Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-23T22:01:34.407Z Has data issue: false hasContentIssue false

Variations in Disaster Preparedness by Mental Health, Perceived General Health, and Disability Status

Published online by Cambridge University Press:  08 April 2013


Objectives: Chronic medical and mental illness and disability increase vulnerability to disasters. National efforts have focused on preparing people with disabilities, and studies find them to be increasingly prepared, but less is known about people with chronic mental and medical illnesses. We examined the relation between health status (mental health, perceived general health, and disability) and disaster preparedness (home disaster supplies and family communication plan).

Methods: A random-digit-dial telephone survey of the Los Angeles County population was conducted October 2004 to January 2005 in 6 languages. Separate multivariate regressions modeled determinants of disaster preparedness, adjusting for sociodemographic covariates then sociodemographic variables and health status variables.

Results: Only 40.7% of people who rated their health as fair/poor have disaster supplies compared with 53.1% of those who rate their health as excellent (P < 0.001). Only 34.8% of people who rated their health as fair/poor have an emergency plan compared with 44.8% of those who rate their health as excellent (P < 0.01). Only 29.5% of people who have a serious mental illness have disaster supplies compared with 49.2% of those who do not have a serious mental illness (P < 0.001). People with fair/poor health remained less likely to have disaster supplies (adjusted odds ratio [AOR] 0.69, 95% confidence interval [CI] 0.50–0.96) and less likely to have an emergency plan (AOR 0.68, 95% CI 0.51–0.92) compared with those who rate their health as excellent, after adjusting for the sociodemographic covariates. People with serious mental illness remained less likely to have disaster supplies after adjusting for the sociodemographic covariates (AOR 0.67, 95% CI 0.48–0.93). Disability status was not associated with lower rates of disaster supplies or emergency communication plans in bivariate or multivariate analyses. Finally, adjusting for the sociodemographic and other health variables, people with fair/poor health remained less likely to have an emergency plan (AOR 0.66, 95% CI 0.48–0.92) and people with serious mental illness remained less likely to have disaster supplies (AOR 0.67, 95% CI 0.47–0.95).

Conclusions: People who report fair/poor general health and probable serious mental illness are less likely to report household disaster preparedness and an emergency communication plan. Our results could add to our understanding of why people with preexisting health problems suffer disproportionately from disasters. Public health may consider collaborating with community partners and health services providers to improve preparedness among people with chronic illness and people who are mentally ill. (Disaster Med Public Health Preparedness. 2009;3:33–41)

Original Research and Critical Analysis
Copyright © Society for Disaster Medicine and Public Health, Inc. 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



1.Nelson, C, Lurie, N, Wasserman, J, et alConceptualizing and defining public health emergency preparedness. Am J Public Health. 2007;97 (Suppl 1) S9S11.Google Scholar
2.Bourque, LB, Siegel, JM, Kano, M, et alWeathering the storm: the impact of hurricanes on physical and mental health. Ann Am Acad Pol Soc Sci. 2006;604:129151.Google Scholar
3.Norris, FH. 50,000 Disaster Victims Speak: An Empirical Review of the Empirical Literature, 1981–2001. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2001.Google Scholar
4.Semenza, JC, Rubin, CH, Falter, KH, et alHeat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med. 1996;335:8490.Google Scholar
5.Kaiser, R, Le Tertre, A, Schwartz, J, et alThe effect of the 1995 heat wave in Chicago on all-cause and cause-specific mortality. Am J Public Health. 2007;97 (Suppl 1) S158S162.Google Scholar
6.Rath, B, Donato, J, Duggan, A, et alAdverse health outcomes after Hurricane Katrina among children and adolescents with chronic conditions. J Health Care Poor Underserved. 2007;18:405417.CrossRefGoogle ScholarPubMed
7.Mokdad, AH, Mensah, GA, Posner, SF, et alWhen chronic conditions become acute: prevention and control of chronic diseases and adverse health outcomes during natural disasters. Prev Chronic Dis. 2005;2:A04.Google ScholarPubMed
8.Messias, DK, Lacy, E. Katrina-related health concerns of Latino survivors and evacuees. J Health Care Poor Underserved. 2007;18:443464.Google Scholar
9.Brodie, M, Weltzien, E, Altman, D, et alExperiences of Hurricane Katrina evacuees in Houston shelters: implications for future planning. Am J Public Health. 2006;96:14021408.CrossRefGoogle ScholarPubMed
10.Wingate, MS, Perry, EC, Campbell, PH, et alIdentifying and protecting vulnerable populations in public health emergencies: addressing gaps in education and training. Public Health Rep. 2007;122:422426.Google Scholar
11.Jhung, MA, Shehab, N, Rohr-Allegrini, C, et alChronic disease and disasters: medication demands of Hurricane Katrina evacuees. Am J Prev Med. 2007;33:207210.Google Scholar
12.Ghosh, TS, Patnaik, JL, Vogt, RL. Rapid needs assessment among Hurricane Katrina evacuees in metro Denver. J Health Care Poor Underserved. 2007;18:362368.Google Scholar
13.Edwards, TD, Young, RA, Lowe, AF. Caring for a surge of Hurricane Katrina evacuees in primary care clinics. Ann Fam Med. 2007;5:170174.Google Scholar
14.Currier, M, King, DS, Wofford, MR, et alA Katrina experience: lessons learned. Am J Med. 2006;119:986992.Google Scholar
15.Krol, DM, Redlener, M, Shapiro, A, et alA mobile medical care approach targeting underserved populations in post-Hurricane Katrina Mississippi. J Health Care Poor Underserved. 2007;18:331340.Google Scholar
16.Sharma, AJ, Weiss, EC, Young, SL, et alChronic disease and related conditions at emergency treatment facilities in the New Orleans area after Hurricane Katrina. Disaster Med Public Health Preparedness. 2008;2:2732.Google Scholar
17.Rodriquez, SR, Tocco Stone, J, Malloneee, S, et alRapid needs assessment of Hurricane Katrina evacuees—Oklahoma, September 2005. Prehosp Disaster Med. 2006;6:390395.Google Scholar
18.Ridenour, M, Cummings, K, Sinclair, J, et alDisplacement of the underserved: medical needs of Hurricane Katrina evacuees in West Virginia. J Health Care Poor Underserved. 2007;18:369381.CrossRefGoogle ScholarPubMed
19.Rogers, N, Guerra, F, Suchdev, PF, et alRapid assessment of health needs and resettlement plans among Hurricane Katrina evacuees—San Antonio, Texas, September 2005. MMWR Morb Mortal Wkly Rep. 2006;55:242244.Google Scholar
20.Person, C, Fuller, EJ. Disaster care for persons with psychiatric disabilities: recommendations for policy change. J Disabil Policy Stud. 2007;17:239248.Google Scholar
21.Rooney, C, White, GW. Narrative analysis of a disaster preparedness and emergency response survey from persons with mobility impairments. J Disabil Policy Stud. 2007;17:206215.Google Scholar
22.Soeteman, RJH, Yzermans, CJ, Kerssens, JJ, et alThe course of post-disaster health problems of victims with pre-disaster psychological problems as presented in general practice. Fam Pract. 2006;23:378384.Google Scholar
23.Dirkzwager, AJE, Grievink, L, Van der Velden, PG, et alRisk factors for psychological and physical health problems after a man-made disaster: prospective study. Br J Psychiatry. 2006;189:144149.CrossRefGoogle ScholarPubMed
24.Mori, K, Ugai, K, Nonami, Y, et alHealth needs of patients with chronic diseases who lived through the Great Hanshin Earthquake. Disaster Manag Response. 2007;5:813.Google Scholar
25.Aldrich, N, Benson, WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev Chronic Dis. 2008;5:A27.Google Scholar
26.Mudur, G. Aid agencies ignored special needs of elderly people after tsunami. BMJ. 2005;331:422.Google Scholar
27.Vespa, J, Watson, F. Who is nutritionally vulnerable in Bosnia-Hercegovina?. BMJ. 1995;311:652654.Google Scholar
28.Fernandez, LS, Byard, D, Lin, CC, et alFrail elderly as disaster victims: emergency management strategies. Prehosp Disaster Med. 2002;17:6774.Google Scholar
29.Spiegel, P, Sheik, M, Gotway-Crawford, C, et alHealth programmes and policies associated with decreased mortality in displaced people in postemergency phase camps: a retrospective study. Lancet. 2002;360:19271934.CrossRefGoogle ScholarPubMed
30.Summerfield, D. War and mental health: a brief overview. BMJ. 2000;321:232235.Google Scholar
31.Nice, DS, Garland, CF, Hilton, SM, et alLong-term health outcomes and medical effects of torture among US Navy prisoners of war in Vietnam. JAMA. 1996;276:375381.CrossRefGoogle ScholarPubMed
32.Bravo, M, Rubio-Stipec, M, Canino, GJ, et alThe psychological sequelae of disaster stress prospectively and retrospectively evaluated. Am J Community Psychol. 1990;18:661680.CrossRefGoogle ScholarPubMed
33.Christensen, K. The built environment, evacuations, and individuals with disabilities. J Disabil Policy Stud. 2007;17:249254.Google Scholar
34.Rowland, J. Emergency response training practices for people with disabilities. J Disabil Policy Stud. 2007;17:216222.Google Scholar
35. Harris, Interactive. National Organization on Disability Emergency Preparedness: Topline Results (Study No. 26441). Accessed June 18, 2007.Google Scholar
36.Andersen, R. Behavior Models of Families' Use of Health Services. Chicago: University of Chicago; 1968.Google Scholar
37.Gelberg, L, Andersen, RM, Leake, BD. The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34:12731302.Google Scholar
38.Fothergill, A, Maestas, E, Darlington, J. Race, ethnicity, and disasters in the United States: a review of the literature. Disasters. 1999;23:156173.Google Scholar
39.Lindell, MK, Perry, R. Household adjustment to earthquake hazard: a review of research. Environ Behav. 2000;32:461501.Google Scholar
40.Turner, RH, Nigg, JM, Paz, DH. Waiting for Disaster: Earthquake Watch in California. Berkeley: University of California; 1986.Google Scholar
41.Kessler, R, Andrews, G, Colpe, L, et alShort screening scales to monitor population prevalences and trends in nonspecific psychological distress. Psychol Med. 2002;32:959976.Google Scholar
42.Kessler, RC, Barker, PR, Colpe, LJ, et alScreening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60:184189.Google Scholar
43.DeSalvo, KB, Fan, VS, McDonell, MB, et alPredicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40:12341246.Google Scholar
44.JrWare, JE, Sherbourne, CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473483.Google Scholar
45.Bancroft, E, Lightstone, A, Simon, P, et alEnvironmental barriers to health care among persons with disabilities—Los Angeles County, California, 2002–2003. MMWR Morb Mortal Wkly Rep. 2006;55:13001303.Google Scholar
46.Kessler, RC, Chiu, WT, Demler, O, et alPrevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617627.Google Scholar
47.Kessler, R, Berglund, P, Zhao, S, et alThe 12-month Prevalence and Correlates of Serious Mental Illness (SMI). Washington, DC: US Government Printing Office; 1996.Google Scholar
48.McLennan, JD, Kotelchuck, M. Parental prevention practices for young children in the context of maternal depression. Pediatrics. 2000;105:10901095.Google Scholar
49.Leiferman, J. The effect of maternal depressive symptomatology on maternal behaviors associated with child health. Health Educ Behav. 2002;29:596607.Google Scholar
50.O'Connor, TG, Davies, L, Dunn, J, et alDistribution of accidents, injuries, and illnesses by family type. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Pediatrics. 2000;106:E68.CrossRefGoogle Scholar
51.Eaton, W, Anthony, J, Tepper, S, et alPsychopathology and attrition in the Epidemiologic Catchment Area Study. Am J Epidemiol. 1992;135:10511059.Google Scholar
52. 2004 BRFSS Summary Data Quality Report. Accessed June 18, 2007.Google Scholar
53.Kilbourne, AM, Switzer, G, Hyman, K, et alAdvancing health disparities research within the health care system: a conceptual framework. Am J Public Health. 2006;96:21132121.Google Scholar