Religiousness and Psychological Distress of Women after ... · National Poverty Center Working Paper Series #09-03 . January 2009. Religiousness and Psychological Distress of Women

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: [email protected] or [email protected]

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.

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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.

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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................................................... 17 Hypotheses.................................................................. 18 Method....................................................................... 19 Results........................................................................ 24 Discussion.................................................................. 29 Conclusion................................................................. 35

REFERENCES.................................................................................... 42

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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

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LIST OF FIGURES

Figure Page

1. The hypothesized model predicting post-disaster distress................... 40

2. The final model predicting post-disaster distress................................ 41

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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,

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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

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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 post-

disaster 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,

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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

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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,

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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,

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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

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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, Tusaie-

Mumford, & 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.

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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

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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, pre-

disaster psychological functioning is repeatedly found as a robust predictor of post-

disaster 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.

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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 pre-

disaster 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 socio-

demographic 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

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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

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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 Likert-

type 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 4-

point 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 5-

point 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.

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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 post-

disaster distress) and 2) the structural regression model that related the latent and

measured variables (i.e., religiousness, social support, optimism, and pre- and post-

disaster 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 pre-

disaster 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 post-

disaster 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. Pre-

disaster 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 pre-

disaster 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 pre-

disaster 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

  36

Table 1 Selected characteristics of participants at Time 1 (pre-disaster)

Present Study (N=386)

Female 100% Average age (years at baseline) 25.4 (SD = 4.43) Living with neither spouse nor partner 72.8% Hispanic 2.8% Black non-Hispanic 82.1% White non-Hispanic 9.8% Number of children One 42.5% Two 32.1% Three or more 25.4% Households receiving any social benefits (UI, SSI, food stamps, or TANF)

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 1. Age - 2. Number of Children .33** - 3. Pre-Katrina Physical Symptoms .02 .01 -

4. Pre-Katrina Frequency of Religious Attendance .09 -.02 -.09 -

5. Pre-Katrina Importance of Religion .09 .01 -.08 .47** -

6. Pre-Katrina Mood and Anxiety Symptoms .04 .06 .39** -.12* -.09 -

7. Pre-Katrina Perceived Stress .00 -.07 .29** -.16** -.12* .62** -

8. Post-Katrina Perceived Social Support -.07 -.16** .02 .07 .03 -.08 -.17** -

9. Post-Katrina Social Efficacy -.02 -.06 -.08 .13* .07 .01 -.19** .48** - 10. Post-Katrina Optimism -.01 .13* -.06 .20** .14** -.15** -.27** .33** .46** - 11. Level of Exposure .18** .17** .09 .07 .12* .15** .05 -15** -.04 -.04 -

12. Post-Katrina Mood and Anxiety Symptoms .10 -.01 .23** -.05 .02 .37** .34** -.27** -.18** -.31** .29** -

13. Post-Katrina Perceived Stress .10 -.06 .19** -.12* -.07 .27** .37** -.31** -.22** -.40** .21** .69** - N 386 384 385 386 384 384 384 371 384 380 378 385 384 M 25.42 1.25 1.08 2.33 3.61 5.54 4.28 17.63 11.80 12.45 4.03 6.68 5.35 SD 4.43 1.13 1.05 1.25 .80 4.07 3.31 3.86 2.45 3.19 3.47 5.21 3.6 NOTE. *p < .05. **p < .01, ***p < .001

 37

Table 3

Factor Loadings for the Measurement Model

Unstandardized factor loading

Standardized factor loading Measure and variable SE C.R.

Religiousness Frequency of Religious Attendance 1.00a - - .84 Importance of Religionb -.16 .06 -2.65 -.57***

Social resources Perceived Social Support 1.00a - - .81 Social Efficacy .47 .09 5.15 .60***

Pre-Katrina Distress Symptoms of Mood-Anxiety Disorders 1.00a - - .72 Stress .99 .12 11.00 .87***

Post-Katrina Distress Symptoms of Mood-Anxiety Disorders 1.00a - - .81 Stress .70 .07 -2.65 .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 2 3 4 1. Religiousness - 2. Social support .15* - 3. Pre-Katrina distress -.22** -.25*** - 4. Post-Katrina distress -.12, p=.07 -.44*** .51*** -

NOTE. *p < .05. **p < .01, ***p < .001

 39

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, 719-725.

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 self-

efficacy 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, 1561-1572.

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, 190-200.

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, S344-S353.

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 three-generations 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 community-

dwelling 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 well-

being among older Australian women. Journal of Health Psychology, 9, 741-752.

Solomon, S. D., & Green, B. L. (1992). Mental health effects of natural and human-

made 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, 455-472.

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, 1403-1411.

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

 53

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. 399-411). 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.