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Post-Hurricane Distress Scale (PHDS): A Novel Tool for First Responders and Disaster Researchers

  • Yonatan Carl (a1), Ediricardo Rodríguez Ortiz (a1), Moisés Cintrón (a1), Andy Vega (a1), Cristina Font (a1), Marina Stukova (a1), Andrew Blundell (a1), Ashley N. Gutierréz (a1) and Raúl Ferrer Burgos (a1)...



The aim of this study was the construction and validation of a novel research instrument to quantify the degree of post-hurricane trauma and distress in an affected population. The Post-Hurricane Distress Scale (PHDS) has quantitative measures of both acute and prolonged distress, attributable to meteorological and hydrological disasters.


A careful evaluation of existing questionnaires, as well as extensive canvasing of the post-Maria population of Puerto Rico, availed the construction of the PHDS. The PHDS consists of 20 items, organized into 4 subscales. The PHDS was pre-validated (n=79), revised, and then distributed to a broad sampling of the post-Hurricane Maria Puerto Rican population (n=597). Validation, including factor analysis, analyses of concurrent validity, discriminant validity, and internal reliability, was performed.


After comparing various scales, factor loading profiles, concurrent validities, and models of fit, we show that the PHDS is best scored as a single 0–6 distress scale. When compared with the Traumatic Exposure Severity Scale, the PHDS shows superior concurrent validity, more accurately predicting scores for the Peritraumatic Distress Inventory, Impact of Event Scale – Revised, and Generalized Anxiety Disorder 7 Scale. The PHDS shows good internal reliability and discriminant validity.


The PHDS represents a novel, useful instrument for disaster first-responders and researchers. The prompt identification of high-risk populations is possible using this instrument. (Disaster Med Public Health Preparedness. 2019;13:82-89)


Corresponding author

Correspondence and reprint requests to Mr Yonatan Carl, San Juan Bautista School of Medicine, Salida 21, Carr. 12, Urb. Turabo Gardens, Caguas, Puerto Rico 00726 (e-mail:


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1. Davis, TE 3rd, Grills-Taquechel, AE, Ollendick, TH. The psychological impact from Hurricane Katrina: effects of displacement and trauma exposure on university students. Behav Ther. 2010;41(3):340-349.
2. Ford, ES, Mokdad, AH, Link, MW, et al. Chronic disease in health emergencies: in the eye of the hurricane. Prev Chronic Dis. 2006;3(2):A46.
3. Gleser, GC, Green, BL, Winget, CN. Prolonged psychosocial effects of disaster: a study of Buffalo Creek. New York: Academic Press; 1981.
4. Kishore, V, Theall, KP, Robinson, W, et al. Resource loss, coping, alcohol use, and posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross-sectional study. Am J Disaster Med. 2008;3(6):345-357.
5. Parker, G, Lie, D, Siskind, DJ, et al. Mental health implications for older adults after natural disasters – a systematic review and meta-analysis. Int Psychogeriatr. 2016;28(1):11-20.
6. Schnurr, PP, Green, BL. Trauma and health: physical health consequences of exposure to extreme stress. 1st ed. Washington, DC: American Psychological Association; 2004.
7. Chan, CS, Rhodes, JE. Measuring exposure in Hurricane Katrina: a meta-analysis and an integrative data analysis. PLoS One. 2014;9(4):e92899.
8. Green, BL. Evaluating the effects of disasters. J Consult Clin Psychol. 1991;3(4):538-546.
9. Kaniasty, K, Norris, FH. Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. J Trauma Stress. 2008;21(3):274-281.
10. Norris, FH, Friedman, MJ, Watson, PJ, et al. 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry. 2002;65(3):207-239.
11. Norris, FH, Sherrieb, K, Galea, S. Prevalence and consequences of disaster-related illness and injury from Hurricane Ike. Rehabil Psychol. 2010;55(3):221-230.
12. Chastang, F, Rioux, P, Dupont, I, et al. Suicide attempts and job insecurity: a complex association. Eur Psychiatry. 1998;13(7):359-364.
13. Reuther, ET, Davis, TE 3rd, Matthews, RA, et al. Fear of anxiety as a partial mediator of the relation between trauma severity and PTSD symptoms. J Trauma Stress. 2010;23(4):519-522.
14. Beck, JG, Grant, DM, Read, JP, et al. The impact of event scale-revised: psychometric properties in a sample of motor vehicle accident survivors. J Anxiety Disord. 2008;22(2):187-198.
15. Elal, G, Slade, P. Traumatic Exposure Severity Scale (TESS): a measure of exposure to major disasters. J Trauma Stress. 2005;18(3):213-220.
16. Cepeda, A, Valdez, A, Kaplan, C, Hill, LE. Patterns of substance use among Hurricane Katrina evacuees in Houston, Texas. Disasters. 2010;34(2):426-446.
17. LaJoie, AS, Sprang, G, McKinney, WP. Long-term effects of Hurricane Katrina on the psychological well-being of evacuees. Disasters. 2010;34(4):1031-1044.
18. Wadsworth, ME, Santiago, CD, Einhorn, L. Coping with displacement from Hurricane Katrina: predictors of one-year post-traumatic stress and depression symptom trajectories. Anxiety Stress Coping. 2009;22(4):413-432.
19. Heptulla, R, Hashim, R, Johnson, DN, et al. Evaluating emergency preparedness and impact of Hurricane Sandy in pediatric patients with diabetes. Disaster Mil Med. 2016;2:2.
20. Joyette, AR, Nurse, LA, Pulwarty, RS. Disaster risk insurance and catastrophe models in risk-prone small Caribbean islands. Disasters. 2015;39(3):467-492.
21. Staff, J. A guide to hurricanes. Sci Am. Published Sept 5, 2008. Accessed October 21, 2018.
22. Hernandez-Suarez, DF, Rodriguez-Ruiz, C, Malave-Sanchez, M, et al. Adapt and evolve: how our internal medicine residency changed in Hurricane Maria. P R Health Sci J. 2018;37(1):3-4.
23. Kishore, N, Marques, D, Mahmud, A, et al. Mortality in Puerto Rico after Hurricane Maria. N Engl J Med. 2018;379(2):162-170.
24. Staff: The National Center for Health Statistics. A reference guide for certification of deaths in the event of a natural, human-induced, or chemical/radiological disaster. Hyattsville, MD :The National Center for Health Statistics; 2017.
25. Robert, L, Spitzer, JBWW, Kroenke, K. Patient health questionnaire screeners. Accessed January 3, 2018.
26. Brunet, A, Weiss, DS, Metzler, TJ, et al. The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2. Am J Psychiatry. 2001;158(9):1480-1485.
27. Morina, N, Ehring, T, Priebe, S. Diagnostic utility of the impact of event scale-revised in two samples of survivors of war. PLoS One. 2013;8(12):e83916.
28. Thomas, E, Saumier, D, Brunet, A. Peritraumatic distress and the course of posttraumatic stress disorder symptoms: a meta-analysis. Can J Psychiatry. 2012;57(2):122-129.
29. Spitzer, RL, Kroenke, K, Williams, JB, Lowe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
30. Akaike, H. A new look at the statistical model identification. IEEE Trans Automat Contr. 1974;AC-19 (6):716-723.
31. Norris, M, Lecavalier, L. Evaluating the use of exploratory factor analysis in developmental disability psychological research. J Autism Dev Disord. 2010;40(1):8-20.
32. Reise, SP, Waller, NG, Comrey, AL. Factor analysis and scale revision. Psychol Assess. 2000;12(3):287-297.
33. Tran, Q-N, Arabnia, H. Emerging trends in computational biology, bioinformatics, and systems biology: algorithms and software tools. Waltham, MA: Morgan Kaufman (Elsevier); 2015.
34. Cahill, SP, Pontoski, K. Post-traumatic stress disorder and acute stress disorder I: their nature and assessment considerations. Psychiatry (Edgmont). 2005;2(4):14-25.
35. Keane, TM, Marshall, AD, Taft, CT. Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annu Rev Clin Psychol. 2006;2:161-197.
36. Ranasinghe, S, Ramesh, S, Jacobsen, KH. Hygiene and mental health among middle school students in India and 11 other countries. J Infect Public Health. 2016;9(4):429-435.
37. Libby, AM, Ghushchyan, V, McQueen, RB, Campbell, JD. Economic grand rounds: psychological distress and depression associated with job loss and gain: the social costs of job instability. Psychiatr Serv. 2010;61(12):1178-1180.



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