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Acknowledgements. □ Co-authors: Brandon Marshall, Benjamin Vicente,. Sandra Saldivia, Karestan Koenen, Kristopher. Arheart, Robert Kohn, Stephen Buka.
ASSESSING THE RELATIONSHIP BETWEEN PSYCHOSOCIAL STRESSORS AND PSYCHIATRIC RESILIENCE AMONG CHILEAN DISASTER SURVIVORS 2016 Epidemiology Congress of Americas Conference Cristina A. Fernandez, MSEd

Acknowledgements 2

Co-authors: Brandon Marshall, Benjamin Vicente, Sandra Saldivia, Karestan Koenen, Kristopher Arheart, Robert Kohn, Stephen Buka ¨ Funding: ¨

¤ NIMH

(US): F31MH104000 ¤ FONDEF (Chile): D021-1140 ¤ FONDECYT (Chile): 1110687 ¤ NIGMS (US): R25GM083270

Introduction 3

“What does not destroy me, makes me stronger” -Friedrich Nietzsche, 18891

4

5

6

2/27/10 Earthquake & Tsunami 7

Introduction 8

¨

Inoculation Hypothesis:2-6 ¤ Successfully

overcoming manageable stressors improves ability to cope with future stressors ¤ 2 types of inoculation: n Direct tolerance n Cross

tolerance

Study Aim 9

¨

To test the applicability of the Inoculation Hypothesis on psychiatric resilience

2003: Pre-Disaster Stressor

2010: Disaster

2011: Post-Disaster MDD/PTSD

Study Design 10

¨

PREDICT study:7-9 ¨

¨

Prospective 5-wave longitudinal cohort of Chilean adults (years 2003-2011)

Recruitment: ¨

10 primary care centers in Concepción and Talcahuano

Figure 1. Flow diagram of excluded/ineligible individuals 2003: Completed wave 1 (n=2,832) 11

Died before disaster (n=165) n=2,667 Did not experience disaster (n=18) n=2,649 Lost to follow-up (n=941) n=1,708 Pre-disaster MDD/PTSD (n=548)

2011: Final analytic sample (n=1,160)

Independent Variables (2003) 12

¨

Pre-disaster Stressors: ¤ Direct

tolerance

n The

Composite International Diagnostic Interview (CIDI), Spanish v2.110 n Prior lifetime disaster experience (PTSD module) ¤ Cross

tolerance

of Threatening Experiences (LTE)11 n 12-item questionnaire used to measure major categories of stressful life events (from the prior 6 months) n List

Dependent Variables (2011) 13

¨

Post-Disaster PTSD:10 ¤ Modified

version of the PTSD module of the CIDI ¤ Tailored such that the only traumatic event that could be endorsed was if the participant was involved in the disaster ¨

Post-Disaster MDD:10 ¤

CIDI Depressive Disorders module

Sensitivity Analyses 14

¨

Those lost to follow-up (N=941; 33%) were significantly more likely to have been: ¤ Females n χ2

(69%) vs. males (31%)

= 14.8

¤ High

school/college education (73%) vs. illiterate/elementary school (27%) n χ2 =

11.9

¤ Not

middle age (55 years; 84%) vs. middle age (17%) n χ2 =

4.7

Statistical Analyses 15

To mitigate selection & confounding biases, stabilized inverse probability weights (by gender, age, and education) were calculated12,13 ¨ Marginal structural logistic models (with robust variance estimators) were utilized to predict postdisaster PTSD and MDD12 ¨

Demographics: PTSD 16

Table 1. Descriptive information of participants with post-disaster PTSD (n=106).* Variable % with post-disaster PTSD Gender: Female 82.1 Age: