Skip to main content Accessibility help

Posttraumatic Stress Disorder and Mental Distress Following the 2004 and 2005 Florida Hurricanes

  • Carol S. Fullerton (a1), Holly B. Herberman Mash (a1), Leming Wang (a1), Joshua C. Morganstein (a1) and Robert J. Ursano (a1)...



Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons.


Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher.


In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96).


Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44–52).


Corresponding author

Correspondence and reprint requests Holly B. Herberman Mash, 4301 Jones Bridge Road, Bethesda, MD 20814, USA (e-mail:


Hide All
1. Akbayrak, N, Oflaz, F, Aslan, O, et al. Post-traumatic stress disorder symptoms among military health professionals in Turkey. Mil Med. 2005;170:125-129.
2. Benedek, DM, Fullerton, C, Ursano, RJ. First responders: mental health consequences of natural and human-made disasters for public health and public safety workers. Annu Rev Public Health. 2007;28:55-68.
3. Carson, MA, Paulus, LA, Lasko, NB, et al. Psychophysiologic assessment of posttraumatic stress disorder in Vietnam nurse veterans who witnessed injury or death. J Consult Clin Psychol. 2000;68:890-897.
4. Kerasiotis, B, Motta, RW. Assessment of PTSD symptoms in emergency room, intensive care unit, and general floor nurses. Int J Emerg Ment Health. 2004;6:121-133.
5. Bai, Y, Lin, CC, Lin, CY, et al. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004;55:1055-1057.
6. Fullerton, CS, Ursano, RJ, Liu, X, et al. Depressive symptom severity and community collective efficacy following the 2004 Florida Hurricanes. PLoS One. 2015;10(6):e0130863. doi: 10.1371/journal.pone.0130863
7. Grieger, TA, Fullerton, CS, Ursano, RJ, et al. Acute stress disorder, alcohol use, and perception of safety among hospital staff after the sniper attacks. Psychiatr Serv. 2003;54:1383-1387.
8. Perrin, MA, Di Grande, L, Wheeler, K, et al. Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. 2007;164:1385-1394.
9. Ursano, RJ, McKibben, JBA, Reissman, DB, et al. Posttraumatic stress disorder and community collective efficacy following the 2004 Florida hurricanes. PLoS One. 2014;9(2):e88467. doi: 10.1371/journal.pone.0088467
10. van Kamp, I, van der Velden, PG, Stellato, RK, et al. Physical and mental health shortly after a disaster: first results from the Enschede firework disaster study. Eur J Public Health. 2006;16:253-259.
11. Witteveen, AB, Bramsen, I, Twisk, JWR, et al. Psychological distress of rescue workers eight and one-half years after professional involvement in the Amsterdam air disaster. J Nerv Ment Dis. 2007;195:31-40.
12. Sampson, RJ, Raudenbush, SW, Earls, F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277:918-924.
13. Benight, CC. Collective efficacy following a series of natural disasters. Anxiety Stress Coping. 2004;17:401-420.
14. Norris, FH, Stevens, SP, Pfefferbaum, B, et al. Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. Am J Community Psychol. 2008;41:127-150.
15. Drury, J. Collective resilience in mass emergencies and disasters: a social identity model. In: Jetten J, Haslam C, Haslam SA, eds. The Social Cure: Identity, Health, and Well-being. Hove, UK: Psychology Press; 2012:195-215.
16. Drury, J, Brown, R, Gonzalez, R, et al. Emergent social identity and observing social support predict social support provided by survivors in a disaster: solidarity in the 2010 Chile earthquake. Eur J Soc Psychol. 2016;46:209-222.
17. Fay-Ramirez, S, Antrobus, E, Piquero, AR. Assessing the effect of the Queensland “Summer of Disasters” on perceptions of collective efficacy. Soc Sci Res. 2015;54:21-35.
18. Gapen, M, Cross, D, Ortigo, K, et al. Perceived neighborhood disorder, community cohesion, and PTSD symptoms among low-income African Americans in an urban health setting. Am J Orthopsychiatry. 2011;81:31-37.
19. Coleman, J. Foundations of Social Theory. Cambridge, MA: Harvard University Press; 1990.
20. Council of Europe. Concerted Development of Social Cohesion Indicators: Methodological Guide. Strasbourg: Council of Europe; 2005.
21. Cohen, DA, Farley, TA, Mason, K. Why is poverty unhealthy? Social and physical mediators. Soc Sci Med. 2003;57:1631-1641.
22. Cohen, DA, Finch, BK, Bower, A, et al. Collective efficacy and obesity: the potential influence of social factors on health. Soc Sci Med. 2006;62:769-778.
23. Odgers, CL, Moffitt, TE, Tach, LM, et al. The protective effects of neighborhood collective efficacy on British children growing up in deprivation: a developmental analysis. Dev Psychol. 2009;45:942-957.
24. Sapouna, M. Collective efficacy in the school context: does it help explain victimization and bullying among Greek primary and secondary school students? J Interpers Violence. 2010;25:1912-1927.
25. Simons, RL, Simons, LG, Burt, CH, et al. Collective efficacy, authoritative parenting, and delinquency: a longitudinal test of a model integrating community-and-family level processes. Criminol. 2005;43:989-1029.
26. Xue, Y, Leventhal, T, Brooks-Gunn, J, et al. Neighborhood residence and mental health problems of 5- to 11-year-olds. Arch Gen Psychiatry. 2005;62:554-563.
27. Vaeth, PA, Ramisetty-Mikler, S, Caetano, R. Depression among couples in the United States in the context of intimate partner violence. J Interpers Violence. 2010;25:771-790.
28. Lowe, SR, Joshi, S, Pietrzak, RH, et al. Mental health and general wellness in the aftermath of Hurricane Ike. Soc Sci Med. 2015;124:162-170.
29. Matlin, SL, Molock, SD, Tebes, JK. Suicidality and depression among African American adolescents: the role of family and peer support and community connectedness. Am J Orthopsychiatry. 2011;81(1):108-117.
30. Maimon, D, Browning, CR, Brooks-Gunn, J. Family attachment and urban adolescent suicide attempts. J Health Soc Behav. 2010;51(3):307-324.
31. Browning, CR. The span of collective efficacy: extending social disorganization theory to partner violence. J Marriage Fam. 2002;64:833-850.
32. Hembree, C, Galea, S, Ahern, J, et al. The urban built environment and overdose mortality in New York City neighborhoods. Health Place. 2005;11:147-156.
33. Acierno, R, Ruggiero, KJ, Galea, S, et al. Psychological sequelae resulting from the 2004 Florida hurricanes: implications for postdisaster intervention. Am J Public Health. 2007;97(suppl 1):S103-S108.
34. US National Oceanic and Atmospheric Administration National Hurricane Center. Atlantic Hurricane Season. Published 2005. Accessed October 3, 2018.
35. US Federal Emergency Management Agency. FEMA’s Public Assistance Program - Building The Road To Recovery. Published 2010. Accessed August 6, 2018.
36. US National Oceanic and Atmospheric Administration National Centers for Environmental Information. State of the Climate: Hurricanes and Tropical Storms for Annual 2005. Published January 2016. Accessed September 25, 2018.
37. Weathers, FW, Ford, J. Psychometric review of PTSD Checklist (PCL-C, PCL-S, PCL-M, PCL- PR). In: Stamm BH, ed. Measurement of Stress, Trauma, and Adaptation. Lutherville, MD: Sidran Press; 1996:250-251.
38. Lang, AJ, Laffaye, C, Satz, LE, et al. Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care. J Trauma Stress. 2003;16:257-264.
39. Walker, EA, Newman, E, Dobie, DJ, et al. Validation of the PTSD checklist in an HMO sample of women. Gen Hosp Psychiatry. 2002;24:375-380.
40. US Centers for Disease Control and Prevention. Measuring Healthy Days: Population Assessment of Health-Related Quality of Life. Atlanta, GA: US Centers for Disease Control and Prevention; 2000.
41. Rothman, K, Greenland, S. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998.
42. SAS Institute Inc. SAS® 9.4 Software. Cary, NC: SAS Institute Inc; 2013.
43. Bills, CB, Levy, NA, Sharma, V, et al. Mental health of workers and volunteers responding to events of 9/11: review of the literature. Mt Sinai J Med. 2008;75:115-127.
44. Bryant, RA, Harvey, AG. Posttraumatic stress reactions in volunteer firefighters. J Trauma Stress. 1996;9:51-62.
45. Fullerton, CS, Ursano, RJ, Wang, L. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry. 2004;161:1370-1376.
46. Hobfoll, SE, Tracy, M, Galea, S. The impact of resource loss and traumatic growth on probable PTSD and depression following terrorist attacks. J Trauma Stress. 2006;19:867-878.
47. Breslau, N, Kessler, RC, Chilcoat, HD, et al. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry. 1998;55:626-632.
48. Hobfoll, SE, Watson, P, Bell, CC, et al. Five elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry. 2007;70:283-315.
49. Fontana, A, Rosenheck, R. Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment. Am J Psychiatry. 1997;154:758-765.
50. Jack, K, Glied, S. The public costs of mental health response: lessons from the New York City post-9/11 needs assessment. J Urban Health. 2002;79:332-339.
51. Siegel, CE, Laska, E, Meisner, M. Estimating capacity requirements for mental health services after a disaster has occurred: a call for new data. Am J Public Health. 2004;94:582-585.
52. Tanielian, TL, Jaycox, LH. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation; 2008.
53. Schoenbaum, M, Butler, B, Kataoka, S, et al. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost. Arch Gen Psychiatry. 2009;66:906-914.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed