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Environmental Disaster and Mental Health: Coping and Depression among Survivors of Multiple Disasters.

Environmental disasters are considered traumatic events for both the individuals and the communities affected. Because of the distress and disruption an environmental disaster may bring to an individual's life, it is imperative to reflect on the way that these major life events may affect mental health. Many studies have reported a salient link between trauma and mental health such that an individual who has experienced multiple traumatic events is at an increased risk of experiencing mental health problems such as depression, anxiety, and posttraumatic stress (Bifulco, Bernazzani, Moran, & Ball, 2000; Harville, Shankar, Dunkel Schetter, & Lichtveld, 2018; Turner & Lloyd, 2004). Moreover, other studies have found that mental health problems, such as depression or posttraumatic stress, may increase an individual's risk of experiencing a traumatic event in the future (Cougle, Resnick, & Kilpatrick, 2009; Lowe, Walsh, Uddin, Galea, & Koenen, 2014).

Although previous studies have revealed that environmental disasters do not negatively affect mental health as significantly as other traumatic events such as physical assault, sexual assault, or abuse (Kumar & Fonagy, 2013), it is vital to consider that the risk of interpersonal trauma is increased after an environmental disaster (Harville, Taylor, Tesfai, Xiong, & Buekens, 2011; Keenan, Marshall, Nocera, & Runyan, 2004; Schumacher et al., 2010). Furthermore, environmental disasters typically leave behind secondary stressors (e.g., inadequate housing, financial instability, and limited access to community resources) that may negatively impact an individual's mental health and may last for weeks, months, or even years (Cerda et al., 2013). Individuals affected by environmental disaster must enact coping skills to deal with the immediate destruction and long-term stressors. This study sought to analyze the relationship between various coping styles and depressive symptoms among survivors of multiple environmental disasters.

Depression

Mental health problems--particularly depressive disorders--affect many individuals worldwide. The World Health Organization (WHO; 2017) regards depression as the top worldwide contributor to disability, estimating that it affects more than 320 million people (roughly 4.4 percent of the global population). Furthermore, depression is the largest contributor to the approximately eight hundred thousand global deaths by suicide each year. Researchers with the National Center of Health Statistics, a division within the Centers for Disease Control and Prevention, recently studied rates of depression in American adults and found that 8.1 percent of Americans aged twenty and older experienced depression for at least a two-week period between 2013 and 2016 (Brody, Pratt, & Hughes, 2018). Their findings also revealed that American women were twice as likely to experience depression as American men; likewise, Americans living in poverty were twice as likely to experience depression as Americans with household incomes above the poverty threshold.

In the state of Mississippi, approximately 21 percent of adults have at some time been diagnosed with depression (Mississippi State Department of Health, 2018). Furthermore, the Behavioral Health Barometer published by the Substance Abuse and Mental Health Services Administration (SAMHSA; 2017) found that more than 60 percent of Mississippians with mental illness (more than 250,000 people) were not receiving mental health services. It is likely that this statistic contributed to the fact that approximately ninety thousand adults in Mississippi reported having serious thoughts of suicide in 2016.

These findings highlight the complex biopsychosocial nature of depression. The World Health Organization (2017) echoed this concept by maintaining that, although depression affects individuals of all ages, races, religions, and backgrounds, individuals affected by poverty, unemployment, chronic illness, addiction, or stressful major life events are at an increased risk of depression. These facts led researchers and mental health practitioners to consider interventions for individuals, especially vulnerable and historically marginalized groups, that experience depressive symptoms.

Coping and Depression

Although there are many avenues of treatment for depression, including pharmacological treatment and various forms of psychotherapy, existing research has pointed to a salient link between individual coping styles and depressive symptoms (Billings & Moos, 1984; Folkman & Lazarus, 1986). Researchers have spent many years studying coping processes and conceptualizing adaptive functioning (Folkman, 1991). Folkman and Lazarus (1985), who developed the two-category typology of problem-focused and emotion-focused coping, were among the first to categorize coping styles. Holahan and Moos (1987) later added to the two-category system, maintaining that individuals engage in either approach-oriented coping or avoidance-oriented coping. Many studies have analyzed these four coping styles, and most have found that individuals who cope with stress via problem-focused or approach-oriented coping are less likely to experience depression than those who cope with stress via emotion-focused or avoidance-oriented coping (Aranda, Castaneda, Lee, & Sobel, 2001; Billings & Moos, 1981; Howerton & Van Gundy, 2009).

Although these categories of coping styles are still widely used, more recent research has emphasized individual strengths and resilience (Holahan & Moos, 1994). A study by Holahan, Moos, Holahan, and Cronkite (1999) found a significant relationship between depressive symptoms and psychosocial resources, which are defined as psychological processes and/or social relationships that have "the capacity to hinder, prevent, or cushion the development of the stress processes and its outcomes" (Pearlin, 1999, p. 405). In their study, they found that a decrease in psychosocial resources over ten years was associated with an increase in depressive symptoms and an increase in psychosocial resources over ten years was associated with a decrease in depressive symptoms. In the same study, psychosocial resource change was observed as a complete mediator in the relationship between changing life events and future depressive symptoms (Holahan et al., 1999). These findings are especially useful when analyzing the ways in which individuals cope with major life events and the positive or negative effects of those coping styles on their mental health.

This study aimed to examine three specific coping styles: positive reframe coping, help-seeking coping, and substance use coping. Positive coping strategies, including positive reframe coping, have been associated with better psychological well-being (Benson, 2010; Kim, Han, Shaw, McTavish, & Gustafson, 2010; Padden, Connors, & Agazio, 2011). With regard to the relationship between help-seeking coping and depression, studies have reported inconsistent results. A longitudinal study by Rodgers and colleagues (2017) revealed a salient link between informal help-seeking coping and decreased depression. On the other hand, a study by Adams and colleagues (2017) of veterans who have survived traumatic events found unexpectedly that increased help-seeking behavior was associated with an increased prevalence of mental health problems. Findings regarding substance use coping have been more consistent; there is a significant amount of literature supporting the link between substance use and increased depression (Heggeness, Lechner, & Ciesla, 2019; Hobden et al., 2018; Riper, Andersson, & Hunter, 2014; Lai, Cleary, & Sitharthan, 2015). Conjointly, these findings highlight the need for additional research analyzing specific coping styles and mental health outcomes, especially among particularly vulnerable populations.

Current Study

Although previous studies have focused on various coping strategies and their relationships with mental health, limited attention has been given to exploring coping and depression among residents living in disaster-prone communities. Because the Mississippi Gulf Coast is not only subject to the typical stressors of average communities but also prone to a higher rate of environmental disasters, it is imperative to examine the manner in which residents are coping with these stressful events in order to most effectively treat the depressive symptoms that they are experiencing. Therefore, the purpose of this study was to examine how various coping methods affect depressive symptoms among residents of the Mississippi Gulf Coast who have survived multiple environmental disasters.

This study specifically examined coping and depressive symptoms among individuals who lived in the Gulf Coast area during both Hurricane Katrina in 2005 and the Deepwater Horizon oil spill in 2010. Moreover, it analyzed three methods of coping--positive reframe coping, help-seeking coping, and substance use coping--and their impact on depressive symptoms. It was hypothesized that all three coping styles would be significantly associated with depressive symptoms at the bivariate and multivariate levels.

Methods

Sample and Sampling Procedure

Data collection for this study took place during the spring of 2017, when trained undergraduate and graduate students administered door-to-door surveys to a spatially stratified random sample of residents within the study area. The sample for this study included a total of 216 Mississippi Gulf Coast residents who lived on the area between Interstate 10 and the Gulf of Mexico coastline at the time of Hurricane Katrina and the Deepwater Horizon oil spill. The project was reviewed and approved by the Human Subjects Protection Review Committee of the university with which the authors of the current study are affiliated.

Measures

Depression

The twenty-item Center for Epidemiologic Studies-Depression scale (CES-D; Radloff, 1977) was used to measure depressive symptoms. The frequency of each symptom during the week was rated using a four-point Likert scale that ranged from 0 (rarely or none of the time) to 3 (most or all of the time). A sum score was computed from the twenty individual items (ranging from 0 to 60), with higher scores indicating greater depressive symptoms. The CES-D has evidence of adequate internal consistency and validity (Conerly, Baker, Dye, Douglas, & Zabora, 2002; Radloff, 1977; Siddaway, Wood, & Taylor, 2017). Cronbach's alpha as calculated in the current study was .87.

Coping

The Brief COPE (Carver, 1997) was used to measure individual coping strategies in response to stressful situations. It has fourteen subscales composed of two items each. For the current study, three Brief COPE subscales were used: Use of Instrumental Support for measuring help-seeking coping, Positive Reframing for measuring positive reframing coping, and Substance Use for measuring substance use coping. Respondents were instructed to indicate to what extent they have used the coping response on a four-point Likert scale ranging from 1 (I have not been doing this at all) to 4 (I have been doing this a lot).

For each type of coping, a sum score (ranging from 2 to 8) was computed from the two individual items, with higher scores indicating greater use of the coping method. In a previous study, acceptable internal consistency reliabilities were reported for these subscales (Carver, 1997). In the current study, the Spearman-Brown coefficient was used for testing reliability, and the scores for positive reframing, instrumental support, and substance use were .77, .83, and .86, respectively. Demographic data, including gender, ethnicity, education, income, marital status, and age, were collected to serve as confounding factors.

Statistical Analysis Plan

The distribution of the study variables was screened for normality and outliers by applying the value of the skewness and kurtosis [+ or -] 1.96 and the value of the z-score (3.29), respectively. Although variables of positive reframe coping and help-seeking coping met the criteria for normality, the variable of substance use coping did not. The researchers then decided to transform substance use coping into a dichotomous variable, with 0 representing those who did not use substances at all to make themselves feel better or get through their situation and 1 representing those who did use substances as a means of making themselves feel better or getting through their situation (i.e., those who answered "a little bit," "medium," or "a lot"). Next, bivariate correlations were performed in order to examine relationships between variables. Finally, a hierarchical multiple regression analysis was used to examine the association of each coping variable with depressive symptoms and the relative contribution of different coping strategies to depressive symptoms.

Results

Sample Characteristics

The sample included 216 respondents, of whom 54 percent were female and 46 percent were male. Although the average age of this sample was fifty-three, the respondents ranged in age from eighteen to ninety-five. Sixty-three percent of the respondents were white, 31 percent were African American, and 6 percent identified as another race or ethnicity. The respondents were educationally diverse: 9 percent had less than a high school diploma; 57 percent had a high school diploma, some college, or an associate's degree; and 34 percent had a bachelor's or higher degree. Approximately 48 percent of the respondents were married; 21 percent were single, never married; and 31 percent were cohabitating, divorced, or separated. Finally, 14 percent of respondents reported that their annual household income was less than $20,000; 32 percent reported an income between $20,000 and $39,999; 20 percent reported an income between $40,000 and $59,999; and 34 percent reported an income above $60,000.

Bivariate Analysis

The following sociodemographic variables were correlated with depressive symptoms: age (r = -.18, p = .011), income ([r.sub.s] = -.30, p < .001), education ([r.sub.s] = -.30, p < .001), race/ethnicity ([r.sub.pb] = -.19, p = .008), and marital status =([r.sub.pb] -.27, p < .001). Gender was not significantly correlated with depressive symptoms. For coping variables, there was a negative correlation between positive reframing coping and depressive symptoms (r = -.25, p < .001) and a positive correlation between substance use coping and depressive symptoms ([r.sub.pb] = .48, p < .001). However, there was no significant correlation between using help-seeking coping and depressive symptoms.

