Psychological Trauma: Theory, Research, Practice, and Policy In the public domain

2012, Vol. 4, No. 5, 447 456 DOI: 10.1037/a0025501

Racial Variations in Postdisaster PTSD Among Veteran Survivors of

Hurricane Katrina

Teri D. Davis Greer Sullivan

South Central VA Mental Illness Research, Education, and South Central VA Mental Illness Research, Education, and
Clinical Center; Central Arkansas Veterans Healthcare System; Clinical Center and University of Arkansas for Medical Sciences
and University of Arkansas for Medical Sciences

Jennifer J. Vasterling Andra L. Teten Tharp

VA Boston Healthcare System and Boston University School of Baylor College of Medicine
Medicine

Xiaotong Han Elizabeth A. Deitch

South Central VA Mental Illness Research, Education, and University of New Orleans
Clinical Center and University of Arkansas for Medical Sciences

Joseph I. Constans
Southeast Louisiana Veterans Healthcare System; South Central VA Mental Illness Research, Education, and Clinical Center;
and Tulane University

To date, few hurricane trauma-related studies have focused on racial variations in psychological
outcomes such as posttraumatic stress disorder (PTSD) following natural disaster exposure. Of those that
have reported racial differences in postdisaster outcomes, only some have controlled for covariates such
as preexisting vulnerability factors (i.e., prior mental health problems), during-disaster factors (i.e.,
exposure severity) and postdisaster factors (i.e., social support). The present investigation examined
racial differences in postdisaster clinical outcomes (positive screen for and new onset of PTSD), while
controlling for these factors, among a sample of 304 military veterans 212 years after being exposed to
Hurricane Katrina. The sample was composed of 149 African American and 155 White survivors.
Bivariate results revealed racial differences in age, education, income, number of chronic medical
problems, lifetime traumatic events, and Katrina traumatic events. Racial differences were identified in
PTSD outcomes, with African American veterans more likely to have post-Katrina PTSD than Whites,
40% versus 27%, respectively. Racial differences in new onset PTSD remained after adjustment for
covariates. Post hoc analyses, however, indicated that racial differences remained significant only for
veterans with combat experience. Significant covariates included employment status, number of prior
lifetime traumatic experiences, number of Katrina-related traumatic stressors, and current social support.
In general, the difference in post-Katrina PTSD appeared to be associated with lifetime traumatic events
and stressors, including those experienced during Hurricane Katrina and those prior to the hurricane,
especially military combat for African American survivors.

Keywords: Hurricane Katrina, disasters, PTSD, racial differences in psychological distress

This article was published Online First November 7, 2011.
Teri D. Davis, South Central VA Mental Illness Research, Education, and
Clinical Center; Central Arkansas Veterans Healthcare System; and Division
of Health Services Research, University of Arkansas for Medical Sciences;
Greer Sullivan and Xiaotong Han, South Central VA Mental Illness Research,
Education, and Clinical Center and Division of Health Services Research,
University of Arkansas for Medical Sciences; Jennifer J. Vasterling, VA
Boston Healthcare System and Department of Psychiatry, Boston University
School of Medicine; Andra L. Teten Tharp, Department of Psychiatry, Baylor
College of Medicine; Elizabeth A. Deitch, Department of Psychiatry, Univer-
sity of New Orleans; Joseph I. Constans, Southeast Louisiana Veterans Health-
care System; South Central VA Mental Illness Research, Education, and
Clinical Center; and Department of Psychiatry, Tulane University.
Teri D. Davis is a postdoctoral research fellow at the South Central VA
Mental Illness Research, Education, and Clinical Center, Central Arkansas
Veterans Healthcare System, North Little Rock, AR. This work was
supported by the Department of Veterans Affairs South Central Mental
Illness Research, Education, and Clinical Center, Joseph I. Constans,
Principal Investigator. We acknowledge Bryman E. Williams, Jackson
State University, for familiarizing Teri D. Davis with this literature and
encouraging her to think more critically about postdisaster experiences of
African American Katrina survivors during her dissertation work; doing so
laid the foundation of the present work.
Hurricane Katrinas disastrous impact resulted from a combined natural
and man-made disaster.
Correspondence concerning this article should be addressed to Teri D.
Davis, Mental Illness Research, Education and Clinical Center (MIRECC),
Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive,
Building 58 (152/NLR), North Little Rock, AR 72114. E-mail: Teri.Davis4@
va.gov

447
448 DAVIS ET AL.
Many survivors of natural disasters, such as hurricanes, face
significant short- and long-term challenges, such as financial
losses, property damages, depleted community resources and so-
cial support systems, and significant emotional distress (Galea,
Tracy, Norris, & Coffey, 2008; Norris et al., 2002; Sattler, Preston,
Kaiser, Olivera, Valdez, & Schlueter, 2002). Serious psychological
disorders, such as posttraumatic stress disorder (PTSD), are like-
wise elevated among adult survivors of disasters, and PTSD is the
most commonly studied psychological outcome following expo-
sure to natural and man-made disasters (Adams & Boscarino,
2006; Brewin, Andrews, & Valentine, 2000; Galea, Nandi, &
Vlahov, 2005; Norris et al., 2002). Studies of hurricane disasters
prior to Katrina have estimated that between 4% and 51% of
survivors incur a new onset of PTSD following exposure (Acierno
et al., 2007; David, Mellman, Mendoza, & Kulick-Bell, 1996), and
some researchers have noted long-term stability of posttraumatic
symptoms following these disasters (Norris, Perilla, Riad, Ka-
niasty, & Lavizzo, 1999). Early studies after Hurricanes Katrina
and Rita,1 the deadliest and costliest U.S. natural disasters to date
with approximately 1,500 deaths and $81 billion in property dam-
age (Bacon, 2005; Blake, Rappaport, & Landsea, 2007; Insurance
Information Institute, 2007), indicated that between 20% and 35%
of survivors experienced negative psychological sequelae such as
PTSD (Kessler et al., 2008; Kim, Plumb, Gredig, Rankin, &
Taylor, 2008; North et al., 2008).
In general, mental health outcomes following hurricanes are
likely determined by a complex set of factors, but race may be an
important determinant. Some Hurricane Katrina studies that com-
pared survivors from various racial groups (e.g., Hispanics, Afri-
can Americans, Whites) found that African Americans suffered
more emotional distress post-Katrina (Sastry & VanLandingham,
2009), whereas other studies did not (Galea et al., 2008; Kessler et
al., 2008). Similarly, some (Galea et al., 2004; Jones, Frary,
Cunningham, Weddle, & Kaiser, 2001; Norris et al., 2002; Norris
et al., 1999), but not all (Acierno et al., 2007; Galea et al., 2007;
Weems et al., 2007), studies of other man-made and natural
disasters have found a racial disparity in mental health outcomes
such as PTSD.
Our understanding of racial disparities in mental health func-
tioning following disaster exposure is limited. First, few disaster
studies evaluate race as a predictor of mental health outcomes such
as PTSD or the mechanisms that may explain any potential racial
differences in psychological outcomes. Second, the few studies
that have documented racial differences in PTSD among adults
failed to control for probable confounds. Consequently, poorer
outcomes may in some instances be inaccurately attributed to race
rather than to other potentially confounding factors, such as so-
cioeconomic status, social support, and prior mental health prob-
lems. For example, more than 30 years of investigations linking
race and mental health functioning concede that low socioeco-
nomic status and its associated stressors may account for a sub-
stantial portion of the racial variation in emotional response fol-
lowing stressful events (Dohrenwend & Dohrenwend, 1969;
Kessler & Neighbors, 1986; Monnier, Elhai, Frueh, Sauvageot, &
Magruder, 2002; Plant & Sachs-Ericsson, 2004; Ulbrich, Warheit,
& Zimmerman, 1989; Warheit, Holzer, & Arey, 1975). Because
racial minority populations are disproportionately affected by low
economic status (U.S. Department of Health & Human Services
[USDHHS], 2001), poor outcomes may be erroneously attributed
to race. Last, many of the disaster studies that best account for
factors potentially confounded with race, such as socioeconomic
status, have been restricted to children and adolescent hurricane
disaster victims (Khoury et al., 1997; La Greca, Silverman, Vern-
berg, & Prinstein, 1996; La Greca, Silverman, & Wasserstein,
1998). We do not know if these same findings hold true in adults.
Theoretical Explanations for Racial Differences in
Postdisaster Outcomes
There are at least three potential explanations for racial differ-
ences in postdisaster outcomes. The differential vulnerability
model suggests that minority groups may be more vulnerable to
and/or more affected by stressors (Ulbrich et al., 1989), regardless
of the severity of exposure suggesting a potential interaction
between race and exposure. Perilla, Norris, and Lavizzo (2002)
wrote that to understand reactions to stressful circumstances one
should consider the context in which life events are experienced.
Some suggest that minority groups are more likely to experience
distress reactions because they are less likely to have the social
resources to buffer the impact of potentially traumatic life events
(Kaniasty & Norris, 1995). Also, certain experiences common to
racial groups such as poverty, poorer health, and exposure to racial
discrimination (USDHHS, 2001; Plant & Sachs-Ericsson, 2004),
all may contribute to being vulnerable to psychological distress
conditions.
A second model, the differential exposure model, postulates that
minority groups may experience more actual trauma during the
disaster as well as more additional trauma, some of which may not
be readily recognizable. This increased trauma could be related to
living in geographic areas that experience the greatest exposure (as
was true in New Orleans during Hurricane Katrina) or might be
considered a consequence of residing in disadvantaged areas that
may be especially ill-equipped to endure disasters. The lack of
preparedness and community resources might magnify the impact
of the disaster. Exposure for minorities may be more complex,
which may contribute to worse clinical outcomes, relative to White
survivors. For example, early studies of Hurricane Katrina survi-
vors have suggested that during the aftermath of the storm, due to
the southern region in which the storms occurred and some of
cultural experiences of racially diverse groups in highly affected
areas, minority groups were more at risk to experience devalua-
tion, perceived discrimination, prejudicial regard, and/or racism,
thus contributing to potentially worse clinical outcomes (Weems et
al., 2007). Whereas there is limited evidence linking perceived
discrimination and racism to postdisaster outcomes, ongoing or
isolated experiences of perceived racism and exposure to per-
ceived discriminating circumstances may bring about distress re-
actions in African Americans (Bryant-Davis & Ocampo, 2006) and
perhaps other racial minority groups.
Finally, the social support deterioration model is based in part
on cultural differences across racial groups. Whereas low per-
ceived support is likely to have an adverse impact on psycholog-
ical outcomes within all groups, relative to Whites, African Amer-
ican and other minority groups have been noted to place more
value on interpersonal relations with family, friends, and extended
family (Williams, Auslander, Houston, Krebill, & Haire-Joshu,
2000). Others emphasize the importance of family and community
resilience in the healing and recovery process in response to
 RACIAL DIFFERENCES IN PTSD POST HURRICANE KATRINA
stressful experiences and traumatic loss following disaster expo-
sure (Walsh, 1996, 2003, 2007). When postdisaster support de-
clines due to the loss of loved ones and community resources, this
would have a disproportionately negative effect on members of
these communities.
In this paper, we explore the association between race and
trauma-relevant postdisaster outcomes (i.e., positive screen for/
new onset of PTSD) among adult male military Veterans who were
surveyed approximately 30 months after Hurricane Katrina. For
the purposes of this paper, we conceptualize race as a categorical
social construct as defined by Markus (2008). This approach is
limited in terms of broader issues such as individual attributes,
experiences, values, and ethno-cultural beliefs that may accom-
pany this construct and influence outcomes. However, our ap-
proach to assessing racial differences is congruent with the few
studies that have estimated the influence of race on posthurricane
disaster outcomes (Perilla et al., 2002).
We hypothesized that there would be differences across racial
groups in preexisting, during disaster, and postdisaster factors. We
also hypothesized that after controlling for key factors potentially
confounded with race, African American and White Veterans
would not differ in new onset of PTSD. Last, we hypothesized that
we would find evidence for one or more of the theoretical models
explaining racial differences in postdisaster outcomes. A strength
of the study is that, because the participants were all users of
Veterans Hospital Administration (VHA) medical centers, we had
access to pre-Katrina medical record information, including prior
psychological diagnoses and military combat experience as partic-
ular predisaster vulnerability factors. In addition, our sample in-
cluded nearly equal numbers of African American and White
participants.
Method
Identification of Sample Population
We used VA administrative files located at the Austin Informa-
tion Technology Center to identify two pools of potential partici-
pants: (1) veterans with prehurricane mental illness (MI) diagnoses
(MI positive cohort) and (2) veterans with no prehurricane mental
illness (MI negative cohort). To be eligible for participation,
veterans were required to (a) have had at least one outpatient clinic
visit in the 1-year period prior to Hurricane Katrina at the VA
Medical Center (VAMC) in either New Orleans, Louisiana, or
Biloxi, Mississippi and (b) have resided in an area highly affected
by Hurricane Katrina. A veteran was considered to have resided in
a hurricane-affected area if his zip code reflected likely residence
within Hancock, Harrison, or Jackson counties in Mississippi or
Jefferson, Orleans, Plaquemines, St. Bernard, or St. Tammany
parishes in Louisiana. All participants were men between the ages
of 18 and 60 years at Hurricane Katrinas landfall. The study was
restricted to men because the proportion of women veterans was
relatively small (about 12%), and a proportional sampling of men
and women would not have provided adequate power for testing
possible gender effects.
In addition to the inclusion criteria that were applied to all
participants, cohort-specific inclusion/exclusion criteria were also
used. For inclusion in the MI positive cohort, veterans must have
had one or more visits to a VA mental health clinic between
449
August 26, 2004 and August 25, 2005 and been diagnosed with an
affective disorder, anxiety disorder (PTSD and non-PTSD anxiety
disorders), or psychotic disorder. Veterans with substance abuse
diagnoses in the 5 years preceding Hurricane Katrina were ex-
cluded to minimize substance use comorbidity in the sample. For
inclusion in the MI negative cohort, veterans must have had one or
more visits to a VA primary care clinic between August 26, 2004
and August 25, 2005, and had no mental health diagnoses or
substance abuse diagnoses in the preceding 5 years. These criteria
identified a participant sampling pool of 2,098 eligible MI positive
veterans and 2,607 MI negative veterans (N 4,705).
Sampling Strategy and Recruitment
The cohorts were each further stratified according to number of
clinic visits (10 strata, ranging from one visit to a maximum of 10
plus visits) and randomly sampled within those strata in propor-
tions in accordance with the proportions in the overall cohort
participant population. Although the number of visits does not
correspond perfectly to severity of illness, this measure of illness
severity was readily available from the administrative database and
could serve as a proxy for a direct measure of disease severity. We
then randomly sampled from the entire pool of 4,705 participants
with the restriction that the strata proportions for each cohort
sample matched the proportions in the overall cohort population.
Because it is likely that the severity of negative health outcomes
decreases over time and that recruitment of the proposed sample
would require several months, we selected names from the two
cohorts simultaneously to minimize time since the hurricane as
a potential confound. An initial group of 250 potential participants
per cohort was sampled. In accordance with VA regulations,
prenotification letters were sent to prospective participants to
inform them that they had been selected as possible participants for
a VA-sponsored telephone survey. The prenotification letters in-
cluded a brief description of the study, offered a $20 incentive to
complete the 40- to 60-min interview, and included a toll-free
contact number and a postage-paid return postcard to allow the
prospective participant to decline study participation. If the pro-
spective participant did not opt out of participation 2 weeks fol-
lowing our mailing, the individuals name and contact information
were forwarded to a survey administration firm that attempted to
contact all individuals in the sample. When the yield of completed
interviews from that batch dropped to fewer than 10 per cohort in
a week, another batch of 200 per group was randomly drawn and
fielded as described above. This process was repeated twice more,
such that a total of 850 Veterans in each cohort (1,700 total) were
eventually identified for recruitment attempts.
Survey administration personnel attempted to contact the Vet-
eran until the surveyor made contact or the maximum number of
attempts was made. The average number of attempts made to
successfully reach a veteran was eight (range: 150). Following
the initial attempts to call all veterans in a batch, the names of
individuals whose letters could not be delivered or whose phone
numbers were invalid were collected. Survey personnel then used
available contact information and social security numbers to at-
tempt to obtain more recently updated contact information from
credit reporting bureaus, and used this information to make addi-
tional contact efforts. On reaching a veteran, the interviewer ex-
plained the study in detail, answered questions, and asked for
450 DAVIS ET AL.
verbal consent. If consent was given, the interviewer then con-
firmed eligibility by verifying that the respondent was living in the
highly affected area at the time of Hurricane Katrina, on the
basis of the zip codes described above. If the respondent was
eligible, the interviewer then verbally administered the full survey.
Interviews were conducted between November 2007 and May
2008, approximately 2.5 years after the hurricane.
The consent process was completed with 570 Veterans. Of those
consented, 63 individuals were determined to be ineligible at the
outset of the interview because the respondents denied residing in
an eligible parish or county in August of 2005. An additional four
veterans terminated the interview prior to completion of the survey
for reasons unknown. Therefore, of the 937 Veterans we were able
to contact, 503 completed interviews (54%).
Description of the Final Sample
Of the 503 completed interviews, 250 respondents were in the
MI negative cohort and 253 were in the MI positive cohort. The
pre-Katrina medical records revealed that four MI positive cohort
veterans were coded with infrequently occurring diagnoses includ-
ing adjustment disorder with depressed mood (n 2), unspecified
reactive psychosis (n 1), and mood disorder in conditions
classified elsewhere (n 1). Because these infrequently occurring
diagnoses may not accurately reflect a preexisting mental illness,
these participants were not included in the final sample of the MI
positive cohort. Last, for the purpose of this analysis, we excluded
an additional 52 participants who identified themselves as being
from other racial groups (primarily Hispanic) as well as those with
preexisting PTSD per the medical record. We excluded 52 indi-
viduals from our analysis who did not self-identify as White or
non-Hispanic African American (largely Hispanic) because there
were too few participants from each of the individual non-African
American racial minority groups to permit valid statistical analyses
of other race categories. Because Whites and non-Hispanic African
Americans constituted the majority of those affected by the Hur-
ricane Katrina disaster, our sample captures the two main race
categories represented in the larger population of interest. With the
aforementioned exclusions, the final sample was 304 White and
African American veteran survivors.
Measures
Demographic information. Respondents were asked to pro-
vide their age, race, educational attainment, and income (pre- and
post-Katrina). Education and income were measured with ordinal
categories.
To organize and select covariates for this model we followed the
conceptual model proposed by Norris et al. (2002). To be specific,
we identified a number of risk and/or protective factors for the
development of distress reactions following disaster exposure and
classified these factors in terms of predisaster factors (e.g., age,
marital status, education, socioeconomic status, employment sta-
tus, physical health, previous mental health diagnosis, previous
trauma exposures, combat experience), during-disaster factors
(e.g., exposure severity, property damage and losses), and postdi-
saster factors (e.g., social support/resources).
Preexisting vulnerabilities. In addition to preexisting mental
health diagnoses (described above), data regarding whether indi-
viduals had a history of combat exposure were obtained from VA
administrative records. We also asked participants to complete a
checklist of current and chronic medical problems and previous
potentially traumatic events, including nonviolent exposure (e.g.,
natural disaster), nonsexual violent exposure (e.g., domestic vio-
lence), and sexually violent exposure (e.g., rape).
During disaster experiences and stressors. We used an
11-item modified version of a checklist developed by Kessler et al.
(2008) in one of the initial studies of survivors of Hurricane
Katrina. Similar to the original scale, we extracted items based on
knowledge of stressful experiences most frequently encountered
during Hurricane Katrina and its aftermath. These experiences
included: thinking one was going to die; being seriously injured;
seeing dead bodies; witnessing a death; losing a pet; having things
stolen; being assaulted; and having close friends or family injured,
assaulted, stolen from, or die. The items were yes/no questions and
were summed to create a measure of cumulative hurricane-related
stress exposure. Cronbachs alpha for the scale in this sample was
.74.
Postdisaster factors. Social support was assessed with a
nine-item measure (Norris & Kaniasty, 1996) using items from the
Interpersonal Support Evaluation List (Cohen & Hoberman, 1983)
and the Social Provisions Scale (Cutrona & Russell, 1987). Three
facets of social support each were assessed with three items:
tangible support (e.g., having someone who would lend their car),
emotional support (e.g., someone to share ones most private
thoughts and worries with), and informational support (e.g., some-
one to give advice in handling family problems). Respondents used
a 4-point scale to indicate the degree to which each statement is
true. A scale score was calculated as the item mean, with a possible
range of 1 (strongly disagree) to 4 (strongly agree); higher scores
indicate greater levels of support. Cronbachs alpha for the scale in
this sample was .84.
PTSD. Post-Katrina PTSD was assessed with the Short PTSD
Rating Interview (SPRINT; Connor & Davidson, 2001), a measure
commonly used in disaster research. The SPRINT consists of eight
items assessing the presence of intrusion, avoidance/numbing, and
arousal symptoms of PTSD (e.g., How much have you been
bothered by poor sleep, poor concentration, jumpiness, irritability,
or feeling watchful around you?). Respondents indicated the
extent to which they experienced these symptoms during the past
month. A 5-point response scale was used, ranging from 0 (not at
all) to 4 (very much). Scores were summed for an overall scale
score ranging from 0 to 32. Cronbachs alpha for the scale was .94.
A cut score of 14 was used to indicate a positive screen for PTSD.
This cut score was the lower bound of the range of scores that
Connor and Davidson (2001) found best distinguished between
those with and without the disorder in a general population, max-
imizing sensitivity (95%) whereas maintaining high specificity
(96%). Connor and Davidson suggested a lower range of cut scores
(11 to 13) for a purely clinical population to enhance the potential
for identifying positive cases, but we chose to use the recom-
mended general population cut score because the screen would be
applied to both the MI positive and MI negative cohorts.
Weights
Due to the stratified sampling design with MI positive and
negative cohorts being randomly chosen in each of the 10 visit
 RACIAL DIFFERENCES IN PTSD POST HURRICANE KATRINA
groups (strata, ranging from one visit to a maximum of 10 plus
visits), we created a sampling weight using the initial target sample
of 1,700 as the reciprocal of the sampling rates for the 10 visit
groups in both the MI positive and MI negative cohorts. To adjust
for potential bias in response and to increase the chances that our
final sample was representative of the initial pool of 1,700 veter-
ans, we calculated nonresponse weights as the reciprocal of re-
sponse rates in each of the cells formed by diagnosis groups (MI
positive and MI negative cohorts), number of visits groups (groups
with four or more visits were combined due to fewer subjects in
those groups) and residence groups (Mississippi, Louisiana, and
other). The final weight was calculated as the product of the two
above weights.
Statistical Analysis
Bivariate analyses were performed to compare post-Katrina
diagnoses across the racial groups for the variables of interest. For
categorical variables, RsoScott chi-square was used to incorpo-
rate the design variables of weight and strata. For continuous
variables, due to violation of normality, Wilcoxons ranked sum
test was used to test racial differences within the sample. To
examine the associations between racial groups and a positive
screen for a new onset of PTSD, we fit logistic regression models
using PROC SURVEYLOGISTIC in SAS 9.2 to incorporate de-
sign variables. The dependent variable was a positive screen for
new onset PTSD posthurricane. The independent variable was the
dichotomized race variable with White as the reference group.
To evaluate each of the presented theoretical models, three
different logistic regressions were conducted. For the differential
vulnerability model, two interactions were tested to determine
whether the exposure factors (e.g., Katrina trauma and cost of
damages) moderate the association between race and PTSD. This
included the evaluation of Race Katrina-Related Trauma and
Race Interaction terms. For the differential exposure model, two
odd ratios were compared for the association of race and PTSD
with and without controlling for the exposure factors. Last, for the
social deterioration model, a Race Social Support Interaction
term was evaluated to determine whether social support moderates
the association between race and PTSD.
The study was approved by the Research and Development
Committees of the Central Arkansas Veterans Health Care System
in Little Rock, AR, the G. V. (Sonny) Montgomery VA Medical
Center in Jackson, MS, and their affiliated Institutional Review
Boards at the University of Arkansas Medical Sciences, Tulane
University, and the VA Medical Center in New Orleans, LA.
Results
Demographic, Clinical, and Vulnerability
Characteristics
Results of the bivariate analyses are presented in Table 1.
Slightly over half of the study sample (51%) was White. White
veterans were more likely to be in the 61 plus group and more
likely to be married. The sample did not differ on other preexisting
demographic factors (e.g., employment, education) across race.
Analyses identified significant differences on some prehurricane
vulnerability factors, one during-disaster factor, and rates of pos-
451
itive screens for PTSD post-Katrina. White veterans were more
likely to have more chronic medical problems and more lifetime
traumatic events than African American veterans. African Amer-
icans reported significantly more Katrina traumatic events than
White veterans. African Americans were also significantly more
likely than Whites to screen positive for posthurricane new PTSD
(40% vs. 27%). In contrast, there were no significant differences in
postdisaster social support.
Table 2 shows results of the logistic regression analysis evalu-
ating the association between race and new onset of PTSD diag-
nosis post Katrina while controlling for demographics (i.e., age,
income, employment, education, marital status), preexisting so-
ciodemographic and vulnerability variables (i.e., medical prob-
lems, any previous combat experience), during disaster trauma
severity factors (i.e., Katrina-related events and property damages)
and one postdisaster factor of social support. The odds ratio (OR)
for race, after controlling demographics and pre-, during, and
postdisaster factors, was 3.86 and remained significant, but only
for African American survivors with prior combat experience.
Significant covariates to new onset of PTSD were employment
status (OR 0.42, confidence interval (CL) 0.20 0.88), num-
ber of chronic lifetime traumatic events (OR 1.28, CL
1.06 1.56), number of Katrina-related traumatic events or stres-
sors (OR 1.48, CL 1.271.72) and social support (OR .26,
CL 0.16 0.43). Because we found that both lifetime traumatic
events and Katrina-related events were significant, we were curi-
ous to know why we did not find prior combat experience to be
statistically significant. To explore this, we added an interaction
term, Race Combat Experience, to our logistic regression model
and combat experience was indeed associated with new PTSD, but
only for African American survivors (OR 3.86, CI 1.47
10.14; see Table 2).
For the theoretical models, the differential vulnerability model
was not supported as the Race Katrina-Trauma and the Race
Cost of Damages interactions were not significant indicating that
African American veteran survivors were no more responsive or
sensitive to exposures than White survivors. The comparison of the
OR for the test of the differential exposure model revealed a
decrease from 1.78 to 1.24, indicating that the severity of exposure
had a mild to moderate influence on new onset PTSD, more so for
African Americans than Whites. Finally, the Race Social Sup-
port interaction was not significant, which does not offer evidence
for the social support deterioration model. Although social support
was related to outcomes in both racial groups, this finding indi-
cates that low perceived social support was no more detrimental to
African Americans than to Whites.
Discussion
We evaluated the relationship between race and positive screen
for PTSD following hurricane exposure in a population of veterans
with and without prehurricane mental disorders. We found support
for our first hypothesis (i.e., that there would be racial differences
in vulnerability and outcome factors). There were significant racial
differences in preexisting factors (number of lifetime trauma
events), during-disaster factors (number of Katrina trauma events)
and postdisaster factors (post-Katrina PTSD). Our hypothesis that
no racial differences in PTSD outcomes would exist after control-
ling for potentially confounding factors was not supported by the
452 DAVIS ET AL.

Table 1
Participant Characteristics

African
American White Total
(n 149) (n 155) (N 304)

Unweighted N Unweighted N Unweighted N

Demographics (Weighted %) (Weighted %) (Weighted %) 2(df)

Age 9.9 (3)

45 33 (21.86) 27 (17.42) 67 (15.54)
4655 54 (37.59) 43 (27.71) 97 (32.60)
5660 49 (32.36) 56 (36.03) 105 (34.22)
61 plus 13 (8.18) 29 (18.84) 42 (13.57)
Married 90 (59.21) 107 (70.00) 197 (64.65) 3.9 (1)
Education 3.7 (2)
High school graduate or below 60 (39.83) 47 (29.91) 107 (34.82)
Vocational or some college 63 (43.40) 74 (47.75) 137 (45.60)
College graduate or above 26 (16.76) 34 (22.34) 60 (19.58)
Income 5.9 (3)
$20,000 42 (27.25) 36 (22.30) 78 (24.75)
$20,000$39,999 62 (41.43) 54 (33.58) 116 (37.46)
$40,000 or above 42 (29.29) 63 (42.75) 105 (36.09)
Missing 3 (2.04) 2 (1.37) 5 (1.70)
Employment status 98 (66.43) 92 (60.65) 190 (63.51) 1.1 (1)
Predisaster vulnerabilities
No. of chronic lifetime medical problemsa M (SD) 1.48 (1.15) 1.98 (1.40) 1.74 (1.29) 2.9
Combat exposure 70 (46.37) 81 (53.18) 151 (49.81) 1.4 (1)
No. of prior lifetime traumatic eventsa M (SD) 2.63 (1.92) 3.24 (1.68) 2.94 (1.82) 2.7
Prior mental illness
Prior depression 30 (17.86) 33 (18.06) 63 (17.96) 0.0021 (1)
Prior GAD 2 (1.35) 3 (1.34) 5 (1.34) 0.0000 (1)
Prior bipolar disorder 1 (0.58) 5 (2.55) 6 (1.57) 2.2155 (1)
Prior schizophrenia disorder 10 (5.30) 7 (3.75) 17 (4.52) 0.5802 (1)
During disaster experiences
Number of Katrina trauma events a M (SD) 3.18 (2.41) 2.17 (2.00) 2.67 (2.24) 3.5
Cost of property damageb 5.7 (4)
$9 33 (21.56) 39 (24.81) 72 (23.20)
1030 34 (24.35) 53 (33.81) 87 (29.14)
3190 37 (24.12) 28 (17.93) 65 (20.99)
91 plus 37 (24.81) 26 (18.04) 63 (21.38)
Missing 8 (5.16) 9 (5.40) 17 (5.28)
Postdisaster experiences
Social support M (SD)a 3.11 (0.65) 3.19 (0.70) 3.15 (0.67) 1.3
Positive screen for PTSD 60 (40.05) 44 (27.30) 104 (33.60) 5.7 (1)

a b
The statistics for the continuous variables in the table are z value based on Wilcoxon two-sample test. Given in thousands.

Significant at .05.

data. That is, overall, African Americans were still more likely to
have a positive screen for PTSD after we controlled for key
variables believed to be associated with race. This finding is
inconsistent with previous Katrina-specific studies that have con-
trolled for similar sociodemograpic factors, disaster-related
trauma, and social support, and found that race was no longer a
significant predictor of mental health outcomes (Kessler et al.,
2008; Sastry & VanLandingham, 2009). After we controlled for
covariates, although African Americans with combat experience
continued to differ from White veterans, African Americans with-
out combat experience no longer differed from White veterans
without combat experience suggesting that experiencing combat
creates an additional vulnerability among African Americans. This
is supported by a post hoc analysis indicating that combat was a
significant determinant of PTSD outcome among African Ameri-
can but not White veterans. These findings are interesting in light
of studies of combat-related PTSD among military veterans, which
indicate that veterans from minority groups, such as African Amer-
icans and Hispanics, with combat experience have a higher rate of
PTSD relative to White veterans with combat experience, 28% and
21% versus 14%, respectively (Kulka et.al, 1990). These findings
have been largely accounted for by African Americans having a
greater exposure to war stressors and having more predisposing
factors than Whites. However, when Kulka et al. (1990) controlled
for these factors, the differences in PTSD rates between Whites
and African Americans were less apparent, which is inconsistent
with our findings. It is possible that African American veterans in
our sample were more susceptible to mental health conditions or
had unique experiences during their military service, which may
have contributed to their responding more robustly to later poten-
tially traumatic situations. Other reports have noted the importance
of prior trauma to later development of PTSD and it is possible that
 RACIAL DIFFERENCES IN PTSD POST HURRICANE KATRINA 453

Table 2
Logistic Regression for Veteran Survivors With New Probable PTSD Diagnosis

Effect Odds Ratio Lower CL Upper CL

African American
Without combat experience 0.952 0.385 2.355
With combat experience 3.860 1.470 10.137
Age
4655 versus 45 minus 0.617 0.259 1.467
5660 vs 45 minus 0.810 0.331 1.978
61 plus vs 45 minus 0.766 0.211 2.784
Married 1.089 0.542 2.185
Education
College graduate or above versus high school graduate or below 0.426 0.148 1.226
Vocational or some college versus high school graduate or below 1.259 0.631 2.515
Income
$20,000$39,999 versus less than $20,000 0.921 0.365 2.327
$40,000 or above versus less than $20,000 1.291 0.498 3.351
Missing data versus less than $20,000 5.829 0.325 104.512
Employment 0.406 0.193 0.854
No. of chronic lifetime medical problems 1.049 0.807 1.362
No. of lifetime traumatic events 1.292 1.064 1.568
Prior hurricane mental health diagnosis 1.769 0.823 3.802
No. of Katrina trauma events 1.483 1.282 1.715
Cost of property damage
91k plus versus $9,000 minus 0.704 0.239 2.076
31k90k versus $9,000 minus 0.749 0.253 2.220
10k30k versus $9,000 minus 0.724 0.271 1.936
Missing data versus $9,000 minus 0.219 0.040 1.202
Social support 0.256 0.154 0.426
Combat experience
White survivors 0.631 0.240 1.660
African American survivors 2.561 1.028 6.380

Note. N 304. CL confidence interval.

p .05.

trauma, especially military combat, is particularly a risk factor for
African American veterans. As we discuss below, unique charac-
teristics of Hurricane Katrina exposure may explain the inconsis-
tency between prior studies of military veterans and other hurri-
cane survivors and our findings.
Of the three theoretical models that might explain our findings,
our data were most consistent with the differential exposure model.
The influence of the severity of exposure may partially explain the
racial differences in mental health outcomes in our sample. Other
researchers have found that variations in disaster exposure among
a sample of Hurricane Andrew survivors resulted in part from
residing in disadvantaged areas that were ill-equipped to endure a
disaster (Perilla et al., 2002). Survivors who reside in the most
indigent predisaster areas and may have limited resources to evac-
uate frequently suffer the most significant disaster related dam-
ages, losses, and traumatization, tend to endure more postdisaster
stressors and have poorer mental health outcomes (Galea et al.,
2005; Norris et al., 2002; Sastry & VanLandingham, 2009), and
are more likely to be members of minority groups (Galea et al.,
2004; La Greca et al., 1996). Studies of Hurricane Katrina survi-
vors commonly report these trends among minority survivors
(Kessler et al., 2008; Sastry & VanLandingham, 2009; Whaley,
2009). Recently, Lee, Shen, and Tran (2009) found that among
African American Katrina survivors, experiencing more disaster-
related stressors was associated with postdisaster psychological
distress and less perceived resilience to fully recover from the
disaster. Thus, our finding that PTSD was evident 2.5 years after
exposure may suggest that postdisaster distress may actually pro-
long and complicate the recovery process for African American
survivors who are exposed to higher levels of stress.
Our data did not support the differential vulnerability model as
we did not find that exposure factors (Katrina-related events and
cost and damages) moderated the association of race and PTSD
outcomes. The support for this hypothesis in the literature has been
mixed, with some researchers noting that specific types of stressors
(e.g., undesirable life events, various trauma types, and/or eco-
nomic problems) yield different emotional response patterns
among racial groups (Neff, 1985; Norris, 1992; Norris et al.,
2002). For example, Ulbrich et al. (1989) suggested that social
connections are especially important for African Americans. Life
events that threaten their social connections to others and/or re-
sources (i.e., natural disasters, violence) may result in greater
distress reactions, whereas other types of stressors (e.g., economic
problems) may result in less severe responses. Thus, racial groups
may differ in their response to particular types of stressors. Ac-
cordingly, our findings leave room for further conceptualization of
other factors that may have a differential impact on African Amer-
ican survivors vulnerabilities.
Although our data suggest that social support in general is an
important determinant of disaster outcomes, our data suggested
that the influence of perceived social support did not differ be-
tween the two racial groups. Thus, our findings did not support the
454 DAVIS ET AL.
social deterioration model and are inconsistent with other studies
that found support for the social deterioration model among indi-
viduals who experience chronic economic stress (Plant & Sachs-
Ericsson, 2004) as well as those who have survived various natural
disasters such as floods (Kaniasty & Norris, 1993) and hurricanes
(Galea et al., 2008; Norris et al., 1999; Sattler et al., 2002). Norris
and Kaniasty (1996) found that high levels of perceived social
support mediated the association between disaster exposure and
long-term depression symptoms among survivors of Hurricanes
Andrew and Hugo. Weems et al. (2007) found an inverse relation-
ship between social support and anxiety and depression symptoms
among survivors of Hurricane Katrina in that low perceived social
support was associated with high psychological symptoms follow-
ing exposure. It is also possible that the function and importance of
perceived social support may vary by racial groups. Plant and
Sachs-Ericsson (2004) noted that White Americans place more
emphasis on personal independence whereas most racial minority
subgroups place more importance on securing interpersonal rela-
tions with family, friends, and extended family.
Why might our results be different than previous disaster stud-
ies, including those concerning psychological outcomes among
survivors of Hurricane Katrina? Our study, unlike many hurricane-
related studies, focused exclusively on the influence of race be-
tween two racial groups and included only veterans rather than the
general population of disaster survivors. Many researchers have
noted that the differential responsiveness of African Americans to
disasters speaks to years of historical marginalization, racial and
social discrimination, and multigenerational cultural experiences
of this subgroup that encourage mistrust (Perilla et al., 2002;
Whaley, 2009). In a recent study of Hurricane Katrina survivors,
Weems et al. (2007) found a relationship between perceived dis-
crimination, social support, and PTSD symptoms among those
who were most affected by the storm by way of experiencing the
greatest number of traumatic events (i.e., largely minorities).
Bryant-Davis and Ocampo (2006) suggested that perceived expe-
riences of racism may be similar to other traumatic experiences
such as rape or domestic violence in that they may also result in
posttrauma-like symptoms. In addition, in the aftermath of the
storm, media coverage disproportionately depicted African Amer-
icans and disadvantaged groups in a negative light, which may
have exacerbated distress symptoms. Whaley (2009) wrote that
viewing negative images may have compounded the traumatic
response to Hurricane Katrina, which may have compromised
coping with the aftermath. Weems (2007) and others (McLeish &
Del Ben, 2008) reported a positive correlation between TV view-
ing of the Katrina aftermath and PTSD symptoms. These findings
may suggest that for African American survivors, being exposed to
negative coverage could have been regarded as an additional
stressor, which may have subsequently increased their vulnerabil-
ity to postdisaster psychological sequelae such as PTSD. Given the
limitations inherent in our use of race as a categorical social
construct, however, these explanations should be considered as
speculative and not directly supported by our data.
It also is possible that there may be something distinctive about
the relationship between race and PTSD in general. An extensive
literature has indicated that PTSD is the most widely studied
mental health outcome following hurricane disaster exposure (Ga-
lea et al., 2008; Norris et al., 2002; Perilla et al., 2002; Shultz,
Russell, & Espinel, 2005), over and above other potential psycho-
logical conditions (e.g., depression). Our findings are consistent
with studies of survivors of Hurricane Katrina (Sastry & VanLand-
ingham, 2009) and other disasters (Adams & Boscarino, 2005) that
suggest that minority groups are more likely than Whites to de-
velop symptoms of PTSD postdisaster exposure (La Greca et al.,
1998; Norris et al., 2002; Norris et al., 1999; Perilla et al., 2002).
Research has indicated that African Americans from disadvan-
taged backgrounds, in particular, may be more vulnerable, sensi-
tive, and emotionally responsive to stressful circumstances and/or
trauma than White individuals (Dohrenwend & Dohrenwend,
1969; Kessler & Neighbors, 1986; Perilla et al., 2002; Plant &
Sachs-Ericsson, 2004; Ulbrich et al., 1989). Some researchers have
noted more vulnerability to psychological distress among disaster-
exposed African American males (Norris, 1992). We found a
significant interaction between race and combat experience. How-
ever, as previously noted, the type of trauma experienced may
make a difference in the likelihood of developing postdisaster
problems. In our study, African Americans were more likely to
have new PTSD only if they had combat experience, which may
suggest that African Americans with prior trauma experience may
be more likely to develop poorer outcomes following disaster
exposure. Thus, we argue that the type of predisaster trauma
experience may be a reasonable predictor of postdisaster psycho-
logical outcomes.
Our analysis is limited in that the study was not originally
intended to examine race and postdisaster outcomes. As noted
earlier, we obtained information on race by self-report in telephone
interviews and had no objective way to verify the information we
obtained. We relied on categorical data, racial self-designation, as
a stand-in for the salience and/or significance of various cultural
elements implied by the construct of race. Although our measure
of race closely resembled other studies that have evaluated the
influence of racial categories on postdisaster outcomes (Perilla et
al., 2002), our inability to explore race in greater depth limits what
we can conclude about the influence of race in a broader sense.
Further, although we used widely accepted and validated measures
to assess mental health outcomes, screening tools are limited
relative to clinically derived diagnoses. Because we used data from
a study that was not specifically designed to assess the relationship
between race and postdisaster outcomes, there were many poten-
tially important unmeasured variables. For example, we had only
one postdisaster measure, perceived social support, and it is likely
that many other postdisaster factors, unmeasured in this study, may
have been important. Also, we included no females and the results
may not be generalizable to women veterans. The inclusion of
women in studies of veteran populations is challenging given that
only 15% of veterans are women.
Conclusions
We found that African American male veterans in our sample
population were more likely than White male veterans to screen
positive for a new diagnosis of PTSD more than 2 years post-
Katrina, even after controlling for potentially confounding factors,
such as preexisting demographic factors and vulnerabilities,
during-disaster stressors, and postdisaster social support. This dif-
ference appears to be associated with the experience of trauma,
both lifetime and during disaster exposure and, especially for
African Americans, combat experience. Although a broader as-
 RACIAL DIFFERENCES IN PTSD POST HURRICANE KATRINA
sessment of race may have offered more conclusive explanations
for how race plays a role in outcomes, our finding that race as a
social construct is related to more severe postdisaster outcomes, at
best, suggests that there is something distinctive about African
American survivors that contributes to this evidence. To further
clarify this, additional research is needed on the relation between
race and disaster-related mental health outcomes in both Veteran
and civilian populations, particularly research that captures more
of the complexity of race and/or ethnic values. Future work will
also benefit from inclusions of measures of preexisting, disaster
related, and postdisaster factors that capture the myriad of factors
that accompany race, thus offering more clarity to why the con-
struct of race may play a role in postdisaster outcomes.
Our findings highlight some implications for future practice.
Community-level policies or practices developed to assist in post-
disaster response and preparedness should take into account both
the potentially vulnerable populations (i.e., low socioeconomic
status; those with prior trauma experiences) exposed to disasters
and the influence of social determinants of poor health outcomes
following disaster exposure (i.e., PTSD). Tools developed from
understanding the needs of vulnerable populations may be most
helpful to clinicians in their postdisaster recovery efforts and to the
educators who prepare them.
References
Acierno, R., Ruggiero, K. J., Galea, S., Resnick, H. S., Koenen, K.,
Roitzsch, J., . . . Kilpatrick, D. G. (2007). Psychological sequelae result-
ing from the 2004 Florida hurricanes: Implications for postdisaster
intervention. American Journal of Public Health, 97, 103108. doi:
10.2105/AJPH.2006.087007
Adams, R. E., & Boscarino, J. A. (2005). Differences in mental health
outcomes among Whites, African Americans, and Hispanics following a
community disaster. Psychiatry: Interpersonal and Biological Pro-
cesses, 68, 250 265. doi: 10.1521/psyc.2005.68.3.250
Adams, R. E., & Boscarino, J. A. (2006). Predictors of PTSD and delayed
PTSD after disaster: The impact of exposure and psychosocial resources.
Journal of Nervous and Mental Disease, 194, 485 493. doi: 10.1097/
01.nmd.0000228503.95503.e9
Bacon, P., Jr. (2005, September). Paying for Katrina. Time, 166(12), 22.
Blake, J., Rappaport, M., & Landsea, F. (2007). The deadliest, costliest,
and most intense United States tropical cyclones from 1851 to 2006
(NOAA Tech. Memorandum NWS TPC5). Miami, FL: National Hur-
ricane Center, National Weather Service. Available at http://
www.nhc.noaa.gov/pdf/NWS-TPC-5.pdf
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of
risk factors for posttraumatic stress disorder in trauma-exposed adults.
Journal of Consulting and Clinical Psychology, 68, 748 766. doi:
10.1037/0022-006X.68.5.748
Bryant-Davis, T., & Ocampo, C. (2006). A therapeutic approach to the
treatment of racist-incident-based trauma. Journal of Emotional Abuse,
6(4), 122. doi: 10.1300/J135v06n04_01
Cohen, S., & Hoberman, H. M. (1983). Positive events and social supports
as buffers of life change stress. Journal of Applied Social Psychology,
13, 99 125. doi: 10.1111/j.1559-1816.1983.tb02325.x
Connor, K. M., & Davidson, J. R. T. (2001). SPRINT: A brief global
assessment of post-traumatic stress disorder. International Clinical Psy-
chopharmacology, 16, 279 284. doi: 10.1097/00004850-200109000-
00005
Cutrona, C. E., & Russell, D. (1987). The provisions of social relationships
and adaptation to stress. In W. H. Jones & D. Perlman (Eds.), Advances
in personal relationships (Vol. 1, pp. 37 67). Greenwich, Conn.: JAI
Press.
455
David, D., Mellman, T. A., Mendoza, L. M., & Kulick-Bell, R. (1996).
Psychiatric morbidity following Hurricane Andrew. Journal of Trau-
matic Stress, 9, 607 612.
Dohrenwend, B. P., & Dohrenwend, B. S. (Eds.). (1969). Social status and
psychological disorder: A causal inquiry. New York, NY: Wiley.
Galea, S., Brewin, C. R., Gruber, M., Jones, R. T., King, D. W., King,
L. A., . . . Kessler, R. C. (2007). Exposure to hurricane-related stressors
and mental illness after Hurricane Katrina. Archives of General Psychi-
atry, 64, 14271434.
Galea, S., Nandi, A., & Vlahov, D. (2005). The epidemiology of post-
traumatic stress disorder after disasters. Epidemiological Reviews, 27,
78 91.
Galea, S., Tracy, M., Norris, F., & Coffey, S. F. (2008). Financial and
social circumstances and the incidence and course of PTSD in Missis-
sippi during the first two years after Hurricane Katrina. Journal of
Traumatic Stress, 21, 357368.
Galea, S., Vlahov, D., Tracy, M., Hoover, D., Resnick, H., & Kilpatrick, D.
(2004). Hispanic ethnicity and post-traumatic stress disorder after a
disaster: Evidence from a general population survey after September 11,
2001. Annals of Epidemiology, 14, 520 531.
Insurance Information Institute. (2007). The ten most costly world insur-
ance losses, 1970 2006. Retrieved from http://www.iii.org
Jones, R. T., Frary, R., Cunningham, P., Weddle, J. D., & Kaiser, L.
(2001). The psychological effects of Hurricane Andrew on ethnic mi-
nority and Caucasian children and adolescents: A case study. Cultural
Diversity & Ethnic Minority Psychology, 7, 103108.
Kaniasty, K., & Norris, F. H. (1993). In search of altruistic community:
Patterns of social support mobilization following Hurricane Hugo.
American Journal of Community Psychology, 23, 447 477.
Kaniasty, K., & Norris, F. H. (1995). A test of the social support deteri-
oration model in the context of natural disaster. Journal of Personality
and Social Psychology, 64, 395 408.
Kessler, R. C., Galea, S., Gruber, M. J., Sampson, N. A., Ursano, R. J., &
Wessely, S. (2008). Trends in mental illness and suicidality after Hur-
ricane Katrina. Molecular Psychiatry, 13, 374 384.
Kessler, R. C., & Neighbors, H. W. (1986). A new perspective on the
relationships among race, social class, and psychological distress. Jour-
nal of Health and Social Behavior, 27, 107115.
Khoury, E. L., Warheit, G. J., Hargrove, M. C., Zimmerman, R. S., Vega,
W. A., & Gil, A. G. (1997). The impact of Hurricane Andrew on deviant
behavior among a multi-racial/ethnic sample of adolescents in Dade
County, FL: A longitudinal analysis. Journal of Traumatic Stress, 10,
7191.
Kim, S. C., Plumb, R., Gredig, Q., Rankin, L., & Taylor, B. (2008).
Medium-term post-Katrina health sequelae among New Orleans resi-
dents: Predictors of poor mental and physical health. Journal of Clinical
Nursing, 17, 23352342.
Kulka, R. A., Schlenger, W. A., Fairbanks, J. A., Hough, R. L., Jordan,
B. K., Marmar, C. R., & Cranston, A. S. (1990). Trauma and the
Vietnam War generation: Report of findings from the National Vietnam
Veterans Readjustment study. New York, NY: Brunner/Mazel.
La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J.
(1996). Symptoms of posttraumatic stress in children after Hurricane
Andrew: A prospective study. Journal of Consulting and Clinical Psy-
chology, 64, 712723.
La Greca, A. M., Silverman, W. K., & Wasserstein, S. B. (1998). Chil-
drens predisaster functioning as a predictor of posttraumatic stress
following Hurricane Andrew. Journal of Consulting and Clinical Psy-
chology, 66, 883 892.
Lee, E. O., Shen, C., & Tran, T. V. (2009). Coping with Hurricane Katrina:
Psychological distress and resilience among African American evacuees.
Journal of Black Psychology, 35(1), 523.
Markus, H. R. (2008). Of pride, prejudice, and ambivalence: Toward a
456 DAVIS ET AL.
unified theory of race and ethnicity. American Psychologist, 63, 651
670.
McLeish, A. C., & Del Ben, K. S. (2008). Symptoms of depression and
posttraumatic stress disorder in an outpatient population before and after
Hurricane Katrina. Depression and Anxiety, 25, 406 421.
Monnier, J., Elhai, J. D., Frueh, B. C., Sauvageot, J. A., & Magruder, K. M.
(2002). Replication and expansion of findings related to racial differ-
ences in veterans with combat-related PTSD. Depression and Anxiety,
16(2), 64 70.
Neff, J. A. (1985). Race and vulnerability to stress: An examination of
differential vulnerability. Journal of Personality and Social Psychology,
49, 481 491.
Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of
different potentially traumatic events on different demographic groups.
Journal of Consulting and Clinical Psychology, 60, 409 418.
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., &
Kaniasty, K. (2002). 60,000 disaster victims speak: Part I. An empirical
review of the empirical literature, 19812001. Psychiatry: Interpersonal
and Biological Processes, 65, 207239. doi: 10.1521/psyc.65.3
.207.20173
Norris, F. H., & Kaniasty, K. (1996). Received and perceived social
support in times of stress: A test of the social support deterioration
deterrence model. Journal of Personality and Social Psychology, 71,
498 511.
Norris, F. H., Perilla, J. L., Riad, J. K., Kaniasty, K., & Lavizzo, E. A.
(1999). Stability and change in stress, resources, and psychological
distress following natural disaster: Findings from Hurricane Andrew.
Anxiety, Stress & Coping: An International Journal, 12, 363396.
North, C. S., King, R. V., Fowler, R. L., Polatin, P., Smith, R. P., LaGrone,
H. A., . . . Pepe, P. E. (2008). Psychiatric disorders among transported
hurricane evacuees: Acute-phase findings in a large receiving shelter
site. Psychiatric Annals, 38, 104 113.
Perilla, J. L., Norris, F. H., & Lavizzo, E. A. (2002). Ethnicity, culture, and
disaster response: Identifying and explaining ethnic differences in PTSD
six months after Hurricane Andrew. Journal of Social and Clinical
Psychology, 21, 20 45.
Plant, E. A., & Sachs-Ericsson, N. (2004). Racial and ethnic differences in
depression: The roles of social support and meeting basic needs. Journal
of Consulting and Clinical Psychology, 72, 4152.
SAS Institute Inc. (2008). SAS/STAT 9.2 Users Guide. Cary, NC: SAS
Institute Inc.
Sastry, N., & VanLandingham, M. (2009). One year later: Mental illness
prevalence and disparities among New Orleans residents displaced by
Hurricane Katrina. American Journal of Public Health, 99, S725S731.
Sattler, D. N., Preston, A., Kaiser, C. F., Olivera, V. E., Valdez, J., &
Schlueter, S. (2002). Hurricane Georges: A cross-national study exam-
ining preparedness, resource loss, and psychological distress in the U.S.
Virgin Islands, Puerto Rico, Dominican Republic, and the United States.
Journal of Traumatic Stress, 15, 339 350.
Shultz, J. M., Russell, J., & Espinel, Z. (2005). Epidemiology of tropical
cyclones: The dynamics of disaster, disease, and development. Epide-
miological Review, 27, 2135.
Ulbrich, P. M., Warheit, G. J., & Zimmerman, R. S. (1989). Race, socio-
economic status, and psychological distress: An examination of differ-
ential vulnerability. Journal of Health and Social Behavior, 30(1),
131146.
U.S. Department of Health and Human Services. (2001). A supplement to
mental health: A report of the Surgeon General. Rockville, MD: U.S.
Department of Health and Human Services, Public Health Services,
Office of the Surgeon General.
Walsh, F. (1996). The concept of family resilience: Crisis and challenge.
Family Process, 35, 261281.
Walsh, F. (2003). Crisis, trauma, and challenge: A relational resilience
approach for healing, transformation and growth. Smith College Studies
in Social Works, 35, 261281.
Walsh, F. (2007). Traumatic loss and major disaster: Strengthening family
and community resilience. Family Process, 46, 207227.
Warheit, G. J., Holzer, C. E., & Arey, S. A. (1975). Race and mental
illness: An epidemiologic update. Journal of Health and Social Behav-
ior, 16, 243256.
Weems, C. F., Pina, A. A., Costa, N. M., Watts, S. E., Taylor, L. K., &
Cannon, M. F. (2007). Pre-disaster trait anxiety and negative affect
predict posttraumatic stress in youth after hurrican Katrina. Journal of
Consulting and Clinical Psychology, 75, 154 159.
Weems, C. F., Watts, S. E., Marsee, M. A., Taylor, L. K., Costa, N. M.,
Cannon, M. F., . . . Pina, A. A. (2007). The psychosocial impact of
Hurricane Katrina: Contextual differences in psychological symptoms,
social support, and discrimination. Behaviour Research and Therapy,
45, 22952306.
Whaley, A. L. (2009). Trauma among survivors of Hurricane Katrina:
Considerations and recommendations for mental health care. Journal of
Loss and Trauma, 14, 459 476.
Williams, J. H., Auslander, W. F., Houston, C., Krebill, H., & Haire-Joshu,
D. (2000). African American family structure: Are there differences in
social, psychological, and economic well-being? Journal of Family
Issues, 21, 383 857.
Received November 12, 2010
Revision received July 14, 2011
Accepted July 28, 2011