Journal of Pediatric Psychology Advance Access published October 10, 2014
Effects of Stress Related to the Gulf Oil Spill on Child and Adolescent Mental Health Joy D. Osofsky,1 PHD, Howard J. Osofsky,1 MD, PHD, Carl F. Weems,2 PHD, Tonya C. Hansel,1 PHD, and Lucy S. King,1 BA 1
Department of Psychiatry, Louisiana State University Health Sciences Center and 2Department of Psychology,
University of New Orleans
All correspondence concerning this article should be addressed to Joy D. Osofsky, PHD, Departments of Pediatrics and Psychiatry, LSU Health Sciences Center, 1542 Tulane Avenue, 2nd Floor, New Orleans, LA 70112, USA. E-mail: [email protected] Received May 22, 2014; revisions received August 28, 2014; accepted September 9, 2014
Key words
at-risk youth; posttraumatic stress; stress.
Exposure to human-made (or technological) and natural disasters is associated with increased stress responses in youth, especially those with preexisting difficulties (Kronenberg et al., 2010; La Greca, Silverman, Vernberg, Prinstein,1996; Lai, La Greca, Auslander, & Short, 2013; Masten & Osofsky, 2010; Masten, Narayan, Silverman, Osofsky, 2015; McLaughlin et al., 2010; Neuner, Schauer, Catani, Ruf, & Elbert, 2006; Osofsky & Osofsky, 2013; Osofsky, Osofsky, Kronenberg, Brennan, & Hansel, 2009; Weems et al., 2007). For example, the effects of Hurricane Katrina are relevant to an understanding of probable mental health responses to the Deepwater Horizon oil spill (hereafter Gulf oil spill). After Hurricane Katrina, Kessler and colleagues (2008) reported increased frequency and severity of mental health symptoms but a concomitant decrease in the use of mental health services. Data suggest that complex or repeated trauma increases vulnerability in children and adolescents to mental health conditions (Kronenberg et al., 2010; Weems & Graham, 2014).
Although less is known, similar studies of technological disasters, such as oil spills requiring cleanup of affected ecosystems, indicate an increase in stress responses among impacted individuals. For example, lessons and information learned from the Exxon Valdez oil spill (Gill, Picou, & Ritchie, 2012; Palinkas, Patterson, Russell, & Downs, 1993, 2004; Picou & Gill, 1996) suggest that the vulnerability of children and families, as well as whole communities, to the psychological, social, economic, and ecological consequences of these technological disasters can extend well into the future. Oil spills are different from other types of disasters in that communities dependent on natural resources for their social and economic livelihood may remain in an extended period of recovery, and the environmental effects are often not realized until many years in the future (National Commission, 2011). The uncertainty of recovery and subsequent economic hardships may affect children and adolescents differently from other types of disasters. Research on disasters has
Journal of Pediatric Psychology pp. 1–9, 2014 doi:10.1093/jpepsy/jsu085 Journal of Pediatric Psychology ß The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: [email protected]
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
Objective To examine the interactive effects of stress related to the Gulf oil spill on mental health of children and adolescents on the Gulf Coast who were also affected by previous hurricanes. Methods A prospective design, with n ¼ 1,577 youth (aged 3–18 years), evaluated pre-oil spill and again post-oil spill for posttraumatic stress disorder (PTSD) symptoms, previous hurricane exposure, and amount of oil spill stress. Results Stressors related to the spill were common and were associated with PTSD symptoms. Moreover, there was an interactive effect such that those with high preexisting PTSD symptoms, high previous hurricane exposure, and high oil spill stress had the most elevated post-oil spill PTSD symptoms. Conclusions This study provides initial evidence linking stress related to the Gulf oil spill to youth mental health symptoms. The effects of the oil spill on youth mental health were most evident among those with cumulative risk.
2
Osofsky, Osofsky, Weems, Hansel, and King
concerns about their livelihoods, such as loss of work, loss of family businesses, eating local seafood, and loss of normal activities. While the stresses may not be typically considered traumatic, they are likely to be highly stressful and exacerbate existing difficulties associated with exposure to trauma, especially for residents of a region still recovering from multiple devastating hurricanes (e.g., Katrina). With data collected pre- and post-Gulf oil spill, two theoretical possibilities were explored to understand the mental health effects in children following this disaster. First, stress related to the Gulf oil spill may uniquely predict mental health symptoms, particularly PTSD symptoms, among youth. Alternatively, preexisting PTSD symptoms due to exposure to earlier disasters may account for an association between stress related to the Gulf oil spill and PTSD symptoms. If the latter were true, controlling for pre-Gulf oil spill PTSD symptoms or predisaster exposure to hurricanes in the region might negate a postdisaster association between stress related to the Gulf oil spill and PTSD symptoms. Second, there may also be important cumulative or interactive effects such that high preexisting PTSD symptoms (before the spill), high previous hurricane exposure, and high oil spill-related stress may interact to predict post-oil spill PTSD symptoms (Weems & Graham, 2014; Weems, Scott, Banks, & Graham, 2012). Elaborating on these possibilities noted above and based on past research, two predictions were made. The first prediction was that stress related to the Gulf oil spill would be associated with PTSD symptoms following the disaster, even after controlling for predisaster child PTSD symptoms and level of exposure to previous hurricane disasters. The second prediction was that there would be interactive effects of preexisting PTSD symptoms (before the spill), previous hurricane exposure, and oil spill-related stress in that those students with elevations on all three would have the greatest risk. In addition, we explored whether child age, gender, and minority status affected the link between stress related to the oil spill and postdisaster PTSD symptoms. While the effects of age have been somewhat mixed in the hurricane disaster literature (La Greca et al., 1998; Weems et al., 2007), there is reason to believe that younger children may be at increased risk following the oil spill. For example, younger children may be less able to process the oil spill event and cope with the disruption based on the family’s level of stress. On the other hand, female gender has been consistently associated with relatively increased PTSD symptoms following hurricanes, with girls at greater risk owing to both genetic and social factors (Weems et al., 2007). Finally, minority status has also been associated with relatively worse outcomes in
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
shown that the impact on children depends on both variations in exposure and influences on responses immediately after the event and longer term (Comer et al., 2010). Effects on children and youth are related to the nature of the disaster, the proximity of the event, the degree of exposure of the child or family, demographic factors such as the age, gender, and minority status of the child and family, and qualities of the recovery environment, including medical, social, economic, community, and spiritual support (Furr, Comer, Edmunds, & Kendall, 2010; Masten & Osofsky, 2010; Masten et al., 2015; Palinkas et al., 1993, 2004). Baseline data, including predisaster information, are important to draw conclusions about the unique effects of a subsequent disaster (such as the Gulf oil spill) on mental health (La Greca, Silverman, Wasserstein., 1998; Weems et al., 2007). Otherwise, preexisting risk such as exposure to previous disasters and lingering posttraumatic stress disorder (PTSD) symptoms (as opposed to the Gulf oil spill) cannot be ruled out as an alternative explanation of the association (Weems et al., 2007). Prospective studies with data on baseline symptoms provide one of the strongest naturalistic designs available to disaster researchers. While there have been studies examining the effects of exposure to multiple traumas, including disasters, on mental health symptoms (DiGangi et al., 2013; La Greca et al., 1998; Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008; Pfefferbaum & North, 2008; Weems & Graham, 2014; Weems et al., 2007), few, if any, prospective studies have examined the mental health effects of an oil spill disaster in relation to exposure to previous natural disasters (Neria, Galea, & Norris, 2013; Yun, Lurie, & Hyde, 2010). Indeed, owing to the nature of the work, there are a limited number of prospective longitudinal studies of children and adolescents in the disaster literature (Goldstein, Osofsky, & Lichtveld, 2011; La Greca, Silverman, Lai, & Jaccard, 2010; Masten et al., 2015; Pfefferbaum et al., 2010). The explosion that started the Gulf oil spill occurred April 20, 2010, and the well was capped after 87 days on July 15, 2010. Large amounts of crude oil and dispersants were released into the Gulf of Mexico, resulting in damage to the environment and disruptions in a way of life for many communities. In this article, a prospective study is presented examining the effects of the stress from this disaster on child and adolescent mental health. There were a number of consequences that may have increased the stress of area residents, including direct exposure to toxins from oil and dispersants, harm to wildlife, damage to the environment, and disruption of the economy. Thus, children and families may have experienced severe
Gulf Oil Spill Effects
the hurricane disaster literature (Weems et al., 2010). Therefore, we predicted gender and minority status to be main effect predictors, but not that the demographic variables would moderate the main effects of oil spill stress on symptoms.
Method Participants
Measures PTSD symptoms were measured with the Katrina Inspired Disaster Screenings (Osofsky, Osofsky, & Hansel, 2012), a modified version of the National Child Traumatic Stress Network Disaster (NCTSN) Assessment and Referral Tool for Children and Adolescents (NCTSN, 2005). The measure was based on the Post Traumatic Stress Reaction Index for Children (PTSD-RI; Frederick, Pynoos, & Nader, 1992), where youth are asked to rate their symptoms in response to disasters. In this study, 20 items are scored from 1 (not at all) to 4 (very much), and total scores range from 20 to 80. Previous research suggests this version has good validity (Kronenberg et al., 2010) and that similar versions of the PTSD-RI modified to assess disaster responses are valid and reliable (NCTSN, 2005; Weems et al., 2010). In the present sample, internal consistency measured by Cronbach’s a was >.90 for both time points.
Procedures Data collection was conducted as part of a school-initiated screening and intervention project. Screening packets, which included the questionnaires and measures described above, were administered to students in prekindergarten through 12th grade in collaboration with schools in the target community. As a school-initiated screening, the content was deemed necessary for the postdisaster educational environment, and parents and guardians provided annual consent for assessments (see Osofsky & Osofsky, 2013; Osofsky, Osofsky, Wells, & Weems, 2014; Osofsky et al., 2009, 2012 for information on the larger project). The measures were administered to students in 4th–12th grades in the classroom with the teacher and a Louisiana State University (LSU) Health Sciences Center clinician present. For students under Grade 4, the screening packets were sent home for the parents to complete and were then returned to the school. Notification was also sent home regarding dates and the option to request that one’s child not participate. Students were given the opportunity to refuse participation on all or parts of the screener at their discretion. Reports, including compilations of students’ responses, were given to the schools to provide them with more information about students’ concerns in an effort to improve services and enhance the school environment. The questionnaires were administered confidentially, but not anonymously, so that it was possible to provide further evaluation for students with elevated mental health
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
This naturalistic study used a prospective design developed from an ongoing community screening program, in collaboration with schools, of schoolchildren who were affected by Hurricane Katrina and the Gulf oil spill. Data were gathered from 1,730 children and adolescents from three parishes (counties) in the Gulf region directly impacted by the oil spill, who were assessed before and after the spill. A total of 1,577 youth (or parents of children under Grade 4) completed all of the screening packet used in this study and are included in the analyses. The sample was evaluated for PTSD symptoms and hurricane exposure between September 2009 and March 2010 pre-oil spill (Time 1), and was again evaluated between September and December 2010, post-oil spill (Time 2), for PTSD symptoms and amount of Gulf oil spill-related stress. The sample included children aged 3–18 years (mean age ¼ 12.39 years), and 56% were girls. Sixteen percent of the sample was under Grade 4 and therefore completed screenings via parent report. Youth reported their race and ethnicity as 56% White, 25% Black, 7% ‘‘mixed,’’ 4% Hispanic, 4% Asian, and 4% other. Approximately 73% of the students were eligible to receive subsidized or free lunch (KIDS COUNT, 2013), and so the sample was largely from lower socioeconomic backgrounds.
Hurricane exposure was measured with a nine-item survey of exposure to hurricanes and their aftermath that was based on the work of NCTSN (Kronenberg et al., 2010; Pfefferbaum et al., 2010) and La Greca, Silverman, and Wasserstein (LaGreca et al. 1996, 1998; Vernberg, LaGreca, Silverman, & Prinstein, 1996). Respondents indicated Yes (1) or No (0) to whether they experienced each event, and these items were summed to make an exposure events score. Items included house destroyed, personal injury, family/friends injured, and family/friends killed. The measure has been shown to have good validity estimates and internal consistency in this sample (a ¼ .71). Gulf oil spill stress was measured with a similar eightitem scale also patterned on the disaster exposure measure of NCTSN (Kronenberg et al., 2010; NCTSN, 2005) and La Greca et al. (1996, 1998). Respondents indicated Yes (1) or No (0) in response to whether they had experienced an event, and these items were summed to make an oil spill stress score. Items included loss of family business, loss of parent’s job, concern over harm to environment, and concern over sickness (see Table I for all items). Internal consistency in this sample was good (a ¼ .77).
3
4
Osofsky, Osofsky, Weems, Hansel, and King Table I. Oil Spill Concerns Endorsed and Item Correlation With PTSD Symptoms by Boys and Girls and by Younger and Older and Minority Status Concern
% Yes
Full sample
Boys
Girls
Younger
Older
Minority
Nonminority
Loss of family business
11
.121*
.122*
.131*
.113
.114*
.144*
.091*
Loss of parents job/work Having to move away
16 11
.147* .135*
.119* .131*
.161* .138*
.208* .320*
.137* .111*
.170* .151*
.132* .118*
Harm to environment
59
.159*
.154*
.155*
.347*
.106*
.140*
.182*
Harm to animals
60
.144*
.155*
.128*
.289*
.100*
.131*
.167*
Loss of activities
53
.164*
.176*
.170*
.282*
.129*
.163*
.184*
Getting sick
30
.264*
.255*
.250*
.387*
.242*
.292*
.233*
Eating local seafood
51
.202*
.201*
.192*
.266*
.170*
.191*
.219*
Note. *Correlation is significant at the .01 level. For this analysis, younger and older groupings are based on reporting status; younger ¼ parent report and older ¼ self-report.
Data Analysis Data were analyzed with descriptive statistics, Pearson correlation, Spearman rho, and linear regression in SPSS 19.0. Because the distributions of PTSD symptoms were heavily skewed, parallel regression analyses were conducted using a log10 transformation to reduce the skew. These are noted below and produced identical conclusions; therefore, analyses focus on the nontransformed PTSD symptoms.
Results Mean PTSD symptoms scores were 27.94 (10.5) and 27.56 (10.4) for the two time points, and intraclass correlation coefficients (ICC absolute agreement) indicated a fairly high level of stability in PTSD symptoms (Time 1 to 2 ICC ¼ .61). Visual inspection of the distributions of PTSD symptoms suggested that they were positively skewed (skewness > 1.9), while the summed hurricane exposure variable and oil spill stress variable were fairly normally distributed (skewness < 0.12). In terms of previous hurricane exposure, 93% of the sample endorsed at least one item, with the average endorsing 50% of the items. In terms of oil spill stress, 73% endorsed at least one item, with the average endorsing 36% of the items. A summary of endorsements on each of the oil spill stress items are presented in Table I, with the most common concerns being harm to the environment and animals. Table I also presents the correlations between each of the individual oil spill stress items and PTSD symptoms to explore possible oil spill stress item-level differences. However, the table shows a pattern of similar associations across items and across subsamples of males and females, age-groups, and minority status. Thus, the
main hypothesis-testing analyses focus on the summed oil spill stress items. The summed oil spill stress variable was significantly correlated with Time 2 PTSD symptoms (r ¼ .28, p < .001; ¼ .35, p < .001) accounting for 8% of the variance. Linear regression analysis next tested whether oil spill stress was associated with post-oil spill PTSD symptoms at Time 2, while controlling for both Time 1 PTSD symptoms and previous hurricane exposure, age, minority status (coded nonminority ¼ 1, minority ¼ 2), and gender (coded boys ¼ 1, girls ¼ 2). Results indicated that Time 2 PTSD symptoms were significantly predicted (p < .05) by preexisting PTSD symptoms (18.7% unique variance), previous hurricane exposure (0.7% unique variance), girl gender (1.2% unique variance), and minority status (0.4% unique variance). Moreover, level of oil spill stress remained a significant predictor (accounting for 1.2% unique variance) of PTSD symptoms. Using a log10 transformation to reduce skew in the dependent variable produced identical conclusions. Interaction terms were added in a second step of the regression analysis to test the hypothesis that oil spill stress interacts with preexisting symptoms to predict post-oil spill PTSD symptoms. PTSD symptoms at Time 2 were the dependent variable with interaction terms of PTSD symptoms at Time 1 by oil spill stress, oil spill stress by hurricane exposure, hurricane exposure by PTSD at Time 1, and the three-way interaction of PTSD at Time 1 by oil spill stress by hurricane exposure. All variables were centered using standard scores to reduce the influence of multicolinearity. Results indicated a significant three-way interaction term. A summary of this final regression model is presented in Table II. Inspection of variance inflation factors and tolerance indicated acceptable levels in all regression analyses. Again, using a log10 transformation to reduce skew in the dependent variable produced identical conclusions with the significant interaction remaining.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
symptoms or for those that requested services. This study was submitted and received approval by the institutional review board at LSU Health Sciences Center.
Gulf Oil Spill Effects
5
Table II. Summary of Final Regression Model Predicting Time 2 PTSD Symptoms Coefficients Model
Correlations
B
SE
t
Sig.
Intercept
27.242
.220
123.563
.000
PTSD pre
4.978
.222
22.450
.000
.583**
.433**
1.186 0.130
.208 .223
5.717 0.581
.000 .562
.158** .070**
.110** .011
Minority
0.641
.207
3.094
.002
.084**
.060**
Oil spill stress
1.278
.227
5.626
.000
.271**
.109**
Hurricane exposure
1.015
.234
4.335
.000
.266**
.084**
Gender Age
Zero order
Semipartial
Hurricane by oil spill stress
0.061
.209
0.290
.771
.039
PTSD pre by oil spill stress
0.183
.231
0.795
.427
.171**
PTSD pre by hurricane
1.259
.220
5.717
.000
.277**
.110**
PTSD pre by hurricane by oil spill stress
0.590
.194
3.045
.002
.293**
.059**
.006 .015
stress exacerbated the PTSD symptoms of those with preexisting PTSD symptoms related to high hurricane exposure. In addition, there was a significant difference between Slopes 1 and 2 in Figure 1 (p ¼ .002, two tailed), demonstrating a diminished effect of the Gulf oil spill on Time 2 PTSD symptoms among those with high hurricane exposure but low PTSD symptoms at Time 1. Finally, among those with low pre-oil spill PTSD symptoms (Lines 2 and 4), those with low previous hurricane exposure were more affected by the oil spill than those with high previous exposure (p ¼ .023, two tailed).
Gender, Age, and Ethnicity Analyses
Figure 1. Amount of oil spill stress interacts with prespill Time 1 PTSD symptoms and previous hurricane exposure to predict post-oil spill Time 2 PTSD symptoms. Note. PTSD ¼ posttraumatic stress disorder symptoms.
The nature of the interaction is depicted in Figure 1. Post hoc analysis of the interaction (Dawson & Richter, 2006; Holmbeck, 2002) indicated that among those with high PTSD symptoms at Time 1 and high previous hurricane exposure, those with high oil spill stress had the highest Time 2 PTSD symptoms. In other words, oil spill
A number of supplemental analyses were conducted to ensure findings were not affected by age, gender, and minority status. The oil spill stress item correlations with Time 2 PTSD symptoms were explored by boys and girls, reporter status (older [self-report] vs. younger [parent report]), and minority status. Results are summarized in Table I and show a fairly similar pattern of associations across groupings with one exception in that there was a pattern of larger correlations by parent report. The itemlevel data in Table I are primarily descriptive with the formal tests of moderation done on the summed variables. Thus, the final set of analyses formally tested age, gender, and minority status as moderators of the effects of stress related to the oil spill (summed total stress) on Time 2 PTSD symptoms (e.g., the age by oil spill stress interaction was tested in predicting Time 2 PTSD symptoms). The results indicated these demographic factors did not significantly affect the link between stress related to the oil spill and PTSD symptoms (age was tested as a continuous moderator as well as by reporter group status). That is, there
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
Note. PTSD ¼ posttraumatic stress symptoms. B ¼ Beta; SE ¼ Standard Error; t ¼ t statistic; Sig. ¼ Significant. **p < .01.
6
Osofsky, Osofsky, Weems, Hansel, and King
were no significant demographic variable by oil spill stress interactions.
Discussion
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
This study of school-age children and adolescents assessed pre- and post-Gulf oil spill showed that PTSD symptoms were predicted by oil spill-related stress. This study is unique in that, to the best of the authors’ knowledge, there have been no systematic reports on child and adolescent trauma symptoms before and after an oil spill. This study also adds to the limited literature on the effects of disasters on youth over time (Kilmer & Gil-Rivas, 2010; Kronenberg et al., 2010; La Greca et al., 1996, 1998, 2010, 2013; Weems, et al., 2010), where the students were assessed with the same measure in the year before the oil spill as they were 1 year following the event. The link between level of oil spill stress and PTSD symptoms was evident across age and minority groups for both boys and girls. This study helps to empirically demonstrate that the linkage between stress related to the Gulf oil spill and PTSD symptoms in youth is not simply due to preexisting symptoms. Importantly, there does appear to be a cumulative interactive effect such that those with high preexisting PTSD symptoms, high previous hurricane exposure, and high oil spill-related stress had the most elevated post-oil spill PTSD symptoms (see Figure 1). This finding demonstrates the synergistic and disproportionate consequences of cumulative stress and trauma on youth with preexisting difficulties. This study provides new data on a technological disaster, extending previously available work on natural disasters. Previous work following natural disasters has indicated that PTSD symptoms are uniquely predicted by exposure to hurricane events (La Greca et al., 1998, 2010; Weems et al., 2007); however, a link between PTSD symptoms and oil spill stress has not been previously shown among youth. Findings from prior studies related to demographics factors as main-effect predictors, particularly age, have been mixed (Masten & Osofsky, 2010; Masten et al., 2015). Results from this study indicated that girl gender and being from a minority group were associated with increased levels of post-oil spill PTSD symptoms, which is consistent with previous research (Masten et al., 2015; Weems et al., 2007, 2010). However, the prediction of symptoms by oil spill stress did not differ across age, gender, or minority status (i.e., while gender and minority status predicted PTSD post-oil spill, age, gender, or minority status did not moderate the effects of the oil spill on
PTSD symptoms). This study, therefore, substantiated the hypothesis that PTSD symptoms were predicted by level of oil spill stress in youth across age, gender, and minority status following the Gulf oil spill. Interestingly, among students with low pre-oil spill PTSD symptoms (comparison of Lines 2 and 4 in Figure 1), those with low previous hurricane exposure were more affected by the oil spill than those with high previous exposure (p ¼ .023, two tailed). This finding can be interpreted to mean that those youth who were exposed to high levels of previous hurricane experiences but did not react to these events with elevated PTSD symptoms (i.e., were resilient to the effect of previous disasters) were also resilient to the effect of high levels of oil spill stress. However, students who did not have previous hurricane experience were more impacted (albeit modestly) by high oil spill stress. While this study has several methodological advances, including the use of prospectively collected disaster response data, it is not without limitations. Residents living on the Gulf Coast of the United States have experienced multiple natural disasters. The Gulf Coast has also been impacted by coastal erosion, loss of wetlands, economic considerations related to oil drilling and the petrochemical industry, and the effects of this industry on the ecosystem and, possibly, on physical and behavioral health (Osofsky et al., 2014). The main limitation, common with disaster studies (Masten & Osofsky, 2010; Masten et al., 2015), is that definitive causal conclusions about the linkages reported in this study cannot be made owing to the naturalistic design. Other areas of the country, with different prior and current traumas, might have somewhat different responses to a technological disaster. However, the findings of this study, controlling for prior exposure, establish a link between the Gulf oil spill and symptoms in a population of youth affected by cumulative trauma and multiple disasters. It is also important to note that the large size of sample makes relatively small associations statistically significant. Thus, while findings were statistically significant, the effects in this study were in the small to medium range. Finally, we did not examine potentially traumatic events other than the disasters. Therefore, while the Time 1 measures of PTSD symptoms account for preexisting difficulties, we do not know how exposure to other types of traumas (e.g., assault) may have impacted findings. In understanding and responding to the effects of technological disasters on children and families, it is important to have a developmental and public health perspective and consider the impact of the disaster not only on the ecosystem but also on the physical and mental health of those affected. The findings of this study support the
Gulf Oil Spill Effects
Acknowledgment Appreciation is expressed to the LSU Health Sciences Center Department of Psychiatry team that worked on this project.
Funding This research is partially supported as a component of the Gulf Region Health Outreach Program developed jointly by BP and the Plaintiffs’ Steering Committee as part of the Deepwater Horizon Medical Benefits Class Action Settlement, which was approved by the US District Court in New Orleans on January 11, 2013 and became effective on February 12, 2014, and SAMHSA Grant 5U79SM6203 to the Louisiana Rural Trauma Services Center, Baptist Community Ministries, and the Robert Wood Johnson Foundation.
