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Monmouth University Polling Institute

NJ Sandy Panel: Mental Health Issues Persist

Thursday, March 20, 2014

Displacement a major factor, but all victims are more distressed than other New Jerseyans

Many victims of Superstorm Sandy continue to suffer from psychological stress more than a year after the storm.  This finding comes from a Monmouth University Poll  tracking survey of New Jersey residents who suffered significant property damage from the storm.  A majority of those who are still displaced from their homes demonstrate mild to serious emotional distress.  Mental health is better among those who have returned to their homes, but even this group demonstrates significantly more widespread stress than New Jersey residents as a whole.  Interestingly, the survey does not find the same variations in well-being for reports of physical health.

The survey utilized the Kessler6 scale to assess psychological distress among Sandy victims.  According to this scale, nearly one quarter (24%) of Sandy victims suffer from serious distress and a similar number (23%) suffer from mild to moderate distress.  Just over half (53%) do not exhibit distress according to this scale.  The extent of mental health concerns indicated by this scale is significantly higher for Sandy victims than it is for the state population as a whole.  According to the 2012 BRFSS (Behavioral Risk Factor Surveillance System) survey, just over 1-in-10 New Jerseyans exhibit either serious (4%) or mild to moderate (8%) distress on the Kessler6 scale.  In other words, the Sandy victims surveyed are nearly four times as likely as the typical New Jersey resident to suffer at least mild psychological distress.

"These findings are consistent with previous research that suggests that high levels of mental distress continue up to two years after a large scale disaster," said Dr. Christine Hatchard, Assistant Professor of Psychology and Director of the Clinical Psychology Research Center at Monmouth University.  "However, recent research on Hurricane Katrina victims found that mental distress can actually increase over time, and that economically disadvantaged victims were still experiencing significant mental health problems five years after the hurricane."

The survey also found a significant gap in mental well-being among Sandy victims who remain displaced from their pre-Sandy homes and those who are back in those homes.  Those who are displaced (63%) are nearly twice as likely as those who are living in their pre-Sandy homes (35%) to self-report symptoms of psychological distress.

"As a pollster, I rarely see this type of disparity between two groups with similar demographic profiles.  The pace of Sandy recovery is having an undeniable impact on the emotional health of residents who have not been able to return to their homes," said Patrick Murray, director of the Monmouth University Polling Institute.

Distress among those still displaced  

Among Sandy victims who have not returned to their pre-storm homes, 34% show signs of serious distress and 29% report symptoms of mild to moderate distress.  Just 37% have no signs of distress.

Those who are still living in a hotel or trailer (77%) are the most likely to exhibit mental health concerns including nearly half who are in the serious distress category. About two-thirds of those who are in a more stable temporary housing situation (67%) or living with family or friends (65%) have some degree of distress.  About one-third of these two groups have serious distress.  Among those who have moved to a new permanent home or are living in a second home that they own, just 41% show signs of psychological distress, including about 1-in-5 with serious distress.  Overall, those living in a hotel or trailer represent 4% of all Sandy victims in the survey sample, those living in other temporary housing make up 19%, those living with family or friends are 11%, and those in a permanent home are 7%.

"Affected residents need access to low cost mental health services. Those who were at a higher risk for mental health problems prior to Sandy may not recover by simply regaining housing," said Dr. Hatchard, a licensed Psychologist who also counsels Sandy-affected residents in her clinical practice.            Among those displaced from their pre-Sandy home, those who say their family's employment situation is worse since the storm (77%) are more likely than those who have not experienced a negative impact in employment (56%) to suffer at least some mental distress.  Nearly half of those in a worse employment situation since the storm are suffering serious levels of distress.  Income also shows a small correlation with distress, with 69% of those earning less than $100,000 exhibiting distress, compared to 57% of those who earn $100,000 or more.  It is worth noting though, that a majority of displaced victims at all income levels exhibit at least mild signs of psychological distress.

There are some slight differences in distress by age in this group, but no consistent pattern.  Displaced residents showing signs of distress on the Kessler6 scale include 59% of those age 18 to 39, 68% of those age 40 to 59, 54% of those age 60 to 69, and 63% of those age 70 or older.  Parental status appears to be only a minor contributor to these differences - 69% of displaced residents with children under age 18 at home have at least mild distress.

There are also some slight regional differences in mental health concerns among those who are displaced from their pre-Sandy homes.  Residents of Monmouth County's coastal communities (74%) and bayshore communities (67%) are somewhat more likely to exhibit at least mild psychological distress when compared with similarly affected residents in Ocean County (60%) and other parts of the state (58%).

Distress among those in their pre-Sandy homes  

The demographic variations noted for displaced victims are not quite the same for residents who have been able to return to their pre-Sandy homes after repairs (representing 40% of the survey sample) or were displaced for less than a month if at all (20% of the sample).  Among this group who are living in their pre-Sandy homes, 17% exhibit signs of serious distress on the Kessler6 scale and 18% show signs of mild to moderate distress. A majority (65%) show no signs of distress in their responses to the survey questions.  Interestingly, there is no difference in signs of distress based on whether the person was displaced from their home for at least six months (39%), just a few months (33%), a few weeks (36%), or at all (33%).

Employment stability plays a significant role in this group's mental well-being.  More than 6-in-10 (63%) of those who report being in a worse family employment situation since the storm report signs of psychological distress.  This is more than double the reports of psychological distress among those who are in a similar or better employment situation now (28%). It is worth noting that family employment situation has a more significant impact on mental well-being for those living in their pre-Sandy homes than it does for those who are still displaced.

Income also shows a much more significant correlation for the psychological well-being of victims who are in their pre-Sandy homes than it does for those who are still displaced.  While the drop in mental health for displaced resident seems to occur at the $100,000 mark, it is more graduated among those who are back in their homes.  Specifically, 50% of those earning less than $50,000 show signs of distress, which decreases to 39% among those earning $50,000 to $99,000, 30% for those earning $100,000 to $149,000, and 17% for those earning $150,000 or more.

There also seems to be more of a noticeable age correlation for the in-home group than for displaced victims.  Among those in their pre-Sandy homes, distress is exhibited by 56% of those age 18 to 39, 50% of those age 40 to 49, 38% of those age 50 to 59, 28% of those age 60 to 69, and 17% of those age 70 or older.  Parental status (44%) seems to have no significant impact on distress for this group.

Regionally, residents of Monmouth County bayshore communities who are back in their homes (47%) are much more likely than those in Monmouth's coastal communities (25%) to show signs of psychological distress.  Similarly situated residents of Ocean County (33%) and other parts of the state (40%) fall somewhere between the two Monmouth groups.

The survey also found that one's experience with the state's reNew Jersey Stronger Sandy assistance program is related to variations in mental health reports for this group.  Residents living in their pre-Sandy homes who say they have been denied state assistance (49%) are more likely than those who have been approved for assistance (34%) or who never applied for assistance (28%) to show signs of mental distress.  Interestingly, the relationship between mental well-being and state aid experience is not evident among those who are currently displaced from their homes.

"Individuals experiencing psychological distress may become easily overwhelmed and begin to feel helpless and hopeless," said Dr. Hatchard. "If affected New Jersey residents do not receive timely government and mental health assistance to help them regain feelings of safety and stability, they are at high risk for continued psychological distress, which may lead to the development of disorders such as depression, anxiety and posttraumatic stress."

Other health measures

The survey also asked Sandy victims to report how many days in the past month a mental health condition or emotional problem kept them from work or other activities.  Two-thirds (66%) say this never happened in the past month, 17% say it happened between one and 5 days, 9% between 6 and 15 days, and 8% say it happened more than 15 days in the past month.  This is significantly higher than statewide reports of mental health interfering with daily activity.  According to the 2012 BRFSS survey, 91% of all New Jerseyans say that mental health issues never interfered with work or activities in the prior month, 5% say this happened between one and 5 days, 3% between 6 and 15 days, and just 1% for more than 15 days.  Among displaced Sandy victims, 23% say that mental health issues interfered with daily activities on at least 6 of the past 30 days.  Among Sandy victims living in their pre-storm homes the comparable number is 12%.

