The Mental Health Impacts of Successive Disaster Events: Examining the Role of Individual and Community Resilience Following an EF-3 Tornado and the COVID-19 Pandemic in Nashville, Tennessee

Background: On March 3rd, 2020, an EF-3 tornado hit Nashville and surrounding counties in Tennessee, killing 25 individuals, injuring over 300, and resulting in $1.5 billion in physical and economic damages. Eight days later on March 11th, 2020 the World Health Organization declared the coronavirus disease outbreak (COVID-19) a pandemic. Few studies have examined the mental health impacts of multiple disasters including exposure to a natural hazard and a global pandemic. In the current study our objective was to 1.) examine the impacts of tornado exposure and COVID-19 stressors on mental health outcomes of posttraumatic stress (PTSD) and depression, and 2.) identify individual and community-level protective factors associated with better mental health outcomes for residents in Nashville.

Methods: The cross-sectional study included 412 Nashville adults. In partnership with a local volunteer organization data were collected February 26 – March 2, 2021 approximately one year following the March 3^, 2020 tornado and one year into the COVID-19 pandemic. To examine direct and indirect effects of risk (disaster exposure and COVID stressors) and resilience factors (individual and community) predicting mental health outcomes, structural equation modeling (SEM) was used with R statistical software and packages. Individual resilience was measured via the Disaster Adaptation and Resilience Scale (First et al., in press) and community resilience was measured via the Community Assessment of Resilience Tool (Pfefferbaum et al., 2013).

Results: SEM results found more tornado exposure was significantly and positively associated with more PTSD (β = .313, p<.001) and depression (β = .236, p<.001) and COVID-19 stressors were associated with more PTSD (β= .313, p<.001) and depression (β = .101, p<.05). Results also found that individual disaster resilience was significantly associated with having less PTSD (β = -.576, p<.001) and depression (β = -.584, p<.001). Community resilience did not have a direct association with mental health outcomes (p >.05), but rather an indirect association through individual disaster resilience and was associated with having less PTSD (β = -.255, p<.01, [CI 95%: -0.484, -0.217]) and depression (β = -.259, p<.01, [CI 95%: -0.460, -0.206]).

Discussion and Implications: Building resilience is an essential step toward strengthening social responses to the human impacts of environmental challenges. Our study found that individual disaster resilience was the mechanism through which community resilience had an impact on adult mental health outcomes. Findings from this study support the development of a multi-system resilience framework for linking individual disaster resilience indicators (e.g., economic resources, social support, psychological skills) to broader community resilience indicators (e.g., economic development, social capital, communication, community networks, and collective action) to assist in activating and sustaining an individual’s healthy adaptation over the long-term.

References:

First, J. M., Yu, M., & Houston, J. B. (n.d.). Development and Validation of the Disaster Adaptation and Resilience Scale (DARS): A Measure to Assess Individual Disaster Resilience. Disasters, n/a(n/a). https://doi.org/doi:10.1111/disa.12452

Pfefferbaum, R.L., et al. (2013). The Communities Advancing Resilience Toolkit (CART): Development of a survey instrument to assess community resilience. International Journal of Emergency Mental Health and Human Resilience, 15(1), 15-30.