References Comer, J. S., Fan, B., Duarte, C. S., Wu, P., Musa, G. J., Mandell, D. J., . . . Hoven, C. W. (2010). Attack-related life disruption and child psychopathology in New York City public schoolchildren 6-months post9/11. Journal of Clinical Child and Adolescent Psychology, 39, 460–469. Dawson, J. F., & Richter, A. W. (2006). Probing threeway interactions in moderated multiple regression: Development and application of a slope difference test. Journal of Applied Psychology, 91, 917–926. DiGangi, J. A., Gomez, D., Mendoza, L., Jason, L. A., Keys, C. B., & Koenen, K. C. (2013). Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature. Clinical Psychology Review, 33, 728–744. Frederick, C., Pynoos, R. S., & Nader, K. O. (1992). Childhood Post-Traumatic Stress Reaction Index (CPTSRI), Unpublished manuscript, University of California, Los Angeles. Furr, J. M., Comer, J. S., Edmunds, J. M., & Kendall, P. C. (2010). Disasters and youth: A metaanalytic examination of posttraumatic stress. Journal of consulting and clinical psychology, 78, 765. Gill, D. A., Picou, J., & Ritchie, L. A. (2012). The Exxon Valdez and BP oil spills: A comparison of initial social and psychological impacts. The American Behavioral Scientist, 56, 3–23. Goldstein, B. D., Osofsky, H. J., & Lichtveld, M. (2011). The Gulf oil spill. New England Journal of Medicine, 364, 1334–1348. Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and meditational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96. Kessler, R. C., Galea, S., Gruber, M. J., Sampson, N. A., Ursano, R. J., & Wessely, S. (2008). Trends in mental illness and suicidality after Hurricane Katrina. Molecular Psychiatry, 13, 374–384. KIDS COUNT. (2013). Data book: State trends in child well-being. [Pamphlet] Baltimore, MA: The Annie E. Casey Foundation. Kilmer, R. P., & Gil-Rivas, V. (2010). Exploring posttraumatic growth in children impacted by Hurricane Katrina: Correlates of the phenomenon and developmental considerations. Child Development, 81, 1211–1227. Kronenberg, M. E., Hansel, T. C., Brennan, A. M., Osofsky, H. J., Osofsky, J. D., & Lawrason, B. (2010). Children of Katrina: Lessons learned about
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
importance of understanding the mental and behavioral health sequelae in children and adolescents in impacted communities and the interdependence with other stresses that co-occurred with the Gulf oil spill disaster. The findings serve to augment similar studies of technological disasters indicating an increased stress response (Gill et al., 2012; Palinkas et al., 1993, 2004; Picou & Gill, 1996), and reinforce the importance of developing systems that support individual, school, and community mental and behavioral health needs following a technological disaster such as an oil spill. While many of the consequences of the Gulf oil spill would not typically be considered traumatic, our findings suggest that associated stresses may exacerbate existing difficulties associated with exposure to trauma. Thus, the vulnerability of children and families to the economic and ecological consequences of these technological disasters can extend to the mental health problems of youth. The data from this study provide important naturally occurring findings from what may be the largest sample of pre- and postdisaster research on children and adolescents in the current literature. A new association has been established between oil spill stress and PTSD symptoms, controlling for preexisting PTSD symptoms, incrementally substantiating research from previous studies on the effects of disasters on children and youth. Implications of these findings highlight the importance of preparedness, especially for those in vulnerable areas, as well as early and continuing response for children and adolescents to support mental and behavioral health recovery to optimize development.
7
8
Osofsky, Osofsky, Weems, Hansel, and King
Report to the President. Retrieved from http://www. oilspillcommission.gov/final-report Neria, Y. N., Galea, S., & Norris, F. (Eds.), (2013). Disaster mental health research: Past, present, and future. Cambridge: Cambridge University Press. Norris, F., Stevens, S., Pfefferbaum, B., Wyche, K., & Pfefferbaum, R. (2008). Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. American Journal of Community Psychology, 41, 127–150. Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress, 19, 339–347. Osofsky, J. D., & Osofsky, H. J. (2013). Lessons learned about the impact of disasters on children and families and post-disaster recovery. In A. Culp (Ed.) (Ed.), Child and family advocacy (pp. 91–105). New York: Springer. Osofsky, J. D., Osofsky, H. J., & Hansel, T. C. (2012). Special considerations for children and adolescents in psychosocial assessment and surveillance. Disaster psychosocial assessment and surveillance toolkit: Methods to enhance disaster preparedness, response and recovery, Retrieved from: http://www. medschool.lsuhsc.edu/psychiatry/docs/Disaster%20 PAST%20Toolkit.pdf Osofsky, H. J., Osofsky, J. D., Kronenberg, M., Brennan, A., & Hansel, T. C. (2009). Posttraumatic stress symptoms in children after Hurricane Katrina: Predicting the need for mental health services. American Journal of Orthopsychiatry, 79, 212–220. Osofsky, H. J., Osofsky, J. D., Wells, J. H., & Weems, C. F. (2014). Meeting mental health needs after the Gulf Oil Spill. Psychiatric Services, 65, 280–283. Palinkas, L. A., Patterson, J. S., Russell, J., & Downs, M. A. (1993). Community patterns of psychiatric disorders after the Exxon Valdez oil spill. American Journal of Psychiatry, 150, 1517–1523. Palinkas, L., Patterson, J. S., Russell, J. C., & Downs, M. A. (2004). Ethnic differences in symptoms of post-traumatic stress after the Exxon Valdez oil spill. Disaster Medicine, 19, 102–112. Pfefferbaum, B., Houston, J. B., Reyes, G., Steinberg, A. M., Pynoos, R. S., Fairbank, J. A., . . . Maida, C. A. (2010). Building national capacity for child and family disaster mental health research. Professional Psychology: Research and Practice, 41, 26–33.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
postdisaster symptoms and recovery patterns. Child Development, 81, 1241–1259. La Greca, A. M., Lai, B. S., Llabre, M. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (2013). Children’s postdisaster trajectories of pts symptoms: Predicting chronic distress. Child & Youth Care Forum, 42, 351–369. La Greca, A. M., Silverman, W. K., Lai, B., & Jaccard, J. (2010). Hurricane-related exposure experiences and stressors, other life events, and social support: Concurrent and prospective impact on children’s persistent posttraumatic stress symptoms. Journal of Consulting and Clinical Psychology, 78, 794–805. La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. (1996). Symptoms of posttraumatic stress after Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64, 712–723. La Greca, A. M., Silverman, W. K., & Wasserstein, S. B. (1998). Children’s predisaster functioning as a predictor of posttraumatic stress following Hurricane Andrew. Journal of Consulting and Clinical Psychology, 6, 883–892. Lai, B. S., La Greca, A. M., Auslander, B. A., & Short, M. B. (2013). Children’s symptoms of posttraumatic stress and depression after a natural disaster: Comorbidity and risk factors. Journal of Affective Disorders, 146, 71–78. Masten, A. S., Narayan, A. J., Silverman, W. K., & Osofsky, J. D. (2015). Children in war and disaster. In M. H. Bornstein, T. Leventhal, & R. Lerner (Eds.), Handbook of child psychology: Ecological settings and processes, (Vol. IV, 7th ed). New York: Wiley. Masten, A., & Osofsky, J. D. (2010). Disasters and their impact on child development: Introduction to the special section. Child Development, 81, 1029–1039. McLaughlin, K. A., Fairbank, J. A., Gruber, M. J., Jones, R. T., Osofsky, J. D., Pfefferbaum, B., . . . Kessler, R. C. (2010). Trends in serious emotional disturbance among youths exposed to Hurricane Katrina. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 990–1000. National Child Traumatic Stress Network. (2005). Hurricane Assessment and Referral Tool for Children and Adolescents. , Retrieved from http://www. nctsnet.org/nctsn_assets/pdfs/intervention_manuals/ referraltool.pdf National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling. (2011). Deep water: The gulf oil disaster and the future of offshore drilling,
Gulf Oil Spill Effects
trait anxiety and negative affect predict posttraumatic stress in youth after Hurricane Katrina. Journal of Consulting and Clinical Psychology, 75, 154–159. Weems, C. F., Scott, B. G., Banks, D. M., & Graham, R. A. (2012). Is TV traumatic for all youths? The role of pre-existing posttraumatic stress symptoms on the link between disaster coverage and stress. Psychological Science, 23, 1293–1297. Weems, C. F., Taylor, L. K., Cannon, M. F., Marino, R. C., Romano, D. M., Scott, B. G., . . . Triplett, V. (2010). Posttraumatic stress, context, and the lingering effects of the Hurricane Katrina disaster among ethnic minority youth. Journal of Abnormal Child Psychology, 38, 49–56. Yun, K., Lurie, N., & Hyde, P. (2010). Moving mental health into the disaster-preparedness spotlight. New England Journal of Medicine, 363, 1193–1195.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
Pfefferbaum, B., & North, C. S. (2008). Research with children exposed to disasters. International Journal of Methods in Psychiatric Research, 17, S49–S58. Picou, J. S., & Gill, D. A. (1996). The Exxon Valdez oil spill and chronic psychological stress. In S. D. Rice, R. B. Spies, D. A. Wolfe, & B. A. Wright (Eds.), Proceedings of the Exxon Valdez oil spill symposium: 18th American Fisheries Society Symposium (pp. 879– 893). Bethesda, MD: American Fisheries Society. Vernberg, E. M., LaGreca, A. M., Silverman, W. K., & Prinstein, M. (1996). Predictors of children’s post-disaster functioning following Hurricane Andrew. Journal of Abnormal Psychology, 105, 237–248. Weems, C. F., & Graham, R. A. (2014). Resilience and trajectories of posttraumatic stress among youth exposed to disaster. Journal of Child and Adolescent Psychopharmacology, 24, 2–8. Weems, C. F., Pina, A. A., Costa, N. M., Watts, S. E., Taylor, L. K., & Cannon, M. F. (2007). Pre-disaster
9
Effects of Stress Related to the Gulf Oil Spill on Child and Adolescent Mental Health Joy D. Osofsky,1 PHD, Howard J. Osofsky,1 MD, PHD, Carl F. Weems,2 PHD, Tonya C. Hansel,1 PHD, and Lucy S. King,1 BA 1
Department of Psychiatry, Louisiana State University Health Sciences Center and 2Department of Psychology,
University of New Orleans
All correspondence concerning this article should be addressed to Joy D. Osofsky, PHD, Departments of Pediatrics and Psychiatry, LSU Health Sciences Center, 1542 Tulane Avenue, 2nd Floor, New Orleans, LA 70112, USA. E-mail: [email protected] Received May 22, 2014; revisions received August 28, 2014; accepted September 9, 2014
Key words
at-risk youth; posttraumatic stress; stress.
Exposure to human-made (or technological) and natural disasters is associated with increased stress responses in youth, especially those with preexisting difficulties (Kronenberg et al., 2010; La Greca, Silverman, Vernberg, Prinstein,1996; Lai, La Greca, Auslander, & Short, 2013; Masten & Osofsky, 2010; Masten, Narayan, Silverman, Osofsky, 2015; McLaughlin et al., 2010; Neuner, Schauer, Catani, Ruf, & Elbert, 2006; Osofsky & Osofsky, 2013; Osofsky, Osofsky, Kronenberg, Brennan, & Hansel, 2009; Weems et al., 2007). For example, the effects of Hurricane Katrina are relevant to an understanding of probable mental health responses to the Deepwater Horizon oil spill (hereafter Gulf oil spill). After Hurricane Katrina, Kessler and colleagues (2008) reported increased frequency and severity of mental health symptoms but a concomitant decrease in the use of mental health services. Data suggest that complex or repeated trauma increases vulnerability in children and adolescents to mental health conditions (Kronenberg et al., 2010; Weems & Graham, 2014).
Although less is known, similar studies of technological disasters, such as oil spills requiring cleanup of affected ecosystems, indicate an increase in stress responses among impacted individuals. For example, lessons and information learned from the Exxon Valdez oil spill (Gill, Picou, & Ritchie, 2012; Palinkas, Patterson, Russell, & Downs, 1993, 2004; Picou & Gill, 1996) suggest that the vulnerability of children and families, as well as whole communities, to the psychological, social, economic, and ecological consequences of these technological disasters can extend well into the future. Oil spills are different from other types of disasters in that communities dependent on natural resources for their social and economic livelihood may remain in an extended period of recovery, and the environmental effects are often not realized until many years in the future (National Commission, 2011). The uncertainty of recovery and subsequent economic hardships may affect children and adolescents differently from other types of disasters. Research on disasters has
Journal of Pediatric Psychology pp. 1–9, 2014 doi:10.1093/jpepsy/jsu085 Journal of Pediatric Psychology ß The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: [email protected]
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
Objective To examine the interactive effects of stress related to the Gulf oil spill on mental health of children and adolescents on the Gulf Coast who were also affected by previous hurricanes. Methods A prospective design, with n ¼ 1,577 youth (aged 3–18 years), evaluated pre-oil spill and again post-oil spill for posttraumatic stress disorder (PTSD) symptoms, previous hurricane exposure, and amount of oil spill stress. Results Stressors related to the spill were common and were associated with PTSD symptoms. Moreover, there was an interactive effect such that those with high preexisting PTSD symptoms, high previous hurricane exposure, and high oil spill stress had the most elevated post-oil spill PTSD symptoms. Conclusions This study provides initial evidence linking stress related to the Gulf oil spill to youth mental health symptoms. The effects of the oil spill on youth mental health were most evident among those with cumulative risk.
2
Osofsky, Osofsky, Weems, Hansel, and King
concerns about their livelihoods, such as loss of work, loss of family businesses, eating local seafood, and loss of normal activities. While the stresses may not be typically considered traumatic, they are likely to be highly stressful and exacerbate existing difficulties associated with exposure to trauma, especially for residents of a region still recovering from multiple devastating hurricanes (e.g., Katrina). With data collected pre- and post-Gulf oil spill, two theoretical possibilities were explored to understand the mental health effects in children following this disaster. First, stress related to the Gulf oil spill may uniquely predict mental health symptoms, particularly PTSD symptoms, among youth. Alternatively, preexisting PTSD symptoms due to exposure to earlier disasters may account for an association between stress related to the Gulf oil spill and PTSD symptoms. If the latter were true, controlling for pre-Gulf oil spill PTSD symptoms or predisaster exposure to hurricanes in the region might negate a postdisaster association between stress related to the Gulf oil spill and PTSD symptoms. Second, there may also be important cumulative or interactive effects such that high preexisting PTSD symptoms (before the spill), high previous hurricane exposure, and high oil spill-related stress may interact to predict post-oil spill PTSD symptoms (Weems & Graham, 2014; Weems, Scott, Banks, & Graham, 2012). Elaborating on these possibilities noted above and based on past research, two predictions were made. The first prediction was that stress related to the Gulf oil spill would be associated with PTSD symptoms following the disaster, even after controlling for predisaster child PTSD symptoms and level of exposure to previous hurricane disasters. The second prediction was that there would be interactive effects of preexisting PTSD symptoms (before the spill), previous hurricane exposure, and oil spill-related stress in that those students with elevations on all three would have the greatest risk. In addition, we explored whether child age, gender, and minority status affected the link between stress related to the oil spill and postdisaster PTSD symptoms. While the effects of age have been somewhat mixed in the hurricane disaster literature (La Greca et al., 1998; Weems et al., 2007), there is reason to believe that younger children may be at increased risk following the oil spill. For example, younger children may be less able to process the oil spill event and cope with the disruption based on the family’s level of stress. On the other hand, female gender has been consistently associated with relatively increased PTSD symptoms following hurricanes, with girls at greater risk owing to both genetic and social factors (Weems et al., 2007). Finally, minority status has also been associated with relatively worse outcomes in
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
shown that the impact on children depends on both variations in exposure and influences on responses immediately after the event and longer term (Comer et al., 2010). Effects on children and youth are related to the nature of the disaster, the proximity of the event, the degree of exposure of the child or family, demographic factors such as the age, gender, and minority status of the child and family, and qualities of the recovery environment, including medical, social, economic, community, and spiritual support (Furr, Comer, Edmunds, & Kendall, 2010; Masten & Osofsky, 2010; Masten et al., 2015; Palinkas et al., 1993, 2004). Baseline data, including predisaster information, are important to draw conclusions about the unique effects of a subsequent disaster (such as the Gulf oil spill) on mental health (La Greca, Silverman, Wasserstein., 1998; Weems et al., 2007). Otherwise, preexisting risk such as exposure to previous disasters and lingering posttraumatic stress disorder (PTSD) symptoms (as opposed to the Gulf oil spill) cannot be ruled out as an alternative explanation of the association (Weems et al., 2007). Prospective studies with data on baseline symptoms provide one of the strongest naturalistic designs available to disaster researchers. While there have been studies examining the effects of exposure to multiple traumas, including disasters, on mental health symptoms (DiGangi et al., 2013; La Greca et al., 1998; Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008; Pfefferbaum & North, 2008; Weems & Graham, 2014; Weems et al., 2007), few, if any, prospective studies have examined the mental health effects of an oil spill disaster in relation to exposure to previous natural disasters (Neria, Galea, & Norris, 2013; Yun, Lurie, & Hyde, 2010). Indeed, owing to the nature of the work, there are a limited number of prospective longitudinal studies of children and adolescents in the disaster literature (Goldstein, Osofsky, & Lichtveld, 2011; La Greca, Silverman, Lai, & Jaccard, 2010; Masten et al., 2015; Pfefferbaum et al., 2010). The explosion that started the Gulf oil spill occurred April 20, 2010, and the well was capped after 87 days on July 15, 2010. Large amounts of crude oil and dispersants were released into the Gulf of Mexico, resulting in damage to the environment and disruptions in a way of life for many communities. In this article, a prospective study is presented examining the effects of the stress from this disaster on child and adolescent mental health. There were a number of consequences that may have increased the stress of area residents, including direct exposure to toxins from oil and dispersants, harm to wildlife, damage to the environment, and disruption of the economy. Thus, children and families may have experienced severe
Gulf Oil Spill Effects
the hurricane disaster literature (Weems et al., 2010). Therefore, we predicted gender and minority status to be main effect predictors, but not that the demographic variables would moderate the main effects of oil spill stress on symptoms.
Method Participants
Measures PTSD symptoms were measured with the Katrina Inspired Disaster Screenings (Osofsky, Osofsky, & Hansel, 2012), a modified version of the National Child Traumatic Stress Network Disaster (NCTSN) Assessment and Referral Tool for Children and Adolescents (NCTSN, 2005). The measure was based on the Post Traumatic Stress Reaction Index for Children (PTSD-RI; Frederick, Pynoos, & Nader, 1992), where youth are asked to rate their symptoms in response to disasters. In this study, 20 items are scored from 1 (not at all) to 4 (very much), and total scores range from 20 to 80. Previous research suggests this version has good validity (Kronenberg et al., 2010) and that similar versions of the PTSD-RI modified to assess disaster responses are valid and reliable (NCTSN, 2005; Weems et al., 2010). In the present sample, internal consistency measured by Cronbach’s a was >.90 for both time points.
Procedures Data collection was conducted as part of a school-initiated screening and intervention project. Screening packets, which included the questionnaires and measures described above, were administered to students in prekindergarten through 12th grade in collaboration with schools in the target community. As a school-initiated screening, the content was deemed necessary for the postdisaster educational environment, and parents and guardians provided annual consent for assessments (see Osofsky & Osofsky, 2013; Osofsky, Osofsky, Wells, & Weems, 2014; Osofsky et al., 2009, 2012 for information on the larger project). The measures were administered to students in 4th–12th grades in the classroom with the teacher and a Louisiana State University (LSU) Health Sciences Center clinician present. For students under Grade 4, the screening packets were sent home for the parents to complete and were then returned to the school. Notification was also sent home regarding dates and the option to request that one’s child not participate. Students were given the opportunity to refuse participation on all or parts of the screener at their discretion. Reports, including compilations of students’ responses, were given to the schools to provide them with more information about students’ concerns in an effort to improve services and enhance the school environment. The questionnaires were administered confidentially, but not anonymously, so that it was possible to provide further evaluation for students with elevated mental health
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
This naturalistic study used a prospective design developed from an ongoing community screening program, in collaboration with schools, of schoolchildren who were affected by Hurricane Katrina and the Gulf oil spill. Data were gathered from 1,730 children and adolescents from three parishes (counties) in the Gulf region directly impacted by the oil spill, who were assessed before and after the spill. A total of 1,577 youth (or parents of children under Grade 4) completed all of the screening packet used in this study and are included in the analyses. The sample was evaluated for PTSD symptoms and hurricane exposure between September 2009 and March 2010 pre-oil spill (Time 1), and was again evaluated between September and December 2010, post-oil spill (Time 2), for PTSD symptoms and amount of Gulf oil spill-related stress. The sample included children aged 3–18 years (mean age ¼ 12.39 years), and 56% were girls. Sixteen percent of the sample was under Grade 4 and therefore completed screenings via parent report. Youth reported their race and ethnicity as 56% White, 25% Black, 7% ‘‘mixed,’’ 4% Hispanic, 4% Asian, and 4% other. Approximately 73% of the students were eligible to receive subsidized or free lunch (KIDS COUNT, 2013), and so the sample was largely from lower socioeconomic backgrounds.
Hurricane exposure was measured with a nine-item survey of exposure to hurricanes and their aftermath that was based on the work of NCTSN (Kronenberg et al., 2010; Pfefferbaum et al., 2010) and La Greca, Silverman, and Wasserstein (LaGreca et al. 1996, 1998; Vernberg, LaGreca, Silverman, & Prinstein, 1996). Respondents indicated Yes (1) or No (0) to whether they experienced each event, and these items were summed to make an exposure events score. Items included house destroyed, personal injury, family/friends injured, and family/friends killed. The measure has been shown to have good validity estimates and internal consistency in this sample (a ¼ .71). Gulf oil spill stress was measured with a similar eightitem scale also patterned on the disaster exposure measure of NCTSN (Kronenberg et al., 2010; NCTSN, 2005) and La Greca et al. (1996, 1998). Respondents indicated Yes (1) or No (0) in response to whether they had experienced an event, and these items were summed to make an oil spill stress score. Items included loss of family business, loss of parent’s job, concern over harm to environment, and concern over sickness (see Table I for all items). Internal consistency in this sample was good (a ¼ .77).
3
4
Osofsky, Osofsky, Weems, Hansel, and King Table I. Oil Spill Concerns Endorsed and Item Correlation With PTSD Symptoms by Boys and Girls and by Younger and Older and Minority Status Concern
% Yes
Full sample
Boys
Girls
Younger
Older
Minority
Nonminority
Loss of family business
11
.121*
.122*
.131*
.113
.114*
.144*
.091*
Loss of parents job/work Having to move away
16 11
.147* .135*
.119* .131*
.161* .138*
.208* .320*
.137* .111*
.170* .151*
.132* .118*
Harm to environment
59
.159*
.154*
.155*
.347*
.106*
.140*
.182*
Harm to animals
60
.144*
.155*
.128*
.289*
.100*
.131*
.167*
Loss of activities
53
.164*
.176*
.170*
.282*
.129*
.163*
.184*
Getting sick
30
.264*
.255*
.250*
.387*
.242*
.292*
.233*
Eating local seafood
51
.202*
.201*
.192*
.266*
.170*
.191*
.219*
Note. *Correlation is significant at the .01 level. For this analysis, younger and older groupings are based on reporting status; younger ¼ parent report and older ¼ self-report.
Data Analysis Data were analyzed with descriptive statistics, Pearson correlation, Spearman rho, and linear regression in SPSS 19.0. Because the distributions of PTSD symptoms were heavily skewed, parallel regression analyses were conducted using a log10 transformation to reduce the skew. These are noted below and produced identical conclusions; therefore, analyses focus on the nontransformed PTSD symptoms.
Results Mean PTSD symptoms scores were 27.94 (10.5) and 27.56 (10.4) for the two time points, and intraclass correlation coefficients (ICC absolute agreement) indicated a fairly high level of stability in PTSD symptoms (Time 1 to 2 ICC ¼ .61). Visual inspection of the distributions of PTSD symptoms suggested that they were positively skewed (skewness > 1.9), while the summed hurricane exposure variable and oil spill stress variable were fairly normally distributed (skewness < 0.12). In terms of previous hurricane exposure, 93% of the sample endorsed at least one item, with the average endorsing 50% of the items. In terms of oil spill stress, 73% endorsed at least one item, with the average endorsing 36% of the items. A summary of endorsements on each of the oil spill stress items are presented in Table I, with the most common concerns being harm to the environment and animals. Table I also presents the correlations between each of the individual oil spill stress items and PTSD symptoms to explore possible oil spill stress item-level differences. However, the table shows a pattern of similar associations across items and across subsamples of males and females, age-groups, and minority status. Thus, the
main hypothesis-testing analyses focus on the summed oil spill stress items. The summed oil spill stress variable was significantly correlated with Time 2 PTSD symptoms (r ¼ .28, p < .001; ¼ .35, p < .001) accounting for 8% of the variance. Linear regression analysis next tested whether oil spill stress was associated with post-oil spill PTSD symptoms at Time 2, while controlling for both Time 1 PTSD symptoms and previous hurricane exposure, age, minority status (coded nonminority ¼ 1, minority ¼ 2), and gender (coded boys ¼ 1, girls ¼ 2). Results indicated that Time 2 PTSD symptoms were significantly predicted (p < .05) by preexisting PTSD symptoms (18.7% unique variance), previous hurricane exposure (0.7% unique variance), girl gender (1.2% unique variance), and minority status (0.4% unique variance). Moreover, level of oil spill stress remained a significant predictor (accounting for 1.2% unique variance) of PTSD symptoms. Using a log10 transformation to reduce skew in the dependent variable produced identical conclusions. Interaction terms were added in a second step of the regression analysis to test the hypothesis that oil spill stress interacts with preexisting symptoms to predict post-oil spill PTSD symptoms. PTSD symptoms at Time 2 were the dependent variable with interaction terms of PTSD symptoms at Time 1 by oil spill stress, oil spill stress by hurricane exposure, hurricane exposure by PTSD at Time 1, and the three-way interaction of PTSD at Time 1 by oil spill stress by hurricane exposure. All variables were centered using standard scores to reduce the influence of multicolinearity. Results indicated a significant three-way interaction term. A summary of this final regression model is presented in Table II. Inspection of variance inflation factors and tolerance indicated acceptable levels in all regression analyses. Again, using a log10 transformation to reduce skew in the dependent variable produced identical conclusions with the significant interaction remaining.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
symptoms or for those that requested services. This study was submitted and received approval by the institutional review board at LSU Health Sciences Center.
Gulf Oil Spill Effects
5
Table II. Summary of Final Regression Model Predicting Time 2 PTSD Symptoms Coefficients Model
Correlations
B
SE
t
Sig.
Intercept
27.242
.220
123.563
.000
PTSD pre
4.978
.222
22.450
.000
.583**
.433**
1.186 0.130
.208 .223
5.717 0.581
.000 .562
.158** .070**
.110** .011
Minority
0.641
.207
3.094
.002
.084**
.060**
Oil spill stress
1.278
.227
5.626
.000
.271**
.109**
Hurricane exposure
1.015
.234
4.335
.000
.266**
.084**
Gender Age
Zero order
Semipartial
Hurricane by oil spill stress
0.061
.209
0.290
.771
.039
PTSD pre by oil spill stress
0.183
.231
0.795
.427
.171**
PTSD pre by hurricane
1.259
.220
5.717
.000
.277**
.110**
PTSD pre by hurricane by oil spill stress
0.590
.194
3.045
.002
.293**
.059**
.006 .015
stress exacerbated the PTSD symptoms of those with preexisting PTSD symptoms related to high hurricane exposure. In addition, there was a significant difference between Slopes 1 and 2 in Figure 1 (p ¼ .002, two tailed), demonstrating a diminished effect of the Gulf oil spill on Time 2 PTSD symptoms among those with high hurricane exposure but low PTSD symptoms at Time 1. Finally, among those with low pre-oil spill PTSD symptoms (Lines 2 and 4), those with low previous hurricane exposure were more affected by the oil spill than those with high previous exposure (p ¼ .023, two tailed).
Gender, Age, and Ethnicity Analyses
Figure 1. Amount of oil spill stress interacts with prespill Time 1 PTSD symptoms and previous hurricane exposure to predict post-oil spill Time 2 PTSD symptoms. Note. PTSD ¼ posttraumatic stress disorder symptoms.
The nature of the interaction is depicted in Figure 1. Post hoc analysis of the interaction (Dawson & Richter, 2006; Holmbeck, 2002) indicated that among those with high PTSD symptoms at Time 1 and high previous hurricane exposure, those with high oil spill stress had the highest Time 2 PTSD symptoms. In other words, oil spill
A number of supplemental analyses were conducted to ensure findings were not affected by age, gender, and minority status. The oil spill stress item correlations with Time 2 PTSD symptoms were explored by boys and girls, reporter status (older [self-report] vs. younger [parent report]), and minority status. Results are summarized in Table I and show a fairly similar pattern of associations across groupings with one exception in that there was a pattern of larger correlations by parent report. The itemlevel data in Table I are primarily descriptive with the formal tests of moderation done on the summed variables. Thus, the final set of analyses formally tested age, gender, and minority status as moderators of the effects of stress related to the oil spill (summed total stress) on Time 2 PTSD symptoms (e.g., the age by oil spill stress interaction was tested in predicting Time 2 PTSD symptoms). The results indicated these demographic factors did not significantly affect the link between stress related to the oil spill and PTSD symptoms (age was tested as a continuous moderator as well as by reporter group status). That is, there
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
Note. PTSD ¼ posttraumatic stress symptoms. B ¼ Beta; SE ¼ Standard Error; t ¼ t statistic; Sig. ¼ Significant. **p < .01.
6
Osofsky, Osofsky, Weems, Hansel, and King
were no significant demographic variable by oil spill stress interactions.
Discussion
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
This study of school-age children and adolescents assessed pre- and post-Gulf oil spill showed that PTSD symptoms were predicted by oil spill-related stress. This study is unique in that, to the best of the authors’ knowledge, there have been no systematic reports on child and adolescent trauma symptoms before and after an oil spill. This study also adds to the limited literature on the effects of disasters on youth over time (Kilmer & Gil-Rivas, 2010; Kronenberg et al., 2010; La Greca et al., 1996, 1998, 2010, 2013; Weems, et al., 2010), where the students were assessed with the same measure in the year before the oil spill as they were 1 year following the event. The link between level of oil spill stress and PTSD symptoms was evident across age and minority groups for both boys and girls. This study helps to empirically demonstrate that the linkage between stress related to the Gulf oil spill and PTSD symptoms in youth is not simply due to preexisting symptoms. Importantly, there does appear to be a cumulative interactive effect such that those with high preexisting PTSD symptoms, high previous hurricane exposure, and high oil spill-related stress had the most elevated post-oil spill PTSD symptoms (see Figure 1). This finding demonstrates the synergistic and disproportionate consequences of cumulative stress and trauma on youth with preexisting difficulties. This study provides new data on a technological disaster, extending previously available work on natural disasters. Previous work following natural disasters has indicated that PTSD symptoms are uniquely predicted by exposure to hurricane events (La Greca et al., 1998, 2010; Weems et al., 2007); however, a link between PTSD symptoms and oil spill stress has not been previously shown among youth. Findings from prior studies related to demographics factors as main-effect predictors, particularly age, have been mixed (Masten & Osofsky, 2010; Masten et al., 2015). Results from this study indicated that girl gender and being from a minority group were associated with increased levels of post-oil spill PTSD symptoms, which is consistent with previous research (Masten et al., 2015; Weems et al., 2007, 2010). However, the prediction of symptoms by oil spill stress did not differ across age, gender, or minority status (i.e., while gender and minority status predicted PTSD post-oil spill, age, gender, or minority status did not moderate the effects of the oil spill on
PTSD symptoms). This study, therefore, substantiated the hypothesis that PTSD symptoms were predicted by level of oil spill stress in youth across age, gender, and minority status following the Gulf oil spill. Interestingly, among students with low pre-oil spill PTSD symptoms (comparison of Lines 2 and 4 in Figure 1), those with low previous hurricane exposure were more affected by the oil spill than those with high previous exposure (p ¼ .023, two tailed). This finding can be interpreted to mean that those youth who were exposed to high levels of previous hurricane experiences but did not react to these events with elevated PTSD symptoms (i.e., were resilient to the effect of previous disasters) were also resilient to the effect of high levels of oil spill stress. However, students who did not have previous hurricane experience were more impacted (albeit modestly) by high oil spill stress. While this study has several methodological advances, including the use of prospectively collected disaster response data, it is not without limitations. Residents living on the Gulf Coast of the United States have experienced multiple natural disasters. The Gulf Coast has also been impacted by coastal erosion, loss of wetlands, economic considerations related to oil drilling and the petrochemical industry, and the effects of this industry on the ecosystem and, possibly, on physical and behavioral health (Osofsky et al., 2014). The main limitation, common with disaster studies (Masten & Osofsky, 2010; Masten et al., 2015), is that definitive causal conclusions about the linkages reported in this study cannot be made owing to the naturalistic design. Other areas of the country, with different prior and current traumas, might have somewhat different responses to a technological disaster. However, the findings of this study, controlling for prior exposure, establish a link between the Gulf oil spill and symptoms in a population of youth affected by cumulative trauma and multiple disasters. It is also important to note that the large size of sample makes relatively small associations statistically significant. Thus, while findings were statistically significant, the effects in this study were in the small to medium range. Finally, we did not examine potentially traumatic events other than the disasters. Therefore, while the Time 1 measures of PTSD symptoms account for preexisting difficulties, we do not know how exposure to other types of traumas (e.g., assault) may have impacted findings. In understanding and responding to the effects of technological disasters on children and families, it is important to have a developmental and public health perspective and consider the impact of the disaster not only on the ecosystem but also on the physical and mental health of those affected. The findings of this study support the
Gulf Oil Spill Effects
Acknowledgment Appreciation is expressed to the LSU Health Sciences Center Department of Psychiatry team that worked on this project.
Funding This research is partially supported as a component of the Gulf Region Health Outreach Program developed jointly by BP and the Plaintiffs’ Steering Committee as part of the Deepwater Horizon Medical Benefits Class Action Settlement, which was approved by the US District Court in New Orleans on January 11, 2013 and became effective on February 12, 2014, and SAMHSA Grant 5U79SM6203 to the Louisiana Rural Trauma Services Center, Baptist Community Ministries, and the Robert Wood Johnson Foundation.
References Comer, J. S., Fan, B., Duarte, C. S., Wu, P., Musa, G. J., Mandell, D. J., . . . Hoven, C. W. (2010). Attack-related life disruption and child psychopathology in New York City public schoolchildren 6-months post9/11. Journal of Clinical Child and Adolescent Psychology, 39, 460–469. Dawson, J. F., & Richter, A. W. (2006). Probing threeway interactions in moderated multiple regression: Development and application of a slope difference test. Journal of Applied Psychology, 91, 917–926. DiGangi, J. A., Gomez, D., Mendoza, L., Jason, L. A., Keys, C. B., & Koenen, K. C. (2013). Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature. Clinical Psychology Review, 33, 728–744. Frederick, C., Pynoos, R. S., & Nader, K. O. (1992). Childhood Post-Traumatic Stress Reaction Index (CPTSRI), Unpublished manuscript, University of California, Los Angeles. Furr, J. M., Comer, J. S., Edmunds, J. M., & Kendall, P. C. (2010). Disasters and youth: A metaanalytic examination of posttraumatic stress. Journal of consulting and clinical psychology, 78, 765. Gill, D. A., Picou, J., & Ritchie, L. A. (2012). The Exxon Valdez and BP oil spills: A comparison of initial social and psychological impacts. The American Behavioral Scientist, 56, 3–23. Goldstein, B. D., Osofsky, H. J., & Lichtveld, M. (2011). The Gulf oil spill. New England Journal of Medicine, 364, 1334–1348. Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and meditational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96. Kessler, R. C., Galea, S., Gruber, M. J., Sampson, N. A., Ursano, R. J., & Wessely, S. (2008). Trends in mental illness and suicidality after Hurricane Katrina. Molecular Psychiatry, 13, 374–384. KIDS COUNT. (2013). Data book: State trends in child well-being. [Pamphlet] Baltimore, MA: The Annie E. Casey Foundation. Kilmer, R. P., & Gil-Rivas, V. (2010). Exploring posttraumatic growth in children impacted by Hurricane Katrina: Correlates of the phenomenon and developmental considerations. Child Development, 81, 1211–1227. Kronenberg, M. E., Hansel, T. C., Brennan, A. M., Osofsky, H. J., Osofsky, J. D., & Lawrason, B. (2010). Children of Katrina: Lessons learned about
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
importance of understanding the mental and behavioral health sequelae in children and adolescents in impacted communities and the interdependence with other stresses that co-occurred with the Gulf oil spill disaster. The findings serve to augment similar studies of technological disasters indicating an increased stress response (Gill et al., 2012; Palinkas et al., 1993, 2004; Picou & Gill, 1996), and reinforce the importance of developing systems that support individual, school, and community mental and behavioral health needs following a technological disaster such as an oil spill. While many of the consequences of the Gulf oil spill would not typically be considered traumatic, our findings suggest that associated stresses may exacerbate existing difficulties associated with exposure to trauma. Thus, the vulnerability of children and families to the economic and ecological consequences of these technological disasters can extend to the mental health problems of youth. The data from this study provide important naturally occurring findings from what may be the largest sample of pre- and postdisaster research on children and adolescents in the current literature. A new association has been established between oil spill stress and PTSD symptoms, controlling for preexisting PTSD symptoms, incrementally substantiating research from previous studies on the effects of disasters on children and youth. Implications of these findings highlight the importance of preparedness, especially for those in vulnerable areas, as well as early and continuing response for children and adolescents to support mental and behavioral health recovery to optimize development.
7
8
Osofsky, Osofsky, Weems, Hansel, and King
Report to the President. Retrieved from http://www. oilspillcommission.gov/final-report Neria, Y. N., Galea, S., & Norris, F. (Eds.), (2013). Disaster mental health research: Past, present, and future. Cambridge: Cambridge University Press. Norris, F., Stevens, S., Pfefferbaum, B., Wyche, K., & Pfefferbaum, R. (2008). Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. American Journal of Community Psychology, 41, 127–150. Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress, 19, 339–347. Osofsky, J. D., & Osofsky, H. J. (2013). Lessons learned about the impact of disasters on children and families and post-disaster recovery. In A. Culp (Ed.) (Ed.), Child and family advocacy (pp. 91–105). New York: Springer. Osofsky, J. D., Osofsky, H. J., & Hansel, T. C. (2012). Special considerations for children and adolescents in psychosocial assessment and surveillance. Disaster psychosocial assessment and surveillance toolkit: Methods to enhance disaster preparedness, response and recovery, Retrieved from: http://www. medschool.lsuhsc.edu/psychiatry/docs/Disaster%20 PAST%20Toolkit.pdf Osofsky, H. J., Osofsky, J. D., Kronenberg, M., Brennan, A., & Hansel, T. C. (2009). Posttraumatic stress symptoms in children after Hurricane Katrina: Predicting the need for mental health services. American Journal of Orthopsychiatry, 79, 212–220. Osofsky, H. J., Osofsky, J. D., Wells, J. H., & Weems, C. F. (2014). Meeting mental health needs after the Gulf Oil Spill. Psychiatric Services, 65, 280–283. Palinkas, L. A., Patterson, J. S., Russell, J., & Downs, M. A. (1993). Community patterns of psychiatric disorders after the Exxon Valdez oil spill. American Journal of Psychiatry, 150, 1517–1523. Palinkas, L., Patterson, J. S., Russell, J. C., & Downs, M. A. (2004). Ethnic differences in symptoms of post-traumatic stress after the Exxon Valdez oil spill. Disaster Medicine, 19, 102–112. Pfefferbaum, B., Houston, J. B., Reyes, G., Steinberg, A. M., Pynoos, R. S., Fairbank, J. A., . . . Maida, C. A. (2010). Building national capacity for child and family disaster mental health research. Professional Psychology: Research and Practice, 41, 26–33.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
postdisaster symptoms and recovery patterns. Child Development, 81, 1241–1259. La Greca, A. M., Lai, B. S., Llabre, M. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (2013). Children’s postdisaster trajectories of pts symptoms: Predicting chronic distress. Child & Youth Care Forum, 42, 351–369. La Greca, A. M., Silverman, W. K., Lai, B., & Jaccard, J. (2010). Hurricane-related exposure experiences and stressors, other life events, and social support: Concurrent and prospective impact on children’s persistent posttraumatic stress symptoms. Journal of Consulting and Clinical Psychology, 78, 794–805. La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. (1996). Symptoms of posttraumatic stress after Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64, 712–723. La Greca, A. M., Silverman, W. K., & Wasserstein, S. B. (1998). Children’s predisaster functioning as a predictor of posttraumatic stress following Hurricane Andrew. Journal of Consulting and Clinical Psychology, 6, 883–892. Lai, B. S., La Greca, A. M., Auslander, B. A., & Short, M. B. (2013). Children’s symptoms of posttraumatic stress and depression after a natural disaster: Comorbidity and risk factors. Journal of Affective Disorders, 146, 71–78. Masten, A. S., Narayan, A. J., Silverman, W. K., & Osofsky, J. D. (2015). Children in war and disaster. In M. H. Bornstein, T. Leventhal, & R. Lerner (Eds.), Handbook of child psychology: Ecological settings and processes, (Vol. IV, 7th ed). New York: Wiley. Masten, A., & Osofsky, J. D. (2010). Disasters and their impact on child development: Introduction to the special section. Child Development, 81, 1029–1039. McLaughlin, K. A., Fairbank, J. A., Gruber, M. J., Jones, R. T., Osofsky, J. D., Pfefferbaum, B., . . . Kessler, R. C. (2010). Trends in serious emotional disturbance among youths exposed to Hurricane Katrina. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 990–1000. National Child Traumatic Stress Network. (2005). Hurricane Assessment and Referral Tool for Children and Adolescents. , Retrieved from http://www. nctsnet.org/nctsn_assets/pdfs/intervention_manuals/ referraltool.pdf National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling. (2011). Deep water: The gulf oil disaster and the future of offshore drilling,
Gulf Oil Spill Effects
trait anxiety and negative affect predict posttraumatic stress in youth after Hurricane Katrina. Journal of Consulting and Clinical Psychology, 75, 154–159. Weems, C. F., Scott, B. G., Banks, D. M., & Graham, R. A. (2012). Is TV traumatic for all youths? The role of pre-existing posttraumatic stress symptoms on the link between disaster coverage and stress. Psychological Science, 23, 1293–1297. Weems, C. F., Taylor, L. K., Cannon, M. F., Marino, R. C., Romano, D. M., Scott, B. G., . . . Triplett, V. (2010). Posttraumatic stress, context, and the lingering effects of the Hurricane Katrina disaster among ethnic minority youth. Journal of Abnormal Child Psychology, 38, 49–56. Yun, K., Lurie, N., & Hyde, P. (2010). Moving mental health into the disaster-preparedness spotlight. New England Journal of Medicine, 363, 1193–1195.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on November 16, 2015
Pfefferbaum, B., & North, C. S. (2008). Research with children exposed to disasters. International Journal of Methods in Psychiatric Research, 17, S49–S58. Picou, J. S., & Gill, D. A. (1996). The Exxon Valdez oil spill and chronic psychological stress. In S. D. Rice, R. B. Spies, D. A. Wolfe, & B. A. Wright (Eds.), Proceedings of the Exxon Valdez oil spill symposium: 18th American Fisheries Society Symposium (pp. 879– 893). Bethesda, MD: American Fisheries Society. Vernberg, E. M., LaGreca, A. M., Silverman, W. K., & Prinstein, M. (1996). Predictors of children’s post-disaster functioning following Hurricane Andrew. Journal of Abnormal Psychology, 105, 237–248. Weems, C. F., & Graham, R. A. (2014). Resilience and trajectories of posttraumatic stress among youth exposed to disaster. Journal of Child and Adolescent Psychopharmacology, 24, 2–8. Weems, C. F., Pina, A. A., Costa, N. M., Watts, S. E., Taylor, L. K., & Cannon, M. F. (2007). Pre-disaster
9
