American Journal of Orthopsychiatry 2014, Vol. 84, No. 2, 142–151

© 2014 American Orthopsychiatric Association DOI: 10.1037/h0099382

The Deepwater Horizon Oil Spill and the Mississippi Gulf Coast: Mental Health in the Context of a Technological Disaster Christopher F. Drescher, Stefan E. Schulenberg, and C. Veronica Smith

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The University of Mississippi

A significant percentage of disaster survivors experience negative psychological, physical, and social outcomes after a disaster. The current study advances the literature concerning the Deepwater Horizon Oil Spill (the Gulf Oil Spill) while addressing weaknesses of previous research. The current study includes a clinical sample of 1,119 adults receiving mental health services in the coastal counties of Mississippi after the Gulf Oil Spill. The levels of clinical symptoms reported on the Depression Anxiety Stress Scales (DASS-21) and PTSD Checklist (PCL-S) were examined in relation to other domains of functioning potentially affected by the spill (finances, social relationships, and physical health). Participants reported substantial worsening of their functioning across each life domain. Furthermore, chronic problems in living related to the Gulf Oil Spill were significantly associated with higher levels of psychological distress, although the pattern differed somewhat for persons living above and below the poverty line, with lower income individuals reporting a higher level of overall distress. These data support the perspective that the experience of the Gulf Oil Spill is strongly associated with a deleterious effect on mental health symptoms.

P

relations than other disasters (Palinkas, 2012). Despite this variability, there are also many commonalities among disasters and reviews of the disaster literature can be particularly informative. Reviews of disaster studies conclude that posttraumatic stress disorder (PTSD; see Neria, Nandi, & Galea, 2008), depression (see Maguen, Neria, Conoscenti, & Litz, 2009), and other anxiety-related disorders (see McFarlane, Van Hooff, & Goodhew, 2009) are the most commonly observed psychological problems experienced by disaster survivors (Bonanno et al., 2010; Norris et al., 2002). These effects are moderated by a number of risk and resilience factors such as socioeconomic status, or SES (lower SES being associated with greater postdisaster distress), ethnicity (minority individuals experiencing greater distress following disasters), and gender (women reporting longer lasting and more severe stress reactions; Halpern & Tramontin, 2007; Hawkins, Zinzow, Amstadter, Danielson, & Ruggiero, 2009; Kimerling, Mack, & Alvarez, 2009). Additionally, disasters can produce chronically stressful life conditions that can lead to declines in physical health status (Bonanno et al., 2010). Although less frequently included in research of disaster survivors, physical health problems and chronic problems in living (e.g., financial or occupational stress, disruption of social relationships) are also often observed (Norris et al., 2002). Within the first year (and in some cases beyond the first year) following a disaster, chronic health problems often emerge which are attributed to disaster exposure (Yzermans, van den Berg, & Dirkzwager, 2009). Physical health problems can emerge either as a direct result of disasters (e.g., exposure to toxic material), indirectly as a result of

revious research has demonstrated that a significant percentage of disaster survivors experience negative psychological, physical, and social outcomes in the months and years after a disaster (Bonanno, Brewin, Kaniasty, & La Greca, 2010; Norris et al., 2002). The current study reports on these negative effects in a clinical sample of individuals living on the Mississippi Gulf Coast after the Deepwater Horizon Oil Spill (also known as the Gulf Oil Spill). To better understand the potential impact of the Gulf Oil Spill on the mental health of those affected, the current study examined mental health symptoms and their relationship to physical health, social relations, and financial problems in the context of this technological disaster. Disasters can have wide-ranging impacts at the cultural, economic, community, and familial levels, which in turn influence the mental health of community members over time (Bonanno, 2012; Palinkas, 2012). Individual disasters will vary in important ways that affect how their impacts are experienced. For example, oil spills have a longer duration and are more disruptive of social

Christopher F. Drescher, Stefan E. Schulenberg, and C. Veronica Smith, Department of Psychology, The University of Mississippi. The data for the present study were collected through a contract between Dr. Schulenberg and the Mississippi Department of Mental Health, which funded the clinical sites through a grant program made possible by funding from BP p.l.c. Dr. Schulenberg and the members of the research team evaluated the clinical services provided by the sites funded under this grant. Correspondence concerning this article should be addressed to Stefan E. Schulenberg, The University of Mississippi, 207 Peabody Building, University, MS 38677. E-mail: [email protected] 142

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MENTAL HEALTH AND THE GULF OIL SPILL

chronic stress (Bonanno et al., 2010), or because of psychological disorders (Yzermans et al., 2009). Economic resource loss following disasters may be particularly influential concerning long-term mental health outcomes. For example, Arata, Picou, Johnson, and McNally (2000) found that income loss among fisherman following the Exxon Valdez Oil Spill was associated with elevated levels of anxiety, depression, and posttraumatic stress. Additionally, Arata et al. found that deterioration in social relations (i.e., social resource loss) was associated with mental health symptomology. The relationship between social relations and disaster outcomes is somewhat unclear, with some studies reporting an increase in social conflicts following disasters (Hutchins & Norris, 1989) and others reporting that disasters actually increased closeness within social relationships (e.g., Kessler, Galea, Jones, & Parker, 2006). Diverse findings may be the result of an initial rush of helping and social support immediately after a disaster, followed by declining social support over time (Kaniasty & Norris, 2009). This social support deterioration may then lead to declines in both physical and mental health (Kaniasty & Norris, 2009). The effects of disasters on physical health, financial resources, and social relationships can manifest in a variety of reactions. It is common for disaster survivors to experience physical (e.g., nausea, fatigue, headaches), behavioral (e.g., dietary changes, avoidance of disasters cues, substance use), emotional (e.g., distress, emotionality, irritability), and cognitive (e.g., worry, concentration difficulties, forgetfulness) stress reactions (Halpern & Tramontin, 2007). Most disaster survivors (ⱖ70%) successfully cope with these difficulties without the necessity for clinical treatment (Bonanno et al., 2010). However, understanding the factors that are related to the significant minority of disaster survivors who do need clinical attention is important. The current study focuses on a large sample of adults seeking mental health services to examine the relationship between physical health, social relations, and financial problems associated with mental health symptoms in the context of the Gulf Oil Spill, with particular attention to potentially important differences across economic groups.

The Gulf Oil Spill On April 20, 2010, an explosion on the BP-operated Deepwater Horizon oil rig caused 4.9 million barrels of oil to be spilled into the Gulf of Mexico over a period of about three months (McNutt et al., 2011). Reviews of research concerning the psychological effects of previous oil spills have demonstrated significant, negative mental health effects in survivors (e.g., Aguilera, Méndez, Pásaro, & Laffon, 2010). A recent review of the effects of the seven oil spills that have previously been studied (beginning with the Exxon Valdez Oil Spill in 1993) concluded that oil spills have “psychological consequences and continuing disruptive and stressprovoking consequences for resident communities” (Aguilera et al., 2010, p. 298). For a subset of people, this technological disaster will have a significant impact on psychological and physical health, as well as chronic problems in living. Despite the growing body of literature surrounding the psychological effects around oil spills, each spill occurs in a unique context and one cannot assume that the effects will be equivalent across spills (Sabucedo, Arce, Ferraces, Merion, & Duran,

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2009). Although comparisons have been made between the Gulf Oil Spill and the Exxon Valdez Oil Spill (Gill, Picou, & Ritchie, 2012), 19 times more oil was released into the Gulf of Mexico than into Prince William Sound. Moreover, many residents living on the Gulf Coast at the time of the Gulf Oil Spill endured the devastating and complex effects of Hurricane Katrina 5 years earlier. Galea et al. (2007) found that 82% of Gulf Coast residents, excluding New Orleans residents, experienced at least one hurricane-related stressor, with half of their sample experiencing multiple stressors. Additionally, when considering only “traumatic” experiences (e.g., life-threatening experiences, victimization, death of a loved one, or victimization of a loved one), 17% of their sample outside of New Orleans reported experiencing some type of trauma (Galea et al., 2007). Importantly, these stressors and traumatic experiences were strongly associated with reported mood and anxiety disorders (Galea et al., 2007). The effects of Hurricane Katrina will likely be ongoing for years to come (see, e.g., Rhodes et al., 2010), and there is new concern with regard to the deleterious effects (e.g., community stress, individual mental health) for a range of Gulf Coast disasters, Hurricanes Gustav and Isaac being examples (Burdeau & Kunzelman, 2012; Harville et al., 2011; Peebles, 2012; Salloum, Carter, Burch, Garfinkel, & Overstreet, 2011). Beyond the contributions of distinct community stressors like natural disasters, the low socioeconomic status of the region serves as a chronic community stressor. For the years 2009 –2010, the four Gulf Coast states affected by the Gulf Oil Spill (Alabama, Florida, Louisiana, and Mississippi) all had median incomes below the national median income ($50,002), with Alabama ($40,808) and Mississippi ($36,821) representing the fourth lowest and lowest median incomes in the United States, respectively (U.S. Census Bureau, 2011a). Poverty is associated with, among other things, an increased risk for psychological disorders and suicide attempts (Sareen, Afifi, McMillan, & Asmundson, 2011), and poverty is consistently linked with worse postdisaster outcomes (Norris et al., 2002). Thus, the Gulf Oil Spill directly affected some of the most impoverished areas of the United States, areas that exist in a vulnerable economic state with histories of previous disasters, and that are at risk to experience disasters in the future. Even though a number of authors have speculated about the effects of the Gulf Oil Spill (e.g., Goldstein, Osofsky, & Lichtveld, 2011; Osofsky, Palinkas, & Galloway, 2010; Yun, Lurie, & Hyde, 2010), few empirical articles have been published that directly examine these effects. However, emerging research concerning the mental health effects of the Gulf Oil Spill on community members living on the Gulf Coast (Florida, Alabama) following the spill indicates elevated levels of depression and tension- and anxiety-related symptoms (Grattan et al., 2011). In addition, individuals who reported spill-related loss of income were more likely to present with clinical impairment in the areas of depression and anxiety (Grattan et al., 2011). Likewise, Gill et al. (2012) found high levels of PTSD symptoms among residents in south Mobile County (AL) in the aftermath of the Gulf Oil Spill, with 18% of respondents reporting severe PTSD symptoms. Also, they found that economic loss and family health concerns associated with the spill were significant predictors of PTSD symptomology. Finally, Osofsky, Osofsky, and Hansel (2011) found that 21% of Louisiana Gulf Coast community members met clinical cutoffs for either PTSD symptoms or other forms of serious mental

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illness. The perceived effects of the oil spill in financial, social, physical health, and other domains significantly predicted PTSD and other mental health symptoms (Osofsky et al., 2011). The prevalence rates of PTSD symptomology identified by Osofsky et al. and Gill et al. are just above the lower end of the reported range of PTSD prevalence rates following technological disasters (15% to 75%; Neria et al., 2008). The work reviewed previously is an important early step in evaluating the mental health effects of the Gulf Oil Spill. However, there are several areas that remain to be addressed. First, the studies noted focused on community samples; examining the effects of the spill on clinical samples could elucidate how the spill is affecting vulnerable individuals and indicate the impact of the spill among those actively seeking mental health services. Examining the effects of the Gulf Oil Spill among those seeking mental health services is strategically useful as results from such studies are directly applicable to service providers’ work with disaster survivors. Second, the studies have primarily focused on one possible chronic problem in living (loss of material resources), while downplaying other potentially important domains (e.g., social relationships). For example, although Osofsky et al. (2011) did measure a variety of domains, these domains were combined into an aggregate score, obscuring possible differential relations to mental health symptoms across domains. Although it is useful to create aggregate scores for psychometric reasons, we believe that it is also useful to examine these effects separately so that one can better understand the unique contributions of each factor. Finally, noticeably absent from the previous studies has been the inclusion of participants from the Mississippi Gulf Coast. Although Mississippi has a relatively small stretch of coastal land, the particularly difficult economic and social conditions present in Mississippi may make its residents especially susceptible to an increase in psychological distress following the spill. Disaster studies have generally found that individuals with a lower SES experience greater postdisaster distress and this effect increases with severity of exposure (Halpern & Tramontin, 2007). As previously mentioned, Mississippi has the lowest median income of any U.S. state and also ranks poorly on a variety of indicators of well-being, including teen pregnancy (5th highest state rate in 2005; Kost, Henshaw, & Carlin, 2010), percent of smokers (5th highest state rate in 2010; Centers for Disease Control & Prevention, 2010), and educational attainment (2nd lowest state rate in 2009; U.S. Census Bureau, 2011b). Such difficult economic conditions may make recovery from the Gulf Oil Spill especially difficult. The current study aims to advance the literature concerning the Gulf Oil Spill, while overcoming some of the limitations of previous research. The current sample includes 1,119 adults receiving services from mental health agencies in the coastal counties of Mississippi following the Gulf Oil Spill. The levels of reported depression, anxiety, stress, and posttraumatic stress symptoms were examined in relation to other domains of functioning potentially affected by the spill. Overall, high levels of declines in measured life domains (finances, social relationships, and physical health) as well as high levels of self-reported mental health symptoms were expected. In concordance with previous research findings, it was expected that individuals living below the poverty line would express greater levels of clinical symptoms. Furthermore, it was expected that problems in the financial, social, and physical

domains related to the Gulf Oil Spill would be significantly associated with higher levels of psychological distress.

Method Participants All participants in this study were adult clients in various mental health agencies on the Gulf Coast of Mississippi. Of the 1,119 participants for this sample, 54.8% (n ⫽ 613) were female. The ages of the sample ranged from 18 to 79 years of age with an average age of 38.76 (SD ⫽ 12.73). The majority of the sample (n ⫽ 765; 68.4%) reported being white/nonHispanic. The second largest racial group was African Americans (n ⫽ 236), constituting 21.1% of the sample. A large majority reported an annual income level below $19,999 (n ⫽ 833; 74.4%), with an equally large majority reporting at least a high school education (n ⫽ 854; 76.4%). Participants in this study were part of a larger grant-funded project (described later) to provide clinical services to Mississippi Gulf Coast residents following the Gulf Oil Spill.1 Participants included clients who had been receiving services for both long and brief periods of time, as well as new clients.

Measures Depression Anxiety Stress Scales (DASS-21). Participants were asked to complete the short-form version of the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995), the DASS-21. Scores on the depression, anxiety, and stress scales of the DASS-21 range from 0 to 42. An example of cutoff scores, suggested by the Psychology Foundation of Australia (2011), is as follows for depression: 0 to 9 (normal depression), 10 to 13 (mild depression), 14 to 20 (moderate depression), 21 to 27 (severe depression), and ⱖ28 (extremely severe depression). The cutoffs are 0 to 7 (normal), 8 to 9 (mild), 10 to 14 (moderate), 15 to 19 (severe), and ⱖ20 (extremely severe) for anxiety. For stress, the cutoffs are 0 to 14 (normal), 15 to 18 (mild), 19 to 25 (moderate), 26 to 33 (severe), and ⱖ34 (extremely severe). When compared with normative data from a nonclinical U.S. sample (Sinclair et al., 2012), the extremely severe ranges are approximately one standard deviation above the mean. In the current study, all three scales yielded reliable scores, with alpha coefficients of .89 and above (see Table 1). Investigations of the DASS-21 have consistently supported its use in community and clinical samples. Factor analytic studies have suggested the depression, anxiety, and stress scales measure distinct aspects of psychopathology (Antony, Bieling, Cox, Enns, & Swinson, 1998; Clara, Cox, & Enns, 2001; Henry & Crawford, 2005; Norton, 2007). Depression (␣ ⫽ .82 to .94), anxiety (␣ ⫽ .78 to .87), and stress (␣ ⫽ .87 to .92) scale scores have displayed respectable to very good internal consistency (using DeVellis’ 2012 guidelines) and have demonstrated good

1

This research was funded in part by a grant from the Mississippi Department of Mental Health (MS DMH). Although MS DMH funded this research, the conclusions and findings herein do not necessarily reflect the views of the State of Mississippi.

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Table 1. Descriptive Statistics and Impairment Frequencies for the DASS-21 Descriptive statistics

Depression Anxiety Stress

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Note.

Clinical cut-offs (n/%)



Low score

High score

Mean

Standard deviation

Normal

Mild

Moderate

Severe

Extremely severe

.94 .89 .92

0 0 0

42 42 42

13.88 11.68 16.22

12.79 11.29 12.29

466 (41.6%) 459 (41.0%) 523 (46.7%)

103 (9.2%) 81 (7.2%) 95 (8.5%)

174 (15.5%) 152 (13.6%) 146 (13.0%)

98 (8.8%) 84 (7.5%) 165 (14.7%)

202 (18.1%) 270 (24.1%) 114 (10.2%)

Percentages do not add up to 100% because some participants did not complete each of the measures.

convergent and discriminant validity (Antony et al., 1998; Henry & Crawford, 2005; Norton, 2007). PTSD Checklist – Stressor Specific Version (PCL-S). Participants also completed the PTSD Checklist – Stressor Specific Version (PCL-S; Weathers, Huska, & Keane, 1991). The PCL is one of the most commonly used measures of PTSD symptoms in the literature (Wilkins, Lang, & Norman, 2011).2 The 17 items of the PCL-S represent the three PTSD symptom clusters as defined by the DSM–IV (reexperiencing, avoidance, and hyperarousal; American Psychiatric Association, 2000). Each item is evaluated on a Likert-type scale ranging from 1 (not at all) to 5 (extremely), with possible total scores ranging from 17 to 85. The PCL-S allows users to identify a specific stressor for participants to respond to when completing items; the stressor on the PCL-S was identified as the “Gulf Oil Spill.” Initial studies of the PCL demonstrated very good internal consistency for the total score and three symptom clusters (␣ ⫽ .82 to .94) and excellent diagnostic efficiency of the measure (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996; Weathers, Litz, Herman, Huska, & Keane, 1993). In the current study, the total scale scores were found to be reliable (␣ ⫽ .97). More recent studies have continued to support the internal consistency, test– retest reliability, convergent and discriminant validity, and diagnostic utility of PCL scores (Adkins, Weathers, McDevitt-Murphy, & Daniels, 2008; Ruggiero, Del Ben, Scotti, & Rabalais, 2003), although the PCL may overestimate PTSD prevalence when it is not combined with other PTSD measures (Del Ben, Scotti, Chen, & Fortson, 2006; McDonald & Calhoun, 2010). When working with civilians, Blanchard et al. (1996) recommend using a cutoff score of 44 to identify persons likely to be experiencing clinically significant levels of PTSD symptoms, because this cutoff score displayed the greatest diagnostic efficiency (.90) among a sample of vehicular accident and sexual assault survivors. The PCL also has garnered support for its use in assessing PTSD symptoms among people with severe mental illness (Mueser et al., 2001) and has been utilized in studies examining the effects of the Gulf Oil Spill (Osofsky et al., 2011) and other disasters, such as Hurricane Katrina (e.g., Hirschel & Schulenberg, 2009). Affected domains. Participants also rated the extent to which three aspects of their lives had changed as a result of the Gulf Oil Spill: finances, social relationships, and physical health. All items followed the general format of How has the Gulf Oil Spill affected your financial situation (or social relationships or physical health)? Participants responded to these items using a 7-point ordered response scale (1 – greatly worsened, 4 – no change, 7 – greatly improved). To make interpretation easier for the descriptive analyses reported later,

these ratings were collapsed for each dimension into three categories to indicate worsening (score of 3 or less), no change (score of 4), or improvement (score of 5 or more). In the regression analyses, the 7-point scales are used.

Procedures Data collection for this project was part of a large-scale collaboration between the University of Mississippi, the Mississippi Department of Mental Health (MS DMH), and 19 mental health organizations on the Gulf Coast of Mississippi. In the wake of the Gulf Oil Spill, BP issued funds to public mental health departments in each of the Gulf Coast states to address the psychological impact of the spill. In Mississippi, the MS DMH used the funds they received to create the BP Behavioral Health Grant to fund 19 mental health organizations on the Mississippi Gulf Coast. Funds for this project were primarily used for direct service provision, although funding was also provided for other areas, such as mental health training and outreach efforts. Through a contract between the MS DMH and the second author, a university-based research team was hired to evaluate the impact of the spill on Mississippi Gulf Coast residents seeking mental health services. Of the 19 sites, 10 mental health organizations provided direct therapeutic services (e.g., psychotherapy, medication management) and collected data related to the present study. This group of organizations included two mental health centers, one Vietnamese community organization, one school-based counseling service, four private counseling centers, one women’s shelter, and one inpatient mental health hospital. These 10 mental health organizations asked clients who were deemed to have been potentially affected by the Gulf Oil Spill to complete a series of questionnaires which included demographic measures, items assessing the impact of the spill, the DASS-21, the PCL-S, and other psychological measures.3 All participants provided written informed consent to participate. Data were collected from March, 2011 through June, 2012, approximately 11 to 26

2 Although the PCL is a measure of PTSD symptoms, it is not appropriate to use the PCL as the sole diagnostic indicator of PTSD. The PCL does not assess criterions A, E, or F for a DSM–IV diagnosis of PTSD. Clinical diagnoses should only be made by trained clinicians using multiple, sound sources of information. Although the PCL was used as a measure of posttraumatic stress symptoms in the present study, we do not intend to imply that PCL scores suggest diagnoses of PTSD specifically. 3 All surveys were available in English, Spanish, and Vietnamese for participants to complete in their language of choice. All participants completed the survey in English except for a small minority (n ⫽ 11) who completed the measure in Vietnamese.

DRESCHER, SCHULENBERG, AND SMITH

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months after the spill began. Institutional Review Boards of the MS DMH and The University of Mississippi provided oversight.

Table 3. Descriptive Statistics for the DASS-21 and the PCL-S Based on Poverty Income

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Data Analysis We first report on the extent of the negative life conditions experienced by our sample. Next, using a series of independent sample t tests, we compared the mental health outcomes of our sample based on their position above or below the poverty line. To determine whether perceived life changes caused by the Gulf Oil Spill were related to clinical symptomology, a series of linear regression analyses was then conducted whereby each clinical area (e.g., depression) was regressed simultaneously on each of the three life areas (e.g., physical health) rated by participants. (Given the roughly equal number of participants experiencing a worsened situation across the three domains, we had no a priori reason to suspect any particular domain was more important than the others.) In addition, given the finding that poverty status was associated with increased symptomology in the four clinical areas assessed, analyses were conducted separately for those above and below the poverty line.

Results Life Domains Affected by the Gulf Oil Spill Examination of the number of participants experiencing worsened life conditions in response to the Gulf Oil Spill revealed that 410 participants (36.6% of the sample) reported a worsened financial situation, 264 participants (23.6%) reported a worsening of their social relationships, and 272 participants (24.3%) reported worsened physical health. Considering all life changes assessed, 534 participants (47.8%) reported a worsened situation because of the Gulf Oil Spill in at least one of the three areas, and 134 participants (12.0%) reported a worsened situation in all three areas.

Clinical Symptomology Descriptive statistics for the DASS-21 can be found in Table 1, as well as degree of impairment calculated by using established cutoffs (Psychology Foundation of Australia, 2011). Scores on the PCL-S ranged from 17 to 85, with a mean of 40.90 (SD ⫽ 19.21). Using a previously suggested cutoff score of 44 for civilians (Blanchard et al., 1996), 437 participants (39.1% of the sample) reported clinically significant levels of posttraumatic stress symptoms. Correlations between the scales of the DASS-21 and posttraumatic stress symptoms can be found in Table 2. Using Cohen’s (1992) conventions, the strength of relationships is large, indicat-

Above the poverty line (n ⫽ 243)

Depression Anxiety Stress PTSD symptoms

Below the poverty line (n ⫽ 833)

M

SD

M

SD

11.20 8.77 14.61 35.15

11.27 13.20 10.76 17.64

14.80 12.55 16.70 42.72

13.20 11.90 12.76 19.34

Note. Group size for individual analyses varied based on a small percentage of respondents not completing data from clinical scales.

ing that mental health symptoms were strongly associated with each other. Analyses were conducted to determine whether poverty was associated with different degrees of clinical symptomology. Means and standard deviations of the PCL-S and DASS-21, organized by the poverty line, can be found in Table 3. Given that a majority of participants in the study (n ⫽ 590, 52.7%) reported living in households of three or more, we used the poverty line of $19,090 for a family of three as a rough guideline of poverty (U.S. Department of Health & Human Services, 2012). Those participants who reported a household income of $19,999 or less (n ⫽ 833; 74.4%) were coded as being below the poverty line. Participants who reported a household income of $20,000 or more (n ⫽ 243; 21.7%) were coded as being above the poverty line.4 Forty-three participants (3.8%) did not respond to the income item. In all four clinical domains, there were significant differences between those below the poverty line and those above the poverty line— depression, t(1012) ⫽ 3.77, p ⱕ .001, d ⫽ 0.29; anxiety, t(1015) ⫽ 4.50, p ⱕ .001, d ⫽ 0.36; stress, t(1011) ⫽ 2.27, p ⫽ .02, d ⫽ 0.18; and posttraumatic stress symptoms, t(970) ⫽ ⫺5.21, p ⱕ .001, d ⫽ 0.41. Those reporting income below the poverty line indicated higher levels of symptomology in all clinical areas assessed. For those below the poverty line, correlational analyses revealed significant and negative relations between oil spill impact (financial, social, physical well-being) and the assessed clinical outcomes (all ps ⬍ .001). For those above the poverty line, only posttraumatic stress symptoms were significantly and negatively associated with oil spill impact (financial, social, physical well-being; ps ⬍ .001).

Predicting Clinical Implications of the Oil Spill Participants living above the poverty line. In examining depression as the outcome variable for those with incomes

Table 2. Correlations Between the DASS-21 and the PCL-S 4

D Depression (D) Anxiety (A) Stress (S) PTSD symptoms (P) Note.

A

S

P

.79

.86 .84

.47 .50 .49

All correlations are significant at p ⱕ .001.

Rather than ask participants to provide their income with an openended question, we asked them a closed-ended question that provided income ranges (e.g., $19,999 and below). Because we did not know a priori the household size, we could not create categories that directly matched the poverty line value. Thus, we chose the categories that most closely aligned with the government provided figure. This corresponded to $19,999 and below for those below the poverty line and $20,000 and above for those above the poverty line.

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MENTAL HEALTH AND THE GULF OIL SPILL

above the poverty line, the model was not statistically significant, F(3, 212) ⫽ .84, ns, R2 ⫽ .01. Further, no changes in any specific area significantly predicted depression. The models for anxiety, F(3, 212) ⫽ 1.35, ns, R2 ⫽ .02, and stress, F(3, 211) ⫽ 0.97, ns, R2 ⫽ .01, were similar. These findings suggest that the experience of depression, anxiety, and stress is not significantly associated with experiences with the Gulf Oil Spill for those who live above the poverty line. By contrast, the examination of the PCL-S scores, however, revealed that the entire model was significant, F(3, 202) ⫽ 12.73, p ⱕ .001, R2 ⫽ .16. Participants who experienced worsened finances (␤ ⫽ ⫺0.18, p ⱕ .05) and worsened social relationships (␤ ⫽ ⫺0.25, p ⱕ .01) reported increased posttraumatic stress symptoms. Participants living below the poverty line. The same analyses were conducted for those participants reporting incomes below the poverty line. The pattern was the same for all three scales of the DASS-21. In the case of depression symptoms, the entire model was significant, F(3, 678) ⫽ 10.59, p ⱕ .001, R2 ⫽ .05. Closer examination revealed that worsened physical health (␤ ⫽ ⫺0.15, p ⱕ .001) was a significant predictor of increased depression symptoms. The entire model was significant for anxiety as well, F(3, 684) ⫽ 12.01, p ⱕ .001, R2 ⫽ .05. As was the case previously, physical health (␤ ⫽ ⫺0.16, p ⱕ .001) was a significant predictor of anxiety. Stress followed the same pattern, F(3, 680) ⫽ 11.84, p ⱕ .001, R2 ⫽ .05, again with worsened physical health (␤ ⫽ ⫺0.13, p ⱕ .01) being a significant predictor of stress. The pattern was slightly different for posttraumatic stress symptoms. Although the entire model was significant, F(3, 657) ⫽ 36.42, p ⱕ .001, R2 ⫽ .14, and worsened finances (␤ ⫽ ⫺0.15, p ⱕ .001) was a significant predictor of posttraumatic stress symptoms as it was with those living above the poverty line, decreased physical well-being (␤ ⫽ ⫺0.25, p ⱕ .001) was also a significant predictor (as opposed to social relationships).

Discussion In the current sample of 1,119 adults receiving services from 10 mental health agencies in the coastal counties of Mississippi following the Gulf Oil Spill, the levels of reported depression, anxiety, stress, and posttraumatic stress symptoms were examined in relation to other domains of functioning potentially affected by the spill. As predicted, high levels of declines in finances, social relationships, and physical health were observed, as were high levels of self-reported mental health symptoms. Also, consistent with our hypotheses, individuals with low incomes expressed greater levels of clinical symptoms on both the DASS-21 and the PCL-S. Although oil spill-related declines in life domains predicted only posttraumatic stress symptoms for individuals living above the poverty line, these declines predicted all measured clinical symptoms for those living below the poverty line. Of particular note, nearly half of our sample (48%) reported Gulf Oil Spill-related declines (a score of less than three) in at least one of the domains measured, most commonly finances. This represents hundreds of individuals experiencing negative life effects from the spill among our sample. Almost certainly, thousands of individuals across the Gulf Coast of the United States have experienced negative effects from the spill.

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As predicted, rates of psychological symptoms were high among this sample. This is not surprising given that the sample comprised individuals seeking mental health services. However, the finding that 39% of the sample reported clinically significant posttraumatic stress symptoms with the Gulf Oil Spill identified as the stressor is concerning. Although not all of these persons would be given a diagnosis of PTSD (see Del Ben et al., 2006; McDonald & Calhoun, 2010) if assessed comprehensively, these data represent a high level of posttraumatic stress symptoms reported in relation to the spill, and the data are congruent with other findings highlighting posttraumatic stress reactions following the Gulf Oil Spill (Gill et al., 2012; Osofsky et al., 2011). Further, the data indicate that Gulf Oil Spill–related declines were associated with statistically significant increases in mental health symptoms. Although this model only held for posttraumatic stress symptoms for individuals living above the poverty line, it was significant for depression, anxiety, stress, and posttraumatic stress symptoms for those living below the poverty line. Though physical health was the only consistent factor that was predictive of depression, anxiety, stress, and posttraumatic stress symptoms in the regression analyses, this is likely due to shared variance among the life domains; all mental health symptoms and life domains were significantly related at the bivariate level for those living below the poverty line. The finding that worsening of life situations in relation to a disaster was associated with mental health is consistent with previous research. For example, Gallacher, Bronstering, Palmer, Fone, and Lyones (2007) found that perceived health and financial risks (but not actual exposure to oil) were associated with depression and anxiety following the Sea Empress Oil Tanker Spill of 1996 (Gallacher et al., 2007). Exposure to disasters is a deceivingly difficult variable to measure (especially when considering indirect exposure) and often varies from disaster to disaster (Galea & Maxwell, 2009). These results point to the importance of directly measuring the impact of oil spills in a variety of domains rather than focusing on area of residence or contact with oil as an indirect measure of impact. When considering mental health, it seems likely that the perception of the disaster’s impact will be as or more important than geographical distance from a disaster’s epicenter. Although the spill’s perceived effect on life domains was related to mental health symptoms, the relationship was not consistent across economic lines. The impact of the spill was associated with symptoms of depression, anxiety, and stress only for participants living below the poverty line. This indicates that the impact of the spill was more strongly related to mental health in persons with low income. The data also indicated that people with lower income experienced greater mental health symptoms. This is consistent with previous research linking lower SES to greater postdisaster distress (Norris et al., 2002). The current data also support previous research indicating that the Gulf Oil Spill is associated with a deleterious effect on mental health (Gill et al., 2012; Grattan et al., 2011; Osofsky et al., 2011). Not only are people within the area affected by the Gulf Oil Spill suffering and seeking assistance, but their experience of the spill appears to be associated with their mental health symptoms as well. These results call for a strong, evidence-based clinical response to the Gulf Oil Spill, as well as continued research into its possible mental and physical health effects. Of additional interest, the results show that the negative effects of the oil spill account for a relatively small percentage (5%–16%) of the

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variance in depression, anxiety, stress, and posttraumatic stress symptom scores. Mental health after a disaster is affected by a broad range of risk and resilience factors that individually exert small to moderate effects; there is no single dominant factor that determines outcomes following disasters (Bonanno et al., 2010). Specific historical (e.g., effects of Hurricane Katrina), disaster (e.g., exposure to TV coverage of the spill), social (e.g., social support), and personal (e.g., personality) variables likely contributed to individuals’ overall mental health outcomes, although they were not specifically addressed in this study as we were particularly interested in the effects of the Gulf Oil Spill.

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Strengths and Limitations Despite the importance of these findings, there are limitations to the data. As with many clinical-disaster studies, the current study is a post-only design (Galea, Maxwell, & Norris, 2008). This concern may be especially prescient in the present study, given that many individuals in this area continue to experience psychological distress in relation to the devastating effects of Hurricane Katrina, which occurred in 2005 (Picou & Hudson, 2010). Although there is no definitive solution to overcoming this kind of design flaw in disaster-related research, additional methodological features such as matched control groups can improve inferential power with respect to future studies (Galea et al., 2008). A related concern, considering the clinical nature of the sample studied, is the lack of information concerning pre–Gulf Oil Spill treatment and diagnostic histories. The present study was part of a larger collaboration between government and community agencies, researchers, and private entities, and involved hundreds of service providers. As a result, some inherent difficulties were encountered with respect to collecting in-depth histories for each client receiving services. Thus, while we were able to collect substantial, useful information across a range of domains, additional studies of individuals affected by the Gulf Oil Spill should look with greater depth at client histories, with respect to mental health services as well as experiences with previous disasters. For example, it is quite possible that previous psychological diagnoses may have predicted response to the Gulf Oil Spill (e.g., previous diagnosis of an anxiety disorder related to an increased risk of an extreme stress reaction to the Gulf Oil Spill). Specific data concerning a participant’s course of treatment would also have been useful. For instance, some therapy models may work to change participants’ appraisals of life events (e.g., cognitive therapy), potentially affecting how they answered self-report measures in this study. Moreover, given that some respondents were new clients at the time data were collected, and that some respondents were already receiving services at the time data were collected, it is unclear how stage of treatment may have affected the results of this study. Collecting reliable data on such variables is difficult in the context of a large, multisite disaster mental health study; future studies should employ creative methods to overcome these difficulties. For example, ongoing partnerships between researchers and community agencies that are in place before disasters occur may allow for reliable information on premorbid functioning and treatment course to be available when a disaster occurs (see, e.g., Schulenberg, Dellinger, et al., 2008). This approach may be especially useful in areas that are at a greater risk of experiencing disaster (e.g., coastal regions). A final important limitation of this study is that the majority of participants (68%) identified as white/non-Hispanic. Given the

results of previous studies that highlight potential ethnic differences in response to disasters, it is essential to study disaster mental health within large, representative samples of minority individuals. Future research should target these groups of individuals specifically, especially given that African American and Hispanic individuals are at a higher risk of living below the poverty line (U.S. Census Bureau, 2012). Despite these limitations, this study takes a useful, novel approach to examining disaster effects. We examined the effects of the Gulf Oil Spill in a clinical sample, providing much needed information about mental health symptoms related to the spill with people who are seeking mental health services from agencies throughout the Gulf Coast. These data are especially significant, as they point to the importance of individual perception of the Gulf Oil Spill and mental health symptoms related to functioning across multiple domains. Although these individuals received some mental health assistance related to the Gulf Oil Spill’s effects, through financial support provided to various agencies by MS DMH (funded by BP), it is the view of the authors that the individuals affected by the Gulf Oil Spill, in this case those people seeking mental health services related to the spill, will benefit from assistance in the long term, with needs that ultimately extend beyond the support available via the initial grant program. Addressing the impact of the Gulf Oil Spill will be an important point of study for the foreseeable future. Technological disasters can cause chronic community stress that persists after the discrete disaster has passed (e.g., stopping the flow of oil in the environment; Gill & Picou, 1998). Furthermore, longitudinal work with disaster survivors has shown that the negative psychological effects of disasters can persist for decades (Holgersen, Klockner, Boe, Weisaeth, & Holen, 2011). Future studies should examine disaster survivors across a number of dimensions. Given the extant level of distress evident in the results of the present study, studies should examine which interventions are most effective at promoting recovery. Additionally, longitudinal studies examining psychological distress, recovery, and resilience among survivors will help to elucidate survivors’ life courses after a disaster. Given growing support that mental health is more strongly associated with disaster effects for low income populations, this is an especially important population to include in future research, especially with respect to resilience studies (Hawkins et al., 2009). Studies of the Gulf Oil Spill’s effects would benefit from incorporating resilience and positive psychology perspectives. Along these lines, studies with individuals affected by the Gulf Oil Spill (a subset of the current sample) suggested that related variables, such as perceived meaning in life and self-efficacy, are associated with life satisfaction and may be fruitful areas for intervention (Drescher et al., 2012). Approaches that serve to enhance one’s perceived meaning in life (e.g., positive psychology) may be particularly important for postdisaster recovery as well as posttraumatic growth, and are promising avenues of empirical inquiry (Schulenberg, Drescher, & Baczwaski, in press; Schulenberg, Hutzell, Nassif, & Rogina, 2008; Steger, Frazier, & Zacchanini, 2008; Triplett, Tedeschi, Cann, Calhoun, & Reeve, 2012).

Conclusions The effects of a technological disaster such as the Gulf Oil Spill can be devastating to the lives of survivors. Although many disas-

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MENTAL HEALTH AND THE GULF OIL SPILL

ter survivors show significant resilience in the face of such adversity, a significant proportion of affected individuals develop clinically significant mental health symptoms (Bonanno et al., 2010). The present study demonstrates how the Gulf Oil Spill contributed to high rates of psychological distress among Mississippi Gulf Coast residents seeking mental health care. Continued attention toward the Gulf Oil Spill is necessary to provide appropriate care and research in the aftermath of this disaster. In the coming months and years, many Gulf Coast residents will continue to experience the effects of the Gulf Oil Spill. Additional steps need to be taken toward mitigating these effects and preparing individuals for the next coastal disaster. Recent success in disseminating evidence-based mental health techniques in postdisaster settings speaks to the feasibility of providing useful services in the wake of technological disasters (Hamblen, Norris, Gibson, & Lee, 2010). With continued collaboration between government and community agencies, researchers, and private entities, progress can be made toward ameliorating the effects of the Gulf Oil Spill and other technological disasters. We conclude by advocating for continued service provision for coastal residents affected by the Gulf Oil Spill, further emphasizing the need for longitudinal research studies including added focus on such areas as SES and racial and ethnic diversity. Keywords: Gulf Oil Spill; Deepwater Horizon Oil Spill; mental health; socioeconomic status; technological disaster

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The Deepwater Horizon Oil Spill and the Mississippi Gulf Coast: Mental health in the context of a technological disaster.

A significant percentage of disaster survivors experience negative psychological, physical, and social outcomes after a disaster. The current study ad...
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