title: Looking for resilience: understanding the longitudinal trajectories of responses to stress.
abstract: Taking advantage of two large, population-based, and longitudinal datasets collected after the 1999 floods in Mexico (n=561) and the September 11, 2001 terrorist attacks in New York (n=1267), we examined the notion that resilience may be best understood and measured as one member of a set of trajectories that may follow exposure to trauma or severe stress. We hypothesized that resistance, resilience, recovery, relapsing/remitting, delayed dysfunction, and chronic dysfunction trajectories were all possible in the aftermath of major disasters. Semi-parametric group-based modeling yielded the strongest evidence for resistance (no or mild and stable symptoms), resilience (initially moderate or severe symptoms followed by a sharp decrease), recovery (initially moderate or severe symptoms followed by a gradual decrease), and chronic dysfunction (moderate or severe and stable symptoms), as these trajectories were prevalent in both samples. Neither Mexico nor New York showed a relapsing/remitting trajectory, and only New York showed a delayed dysfunction trajectory. Understanding patterns of psychological distress over time may present opportunities for interventions that aim to increase resilience, and decrease more adverse trajectories, after mass traumatic events.
authors.affiliation: Dartmouth Medical School, Psychiatry/NCPTSD, VA Medical Center, White River Junction, VT 05009, USA. fran.norris@dartmouth.edu
authors.forename: Fran H
authors.initials: FH
authors.lastname: Norris
authors.forename: Melissa
authors.initials: M
authors.lastname: Tracy
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000328:Adult; D004190:Disasters; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008800:Mexico; D008875:Middle Aged; D055500:Resilience, Psychological; D047851:September 11 Terrorist Attacks / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D013315:Stress, Psychological; D011795:Surveys and Questionnaires