title: The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute versus ongoing traumatic events and stressors?
abstract: OBJECTIVE
  Ongoing traumatic events and stressors, rather than acute sources of trauma, may shape long-term post-disaster mental health. The purpose of this study was to compare the influence of acute hurricane-related exposures and ongoing post-hurricane exposures on the short- and long-term course of posttraumatic stress symptoms (PTSS) and functional impairment (FI).
  
  
  METHODS
  A random sample of adults (n = 658) in Galveston and Chambers Counties, Texas, was selected 2-6 months after Hurricane Ike and interviewed 3 times over 18 months. Hurricane-related exposures included traumatic events such as death of a family member due to the hurricane and stressors such as loss/damage to personal property due to the hurricane. Post-hurricane exposures included traumatic events such as sexual assault and stressors such as divorce or serious financial problems.
  
  
  RESULTS
  Experiencing an acute hurricane-related traumatic event or stressor was associated with initial post-hurricane PTSS [RR = 1.92 (95% CI = 1.13-3.26) and RR = 1.62 (1.36-1.94), respectively] and FI [RR = 1.76; (1.05-2.97) and RR = 1.74 (1.46-2.08)], respectively, and acute hurricane-related stressors were associated with a higher rate of increase in FI over time [RR = 1.09; (1.01-1.19)]. In contrast, ongoing post-hurricane daily stressors were not associated within initial PTSS and FI, but were associated with PTSS and FI at the second and third interviews.
  
  
  CONCLUSIONS
  While immediate postdisaster interventions may influence short-term mental health, investment in the prevention of ongoing stressors may be instrumental to manage long-term mental health status.
authors.affiliation: Department of Epidemiology, Columbia University, University Mailman School of Public Health, 722 W168th St, 10032, New York, NY, USA, mc3226@columbia.edu.
authors.forename: M
authors.initials: M
authors.lastname: Cerdá
authors.forename: P M
authors.initials: PM
authors.lastname: Bordelois
authors.forename: S
authors.initials: S
authors.lastname: Galea
authors.forename: F
authors.initials: F
authors.lastname: Norris
authors.forename: M
authors.initials: M
authors.lastname: Tracy
authors.forename: K C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D055867:Cyclonic Storms; D004190:Disasters; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult