title: The Geography of Mental Health and General Wellness in Galveston Bay After Hurricane Ike: A Spatial Epidemiologic Study With Longitudinal Data.
abstract: OBJECTIVE
  To demonstrate a spatial epidemiologic approach that could be used in the aftermath of disasters to (1) detect spatial clusters and (2) explore geographic heterogeneity in predictors for mental health and general wellness.
  
  
  METHODS
  We used a cohort study of Hurricane Ike survivors (n=508) to assess the spatial distribution of postdisaster mental health wellness (most likely resilience trajectory for posttraumatic stress symptoms [PTSS] and depression) and general wellness (most likely resilience trajectory for PTSS, depression, functional impairment, and days of poor health) in Galveston, Texas. We applied the spatial scan statistic (SaTScan) and geographically weighted regression.
  
  
  RESULTS
  We found spatial clusters of high likelihood wellness in areas north of Texas City and spatial concentrations of low likelihood wellness in Galveston Island. Geographic variation was found in predictors of wellness, showing increasing associations with both forms of wellness the closer respondents were located to Galveston City in Galveston Island.
  
  
  CONCLUSIONS
  Predictors for postdisaster wellness may manifest differently across geographic space with concentrations of lower likelihood wellness and increased associations with predictors in areas of higher exposure. Our approach could be used to inform geographically targeted interventions to promote mental health and general wellness in disaster-affected communities.
authors.affiliation: 1Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,New York.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gruebner
authors.affiliation: 1Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,New York.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Lowe
authors.affiliation: 2Department of Epidemiology and Biostatistics,School of Public Health,University at Albany,State University of New York,Albany,New York.
authors.forename: Melissa
authors.initials: M
authors.lastname: Tracy
authors.affiliation: 1Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,New York.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerdá
authors.affiliation: 1Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,New York.
authors.forename: Spruha
authors.initials: S
authors.lastname: Joshi
authors.affiliation: 3Geisel School of Medicine at Dartmouth,Hanover,New Hampshire.
authors.forename: Fran H
authors.initials: FH
authors.lastname: Norris
authors.affiliation: 4School of Public Health,Boston University,Boston,Massachusetts.
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D055867:Cyclonic Storms / Q000706:statistics & numerical data*; D016021:Epidemiologic Studies; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008603:Mental Health / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D055500:Resilience, Psychological; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D017741:Survivors / Q000523:psychology; D013781:Texas / Q000453:epidemiology
keywords: geographic mapping; mental disorders; natural disasters; post-traumatic stress disorders; psychological resilience