Communities have the potential to function effectively and adapt successfully in the aftermath of disasters. Drawing upon literatures in several disciplines, we present a theory of resilience that encompasses contemporary understandings of stress, adaptation, wellness, and resource dynamics. Community resilience is a process linking a network of adaptive capacities (resources with dynamic attributes) to adaptation after a disturbance or adversity. Community adaptation is manifest in population wellness, defined as high and non-disparate levels of mental and behavioral health, functioning, and quality of life. Community resilience emerges from four primary sets of adaptive capacities—Economic Development, Social Capital, Information and Communication, and Community Competence—that together provide a strategy for disaster readiness. To build collective resilience, communities must reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, and plan for not having a plan, which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns.

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Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.

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Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

Background People who are not present at a traumatic event may experience stress reactions. We assessed the immediate mental health effects of the terrorist attacks on September 11, 2001. Methods Using random-digit dialing three to five days after September 11, we interviewed a nationally representative sample of 560 U.S. adults about their reactions to the terrorist attacks and their perceptions of their children's reactions. Results Forty-four percent of the adults reported one or more substantial symptoms of stress; 90 percent had one or more symptoms to at least some degree. Respondents throughout the country reported stress symptoms. They coped by talking with others (98 percent), turning to religion (90 percent), participating in group activities (60 percent), and making donations (36 percent). Eighty-four percent of parents reported that they or other adults in the household had talked to their children about the attacks for an hour or more; 34 percent restricted their children's television viewing...

https://www.nejm.org/doi/pdf/10.1056/NEJM200111153452024

A national survey of stress reactions after the September 11, 2001, terrorist attacks.

Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual's biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.

Stress and Health: Psychological, Behavioral, and Biological Determinants

This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.

Television exposure in children after a terrorist incident.

Objective: To describe the effect of wartime military deployments on the behavior of young children in military families. Design: Cross-sectional study. Setting: Childcare centers on a large Marine base. Participants: Parents and childcare providers of children aged 1 1 / 2 to 5 years enrolled in on-base childcare centers. Main Exposure: Parental deployment. Outcome Measures: Mean externalizing, internalizing, and total symptom scores on the Child Behavior Checklist (CBCL) (1 1 / 2 -5 years) and the CBCL-Teacher Report Form (TRF) (1 1 / 2 -5 years). Results: One hundred sixty-nine of 233 consenting families (73%) participated. Nonresponders did not differ from responders in their child's age or TRF scores. Fifty-five children (33%) had a deployed parent. Parents with children aged 3 years or older and a deployed spouse had significantly higher depression scores than those without a deployed spouse. There were no differences in the demographic characteristics between groups. After controlling for respondent's age, stress and depressive symptoms, deployed service member's rank, and total number of children in the home, we found an age by deployment interaction: children aged 3 years or older with a deployed parent had significantly higher CBCL externalizing and total scores (externalizing, 48.50 vs 43.31, P<.05; total, 47.71 vs 42.68, P<.05) and externalizing and total TRF scores (externalizing, 50.21 vs 45.62, P<.05; total, 48.54 vs 43.73, P<.05) compared with same-aged peers without a deployed parent. Conclusions: This study is the first to show that children aged 3 years or older with a deployed parent exhibit increased behavioral symptoms compared with peers without a deployed parent after controlling for caregiver's stress and depressive symptoms.

Effect of Parents' Wartime Deployment on the Behavior of Young Children in Military Families. Commentary

Objective: A package of parent–child interaction therapy (PCIT) combined with a self-motivational (SM) orientation previously was found in a laboratory trial to reduce child abuse recidivism compared with services as usual (SAU). Objectives of the present study were to test effectiveness in a field agency rather than in a laboratory setting and to dismantle the SM versus SAU orientation and PCIT versus SAU parenting component effects. Method: Participants were 192 parents in child welfare with an average of 6 prior referrals and most with all of their children removed. Following a 2 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM vs. SAU) and then subsequently randomized to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment-related differences in timing and frequency of children returned home. Results: A significant orientation condition by parenting condition interaction favoring the SM PCIT combination was found for reducing future child welfare reports, and this effect was stronger when children were returned to the home sooner rather than later. Conclusions: Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized.

A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial.

Building Resilience to Mass Trauma Events

OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N=3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.

https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.7.1069

Robin H. Gurwitch

Papers

Television exposure in children after a terrorist incident.

Effect of Parents' Wartime Deployment on the Behavior of Young Children in Military Families. Commentary

A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial.

Building Resilience to Mass Trauma Events

Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing