assessing the relationship between psychosocial ...

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: