaster distress (p < .01).
Discussion
The present prospective study indicates how faith factors might influence the
psychological distress of female survivors of Hurricanes Katrina and Rita. Although no
direct effect was found between religiousness before the hurricanes and post-disaster
psychological distress, pre-disaster religiousness was predictive of better post-disaster
psychosocial resources which, in turn, were associated with lower levels of psychological
distress after the storm.
Supporting Hypothesis 1, post-disaster distress was predicted by severity of
exposure to the hurricanes. Those who had greater exposure to the disaster and related
stressors were worse off psychologically, which is congruent with past research (Bravo,
Rubio-Stipec, Canino, Woodbury, & Ribera, 1990; Palinkas et al., 1993). Level of
exposure, in turn, was predicted by number of children, age, and pre-disaster distress.
This finding is in line with previous studies, suggesting that having more children before
the storm was associated with a higher number of earthquake related stressors, especially
among mothers (Bromet et al., 1982; Gibbs, 1989; Morrow, 1997). The significant
29
indirect effect found between age and post-disaster distress suggests that older
participants had higher level of post-disaster distress because they were exposed to more
hurricane-related stressors. While young children (Acierno, Ruggiero, Kilpatrick,
Resnick, & Galea, 2006) and older adults (Thompson et al., 1993) are particularly
vulnerable to psychological distress after a disaster, the results of this study provide some
evidence for negative influence of age among young adults after a natural disaster. One
possible explanation is that those who are older might have relative higher levels of
maturity and experience, and thus have more awareness of and feel more responsibility
for the plight and needs of their family and friends, as well as themselves (Norris &
Murrell, 1988). Consistent with past findings (see Norris, Friedman, & Watson, 2002),
pre-disaster distress was a strong predictor of post-disaster distress. Interestingly, in
addition to direct effects, indirect effects were found, indicating that pre-disaster distress
impacted post-disaster distress directly as well as through its influence on level of
exposure and optimism. It could be speculated that pre-disaster distress might have
negatively impacted participants’ perception as well as actual severity of exposure and
optimism.
Hypothesis 2 was partially confirmed. Contrary to prediction, pre-disaster
religiousness did not directly predict post-disaster distress directly. However, higher predisaster religiousness was found to be a significant predictor of post-disaster social
support (as indicated by social support and social efficacy) and post-disaster optimism.
The lack of direct association is consistent with previous research. Studying the
protective factor of religiousness among cardiac surgery patients, Ai et al. (2007)
reported no direct effects on post-operation distress. Rather, the effect religiousness had
30
was indirect, via coping style and psychosocial resources. The lack of a mediated effect
in our study suggests that the relationship between pre-disaster religiousness, as measured
by self-rated frequency of attendance and importance, and post-disaster mental health
outcomes might be more complex and indirect. However, it should be underscored that a
negative association between religiousness and psychological distress was found
concurrently before the storm, which is consistent with past correlational studies (see
McCullough & Larson, 1999; Smith et al., 2003).
The finding that pre-disaster religiousness predicted higher levels of social
support and optimism is consistent with previous research on the benefits of religiousness
(Koenig, 2001). Religious practice, especially congregational, provides relatively large
social networks that are conducive to instrumental and emotional support (Bradley, 1995;
Ellison & George, 1994). The findings of this study suggest that people who see religion
as important in their lives and frequently participate in religious events are more likely to
perceive social support and to perceive self as capable of providing support. Similarly,
the positive association between pre-disaster religiousness and post-disaster optimism
confirms previous findings (see Koenig, 2001). Studies conducted in non-disaster
contexts have shown that social support and optimism mediate the effect between
religiousness and psychological well-being (e.g., Salsman et al., 2005). Although such
mediation was not found, to my knowledge, this is the first study to provide empirical
support for the positive relationship between pre-disaster religiousness and post-disaster
psychosocial resources, using prospective pre-disaster data. None of the other pre-disaster
factors (i.e., number of children, age, physical health, and mental health) included in this
31
study predicted post-disaster psychosocial resources, further highlighting the significance
of pre-disaster religiousness in this context.
Consistent with prediction, post-disaster social support (indicated by social
support and social efficacy) and optimism were negatively associated with post-disaster
distress, after controlling for severity of exposure and pre-disaster distress. The negative
association between social support and psychological distress is congruent with previous
research both in non-disaster (e.g., Cohen & Will, 1985) and disaster contexts (e.g.,
Brewin et al., 2000; Vernberg et al., 1996). The SEM results of the present study
complement previous findings to suggest that the perception that one is part of a
reciprocal social network is protective against adverse events and that this resource might
be cultivated by religious factors. Similarly, the negative association found between
optimism and psychological distress complements the existing literature that consistently
demonstrate that optimism is a predictor of lower levels of psychological distress (e.g.,
Aspinwall & Taylor, 1992; Rice, Herman, & Petersen, 1993) and its positive effect of
optimism in stressful situations (e.g., Scheier & Carver, 1992), including natural disasters
(e.g., Sumer et al., 2005). The results suggest that, in the face of a devastating event,
religiousness provides a sense of optimism about the future, which might have helped the
survivors maintain their psychological health.
The main strength of this study is its inclusion of pre-disaster data. Most disaster
studies rely on retrospective data when investigating the factors and pathways through
which post-disaster outcomes are affected (see Norris & Elrod, 2006 for a review). This
study was able to control for pre-disaster demographic variables as well as psychological
32
distress and make conclusions about pre-disaster religiousness’ influence on post-disaster
psychosocial resources and psychological distress.
In interpreting the results of this study, however, a few limitations should be kept
in mind. First, religiousness was measured with two general, single-item questions. There
is a growing discussion on how to measure religious and spiritual constructs in an
adequate way that captures their multifaceted and multilevel nature (e.g., Emmons &
Paloutzian, 2003; Gorsuch, 1984; Hill, 2005; Hill & Pargament, 2003). Because the
current study was embedded in a larger, more comprehensive project, many aspects of
religious beliefs and experiences were left unexamined, such as the type of religious
affiliation (e.g., denomination), level of commitment, history of religiousness, and
religious attribution. Particularly relevant to the current context is religious attribution—
the extent to which one perceives stressful events as caused by God’s love or God’s anger
(Pargament & Hahn, 1986). It has been shown that positive, but not negative, religious
attribution is predictive of better psychological outcomes, possibly because religion
provides positive reinterpretation of negative events (Smith et al., 2000). Furthermore,
internal attribution is shown to be associated with poorer outcomes in traumatic event in
general (Gray, Pumphrey, & Lombaro, 2003; Gray & Lombardo, 2004), and also in
natural disasters in particular (Solomon, Regier, & Burke, 1989; see also Massad &
Hulsey, 2006). Therefore, it seems important to examine different psychological
processes that are informed and affected by one’s religious and spiritual beliefs and
practices. Further studies examining the pathway through which religious factors benefit
mental health outcomes should consider including other psychosocial resources as well as
attribution style and religious coping variables.
33
Second, this study relied on self-report measures which are susceptible to
subjective biases. This might be particularly problematic with the exposure measure in
this study, since it is based on a person’s report of resource loss and perceived threat. It is
possible that the self-report of exposure was influenced by the person’s post-disaster
mental health, thus confounding the present findings. However, in research with geriatric
and cancer patients, self-reported health status is a superior predictor of outcomes than
objective health status (e.g., Smith, Young, & Lee, 2004). Some have argued that the
same might apply to disaster research (Friedman, 2006). Nonetheless future research
should seek to employ more objective measures, particularly of exposure to the event in
question.
Third, the sample used in this study is not representative of the entire population
affected by the hurricanes, thus reducing the generalizability of the findings. However, by
highlighting the experience of poor, predominately Black, single mothers, a population
that is faced with multiple stressors and of higher-risk of adverse outcomes (for a review,
see Young, 2006), this study will likely shed light on understanding and ultimately
helping those who are particularly vulnerable to both the exposure to traumatic event as
well as debilitating trajectories after the trauma.
Clinical Implications
The findings of this study suggest that religiousness, its perceived importance and
frequency of religious activity participation, helps by providing important psychosocial
resources that promote more favorable outcomes after a large-scale natural disaster. It
highlights the role of religion, especially those who hold a religious faith. Mental health
care providers should consider this factor to help restore both social networks and
34
internal psychological resources, such as optimism, that in turn might bring positive
psychological effects to the person in need. Similarly, the findings underscore the
importance of helping religious congregations to reconstitute themselves in order to
provide a community environment that is conducive to strengthening psychological
protective factors after a large-scale natural disaster.
Conclusions
The destruction Hurricane Katrina brought to the residents of New Orleans and its
neighboring regions will require years if not decades to recover from. This study
provided some evidence that religious beliefs and affiliations before the storm might have
helped protect some of the survivors through the providence of psychosocial resources.
35
Table 1
Selected characteristics of participants at Time 1 (pre-disaster)
Present Study
(N=386)
Female
Average age (years at baseline)
100%
25.4 (SD = 4.43)
Living with neither spouse nor partner
72.8%
Hispanic
Black non-Hispanic
2.8%
82.1%
White non-Hispanic
9.8%
Number of children
One
Two
42.5%
32.1%
Three or more
Households receiving any social benefits (UI, SSI, food
stamps, or TANF)
36
25.4%
72.0% (at
baseline)
Table 2
Correlations, Means, and Standard Deviations of the Measured Constructs in the Model (N = 386)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
N
M
SD
Age
Number of Children
Pre-Katrina Physical Symptoms
Pre-Katrina Frequency of Religious
Attendance
Pre-Katrina Importance of Religion
Pre-Katrina Mood and Anxiety
Symptoms
Pre-Katrina Perceived Stress
Post-Katrina Perceived Social
Support
Post-Katrina Social Efficacy
Post-Katrina Optimism
Level of Exposure
Post-Katrina Mood and Anxiety
Symptoms
Post-Katrina Perceived Stress
1
2
3
4
5
.33**
.02
.01
-
.09
.09
-.02
.01
.04
.00
-.09
-.08
.47**
-
.06
-.07
.39**
.29**
-.12*
-.16**
-.07
-.02
-.01
.18**
-.16**
-.06
.13*
.17**
.02
-.08
-.06
.09
.10
.10
386
25.42
4.43
-.01
-.06
384
1.25
1.13
.23**
.19**
385
1.08
1.05
NOTE. *p < .05. **p < .01, ***p < .001
37
6
7
8
9
10
11
-.09
-.12*
.62**
-
.07
.13*
.20**
.07
.03
.07
.14**
.12*
-.08
.01
-.15**
.15**
-.17**
-.19**
-.27**
.05
.48**
.33**
-15**
.46**
-.04
-.04
-
-.05
-.12*
386
2.33
1.25
.02
-.07
384
3.61
.80
.37**
.27**
384
5.54
4.07
.34**
.37**
384
4.28
3.31
-.27**
-.31**
371
17.63
3.86
-.18**
-.22**
384
11.80
2.45
-.31**
-.40**
380
12.45
3.19
.29**
.21**
378
4.03
3.47
12
13
.69**
385
6.68
5.21
384
5.35
3.6
Table 3
Factor Loadings for the Measurement Model
Measure and variable
Religiousness
Frequency of Religious Attendance
Importance of Religionb
Social resources
Perceived Social Support
Social Efficacy
Pre-Katrina Distress
Symptoms of Mood-Anxiety Disorders
Stress
Post-Katrina Distress
Symptoms of Mood-Anxiety Disorders
Stress
Unstandardized
factor loading
SE
C.R.
Standardized
factor loading
1.00a
-.16
.06
-2.65
.84
-.57***
1.00a
.47
.09
5.15
.81
.60***
1.00a
.99
.12
11.00
.72
.87***
1.00a
.70
.07
-2.65
.81
.85***
NOTE. aNot tested for statistical significance; bAfter square root transformation;
*p < .05. **p < .01, ***p < .001
38
Table 4
Correlations of Latent Variables in the Model
Latent variable
1. Religiousness
2. Social support
3. Pre-Katrina distress
4. Post-Katrina distress
1
.15*
-.22**
-.12, p=.07
NOTE. *p < .05. **p < .01, ***p < .001
39
2
3
4
-.25***
-.44***
.51***
-
Figure 1
The hypothesized model predicting post-disaster distress
40
Figure 2
The final model predicting post-disaster distress
NOTE. *p < .05. **p < .01, ***p < .001
41
REFERENCES
Acierno, R., Ruggiero, K. J., Kilpatrick, D. G., Resnick, H. S., & Galea, S. (2006).
Risk and protective factors for psychopathology among older versus younger
adults after the 2004 Florida hurricanes. American Journal of Geriatric
Psychiatry, 14, 1051-1059.
Ai, A. L., Evans-Campbell, T., Santangelo, L. K., & Cascio, T. (2006). The traumatic
impact of the September 11, 2001, terrorist attacks and the potential protection
of optimism. Journal of Interpersonal Violence, 21, 689-700.
Ai, A. L., Park, C. L., Huang, B., Rodgers, W., & Tice, T. N. (2007). Psychosocial
mediation of religious coping styles: A study of short-term psychological
distress following cardiac surgery. Personality and Social Psychology
Bulletin, 33, 867-882.
Ai, A. L., Peterson, C., & Huang, B. (2003). The effect of religious-spiritual copping
on positive attitudes of adult Muslim refugees from Kosovo and Bosnia. The
International Journal for the Psychology of Religion, 13, 29-47.
Andersson, G. (1996). The benefits of optimism: a meta-analytic review of the life
orientation test. Journal of Personality and Individual Differences, 21, 719725.
Aspinwall, L. G., Richter, L., & Hoffman, R. R., III. (2001). Understanding how
optimism works: An examination of optimists’ adaptive moderation of belief
and behavior. In H. S. Friedman (Ed.), Encyclopedia of mental health (Vol. 3,
pp. 41-52). San Diego, CA: Academic.
Aspinwall, L. G., & Taylor, S. E. (1992). Modeling cognitive adaptation: A
longitudinal investigation of the impact of individual differences and coping
on college adjustment and performance. Journal of Personality and Social
Psychology, 63, 989-1003.
Bandura, A. (1986). Social foundations of thought and actions: A social cognitive
theory. Englewood Cliffs, NJ: Prentice-Hall.
Benight, C. C., Swift, E., Sanger, J., Smith, A., & Zeppelin, D. (1999). Coping selfefficacy as a mediator of distress following a natural disaster. Journal of
Applied Social Psychology, 12, 2443-2464.
Blank, R. M. (2005). Poverty, policy and place: How poverty and policies to alleviate
poverty are shaped by local characteristics. International Regional Science
Review, 28, 441-464.
42
Bradley, D. E. (1995). Religious involvement and social resources: Evidence from the
data set “Americans' changing lives”. Journal for the Scientific Study of
Religion, 34, 259-267.
Bravo, M., Rubio-Stipec, M., Canino, G. J., Woodbury, M. A., & Ribera, R. C.
(1990). The psychological sequelae of disaster stress prospectively and
retrospectively evaluated. American Journal of Community Psychology, 18,
661-680.
Brewin, C., Andrews, B., & Valentine, J. (2000). Meta-analysis of risk factors for
posttraumatic stress disorder in trauma exposed adults. Journal of Consulting
and Clinical Psychology, 68, 748-766.
Brock, T. & Richburg-Hayes, L. (2006). Paying for Persistence: Early Results of a
Louisiana Scholarship Program for Low-Income Parents Attending
Community College. New York, NY: MDRC.
Bromet, E. J., Parkinson, D. K., Schulberg, H. C., Dunn, L. O., & Gondek, P. C.
(1982). Mental health of residents near the Three Mile Island reactor: A
comparative study of selected groups. Journal of Preventive Psychiatry, 1,
225-276.
Brummett, B. H., Babyak, M. A., Barefoot, J. C., Bosworth, H. B., Clapp-Channing,
N. E., Siegler, I. C., et al. (1998). Social support and hostility as predictors of
depressive symptoms in cardiac patients one month after hospitalization: A
prospective study. Psychosomatic Medicine, 60, 707-713.
Chatters, L. M., Robert, J. T., & Lincoln, K. D. (1999). African American religion
participation: A multi-sample comparison. Journal of the Scientific Study of
Religion, 38, 132-145.
Chen, A. C.-C., Keith, V. M., Airriess, C., Li, W., & Leong, K. J. (2007). Economic
vulnerability, discrimination, and Hurricane Katrina: Health among Black
Katrina survivors in Eastern New Orleans. Journal of the American
Psychiatric Nurses Association, 13, 257-266.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived
stress. Journal of Health and Social Behavior, 24, 385-396.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis.
Psychological Bulletin, 98, 310 –357.
Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the
United States. In S. Spacapan & S. Oskamp (Eds.) The social psychology of
health: Claremont symposium on applied social psychology (pp. 31-67).
Newbury Park, CA: Sage.
43
Cruess, S., Antoni, M., Kilbourn, K., Ironson, G., Klimas, N., Fletcher, M. A., et al.,
(2000). Optimism, distress, and immunologic status in HIV-infected gay men
following Hurricane Andrew. International Journal of Behavioral Medicine,
7, 160-182.
Cutrona, C. E., & Russell, D. W. (1987). The provisions of social relationships and
adaptation to stress, Advances in Personal Relationships, 1, 37-67.
David, D., Mellman, T. A., Mendoza, L. M., Kulick-Bell, R., Ironson, G., &
Schneiderman, N. (1996). Psychiatric morbidity following Hurricane Andrew.
Journal of Traumatic Stress, 9, 607-12.
Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and
benefiting from the experience: two construals of meaning. Journal of
Personality and Social Psychology, 75, 561-74.
Elliott, J. R., & Pais, J. (2006). Race, class, and Hurricane Katrina: Social differences
in human responses to disaster. Social Science Research, 35, 295-321.
Ellison, C. G. (1995). Race, religious involvement, and depressive symptomatology
in a southeastern U. S. community. Social Science and Medicine, 40, 15611572.
Ellison, C. G., & George, L. K. (1994). Religious involvement, social ties, and social
support in a southeastern community. Journal for the Scientific Study of
Religion, 33, 46-61.
Emmons, R. A., & Paloutzian, R. F. (2003). The psychology of religion, Annual
Review of Psychology, 54, 377-402.
Evers, A. W. M., Kraaimaat, F. W., van Lankveld, W., Jongen, P. J. H., Jacobs, J. W.
G., & Bijlsma, J. W. J. (2001). Beyond unfavorable thinking: The illness
cognition questionnaire for chronic diseases. Journal of Consulting and
Clinical Psychology, 69, 1026-1036.
Ferraro, F. R. (2003). Psychological resilience in older adults following the 1997
flood. Clinical Gerontologist, 26, 139-143.
Ferraro, K. F., & Koch, J. R. (1994). Religion and health among Black and White
adults: Examining social support and consolation. Journal for the Scientific
Study of Religion, 33, 362-375.
Friedman, M. J. (2006). Disaster mental health research: Challenges for the future. In
F. H. Norris, S. Galea, M. J. Friedman & P. J. Watson (Eds.), Methods for
disaster mental health research (pp.289-302). New York, NY: The Guilford
Press.
44
Furukawa, T. A., Kessler, R. C., Slade, T., & Andrews, G. (2003). The performance
of the K6 and K10 screening scales for psychological distress in the
Australian. Psychological Medicine, 33, 357-362.
Galea, S., Brewin, C. R., Gruber, M., Jones, R. T., King, D. W., King, L. A., et al.
(2007). Exposure to Hurricane-Related Stressors and Mental Illness After
Hurricane Katrina. Archive of General Psychiatry, 64, 1427-1434.
Galea, S., J. Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold J., et al.
(2002). Psychological sequelae of the September 11 terrorist attacks in New
York City. New England Journal of Medicine, 346, 982-987.
Gallup Organization (2001). Race and Social Audit. Retrieved March 5, 2007, at
http://www.gallup.com
Gallup Organization (2005). Gallup/CNN/USA Today/Red Cross Poll # 2005-45:
Hurricane Katrina Survivors.
Gallup Organization (2006). Religion. Retrieved November 19, 2007, at
http://www.gallup.com/poll/1690/Religion.aspx
George, L. K., Ellison, C. G., & Larson, D. B. (2002). Explaining the relationships
between religious involvement and health. Psychological Inquiry, 13, 190200.
Gibbs, M. S. (1989). Factors in the victim that mediate between disaster and
psychopathology: A review. Journal of Traumatic Stress, 2, 489-514.
Gillham, J.E., Shatté, A.J., Reivich, K.J., & Seligman, M.E.P. (2001). Optimism,
pessimism, and explanatory style. In E.C. Chang (Ed.), Optimism &
pessimism (pp. 53-75). Washington, DC: American Psychological
Association.
Giltay, E. J., Zitman, F. G., & Kromhout, D. (2006). Dispositional optimism and the
risk of depressive symptoms during 15 years of follow-up: The Zutphen
Elderly Study. Journal of affective disorders, 91, 45-52.
Gorsuch, R. L. (1984). Measurement: The boon and bane of investigating religion.
American Psychologist, 39, 228-236.
Gray, M. J., & Lombardo, T. W. (2004). Life event attributions as a potential source
of vulnerability following exposure to a traumatic event. Journal of Loss &
Trauma, 9, 59-72.
45
Gray, M. J., Pumphrey, J. E., & Lombaro, T. W. (2003). The relationship between
dispositional pessimistic attributional style versus trauma-specific attributions
and PTSD symptoms. Journal of Anxiety Disorder, 17, 289-303.
Haney, T. J., Elliott, J. R., & Fussell, E. (2007). Families and hurricane response:
Evacuation, separation, and the emotional toll of Hurricane Katrina. In D. L.
Brunsma, D. Overfeldt, & J. S. Picou (Eds.), The Sociology of Katrina:
Perspectives on a Modern Catastrophe. Lanham, MD: Rowman & Littlefield.
Hill, P. C. (2005). Measurement in the psychology of religion and spirituality:
Current status and evaluation. In R. F. Paloutzian & C. L. Park (Eds.),
Handbook of the Psychology of Religion and Spirituality (pp. 435-459). New
York, NY: The Guilford Press.
Hill, P. C. & Pargament, K. I. (2003). Advances in the conceptualization and
measurement of religion and spirituality: Implications for physical and mental
health research. American Psychologist, 58, 64-74.
Hummer, R. A., Rogers, R. G., Nam, C. B., & Ellison, C. G. (1999). Religious
involvement and US adult mortality. Demography, 36, 273-285.
Hurricane Katrina Community Advisory Group (2006). Overview of Baseline Results.
Retrieved January 20, 2007, at
http://hurricanekatrina.med.harvard.edu/pdf/baseline_report%208-25-06.pdf
Idler, E. L., & Kasl, S. V. (1995). Self-ratings of health: Do they also predict change
in functional ability? Journal of Gerontology: Social Sciences, 508, S344S353.
Joseph, S., Yule, W., & Williams, R. (1994). The herald of free enterprise disaster:
The relationship of intrusion and avoidance to subsequent depression and
anxiety. Behavior Research and Therapy, 32, 115-117.
Kaniasty, K., & Norris, F. (1999). The experience of disaster: Individuals and
communities sharing trauma. In R. Gist & B. Lubin (Eds.), Response to
Disaster: Psychosocial, Community, and Ecological Approaches (pp. 25-62).
Ann Arbor, MI: Braun-Brumfield.
Karanci, N. A., & Acarturk, C. (2005). Post-traumatic growth among Marmara
earthquake survivors involved in disaster prepartedness as volunteers.
Traumatology, 11, 307-323.
46
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.L.T., et al. (2002). Short screening scales to monitor population prevalances
and trends in nonspecific psychological distress. Psychological Medicine, 32,
959-976.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., et
al. (2003). Screening for serious mental illness in the general population.
Archives of General Psychiatry. 60, 184-189.
Kessler, R. C., Galea, S., Jones, R. T., & Parker, H. A. (2006). Mental illness and
suicidality after Hurricane Katrina. Bulletin of the World Health Organization,
84, 930-939.
Koenig, H. G. (2001). Religion and medicine II: Religion, mental health, and related
behaviors. International Journal of Psychiatry in Medicine, 31, 97-109.
Koenig, H. G., Cohen, H. J., George, L. K., Hays, J. C., Larson, D. B., & Blazer D. G.
(1997). Attendance at religious services, interleukin-6, and other biological
indicators of immune function in older adults. International Journal of
Psychiatry in Medicine, 27, 233-250.
Koenig, H. G, Hays, J. C., Larson, D. B., George, L. K., Cohen, H. J., McCullough
M. E., et al. (1999). Does religious attendance prolong survival? A six-year
follow-up study of 3,968 older adults. Journal of Gerontology: Medical
Sciences, 54A, M370-376.
Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion
and health. New York, NY: Oxford University Press.
Krause, N. (2002). Church-based social support and health in old age: Exploring
variations by race. Journal of Gerontology, 57, 332-347.
Krause, N., Ellison, C. G., Shaw, B. A., Marcum, J. P., & Boardman, J. D. (2001).
Church-based social support and religious coping. Journal of the Scientific
Study of Religion, 40, 637-656.
LeClere, F., Richard, R., & Kimberly, P. (1997). Ethnicity and mortality in the United
States: Individual and community correlates. Social Forces, 76, 169-198.
Levin, J. S., Chatters, L. M., & Taylor, R. J. (1995). Religious effects on health status
and life satisfaction among Black Americans. Journal of Gerontology, 50,
154-163.
Levin, J. S., Markides, K. S., & Ray, L. A. (1996). Religious attendance and
psychological well-being in Mexican Americans: A panel analysis of threegenerations data. The Gerontologist, 36, 454-463.
47
Logan, J. R. (2006). The impact of Katrina: Race and class in storm-damaged
neighborhoods. Unpublished manuscript. Spatial Structures in the Social
Sciences Initiative, Brown University.
Massad, P. M., & Hulsey, T. L. (2006). Causal attributions in posttraumatic stress
disorder: Implications for clinical research and practice. Psychotherapy:
Theory, Research, Practice, Training, 43, 201-215.
Maton, K. I. (1988). Social support, organizational characteristics, psychological
well-being, and group appraisal in three self-help group populations.
American Journal of Community Psychology, 16, 53-77.
McIntosh, D. N., Silver, R. C., & Wortman, C. B. (1993). Religious role in
adjustment to a negative life event. Journal of Personality and Social
Psychology, 65, 812-821.
Milam, J. E., Ritt-Oson, A., & Unger, J. B. (2004). Posttraumatic growth among
adolescents. Journal of Adolescent Research, 19, 192-204.
Miller W. R., & Thoresen, C. E. (2003). Spirituality, religion, and health. An
emerging research field. American Psychologist, 58, 24-35.
Morrow, B. H. (1997). Stretching the bonds: The families of Andrew. In W. G.
Peacock, B. H. Morrow, & H. Gladwin (Eds.), Hurricane Andrew: Ethnicity,
gender, and the sociology of disasters (pp. 141-170). New York: Routledge.
Myer, D. G. (2000). The funds, friends, and faith of happy people. American
Psychologist, 55, 56-67.
Norris, F. H., Baker, C. K., Murphy, A. D. & Kaniasty, K. (2005). Social support
mobilization and deterioration after Mexico’s 1999 flood: Effects of context,
gender, and time. American Journal of Community Psychology, 36, 15-28.
Norris, F. H., & Elrod, C. L. (2006). Psychological consequences of disaster: A
review of past research. In F. H. Norris, S. Galea, M. J. Friedman & P. J.
Watson (Eds.), Methods for disaster mental health research (pp. 20-44). New
York, NY: The Guilford Press.
Norris, F., Friedman, M., Watson, P. (2002). 60,000 disaster victims speak: Part II.
Summary and implications of the disaster mental health research. Psychiatry,
65, 240-260.
Norris, F., Friedman, M., Watson, P., Byrne, C., Diaz, E. & Kaniasty, K. (2002).
60,000 disaster victims speak. Part I: An empirical review of the empirical
literature, 1981–2001. Psychiatry, 65, 207–239.
48
Norris, F., & Murrell, S. A. (1988). Prior experience as a moderator of disaster impact
on anxiety symptoms in older adults. American Journal of Community
Psychology, 16, 665-683.
Norris, F. H., Perilla, J. L., Riad, J. K., Kaniasty K., & Lavizzo, E. A. (1999).
Stability and change in stress, resources, and psychological distress following
natural disaster: findings from Hurricane Andrew. Anxiety, Stress, and
Coping, 12, 363-396.
Oman, D., & Reed, D. (1998). Religion and mortality among the communitydwelling elderly. American Journal of Public Health, 88, 1469-1475.
Oman, D., & Thoresen, C. E. (2005). Do religion and spirituality influence health? In
R. F. Paloutzian & C. L. Park (Eds.), Handbook of the Psychology of Religion
and Spirituality (pp. 435-459). New York, NY: The Guilford Press.
Palinkas, L. A., Downs, M. A., Petterson, J. S., & Russell, J. (1993). Social, cultural,
and psychological impacts of the Exxon Valdez oil spill. Human
Organization, 52, 1-13.
Pargament, K. I., & Hahn, J. (1986). God and the just world: Causal and coping
attributions to God in health situations. Journal for the Scientific Study of
Religion, 25, 193-207.
Patrick, H., Ryan, A. M., & Kaplan, A. (2007). Early adolescents’ perception of the
classroom social environment, motivational beliefs, and engagement. Journal
of Educational Psychology, 99, 83-98.
Peacock, W. G., Morrow, B. H., & Gladwin, H. (1997). Hurricane Andrew: Ethnicity,
gender and the sociology of disasters. New York, NY: Routledge.
Perilla, J. L., Norris, F. H., & Lavizzo, E. A. (2002). Ethnicity, culture, and disaster
response: Identifying and explaining ethnic differences in PTSD six months
after Hurricane Andrew. Journal of Social & Clinical Psychology, 21, 20-45.
Peterson, C., Seligman, M. E. P., & Vaillant, G. (1988). Pessimistic explanatory style
as a risk factor for physical illness: A thirty-five year longitudinal study.
Journal of Personality and Social Psychology, 55, 23-27.
Pfefferbaum, B. & Doughty, D. E. (2001). Increased alcohol use in a treatment
sample of Oklahoma City bombing victims. Psychiatry, 64, 296–303.
Pirraglia, P. A., Peterson, J. C., Williams-Russo, P., Gorkin, L., & Charlson, M. E.
(1999). Depressive symptomatology in coronary artery bypass graft surgery
patients. International Journal of Geriatric Psychiatry, 14, 668-680.
49
Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality:
Linkages to physical health. American Psychologist, 58, 36-52.
Puskar, K. R., Sereika, S. M., Lamb, J., Tusaie-Mumford, K. & Mcguinness, T.
(1999). Optimism and its relationship to depression, coping, anger, and life
events in rural adolescents. Issues in Mental Health Nursing, 20, 115-130.
Rice, K. G., Herman, M. A., & Petersen, A. C. (1993). Coping with challenge in
adolescence: A conceptual model and psycho-educational intervention.
Journal of Adolescence, 16, 235-251.
Rubonis, A. V., & Bickman, L. (1991). Psychological impairment in the wake of
disaster: The disaster-psychopathology relationship. Psychological Bulletin,
109, 384-399.
Salsman, J. M., Brown, T. L., Brechting, E. H., & Carlson, C. R. (2005). The link
between religion and spirituality and psychological adjustment: The mediating
role of optimism and social support. Personality and Social Psychology
Bulletin, 31, 522-535.
Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment
and implication of generalized outcome expectancies. Health Psychology, 4,
219-247.
Scheier, M. F., & Carver, C. S. (1992). Effects of optimism on psychological and
physical well-being: Theoretical overview and empirical update. Cognitive
Therapy and Research, 16, 201-228.
Scheier, M. F., & Carver, C. S. (1993). On the power of positive thinking: The
benefits of being optimistic. Current Directions in Psychological Science, 2,
26-30.
Scheier, M. F., Carver, C. S., & Bridges, M. (1994). Distinguishing optimism from
neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation
of the Life Orientation Test. Journal of Personality and Social Psychology,
67, 1063-1078.
Sethi, S. & Seligman, M. E. (1993). Optimism and fundamentalism. Psychological
Science, 4, 256-259.
Seligman, M. E. P. (1991). Learned optimism. New York, NY: Knopf.
50
Shrout, P. E., & Bolger N. (2002). Mediation in experimental and nonexperimental
studies: New procedures and recommendations. Psychological Methods, 7,
422-445.
Smith, B. W., Pargament, K. I., Brant, C., & Oliver, J. M. (2000). Noah revisited:
Religious coping by church members and the impact of the 1993 Midwest
flood. Journal of Community Psychology, 28, 169-186.
Smith, T. B., McCullough, M. E., & Poll, J. (2003). Religiousness and depression:
Evidence for a main effect and the moderating influence of stressful life
events. Psychological Bulletin, 129, 614-636.
Smith, N., Young, A., & Lee, C. (2004). Optimism, health-related hardiness and wellbeing among older Australian women. Journal of Health Psychology, 9, 741752.
Solomon, S. D., & Green, B. L. (1992). Mental health effects of natural and humanmade disasters. PTSD Research Quarterly, 3, 1-8.
Solomon, S. D., Regier, D. A., & Burke, J. D. (1989). Role of perceived control in
coping with disaster. Journal of Social & Clinical Psychology, 8, 376-392.
Solomon, S. D., Smith, E., Robins, L. N. (1987). Social involvement as a mediator of
disaster-induced stress. Journal of Applied Social Psychology, 17, 1092-1112.
Spence, P. R., Lachlan, K. A., & Griffin, D. R. (2007). Crisis Communication, Race,
and Natural Disasters. Journal of Black Studies, 37, 539-554.
Spurrell, M. T., & McFarlane, A. C. (1993). Post-traumatic stress disorder and coping
after a natural disaster. Social Psychiatry and Psychiatric Epidemiology, 28,
194-200.
Steingless, P., & Gerrity, E. (1990). Natural disasters and post-traumatic stress
disorder: Short-term versus long-term recovery in two disaster-affected
communities. Journal of Applied Social Psychology, 20, 1746-1765.
Sumer, N., Karanci, A. N., Berument, S. K., & Gunes, H. (2005). Personal resources,
coping self-efficacy, and quake exposure as predictors of psychological
distress following the 1999 earthquake in Turkey. Journal of Traumatic
Stress, 18, 331-342.
Sundin E. C., & Horowitz, M. J. (2003). Horowitz’s impact of event scale evaluation
of 20 years of use. Psychosomatic Medicine, 65, 870-876.
Taylor, A. J. (1991). The field of disaster and disaster stress. British Journal of
Guidance and Counseling, 19, 1-7.
51
Taylor, R. J. (1988). Structural determinants of religious participation among Black
Americans. Review of Religious Research, 20, 114-125.
Talyor, R. J., & Chatters, L. M. (1998). Church members as a source of informal
social support, Review of Religious Research, 30, 114-125.
Taylor, R. J., Mattis, J. & Chatters, L. M. (1999). Subjective religiosity among
African Americans: A synthesis of qualitative research and findings from five
national samples. Journal of Black Psychology, 25, 524-543.
Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory:
Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455472.
Thompson, M. P., Norris, F. H., & Hanacek, B. (1993). Age differences in the
psychological consequences of Hurricane Hugo. Psychology and Aging, 8,
606-616.
U.S. Census Bureau (2000). Census 2000. Retrieved April 5, 2008, at
http://factfinder.census.gov
U.S. Census Bureau (2007). Census 2007. Retrieved April 5, 2008, at
http://factfinder.census.gov
van der Velden, P. G., Kleber, R. J., Fournier, M., Grievink, L., Drogendijk, A., &
Gersons, B. P. R. (2007). The association between dispositional optimism and
mental health problems among disaster victims and a comparison group: A
prospective study. Journal of Affective Disorders, 102, 35-45.
Vernberg, E. M., La Greca, A. M., Silverman, W. K., & Prinstein, M. J. (1996).
Prediction of posttraumatic stress symptoms in children after Hurricane
Andrew. Journal of Abnormal Psychology, 105, 237-248.
Wang, P., Gruber, M. J., Powers, R. E., Schoenbaum, M., Speier, A. H., Wells, K. B.,
& Kessler, R. C. (2007). Mental health service use among Hurricane Katrina
survivors in the eight months after the disaster. Psychiatric Services, 58, 14031411.
Weaver, A. J., Koenig, H. G., & Ochberg, F. M. (1996). Posttraumatic stress, mental
health professionals, and the clergy: A need for collaboration, training, and
research. Journal of Traumatic Stress, 9, 847-855.
52
Weems, C. F., Watts, S. E., Marsee, M. A., Taylor, L. K., Costa, N. M., Cannon, M.
F., et al. (2007). The psychosocial impact of Hurricane Katrina: Contextual
differences in psychological symptoms, social support, and discrimination.
Behavior Research and Therapy, 45, 2295-2306.
Weisler, R. H., Barbee, J. G., & Townsend, M. H. (2006). Mental health and recovery
in the Gulf Coast after Hurricane Katrina and Rita. Journal of the American
Medical Association, 296, 585-588
Weiss, D.S. & Marmar, C.R. (1996). The impact of event scale – revised. In J. Wilson
& T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399411). New York, NY: The Guilford Press.
White, I. K., Philpot, T. S., Wylie, K., & McGowen, E. (2007). Feeling the pain of
my people: Hurricane Katrina, racial inequality, and the psyche of Black
America. Journal of Black Studies, 37, 523-538.
Young, B. H. (2006). The immediate response to disaster: Guidelines for adult
psychological first aid. In E. C. Ritchie, P. J. Watson, & M. J. Friedman
(Eds.), Interventions following mass violence and disasters: Strategies for
mental health practice (pp. 134-154). New York, NY: The Guilford Press.
53