Impact of coping styles on post-traumatic stress disorder and depressive symptoms among pregnant women exposed to Hurricane Katrina


  • Olurinde Oni, MD, MS
  • Emily W. Harville, PhD
  • Xu Xiong, MD, DrPH
  • Pierre Buekens, MD, PhD



stress-coping styles, post-traumatic stress disorder, depression, Hurricane Katrina, perceived stress


Objective: Experiencing natural disasters such as hurricanes is associated with post-traumatic stress disorder (PTSD) and depression.We examined the role played by perceived stress and coping styles in explaining and modifying this association among pregnant women exposed to Hurricane Katrina.
Design: The study comprised 192 women (133 from New Orleans and 59 from Baton Rouge) who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane. Women were interviewed regarding their hurricane experience, perceived stress, and mental health outcomes. Coping styles was assessed using the Brief COPE, PTSD symptoms using the Post-Traumatic Checklist, and depressive symptoms using the Edinburgh Depression Scale. Multivariable regression models were run to determine the effects of coping styles on mental health and the interactions among coping styles, hurricane experience, and perceived stress on mental health.
Results: Apart from the positive reframing and humor coping styles, all coping styles correlated positively with PTSD or depression (p < 0.05). The instrumental support, denial, venting, and behavioral disengagement coping styles were significantly associated with worsened PTSD symptoms among those who reported higher perceived stress (p < 0.05). Use of a humor coping style seemed to reduce the effect of perceived stress on depressive symptoms (p = 0.02 for interaction) while use of instrumental support (p = 0.04) and behavioral disengagement (p < 0.01) were both associated with more symptoms of depression among those who perceived more stress. There were no strong interactions between coping style and hurricane experience.
Conclusion: Coping styles are potential moderators of the effects of stress on mental health of pregnant women.

Author Biographies

Olurinde Oni, MD, MS

Clinical Research Associate, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri.

Emily W. Harville, PhD

Assistant professor, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.

Xu Xiong, MD, DrPH

Associate professor, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.

Pierre Buekens, MD, PhD

Professor, Department of Epidemiology, and Dean, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.


Centers for Disease Control: Public health response to Hurricanes Katrina and Rita—United States, 2005. MMWR Morb Mortal Wkly Rep. 2006; 55(9): 229-231.

Roberto KA, Henderson TL, Kamo Y, et al.: Challenges to older women’s sense of self in the aftermath of Hurricane Katrina. Health Care Women Int. 2010; 31(11): 981-996.

Tucker P, Jeon-Slaughter H, Pfefferbaum B, et al.: Emotional and biological stress measures in Katrina survivors relocated to Oklahoma. Am J Disaster Med. 2010; 5(2): 113-125.

Amstadter AB, Acierno R, Richardson LK, et al.: Posttyphoon prevalence of posttraumatic stress disorder, major depressive disorder, panic disorder, and generalized anxiety disorder in a Vietnamese sample. J Trauma Stress. 2009; 22(3): 180-188.

Ehrlich M, Harville E, Xiong X, et al.: Loss of resources and hurricane experience as predictors of postpartum depression among women in southern Louisiana. J Womens Health (Larchmt). 2010; 19(5): 877-884.

Davis EP, Glynn LM, Schetter CD, et al.: Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry. 2007; 46(6): 737-746.

Cohen LS,Wang B, Nonacs R, et al.: Treatment of mood disorders during pregnancy and postpartum. Psychiatr Clin North Am. 2010; 33(2): 273-293.

Henshaw C: Mood disturbance in the early puerperium: A review. Arch Womens Ment Health. 2003; 6 (Suppl 2): S33-S42.

Mattocks KM, Skanderson M, Goulet JL, et al.: Pregnancy and mental health among women veterans returning from Iraq and Afghanistan. J Womens Health (Larchmt). 2010.

Seng JS, Oakley DJ, Sampselle CM, et al.:Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol. 2001; 97(1): 17-22.

Harville E, Xiong X, Buekens P: Disasters and perinatal health: A systematic review. Obstet Gynecol Surv. 2010; 65(11): 713-728.

Lazarus R: Coping theory and research: Past, present, and future. Psychosom Med. 1993; 55: 234-247.

Carver CS, Scheier MF,Weintraub JK: Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol. 1989; 56(2): 267-283.

Reed S, Giacobbi PR Jr: The stress and coping responses of certified graduate athletic training students. J Athl Train. 2004; 39(2): 193-200.

Math SB, John JP, Girimaji SC, et al.: Comparative study of psychiatric morbidity among the displaced and non-displaced populations in the Andaman and Nicobar Islands following the tsunami. Prehosp Disaster Med. 2008; 23(1): 29-34; discussion 35.

North CS, Pfefferbaum B, Narayanan P, et al.: Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry. 2005; 186: 487-493.

Ratrin Hestyanti Y: Children survivors of the 2004 tsunami in Aceh, Indonesia: A study of resiliency. Ann N Y Acad Sci. 2006; 1094: 303-307.

Zhang W, Jiang X, Ho KW, et al.: The presence of post-traumatic stress disorder symptoms in adolescents three months after an 8.0 magnitude earthquake in southwest China. J Clin Nurs. 2011; 20(21-22): 3057-3069.

Bodvarsdottir I, Elklit A: Psychological reactions in Icelandic earthquake survivors. Scand J Psychol. 2004; 45(1): 3-13.

Jeney-Gammon P, Daugherty TK, Finch AJ Jr, et al.: Children’s coping styles and report of depressive symptoms following a natural disaster. J Genet Psychol. 1993; 154(2): 259-267.

Oflaz F, Hatipoglu S, Aydin H: Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. J Clin Nurs. 2008; 17(5): 677-687.

Pina AA,Villalta IK, Ortiz CD, et al.: Social support, discrimination, and coping as predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina. J Clin Child Adolesc Psychol. 2008; 37(3): 564-574.

Weathers F, Litz B, Herman DS, et al.: The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. 9th Annual Conference of the International Society of Traumatic Stress Studies. San Antonio,Texas, 1993.

Blanchard EB, Jones-Alexander J, Buckley TC, et al.: Psychometric properties of the PTSD checklist (PCL). Behav Res Ther. 1996; 34(8): 669-673.

Eberhard-Gran M, Eskild A, Tambs K, et al.: Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand. 2001; 104(4): 243-249.

Cox JL, Chapman G, Murray D, et al.: Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord. 1996; 39(3): 185-189.

Cox JL, Holden JM, Sagovsky R: Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987; 150: 782-786.

Carver CS: You want to measure coping but your protocol’s too long: Consider the brief COPE. Int J Behav Med. 1997; 4(1): 92-100.

Xiong X, Harville EW, Mattison DR, et al.: Hurricane Katrina experience and the risk of post-traumatic stress disorder and depression among pregnant women. Am J Disaster Med. 2010; 5(3): 181-187.

Harville EW,Taylor CA,Tesfai H, et al.: Experience of Hurricane Katrina and reported intimate partner violence. J Interpers Violence. 2011; 26(4): 833-845.

Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav. 1983; 24(4): 385-396.

Leung DY, Lam TH, Chan SS: Three versions of Perceived Stress Scale: Validation in a sample of Chinese cardiac patients who smoke. BMC Public Health. 2010; 10: 513.

Connor KM, Zhang W: Recent advances in the understanding and treatment of anxiety disorders. Resilience: Determinants, measurement, and treatment responsiveness. CNS Spectr. 2006; 11(10 Suppl 12): 5-12.

Baschnagel JS, Gudmundsdottir B, Hawk LW Jr, et al.: Posttrauma symptoms following indirect exposure to the September 11th terrorist attacks: The predictive role of dispositional coping. J Anxiety Disord. 2009; 23(7): 915-922.

Solomon Z, Mikulincer M, Benbenishty R: Locus of control and combat-related post-traumatic stress disorder: The intervening role of battle intensity, threat appraisal and coping. Br J Clin Psychol. 1989; 28 (Part 2): 131-144.

Blake DD, Cook JD, Keane TM: Post-traumatic stress disorder and coping in veterans who are seeking medical treatment. J Clin Psychol. 1992; 48(6): 695-704.

Da Costa D, Larouche J, Dritsa M, et al.: Psychosocial correlates of prepartum and postpartum depressed mood. J Affect Disord. 2000; 59(1): 31-40.

Ravindran AV, Matheson K, Griffiths J, et al.: Stress, coping, uplifts, and quality of life in subtypes of depression: A conceptual frame and emerging data. J Affect Disord. 2002; 71(1-3): 121-130.

Kort-Butler LA: Coping styles and sex differences in depressive symptoms and delinquent behavior. J Youth Adolesc. 2009; 38(1): 122-136.

Chung MC, Farmer S, Werrett J, et al.: Traumatic stress and ways of coping of community residents exposed to a train disaster. Aust N Z J Psychiatry. 2001; 35(4): 528-534.

Gavranidou M, Rosner R: The weaker sex? Gender and post-traumatic stress disorder. Depress Anxiety. 2003; 17(3): 130-139.



How to Cite

Oni, MD, MS, O., E. W. Harville, PhD, X. Xiong, MD, DrPH, and P. Buekens, MD, PhD. “Impact of Coping Styles on Post-Traumatic Stress Disorder and Depressive Symptoms Among Pregnant Women Exposed to Hurricane Katrina”. American Journal of Disaster Medicine, vol. 7, no. 3, July 2012, pp. 199-0, doi:10.5055/ajdm.2012.0095.




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