Psychiatry Research 220 (2014) 1160–1162
Contents lists available at ScienceDirect
Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Brief report
Concomitants of perceived trust in hospital and medical services following Hurricane Sandy Menachem Ben-Ezra a,n, Robin Goodwin b, Yuval Palgi c, Krzysztof Kaniasty d,e, Marsha Zibalese Crawford f, Aviva Weinberger a, Yaira Hamama-Raz a a
School of Social Work, Ariel University, Ariel, Israel School of Social Sciences, Brunel University, Uxbridge, United Kingdom c Department of Gerontology, University of Haifa, Haifa, Israel d Department of Psychology, Indiana University of Pennsylvania, Indiana, PA USA e Polish Academy of Sciences, Poland f School of Social Work, Temple University, Philadelphia, PA, USA b
art ic l e i nf o
a b s t r a c t
Article history: Received 2 September 2013 Received in revised form 8 August 2014 Accepted 9 August 2014 Available online 19 August 2014
The relationship between factors associated with perceived trust in hospital and medical services in the aftermath of a natural disaster is understudied. An online sample of 1000 people mainly from affected states was surveyed after Hurricane Sandy. Participants completed a survey which included disaster related questions and PTSD symptoms. Logistic regression revealed a significant association between perceived trust in hospital services to education, subjective well-being, being scared for the life of a loved one and perceived trust in emergency services. These findings may emphasis the positive association between maintaining active hospital services and mental health among the general population during crisis. & 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: PTSD Disaster Emergency Subjective well-Being
1. Introduction Hurricane Sandy struck New York Metropolitan Area on October 29, leading to massive property damage and more than 100 casualties. The effect on the infrastructure was severe, with more than 8 million NY metropolitan residents suffering from power outages, accompanied by severe food shortages and mobility restrictions resulting from the widespread flooding (Neria and Shultz, 2012). During Hurricane Sandy, hospitals, clinics and medical centers, along with first responders were forced to cope with the disaster as power shortages and damages to buildings threatened a decrease of their readiness and efficiency at the peak of the crisis-related burden. Medical facilities that routinely serve large populations had to cope with excessive demands and maintain emergency chains of supplies in order to care for their patients (Redlener and Reilly, 2012). Moreover, the evacuation of New York's flagship public hospital, Bellevue Hospital Center, due to the backup's power failure might have had serious repercussions for the entire community in time of crisis (Powell et al., 2012). According to appraisal theorists (Smith and Ellsworth, 1985), emotions are elicited when a person evaluates an event
or situation as important for his or her well-being and central concerns. Based on the above, the rational for conducting this study is to learn about the association between fear for loved ones during disaster, subjective well-being, perceptions of trust in efficacy of emergency services and its linkages to perceived trust in hospital and medical services in the aftermath of a natural disaster. The trust in hospital and medical services in the aftermath of a disaster is an important factor in disaster management and public health and may be a potentially associated with mental health. Hence, the purpose of the present report was to examine the association between peoples’ trust in hospital and medical services in the aftermath of Hurricane Sandy. Empirical support demonstrating the association between perceived trust in hospital and medical services and perceived trust in emergency services and well-being would benefit disaster health providers and public health professionals.
2. Methods 2.1. Study design
n
Corresponding author. E-mail address: [email protected] (M. Ben-Ezra).
http://dx.doi.org/10.1016/j.psychres.2014.08.012 0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved.
An online survey of 1000 people mainly from New York Metropolitan Area was taken during the fourth week of November 2012. The mean age was 45.16 (S.
M. Ben-Ezra et al. / Psychiatry Research 220 (2014) 1160–1162 D. ¼ 14.30); more than half of the sample were women (n ¼655; 65.5%), married (n¼ 606; 60.6%). Less than half of the sample had college degree or above (n ¼455; 45.5%). All the participants had been exposed to Hurricane Sandy.
2.2. Measures Beyond demographic variables (age, gender, marital status), we asked about the respondents’ trust in emergency services: “How do you rate your trust in emergency services?” on a four point Likert scale ranging from 1 ‘not at all‘ to 4 ‘extremely‘. This variable was aggregated to high trust vs. low trust by grouping the lower vs. higher categories. In this sample, 69.3%, 693 participants answered ‘high trust’. This item was coded dichotomously with value of ‘0’ indicating “low trust” and value of ‘1’ indicating “high trust”. Subjective Well-Being (SWB) was measured by a single item: “In general, how do you rate your life?” on a four point Likert scale ranging from 1 ‘bad‘ to 4 ‘excellent‘ (Oswald and Wu, 2010). Respondents’ answers were aggregated into two categories coded as ‘0’ (poor well-being), and ‘1’ (good well-being). In this sample, 71.7% (717 participants) considered themselves to be in good well-being. Subjective well-being serves as an indicator of mental health (Oswald and Wu, 2010). Although all the participants were exposed to hurricane, direct disaster related experience was measured by two items coded dichotomously as 0¼ ‘no’ and 1¼ ‘yes’ for the following questions: was your home damaged due to Hurricane Sandy (21.2%, 212 participants answered ‘yes’) and did you witness injury due to Hurricane Sandy (14.6%, 146 participants answered ‘yes’). We summed up the items for a scale of 0–2 (‘0‘¼ no direct disaster related experience, 71.6% [716 participants]; ‘1‘¼one direct disaster related experience, 14.7% [147 participants]; ‘2‘¼two direct disaster related experiences, 10.3% [103 participants]). Disaster related anxiety regarding close friends or family members was measured by a single item coded dichotomously as 0¼ ‘no’ and 1¼‘yes’ for the following question: “Were you scared that a loved one would be killed or hurt?” (41.0%, 410 participants answered ‘yes’). Posttraumatic Stress Disorder (PTSD) Symptoms were assessed by the Impact of Event Scale Revised (IES-R), a 22-item measure (Cronbach’s α ¼ 0.98) (Weiss and Marmar, 1997). This scale has been used in numerous previous disaster studies and showed satisfactory psychometric properties (Ben-Ezra and Soffer, 2010; Ben-Ezra et al., 2011; Ben-Ezra et al., 2013; Palgi et al., 2009; Weiss and Marmar, 1997). The IES-R mean score in the present sample was 18.54 (S.D. ¼ 20.26). Perceived trust in hospital and medical services, was measured using the following question: “How do you rate your trust in hospital and medical services?” on a four point Likert scale ranging from 1 ‘not at all‘ to 4 ‘extremely‘. This variable was aggregated to high trust vs. low trust by grouping the lower vs. higher categories. In this sample, 72.1%, 721 participants answered ‘high trust’. This item was coded dichotomously with a value of ‘0’ indicating “low trust” and ‘1’ indicating “high trust”. In order to check if the two trust items are the same construct a multicollinearity test was conducted. The result of the variation inflation factor (1.0) suggests no multicollinearity (O’Brien, 2007).
2.3. Procedure Following the ethics committee approval of the School of Social Work at Ariel University, we conducted an on-line survey using Toluna Inc. of 1000 people of Hurricane Sandy affected states one month after the Hurricane (response rate ¼83.3% out of a potential 1200). We used the same method [collecting data via online panel sample] employed in other medical and psychological studies (Butt et al., 2013; Salsman et al., 2014). The questionnaires asked the participants for their experiences and perception with regard to the crisis followed Hurricane Sandy.
1161
2.4. Data analysis Logistic regression analysis was conducted to assess the associations between the measure of perceived sense of trust in hospital services and the aforementioned variables. SPSS version 19.0 (IBM Corporation) was used. A 2-sided p o 0.05 was used to indicate significance.
3. Results The prevalence of elevated risk of clinical levels of PTSD symptoms (IES-R Z33) one month after Hurricane Sandy was 23.6%. The results of the logistic regression revealed that high sense of trust in hospital services was associated with higher education (OR¼ 1.447; p ¼0.050), higher subjective well-being (OR¼ 2.880; p o0.001), and having lower level of fear for the safety of a loved one during the hurricane (OR ¼ 0.666; p ¼0.037). Those respondents who expressed high trust in the emergency services demonstrated more than 12-fold chances of exhibiting a high trust in hospital services (OR ¼12.217; p o0.001). To our surprise, elevated risk for PTSD (IES-R Z33) was not associated with perceived trust in hospital services. See Table 1. A further t-test comparing the level of trust in hospital services between those with elevated risk for PTSD and those without elevated risk for PTSD showed no significant differences (t¼1.22; p ¼0.224). In addition, we looked at the correlation between trust in emergency services and trust in hospital services in order to rule out the possibility of measuring the same construct of “general trust” (r ¼0.529; p o0.001). This moderate correlation (28% of shared variance) suggests that the two items share some communality yet they are distinct constructs.
4. Discussion The commonly expected and ordinarily observed association between first responders and hospital personnel is particularly significant during disasters. Results of the present report underscore the gravity of the associations between people's trust in emergency services and their efficacious ties with hospital and medical services providers. Subjective well-being was found to be associated with trust in hospital and medical services. This is a known indicator of mental health (Oswald and Wu, 2010). Those with lower trust in hospital services may be paradoxically prone to be in need of such services in the aftermath of a disaster. Beyond that, previous study has shown that trust in institutions was found to be related with well-being (Hudson, 2006). However, the lack of association between trust in hospital and medical services and PTSD symptoms is interesting as it contradicts the findings reported in the existing literature (Hobfoll et al., 2007).
Table 1 Factors associated with trust in hospital services (n¼ 1000).
Trust in hospital servicesa Age (in years) Gender (female vs. male) Marital status (married vs. not married)a Education (college or higher vs. lower)a Subjective ell-beinga Scared for the safety of a loved onea Direct disaster related experiencesa Elevated PTSD symptoms (IES-R Z 33)a Trust in emergency servicesa
β
SE
Adjusted OR (95% CI)
P value
0.012 0.143 0.094 0.370 1.030 0.407 0.004 0.019 2.503
0.007 0.202 0.193 0.189 0.194 0.195 0.142 0.219 0.189
1.012 0.867 1.098 1.447 2.800 0.666 1.004 1.019 12.217
0.070 0.480 0.628 0.050 o0.001 0.037 0.980 0.931 o0.001
(0.999–1.026) (0.584–1.288) (0.752–1.603) (1.000–2.095) (1.915–4.095) (0.454–0.977) (0.760–1.325) (0.663–1.566) (8.432–17.703)
Abbreviation: OR, odds ratio. a
Data were missing among the variables for 7–18 participants (0.7%–1.8% of total; fully completed data in the sample n¼967).
1162
M. Ben-Ezra et al. / Psychiatry Research 220 (2014) 1160–1162
Limitations of the study include cross-sectional design, lack of no-exposure comparison group, use of self-reports measurements, oversampling of women and overrepresentation of people who resided in less severely affected with at least partial access to electricity. The most important finding of the present study is that both perceived trust in emergency services and subjective well-being are associated with perceived trust in hospital and medical services in the aftermath of a disaster. These associations may be considered a part of keystone factors in maintaining critical beliefs concerning return to safety and normalcy following a community wide disaster. Conflict of interest disclosures None disclosed. Acknowledgments Funding/Support: This work was supported by an Internal Researcher Grant of the Research Authority at Ariel University (No. 803590) awarded to Prof. Ben-Ezra. Role of the Sponsor: The funding organization had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The Study was approved by the Ethics committee in the School of Social Work at Ariel University. References Ben-Ezra, M., Palgi, Y., Aviel, O., Dubiner, Y., Baruch, E., Soffer, Y., Shrira, A., 2013. Face it: collecting mental health and disaster related data using facebook vs.
personal interview: the case of the 2011 Fukushima nuclear disaster. Psychiatry Research 208, 91–93. Ben-Ezra, M., Palgi, Y., Wolf, J.J., Shrira, A., 2011. Psychiatric symptoms and psychosocial functioning among hospital personnel during the Gaza War: a repeated cross-sectional controlled study. Psychiatry Research 189, 392–395. Ben-Ezra, M., Soffer, Y., 2010. Hospital personnel reactions to Haiti's earthquake: a preliminary matching study. Journal of Clinical Psychiatry 71, 1700–1701. Butt, Z., Peipert, J., Webster, K., Chen, C., Cella, D., 2013. General population norms for the functional assessment of cancer therapy–Kidney Symptom Index (FKSI). Cancer 119, 429–437. Hobfoll, S.E., Watson, P., Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., Friedman, M., Gersons, B.P., de Jong, J.T., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., Ursano, R.J., 2007. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry 70, 283–315. Hudson, J., 2006. Institutional trust and subjective well‐being across the EU. Kyklos 59, 43–62. Neria, Y., Shultz, J.M., 2012. Mental health effects of Hurricane Sandy: characteristics, potential aftermath, and response. Journal of the American Medical Association 308, 2571–2572. O’Brien, R.M., 2007. A caution regarding rules of thumb for variance inflation factors. Quality and Quantity 41, 673–690. Oswald, A.J., Wu, 2010. Objective confirmation of subjective measures of human well-being: evidence from the USA. Science 327, 576–579. Palgi, Y., Ben-Ezra, M., Langer, S., Essar, N., 2009. The effect of prolong exposure to war stress on the comorbidity of PTSD and depression among hospital personnel. Psychiatry Research 168, 262–264. Powell, T., Hanfling, D., Gostin, L.O., 2012. Emergency preparedness and public health: the lessons of Hurricane Sandy. Journal of the American Medical Association 328, 2569–2570. Redlener, I., Reilly, M.J., 2012. Lessons from Sandy — preparing health systems for future disasters. New England Journal of Medicine 367, 2269–2671. Salsman, J.M., Lai, J.S., Hendrie, H.C., Butt, Z., Zill, N., Pilkonis, P.A., Peterson, C., Stoney, C.M., Brouwers, P.M., Cella, D., 2014. Assessing psychological wellbeing: self-report instruments for the NIH toolbox. Quality of Life Research 23, 205–215. Smith, C.A., Ellsworth, P.C., 1985. Patterns of cognitive appraisal in emotion. Journal of Personality and Social Psychology 48, 813–838. Weiss, D.S., Marmar, C.R., 1997. The impact of event scale–revised. In: Wilson, J.P., Keane, T.M. (Eds.), Assessing Psychological Trauma and PTSD. The Guilford Press, New York, pp. 399–411.
Contents lists available at ScienceDirect
Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Brief report
Concomitants of perceived trust in hospital and medical services following Hurricane Sandy Menachem Ben-Ezra a,n, Robin Goodwin b, Yuval Palgi c, Krzysztof Kaniasty d,e, Marsha Zibalese Crawford f, Aviva Weinberger a, Yaira Hamama-Raz a a
School of Social Work, Ariel University, Ariel, Israel School of Social Sciences, Brunel University, Uxbridge, United Kingdom c Department of Gerontology, University of Haifa, Haifa, Israel d Department of Psychology, Indiana University of Pennsylvania, Indiana, PA USA e Polish Academy of Sciences, Poland f School of Social Work, Temple University, Philadelphia, PA, USA b
art ic l e i nf o
a b s t r a c t
Article history: Received 2 September 2013 Received in revised form 8 August 2014 Accepted 9 August 2014 Available online 19 August 2014
The relationship between factors associated with perceived trust in hospital and medical services in the aftermath of a natural disaster is understudied. An online sample of 1000 people mainly from affected states was surveyed after Hurricane Sandy. Participants completed a survey which included disaster related questions and PTSD symptoms. Logistic regression revealed a significant association between perceived trust in hospital services to education, subjective well-being, being scared for the life of a loved one and perceived trust in emergency services. These findings may emphasis the positive association between maintaining active hospital services and mental health among the general population during crisis. & 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: PTSD Disaster Emergency Subjective well-Being
1. Introduction Hurricane Sandy struck New York Metropolitan Area on October 29, leading to massive property damage and more than 100 casualties. The effect on the infrastructure was severe, with more than 8 million NY metropolitan residents suffering from power outages, accompanied by severe food shortages and mobility restrictions resulting from the widespread flooding (Neria and Shultz, 2012). During Hurricane Sandy, hospitals, clinics and medical centers, along with first responders were forced to cope with the disaster as power shortages and damages to buildings threatened a decrease of their readiness and efficiency at the peak of the crisis-related burden. Medical facilities that routinely serve large populations had to cope with excessive demands and maintain emergency chains of supplies in order to care for their patients (Redlener and Reilly, 2012). Moreover, the evacuation of New York's flagship public hospital, Bellevue Hospital Center, due to the backup's power failure might have had serious repercussions for the entire community in time of crisis (Powell et al., 2012). According to appraisal theorists (Smith and Ellsworth, 1985), emotions are elicited when a person evaluates an event
or situation as important for his or her well-being and central concerns. Based on the above, the rational for conducting this study is to learn about the association between fear for loved ones during disaster, subjective well-being, perceptions of trust in efficacy of emergency services and its linkages to perceived trust in hospital and medical services in the aftermath of a natural disaster. The trust in hospital and medical services in the aftermath of a disaster is an important factor in disaster management and public health and may be a potentially associated with mental health. Hence, the purpose of the present report was to examine the association between peoples’ trust in hospital and medical services in the aftermath of Hurricane Sandy. Empirical support demonstrating the association between perceived trust in hospital and medical services and perceived trust in emergency services and well-being would benefit disaster health providers and public health professionals.
2. Methods 2.1. Study design
n
Corresponding author. E-mail address: [email protected] (M. Ben-Ezra).
http://dx.doi.org/10.1016/j.psychres.2014.08.012 0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved.
An online survey of 1000 people mainly from New York Metropolitan Area was taken during the fourth week of November 2012. The mean age was 45.16 (S.
M. Ben-Ezra et al. / Psychiatry Research 220 (2014) 1160–1162 D. ¼ 14.30); more than half of the sample were women (n ¼655; 65.5%), married (n¼ 606; 60.6%). Less than half of the sample had college degree or above (n ¼455; 45.5%). All the participants had been exposed to Hurricane Sandy.
2.2. Measures Beyond demographic variables (age, gender, marital status), we asked about the respondents’ trust in emergency services: “How do you rate your trust in emergency services?” on a four point Likert scale ranging from 1 ‘not at all‘ to 4 ‘extremely‘. This variable was aggregated to high trust vs. low trust by grouping the lower vs. higher categories. In this sample, 69.3%, 693 participants answered ‘high trust’. This item was coded dichotomously with value of ‘0’ indicating “low trust” and value of ‘1’ indicating “high trust”. Subjective Well-Being (SWB) was measured by a single item: “In general, how do you rate your life?” on a four point Likert scale ranging from 1 ‘bad‘ to 4 ‘excellent‘ (Oswald and Wu, 2010). Respondents’ answers were aggregated into two categories coded as ‘0’ (poor well-being), and ‘1’ (good well-being). In this sample, 71.7% (717 participants) considered themselves to be in good well-being. Subjective well-being serves as an indicator of mental health (Oswald and Wu, 2010). Although all the participants were exposed to hurricane, direct disaster related experience was measured by two items coded dichotomously as 0¼ ‘no’ and 1¼ ‘yes’ for the following questions: was your home damaged due to Hurricane Sandy (21.2%, 212 participants answered ‘yes’) and did you witness injury due to Hurricane Sandy (14.6%, 146 participants answered ‘yes’). We summed up the items for a scale of 0–2 (‘0‘¼ no direct disaster related experience, 71.6% [716 participants]; ‘1‘¼one direct disaster related experience, 14.7% [147 participants]; ‘2‘¼two direct disaster related experiences, 10.3% [103 participants]). Disaster related anxiety regarding close friends or family members was measured by a single item coded dichotomously as 0¼ ‘no’ and 1¼‘yes’ for the following question: “Were you scared that a loved one would be killed or hurt?” (41.0%, 410 participants answered ‘yes’). Posttraumatic Stress Disorder (PTSD) Symptoms were assessed by the Impact of Event Scale Revised (IES-R), a 22-item measure (Cronbach’s α ¼ 0.98) (Weiss and Marmar, 1997). This scale has been used in numerous previous disaster studies and showed satisfactory psychometric properties (Ben-Ezra and Soffer, 2010; Ben-Ezra et al., 2011; Ben-Ezra et al., 2013; Palgi et al., 2009; Weiss and Marmar, 1997). The IES-R mean score in the present sample was 18.54 (S.D. ¼ 20.26). Perceived trust in hospital and medical services, was measured using the following question: “How do you rate your trust in hospital and medical services?” on a four point Likert scale ranging from 1 ‘not at all‘ to 4 ‘extremely‘. This variable was aggregated to high trust vs. low trust by grouping the lower vs. higher categories. In this sample, 72.1%, 721 participants answered ‘high trust’. This item was coded dichotomously with a value of ‘0’ indicating “low trust” and ‘1’ indicating “high trust”. In order to check if the two trust items are the same construct a multicollinearity test was conducted. The result of the variation inflation factor (1.0) suggests no multicollinearity (O’Brien, 2007).
2.3. Procedure Following the ethics committee approval of the School of Social Work at Ariel University, we conducted an on-line survey using Toluna Inc. of 1000 people of Hurricane Sandy affected states one month after the Hurricane (response rate ¼83.3% out of a potential 1200). We used the same method [collecting data via online panel sample] employed in other medical and psychological studies (Butt et al., 2013; Salsman et al., 2014). The questionnaires asked the participants for their experiences and perception with regard to the crisis followed Hurricane Sandy.
1161
2.4. Data analysis Logistic regression analysis was conducted to assess the associations between the measure of perceived sense of trust in hospital services and the aforementioned variables. SPSS version 19.0 (IBM Corporation) was used. A 2-sided p o 0.05 was used to indicate significance.
3. Results The prevalence of elevated risk of clinical levels of PTSD symptoms (IES-R Z33) one month after Hurricane Sandy was 23.6%. The results of the logistic regression revealed that high sense of trust in hospital services was associated with higher education (OR¼ 1.447; p ¼0.050), higher subjective well-being (OR¼ 2.880; p o0.001), and having lower level of fear for the safety of a loved one during the hurricane (OR ¼ 0.666; p ¼0.037). Those respondents who expressed high trust in the emergency services demonstrated more than 12-fold chances of exhibiting a high trust in hospital services (OR ¼12.217; p o0.001). To our surprise, elevated risk for PTSD (IES-R Z33) was not associated with perceived trust in hospital services. See Table 1. A further t-test comparing the level of trust in hospital services between those with elevated risk for PTSD and those without elevated risk for PTSD showed no significant differences (t¼1.22; p ¼0.224). In addition, we looked at the correlation between trust in emergency services and trust in hospital services in order to rule out the possibility of measuring the same construct of “general trust” (r ¼0.529; p o0.001). This moderate correlation (28% of shared variance) suggests that the two items share some communality yet they are distinct constructs.
4. Discussion The commonly expected and ordinarily observed association between first responders and hospital personnel is particularly significant during disasters. Results of the present report underscore the gravity of the associations between people's trust in emergency services and their efficacious ties with hospital and medical services providers. Subjective well-being was found to be associated with trust in hospital and medical services. This is a known indicator of mental health (Oswald and Wu, 2010). Those with lower trust in hospital services may be paradoxically prone to be in need of such services in the aftermath of a disaster. Beyond that, previous study has shown that trust in institutions was found to be related with well-being (Hudson, 2006). However, the lack of association between trust in hospital and medical services and PTSD symptoms is interesting as it contradicts the findings reported in the existing literature (Hobfoll et al., 2007).
Table 1 Factors associated with trust in hospital services (n¼ 1000).
Trust in hospital servicesa Age (in years) Gender (female vs. male) Marital status (married vs. not married)a Education (college or higher vs. lower)a Subjective ell-beinga Scared for the safety of a loved onea Direct disaster related experiencesa Elevated PTSD symptoms (IES-R Z 33)a Trust in emergency servicesa
β
SE
Adjusted OR (95% CI)
P value
0.012 0.143 0.094 0.370 1.030 0.407 0.004 0.019 2.503
0.007 0.202 0.193 0.189 0.194 0.195 0.142 0.219 0.189
1.012 0.867 1.098 1.447 2.800 0.666 1.004 1.019 12.217
0.070 0.480 0.628 0.050 o0.001 0.037 0.980 0.931 o0.001
(0.999–1.026) (0.584–1.288) (0.752–1.603) (1.000–2.095) (1.915–4.095) (0.454–0.977) (0.760–1.325) (0.663–1.566) (8.432–17.703)
Abbreviation: OR, odds ratio. a
Data were missing among the variables for 7–18 participants (0.7%–1.8% of total; fully completed data in the sample n¼967).
1162
M. Ben-Ezra et al. / Psychiatry Research 220 (2014) 1160–1162
Limitations of the study include cross-sectional design, lack of no-exposure comparison group, use of self-reports measurements, oversampling of women and overrepresentation of people who resided in less severely affected with at least partial access to electricity. The most important finding of the present study is that both perceived trust in emergency services and subjective well-being are associated with perceived trust in hospital and medical services in the aftermath of a disaster. These associations may be considered a part of keystone factors in maintaining critical beliefs concerning return to safety and normalcy following a community wide disaster. Conflict of interest disclosures None disclosed. Acknowledgments Funding/Support: This work was supported by an Internal Researcher Grant of the Research Authority at Ariel University (No. 803590) awarded to Prof. Ben-Ezra. Role of the Sponsor: The funding organization had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The Study was approved by the Ethics committee in the School of Social Work at Ariel University. References Ben-Ezra, M., Palgi, Y., Aviel, O., Dubiner, Y., Baruch, E., Soffer, Y., Shrira, A., 2013. Face it: collecting mental health and disaster related data using facebook vs.
personal interview: the case of the 2011 Fukushima nuclear disaster. Psychiatry Research 208, 91–93. Ben-Ezra, M., Palgi, Y., Wolf, J.J., Shrira, A., 2011. Psychiatric symptoms and psychosocial functioning among hospital personnel during the Gaza War: a repeated cross-sectional controlled study. Psychiatry Research 189, 392–395. Ben-Ezra, M., Soffer, Y., 2010. Hospital personnel reactions to Haiti's earthquake: a preliminary matching study. Journal of Clinical Psychiatry 71, 1700–1701. Butt, Z., Peipert, J., Webster, K., Chen, C., Cella, D., 2013. General population norms for the functional assessment of cancer therapy–Kidney Symptom Index (FKSI). Cancer 119, 429–437. Hobfoll, S.E., Watson, P., Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., Friedman, M., Gersons, B.P., de Jong, J.T., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., Ursano, R.J., 2007. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry 70, 283–315. Hudson, J., 2006. Institutional trust and subjective well‐being across the EU. Kyklos 59, 43–62. Neria, Y., Shultz, J.M., 2012. Mental health effects of Hurricane Sandy: characteristics, potential aftermath, and response. Journal of the American Medical Association 308, 2571–2572. O’Brien, R.M., 2007. A caution regarding rules of thumb for variance inflation factors. Quality and Quantity 41, 673–690. Oswald, A.J., Wu, 2010. Objective confirmation of subjective measures of human well-being: evidence from the USA. Science 327, 576–579. Palgi, Y., Ben-Ezra, M., Langer, S., Essar, N., 2009. The effect of prolong exposure to war stress on the comorbidity of PTSD and depression among hospital personnel. Psychiatry Research 168, 262–264. Powell, T., Hanfling, D., Gostin, L.O., 2012. Emergency preparedness and public health: the lessons of Hurricane Sandy. Journal of the American Medical Association 328, 2569–2570. Redlener, I., Reilly, M.J., 2012. Lessons from Sandy — preparing health systems for future disasters. New England Journal of Medicine 367, 2269–2671. Salsman, J.M., Lai, J.S., Hendrie, H.C., Butt, Z., Zill, N., Pilkonis, P.A., Peterson, C., Stoney, C.M., Brouwers, P.M., Cella, D., 2014. Assessing psychological wellbeing: self-report instruments for the NIH toolbox. Quality of Life Research 23, 205–215. Smith, C.A., Ellsworth, P.C., 1985. Patterns of cognitive appraisal in emotion. Journal of Personality and Social Psychology 48, 813–838. Weiss, D.S., Marmar, C.R., 1997. The impact of event scale–revised. In: Wilson, J.P., Keane, T.M. (Eds.), Assessing Psychological Trauma and PTSD. The Guilford Press, New York, pp. 399–411.