This finding underscores the mental health disparities noted in the Kessler6 scores for Sandy victims compared to the general public.  However, the survey found these disparities are not apparent for assessments of physical health.  In fact, Sandy victims' self-reports of physical health are actually in line with other New Jersey adults.  Specifically, just over half of Sandy victims describe their general health as either excellent (17%) or very good (34%).  Another 31% describe it as good and less than 1-in-5 say it is only fair (13%) or poor (5%).  This overall evaluation of physical health is quite similar to findings among all New Jerseyans.  According to the 2012 BRFSS survey, 21% of New Jersey adults rate their general health excellent, 32% say it is very good, 30% good, 13% fair, and 3% poor. 

"Physicians play an important role in identifying mental health problems.  These findings suggest that affected residents are not experiencing a significantly higher level of physical health problems, so physicians may not inquire about their patients' mental health as it relates to Sandy," said Dr. Hatchard.

There are a few differences in physical health reports among various groups of Sandy victims.  Those who are living in their pre-Sandy homes are slightly more likely than those who are still displaced to rate their general health very positively (55% compare to 45%) and less likely to rate their health negatively (15% to 23%).  These differences in self-reports of physical health are important to note, but are not as stark as the impact of housing status on mental well-being of Sandy victims.

This release marks the fourth installment of results from Monmouth University's tracking panel of New Jersey residents who were hardest hit by Sandy.  Prior reports were released in October 2013 and February 2014.  They can be found at https://www.monmouth.edu/polling-institute.  Future reports from this project will the track the ongoing recovery progress and concerns of the impacted New Jersey residents in the panel.

Methodological Note:  

The Monmouth University Polling Institute conducted this Sandy Recovery Survey online and by telephone with 1,239 New Jersey residents who suffered significant damage to their primary home   ( defined as having more than one foot of water in the first floor or at least $8,000 in property damage ).  The results presented in this report were based on interviews completed between September 18, 2013 and January 8, 2014.  This survey is part of a larger panel study designed to track the experiences of New Jersey residents who continue to be impacted by the storm.  Because survey respondents were recruited using a variety of non-probability methods, the survey results cannot be statistically projected to the larger population of all Sandy victims in the state.  The value of these survey findings rests in the internal poll comparisons (e.g. variations between those who remain displaced and those who are now back in their homes, variations by income levels, etc.) as well as to future waves of interviews that will track recovery progress for these individuals.

This project was designed to complement Monmouth University's statewide and regional poll tracking of Sandy issues and specifically to highlight continuing issues in New Jersey's Sandy recovery and provide recommendations for improving communication channels between hardest-hit residents and public/private authorities.  This project was made possible by a New Jersey Recovery Fund grant from the Community Foundation of New Jersey and the Geraldine R. Dodge Foundation.

The questions referred to in this release are as follows:

1.     Would you say that in general your health is excellent, very good, good, fair, or poor?

2.     During the past 30 days, for about how many days did a mental health condition or emotional problem keep you from doing your work or other usual activities?

3.     Kessler6 Psychological Distress Scale (see explanation below).

The Kessler6* scale is based on the responses to six different items (see below).

Each question response is scored from 0 to 4 (0 = none of the time) (4 = all of the time) and each respondent’s answers are totaled (range = 0 - 24).  Serious Psychological Distress is a score of 13 or more; Mild to Moderate Psychological Distress is a score from 8 to 12; and No Psychological Distress is a score of 7 or less. 

Kessler6 scale items: The following questions ask about how you have been feeling during the past 30 days. For each question, please select the option that best describes how often you had this feeling. During the past 30 days, about how often did you feel...

         nervous

         hopeless

         restless or fidgety

         so depressed that nothing could cheer you up

         that everything was an effort

         worthless

Click on pdf file link below for full methodology and results by key demographic groups.

Download this Poll Report with all tables

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