title: Change in the health of tsunami-exposed mothers three years after the natural disaster.
abstract: BACKGROUND
  Women's experiences with secondary stressors resulting from natural disasters, such as increased economic insecurity, expanded caregiving responsibilities and disrupted family life, may contribute to women's mental and physical health problems.
  
  
  OBJECTIVE
  The present study investigates change and stability in post-tsunami depressive symptoms and perceived physical health of tsunami-exposed mothers over three and a half years.
  
  
  METHODS
  Using data from 160 tsunami-affected mothers, the present study uses structural equation modelling to investigate (1) change, stability, cross-lagged reciprocal influences of mental and physical health and (2) the meditation effect of negative life events on the relationship between tsunami exposure and post-tsunami depressive symptoms and perceived physical health of tsunami-exposed mothers from 2005 to 2008.
  
  
  RESULTS
  Tsunami exposure contributed to depressive symptoms among mothers independently of pre-tsunami family adversities. Average depressive symptoms showed a decline whereas poor physical health showed an increase over this period. The results also revealed an interrelated health process between depression and physical health over time. Continuity of health problems were mediated by secondary stressors that also exerted an additive effect on later health problems.
  
  
  CONCLUSIONS
  Post-disaster intervention and recovery programmes should focus not only on mothers' exposure to natural disasters, but also their pre- and post-natural disaster adversities. They should reach disaster-exposed mothers directly and have an integrated health approach to disrupt continuities of health problems.
authors.affiliation: Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849, USA. tzw0003@auburn.edu
authors.forename: Thulitha
authors.initials: T
authors.lastname: Wickrama
authors.forename: Scott A
authors.initials: SA
authors.lastname: Ketring
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires; D057192:Tsunamis