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Biomedical subjects

Fran H Norris

Publications and source records attributed to Fran H Norris.

16 recordsLinked to original sources
PubMed2006

Alcohol use and misuse in urban Mexican men and women: an epidemiologic perspective.

Consumption patterns and misuse of alcohol were examined in adults sampled from three cities in Mexico (n=1933). The sample was divided into groups of persons who abstained from alcohol, drank but endorsed no misuse, or drank and endorsed at least some misuse of alcohol. Half of the entire sample was categorized as drinkers (12 or more drinks in lifetime). Mexican men drank more per occasion and reported more problems with alcohol rather than did Mexican women. Low socioeconomic resources, not being married, and female gender were related to whether Mexicans abstained from alcohol rather than drank without misuse. Lifetime posttraumatic stress disorder (PTSD) or depression increased the likelihood of misusing alcohol versus drinking without misuse, as did greater amount of drinks consumed per occasion and male gender. Younger age and not being married were also related to misuse, although this was true mostly for women. The number of traumatic experiences in childhood and lower socioeconomic resources also predicted misuse, although mostly for men. Specific traumatic experiences and their relationship to alcohol use and misuse were also examined.

Adolescent↗
PubMed2006

Epidemiology of major depression in four cities in Mexico.

Analyses were conducted to estimate lifetime and current prevalence of major depressive disorder (MDD) for four representative cities of Mexico, to identify variables that influence the probability of MDD, and to further describe depression in Mexican culture. A multistage probability sampling design was used to draw a sample of 2,509 adults in four different regions of Mexico. MDD was assessed according to DSM-IV criteria by using the Composite International Diagnostic Interview collected by trained lay interviewers. The prevalence of MDD in these four cities averaged 12.8% for lifetime and 6.1% for the previous 12 months. MDD was highly comorbid with other mental disorders. Women were more likely to have lifetime MDD than were men. Being divorced, separated, or widowed (compared to married or never married) and having experienced childhood trauma were related to higher lifetime prevalence but not to current prevalence. In addition, age and education level were related to current 12-month MDD. Data on the profile of MDD in urban Mexico are provided. This research expands our understanding of MDD across cultures.

Adolescent↗
PubMed2006

Cognitive behavioral therapy for prolonged postdisaster distress.

In this article, we present and illustrate cognitive-behavioral therapy for postdisaster distress. The treatment is for individuals who show more than normal transient stress after disaster and functions as an intermediate step between traditional crisis counseling and longer-term mental health treatments. Thus, it is one part of a larger mental health disaster response and is designed to be implemented no sooner than 60 days post disaster. A clinical case demonstrates its process and technique in a community practice setting.

Adaptation, Psychological↗
PubMed2006

Disaster research methods: past progress and future directions.

Published results for 225 disaster studies were coded on methodological variables, severity of effects, and event year. Methods varied greatly, but cross-sectional, after-only designs, convenience sampling, and small samples were modal. Samples that were assessed before the disaster, selected for reasons of convenience, or were large tended to show less severe effects than other samples. Developing countries were underrepresented overall, but not in recent years. Certain desirable study characteristics (longitudinal designs, representative samples) have been decreasing in prevalence over time, whereas others (early first assessment) have been increasing. Innovations such as latent trajectory modeling or hierarchical linear modeling might advance the field's ability to capture the complexity of disasters, but the field still needs to attend to the fundamentals of sound epidemiologic research.

Data Interpretation, Statistical↗
PubMed2006

A psychometric analysis of Project Liberty's adult enhanced services referral tool.

OBJECTIVES: Project Liberty was the first federally funded crisis counseling program to offer evidence-informed treatments to crisis counseling recipients in need of more intensive clinical intervention. The Adult Enhanced Services Referral Tool was developed as a screening instrument for making and monitoring referrals to enhanced services. This study aimed to examine how well the tool functioned for identifying persons who would perceive a need for professional treatment. METHODS: A one-page tool was created that assessed demographic characteristics, risk categories, and psychological reactions to the focal event, September 11, 2001. Psychosocial reactions were assessed by the 12-item SPRINT-E, which is an expanded version of the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT). The SPRINT-E was embedded in the Adult Enhanced Services Referral Tool. Data were collected from 788 clients who received crisis counseling between June and October 2003. RESULTS: The SPRINT-E is a unidimensional measure of distress and dysfunction. Internal consistency was excellent for the total sample (alpha=.93) and subsamples. Among the 543 clients offered referral, 71 percent accepted. Among those offered referral, the number of intense reactions (score of 4, quite a bit, or 5, very much) was by far the strongest predictor of referral acceptance. CONCLUSIONS: The SPRINT-E was successfully integrated into the crisis counseling program and provided an apparently successful, empirical basis for referral from counseling to professional treatment. Results of the brief psychological assessment provided a stronger basis for referral to treatment than membership in a risk category (for example, family member of deceased) alone.

Adult↗
PubMed2005

Violence and PTSD in Mexico: gender and regional differences.

