Emotional and biological stress measures in Katrina survivors relocated to Oklahoma
DOI:
https://doi.org/10.5055/ajdm.2010.0014Keywords:
hurricane survivors, Hurricane Katrina, biological stress measures, psychophysiologic reactivity, interleukin-6, post-traumatic stress disorderAbstract
Objectives: The authors assessed relocated Hurricane Katrina survivors’ emotional and biological stress measures 20 months postdisaster to understand effects of both hurricane exposure and forced relocation on emotional and physical health.
Design: Psychiatric diagnoses, post-traumatic stress disorder (PTSD) and depressive symptoms, and biological stress measures were compared for total survivor and control groups and subgroups by PTSD diagnoses and lifetime trauma.
Setting: Outpatient university psychiatry clinics in Oklahoma City and Tulsa.
Participants: Thirty-four healthy adult Katrina survivors relocated to Oklahoma, and 34 healthy, demographically matched Oklahoma comparison participants.
Main Outcome Measures: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, assessed Axis I psychiatric disorders. Clinician-Administered PTSD Scale and Beck Depression Inventory quantified PTSD and depression symptoms. Biological stress measures were physiologic reactivity (heart rate and blood pressure responses to a trauma interview), interleukin-2 (IL-2; cell-mediated immunity), and interleukin-6 (IL- 6; proinflammatory cytokine).
Results: Both groups had high lifetime trauma exposure. Among survivors, current hurricane-related and predisaster PTSD were diagnosed in 35.3 and 11.8 percent. Controls had current (11.8 percent) and lifetime (14.7 percent) PTSD. Survivors’ PTSD and depression symptom levels were higher than controls and within illness ranges. The survivors had higher IL-6 than nontraumatized controls, higher IL-6 in the presence of PTSD, and higher baseline heart rates and mean arterial blood pressure reactivity than controls.
Conclusions: Higher IL-6 and autonomic measures for several Katrina survivor subgroups than control subgroups may confer future cardiovascular risks. The results are discussed relative to increased myocardial infarct rates in New Orleans after Katrina. Even healthy survivors should be assessed for cardiovascular risks and mental health sequelae.
References
Druss BG, Henderson KL, Rosenheck RA: Swept away: Use of general medical and mental health services among veterans displaced by Hurricane Katrina. Am J Psychiatry. 2007; 164(1): 154-156.
Landry CE, Bin O, Hindsley P, et al.: Going home: Evacuationmigration decisions of Hurricane Katrina survivors. The Center for Natural Hazards Research. Available at www.ecu.edu/hazards. Accessed January 25, 2008.
Oliver-Smith A: Disasters and forced migration in the 21st century. Available at http://understandingKatrina.ssrc.org/Oliver- Smith. Accessed January 25, 2008.
North CS, Smith EM: Post-traumatic stress disorder in disaster survivors. Compr Ther. 1990; 16(2): 3-9.
David D, Mellman TA, Mendoza LM, et al.: Psychiatric morbidity following Hurricane Andrew. J Trauma Stress. 1996; 9(3): 607-612.
McMillen C, North C, Mosley M, et al.: Untangling the psychiatric comorbidity of posttraumatic stress disorder in a sample of flood survivors. Compr Psychiatry. 2002; 43(6): 478-485.
Caldera T, Palma L, Penayo U, et al.: Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective. Soc Psychiatry Psychiatr Epidemiol. 2001; 36(3): 108-114.
Goenjian AK, Molina L, Steinberg AM, et al.: Posttraumatic stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch. Am J Psychiatry. 2001; 158: 788-794.
Verger P, Rotily M, Baruffol E, et al.: Evaluation of the psychological consequences of environmental catastrophes: A feasibility study based on the 1992 floods in the Vaucluse. Sante. 1999; 9(5): 313-318.
Norris FH, Perilla JL, Murphy AD: Postdisaster stress in the United States and Mexico: A cross-cultural test of the multicriterion conceptual model of posttraumatic stress disorder. J Abnorm Psychol. 2001; 110(4): 553-563.
Sattler DN, Preston AJ, Kaiser CF, et al.: Hurricane Georges: A cross-national study examining preparedness, resource loss, and psychological distress in the U.S.Virgin Islands, Puerto Rico, Dominican Republic, and the United States. J Trauma Stress. 2002; 15(5): 339-350.
Green BL,Korol M, Grace MC, et al.: Children and disaster: Age, gender, and parental effects on PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 1991; 30(6): 945-951.
Green BL, Lindy JD, Grace MC, et al.: Buffalo Creek survivors in the second decade: Stability of stress symptoms. Am J Orthopsychiatry. 1990; 69(1): 43-54.
Green BL, Grace MC,Vary MG, et al.: Children of disaster in the second decade: A 17-year follow-up of Buffalo Creek Survivors. J Am Acad Child Adolesc Psychiatry. 1993; 33(1): 71-79.
Honig RG, Grace MC, Lindy JD, et al.: Assessing long-term effects of trauma: Diagnosing symptoms of avoidance and numbing. Am J Psychiatry. 1999; 156(e): 483-485.
Erikson KT: Disaster at Buffalo Creek. Loss of communality at Buffalo Creek. Am J Psychiatry. 1976; 133(3): 302-305.
Kessler RC, Galea S, Jones RT, et al.: Mental illness and suicidality after Hurricane Katrina. Bull World Health Org. 2006; 84(12): 930-939.
Wang PS, Gruber MJ, Powers RE, et al.: Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. Am J Psychiatry. 2008; 165(1): 34-41.
Mills MA, Edmondson D, Park CL: Trauma and stress response among Hurricane Katrina evacuees. Am J Public Health. 2007; 97 (Suppl 1): S116-S123.
Coker AL, Hanks JS, Eggleston KS, et al.: Social and mental health needs assessment of Katrina evacuees. Disaster Manag Response. 2006; 4(3):88-94.
Rodriguez SR, Tocco JS, Mallonee S, et al.: Rapid needs assessment of Hurricane Katrina evacuees-Oklahoma, September 2005. Prehosp Disaster Med. 2005; 21(6): 390-395.
Tucker P, Pfefferbaum B, Khan Q, et al.: Katrina survivors relocated to Oklahoma: A tale of two cities. Psychiatric Ann. 2008; 38(2): 125-133.
Pitman RK, Orr SP, Forgue DF, et al.: Psychophysiological assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry. 1987; 44: 970-975.
Pitman RK, Orr SP, Steketee GS: Psychophysiological investigations of posttraumatic stress disorder imagery. Psychopharmacol Bull. 1989; 25: 426-431.
McFall ME, Murburg MM,Ko GN, et al.: Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder. Biol Psychiatry 1990; 27: 1165-1175.
Orr SP, Claiborn JM, Altman B, et al.: Psychometric profile of posttraumatic stress disorder, anxious and healthy Vietnam veterans: Correlations with psychophysiological responses. J Consult Clin Psychol. 1990; 58: 329-335.
Rothbaum BO, Kozak MJ, Foa EB, et al.: Posttraumatic stress disorder in rape victims: Autonomic habituation to auditory stimuli. J Traum Stress. 2001; 14(2): 283-293.
Shalev AY, Orr SP, Pitman RK: Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder. Am J Psychiatry. 1993; 150: 620-624.
Blanchard EB, Hickling EJ, Taylor AE: The psychophysiology of motor vehicle accident related posttraumatic stress disorder. Biofeedback Self Regul. 1993; 16: 449-458.
Altemus M, Cloitre M, Dhabhar FS: Enhanced cellular immune response in women with PTSD related to childhood abuse. Am J Psychiatry. 2003; 160: 1705-1707.
Laudenslager ML, Aasal R, Adler L, et al.: Elevated cytotoxicity in combat veterans with long-term post-traumatic stress disorder: Preliminary observations. Brain Behav Immun. 1998; 12: 74-79.
Wilson SN, van der Kolk B, Burbridge J, et al.: Phenotype of blood lymphocytes in PTSD suggests chronic immune activation. Psychosomatics. 1999; 40: 222-225.
Kawamura N, Kim Y, Asukai N: Suppression of cellular immunity in men with a past history of posttraumatic stress disorder. Am J Psychiatry. 2001; 158: 484-486.
Maes M, Bosmans E, Meltzer HY: Immunoendocrine aspects of major depression. Relationships between plasma interleukin-6 and soluble interleukin-2 receptor, prolactin and cortisol. Eur Arch Psychiatry Clin Neurosci. 1995; 245: 172-178.
Plata-Salaman CR: Immunoregulators in the nervous system. Neurosci Biobehav Rev. 1991; 15: 185-215.
Ironson G,Wynings C, Schneiderman N, et al.: Posttraumatic stress symptoms, intrusive thoughts, loss and immune function after Hurricane Andrew. Psychosom Med. 1997; 59: 128-141.
Maes M, Lin A, Delmeire L, et al.: Elevated serum interleukin-6 (IL-6) and IL-6 receptor concentrations in posttraumatic stress disorder following accidental man-made traumatic events. Biol Psychiatry. 1999; 45: 833-839.
Baker DG, Ekhator NN, Kasckow JW, et al.: Plasma and cerebrospinal fluid interleukin-6 concentrations in posttraumatic stress disorder. Neuroimmunomodulation. 2001; 9: 209-217.
Maes M, Song C, Lin A, et al.: The effects of psychological stress on humans: Increased production of pro-inflammatory cytokines and a Th1-like response in stress-induced anxiety. Cytokine. 1998; 10: 313-318.
Suarez EC: Joint effect of hostility and severity of depressive symptoms on plasma Interleukin-6 concentration. Psychosom Med. 2003; 65(4): 523-527.
Kerr R, Stirling D, Ludlam CA: Interleukin 6 and haemostasis. Br J Hematol. 2001; 115: 3-12.
Tucker P, Ruwe WD, Masters B, et al.: Neuroimmune and cortisol changes in selective serotonin reuptake inhibitor and placebo treatment of chronic posttraumatic stress disorder. Biol Psychiatry. 2004; 56: 121-128.
Wong CM, Rapaport MH, Golier JA, et al.: Cytokine function in PTSD: Serum and LPS whole blood responses to the DST. Presented at the 39th annual meeting of the American College of Neuropsychopharmacology, San Juan, 2000.
Spivak B, Shohat B, Mester R, et al.: Elevated levels of serum interleukin-1 beta in combat-related posttraumatic stress disorder. Biol Psychiatry. 1997; 42: 345-348.
Nunes SO, Reiche EM, Morimoto HK, et al.: Immune and hormonal activity in adults suffering from depression. Braz J Med Biol Res. 2002; 35(5): 581-587.
Allen-Mersh TG, Glover C, Fordy C, et al.: Relation between depression and circulating immune products in patients with advanced colorectal cancer. J R Soc Med. 1998; 91: 408-413.
Tucker P, Pfefferbaum B, North CS, et al.: Physiologic reactivity despite emotional resilience several years after direct exposure to terrorism. Am J Psychiatry. 2007; 164: 230-235.
Tucker P, Pfefferbaum B, North CS, et al.: Biological correlates of direct exposure to terrorism several years post-disaster. Ann Clin Psychiatry. (in press).
First MB, Spitzer RL, Gibbon M, et al.: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV), Clinician Version (Administrative Booklet). Washington, DC: American Psychiatric Association, 1997.
Ventura J, Liberman RP, Green MF, et al.: Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-IV). Psychiat Res. 1998; 79(2): 163-173.
Blake DD,Weathers FW, Nagy LM, et al.: The development of a Clinician-Administered PTSD Scale. J Trauma Stress. 1995; 8: 75-90.
Weathers FW, Keane TM, Davidson JR: Clinician-administered PTSD scale: A review of the first ten years of research. Depress Anxiety. 2001; 13: 132-156.
Beck AT,Ward CH, Mendelson M, et al.: An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-71.
Buckley TC, Kaloupek DG: A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder. Psychosom Med. 2001; 63: 585-594.
Blanchard EB: Elevated basal levels of cardiovascular responses in Vietnam veterans with PTSD: A health problem in the making? J Anxiety Disord. 1990; 4: 233-237.
Hopper JW, Spinazzola J, Simpson WB, et al.: Preliminary evidence of parasympathetic influence on basal heart rate in posttraumatic stress disorder. J Psychosom Res. 2006; 60: 83-90.
Rabe S, Dorfel D, Zollner T, et al.: Cardiovascular correlates of motor vehicle accident related posttraumatic stress disorder and its successful treatment. Appl Psychophysiol Biofeedback. 2006; 31: 315-330.
Gautam S, Menachem J, Srivastav S, et al.: Effect of Hurricane Katrina on the incidence of acute coronary syndrome at a primary angioplasty center in New Orleans. Dis Med Pub Health Prep. 2009; 3: 144-150.
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