Hierarchal Multiple Regression Analysis

A hierarchical multiple regression analysis was conducted to examine the contribution of coping variables in predicting depressive symptoms while controlling for demographic confounders (see Table 1). In the first step, only demographic variables were included (i.e., age, gender, income, education, race/ethnicity, and marital status). These variables explained 22 percent of the variance in depressive symptoms [[R.sup.2] = .22, F(6, 166) = 7.88, p < .001]. In the second step, help-seeking coping was added into the analysis alongside the demographic variables. Interestingly, the analysis revealed that this coping style was not significantly related to depressive symptoms, and there was virtually no change in [R.sup.2] (0.1%) from model 1 to model 2 [[R.sup.2] = .22, F(7, 165) = 6.77, p < .001; [R.sup.2] = .001, p = .574]. When positive reframing coping was entered in the model in step 3, the explained variance increased to 27 percent. The analysis revealed that positive reframe coping uniquely explained 4 percent of the variance in depressive symptoms [([R.sup.2] = .27, F(8, 164) = 7.46, p < .001; [R.sup.2] = .04, p = .002]. Finally, when substance use coping was added into the model, the analysis revealed that this type of coping uniquely explained 16 percent of the variance in depressive symptoms [[R.sup.2] = .43, F(9, 163) = 13.43, p < .001; [R.sup.2] = .16, p < .001].

In the final model, positive reframe coping was negatively associated with depressive symptoms ([beta] = -.20, p = .003), suggesting that an individual with increased positive reframe coping is likely to experience fewer depressive symptoms. On the other hand, substance use coping was positively associated with depression ([beta] = .44, p < .001), suggesting that an individual with increased substance use is likely to experience more depressive symptoms. Of the demographic variables, age, education, and race/ethnicity were negatively associated with depressive symptoms ([beta] = -.14, p = .030; [beta] = -.20, p = .004; [beta] = -.17, p = .010). The coping variables and the demographic variables collectively explained 43 percent of the variance in depressive symptoms ([R.sup.2] = .43).

Discussion

This study examined the relationships between coping styles and depressive symptoms among residents of the Mississippi Gulf Coast who have experienced multiple disasters. The results of the multivariate analysis revealed that demographic variables alone (age, gender, income, education, race/ethnicity, and marital status) explained 22 percent of the variance in depressive symptoms in this sample. Of these demographic factors, age, education, and race/ethnicity were statistically significant, which is consistent with the findings of prior studies (Bjelland et al., 2008; Mirowsky & Ross, 1992; Riolo, Nguyen, Greden, & King, 2005). Contrary to the researchers' expectations, there was no salient link between help-seeking coping and depressive symptoms, as shown by the fact that adding this variable into the multivariate analysis did not yield any significant change. In the following two steps, positive reframe coping uniquely explained 4 percent and substance use coping uniquely explained 16 percent of the variance in depressive symptoms. Positive reframe coping was negatively associated with depressive symptoms, suggesting that an individual with increased positive reframe coping is likely to experience fewer depressive symptoms, whereas substance use coping was positively associated with depression, suggesting that an individual with increased substance use is likely to experience more depressive symptoms. These findings are consistent with prior studies that analyzed the broader categories of problem-focused, emotion-focused, approach-oriented, and avoidance-oriented coping (Aranda et al., 2001; Billings & Moos, 1981; Howerton & Van Gundy, 2009). The coping variables and the demographic variables collectively explained 43 percent of the variance in depressive symptoms.

Based on the findings, the researchers' hypotheses were partially supported. Although positive reframe coping and substance use coping were both significantly associated with depression at the bivariate and multivariate levels and explained a significant percentage of the variance in depressive symptoms, help-seeking coping was not significantly associated with depression at any point in the analysis. Although the hypotheses were not fully supported, these findings highlight important implications for social work practice.

It is essential for practitioners to develop disaster preparedness plans and post-disaster intervention plans for different levels of practice (i.e., micro, mezzo, and macro practices) addressing the factors associated with an increased risk for depression at each level. Clinical micro-level practitioners must recognize the demographic factors that may place their clients at an increased risk for depression and consider proactively incorporating the acquisition of adaptive coping skills into their clients' treatment plans. Mezzo-level practitioners may work to build partnering relationships among organizations within the community in order to compensate for demographic risk factors. For example, nonprofit organizations and retail stores can work together to put on emergency supply drives so that community members with financial means may purchase or donate emergency supplies such as weather radios and nonperishable foods to be distributed among community members with lower incomes. Lastly, macro-level practitioners may analyze disparities within their communities that may contribute to the greater likelihood of an individual with minority status or lower socioeconomic status experiencing depression after an environmental disaster. Furthermore, macro-level practitioners can advocate for and influence policy changes that address these disparities.

Additionally, these findings should motivate practitioners to consider potential reasons why help-seeking coping was neither positively nor negatively associated with depressive symptoms. Individuals are often encouraged to reach out and seek help when they are experiencing mental health problems. However, these findings suggest that seeking help made no significant difference in depressive symptoms for this sample, and practitioners must consider why this was the case. Could it be that the individuals did not know how to seek help in their community? If so, then perhaps increased awareness of the resources available in that community (e.g., public service ads on TV or in the mail) could dramatically improve the effectiveness of help-seeking coping. Could it be that the individuals in the community sought help, but the community did not have adequate resources to provide it? The researchers believe that this is likely following an environmental disaster as community agencies could be negatively affected by the disaster as well. It can be argued that this theory only solidifies the importance of disaster preparedness. If the community is successful in making reasonable advance preparations to counter the negative effects of environmental disaster, then perhaps less energy will be needed to figure out where to start with disaster recovery and more energy can be directed to connecting individuals to necessary resources following the disaster. In response to these findings, social workers can advocate for increased funding for disaster preparedness and mental health, and researchers can continue to examine the relationships between various coping styles and depression, as well as the mental health effects of environmental disaster.

Limitations and Future Studies

This study has a few limitations. First, because it was a cross-sectional study, causal relationships cannot be established. It is hoped that future research will include longitudinal studies that explicate the causal processes of these study variables. Future research may examine the long-term mental health effects of environmental disaster by analyzing coping styles and mental health problems within populations that have experienced long-term disaster.

Moreover, the researchers recognize that the sample analyzed in this study was very specific: all participants in this study lived in the Gulf Coast area during both Hurricane Katrina in 2005 and the Deepwater Horizon oil spill in 2010. Therefore, the findings in this study cannot be generalized to other groups. Future research could analyze individuals in various geographic settings as well as individuals who have experienced different types of environmental disasters (e.g., hurricanes, tornadoes, wildfires, oil spills, or blizzards).

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Morgan W. Bradwell, MSW, LMSW, is research coordinator in the School of Social Work, University of Southern Mississippi, Hattiesburg. Also in the School of Social Work, University of Southern Mississippi, Joohee Lee, PhD, is associate professor.
Table 1 Year, types of mock disaster, and number of social welfare
students participating

                                    Model 1               Model 2
                           B            [beta]       B            [beta]

Demographic variables
 Age                        -.10 (**)   -.19          -.09 (*)    -.18
 Gender                     1.28         .08          1.32         .08
 Income                     -.60         .11          -.61        -.11
 Education                 -1 29 (**)   -.25         -1.29 (**)   -.26
 Race/ethnicity
  (white vs. other)        -1.89        -.11         -1.82        -.11
 Marital status
  (married vs. other)      -2.62 (*)    -.16         -2.68        -.17
Coping variables
 Help-seeking coping                                   .17         .04
 Positive reframe coping                                          -.92
 Substance use coping
    [R.sup.2]                .22                       .22
    F                       7.88 (***)  6.77 (***)    7.46 (***)

                                Model 3               Model 4
                           B            [beta]   B            [beta]

Demographic variables
 Age                        -.08 (*)    -.17      -.07 (*)    -.14
 Gender                     1.48         .09      1.99         .12
 Income                     -.56        -.10      -.53        - 10
 Education                 -1.20 (**)   -.24     -1.03 (**)   -.20
 Race/ethnicity
  (white vs. other)        -1.71        -.10     -2.87        -.17
 Marital status
  (married vs. other)      -2.27        -.14      -.65        -.04
Coping variables
 Help-seeking coping         .53         .13      -.04        -.01
 Positive reframe coping    -.23        -.79      -.20
 Substance use coping                             8.25 (***)   .44
    [R.sup.2]                .27                 43
    F                                            13.43 (***)

Note: B = nonstandardized coefficients; [beta] = standardized
coefficients.
(*) p < .05; (**) p < .01; (***) p < .001
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Author:Bradwell, Morgan W.; Lee, Joohee
Publication:Best Practices in Mental Health
Geographic Code:1U6MS
Date:Sep 22, 2019
Words:5030
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