OBJECTIVE: We examined the lifetime prevalence of violence in Mexico and how different characteristics of the violent event effect the probability of meeting criteria for lifetime post-traumatic stress disorder (PTSD). METHOD: We interviewed a probability sample of 2,509 adults from 4 cities in Mexico (Oaxaca, Guadalajara, Hermosillo, Mérida) using the Composite International Diagnostic Interview (CIDI). RESULTS: Lifetime prevalence of violence was 34%. Men reported more single-experience, recurrent, physical, adolescent, adulthood, and stranger violence; women more sexual, childhood, family, and intimate partner violence. Prevalence was generally higher in Guadalajara, though the impact was greater in Oaxaca compared to other cities. Of those exposed, 11.5% met DSM-IV criteria for PTSD. Probabilities were highest after sexual and intimate partner violence, higher for women than men, and higher in Oaxaca than other cities. CONCLUSIONS: It is important to consider the characteristics and the context of violence in order to develop effective prevention and intervention programs to reduce the exposure to and impact of violence.

Adolescent↗
PubMed2005

Social support mobilization and deterioration after Mexico's 1999 flood: effects of context, gender, and time.

Samples of adults representative of Teziutlán, Puebla, and Villahermosa, Tobasco, were interviewed 6, 12, 18, and 24 months after the devastating 1999 flood and mudslides. The interview contained multiple measures of social support that had been normed for Mexico. Comparisons between sample data and population norms suggested minimal mobilization of received support and substantial deterioration of perceived support and social embeddedness. Social support was lowest in Teziutlán, which had experienced mass casualties and displacement, and among women and persons of lower educational attainment. Disparities according to gender, context, and education grew larger as time passed. The results provide compelling evidence that the international health community must be mindful of social as well as psychological functioning when disasters strike the developing world.

Adult↗
PubMed2005

Mental health care for ethnic minority individuals and communities in the aftermath of disasters and mass violence.

Findings from research on psychiatric epidemiology, disaster effects, discrepancies in service use, and cross-cultural psychology are reviewed to generate guidelines for culturally responsive postdisaster interventions. Ethnicity and culture influence mental health care at various points: on need for help; on availability and accessibility of help; on help-seeking comfort (stigma, mistrust), and on the probability that help is provided appropriately. There are aspects of disaster mental health practice that may ameliorate many of barriers that contribute to ethnic disparities in service use. It is proposed that interventions should give greater attention to socially engaged emotions and functioning. To promote disaster recovery, practitioners are advised to: assess community needs early and often; provide easily accessible services; work collaboratively and proactively to reduce stigma and mistrust and engage minorities in care; validate and normalize distress and help-seeking; value interdependence as well as independence as an appropriate developmental goal; promote community action; and advocate for, facilitate, or conduct treatment and evaluation research. Notwithstanding the pain and stress they cause, disasters create opportunities to de-stigmatize mental health needs and build trust between providers and minority communities.

Community Mental Health Services↗
PubMed2004

Postdisaster PTSD over four waves of a panel study of Mexico's 1999 flood.

Samples of adults representative of Tezuitlán, Puebla and Villahermosa, Tobasco (combined N = 561), were interviewed 6, 12, 18, and 24 months after the devastating 1999 floods and mudslides in Mexico. Current DSM-IV PTSD and major depressive disorder (MDD) were assessed with the Composite International Diagnostic Interview. At Wave 1, PTSD was highly prevalent (24% combined), especially in Tezuitlán (46%), which had experienced mass casualties and displacement. Both linear and quadratic effects of time emerged, as PTSD symptoms initially declined but subsequently stabilized. Differences between cities lessened as time passed. Comorbidity between PTSD and MDD was substantial. The findings demonstrate that the international health community needs to be prepared for epidemics of PTSD when disasters strike developing areas of the world.

Adult↗
PubMed2003

Severity, timing, and duration of reactions to trauma in the population: an example from Mexico.

Normative data describing acute reactions to trauma are few. Of 2509 Mexican adults interviewed with the Composite International Diagnostic Interview, 1241 met trauma exposure criteria for index events occurring more than 1 year previously. The modal response, describing 45%, was a reaction to trauma that was mild (present but below levels of posttraumatic stress disorder symptom criteria), immediate (within the first month), and transient (over within a year). Nonetheless, 29% experienced immediate and serious reactions. Of these, 44% had chronic posttraumatic stress disorder symptoms. Those whose reactions were serious and chronic differed in many ways from those whose reactions were serious but transient. They had more traumatic events during their lives, and their index events were more likely to have occurred in childhood and to have involved violence. They had more symptoms and functional impairment after the trauma and higher levels of depressive and somatic symptoms when data were collected. Psychiatrically significant reactions to trauma persist often enough to justify their detection and treatment. Persons in need of acute intervention can be identified on the basis of the nature and severity of the initial response as well as characteristics of the stressor.

Adolescent↗
PubMed2003

Epidemiology of trauma and posttraumatic stress disorder in Mexico.

Prevalence rates of trauma and posttraumatic stress disorder (PTSD) were estimated from a probability sample of 2,509 adults from 4 cities in Mexico. PTSD was assessed according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) criteria using the Composite International Diagnostic Interview (CIDI; WHO, 1997). Lifetime prevalence of exposure and PTSD were 76% and 11.2%, respectively. Risk for PTSD was highest in Oaxaca (the poorest city), persons of lower socioeconomic status, and women. Conditional risk for PTSD was highest following sexual violence, but nonsexual violence and traumatic bereavement had greater overall impact because of their frequency. Of lifetime cases, 62% became chronic; only 42% received medical or professional care. The research demonstrates the importance of expanding the epidemiologic research base on trauma to include developing countries around the world.

Adolescent↗
PubMed2002

Disaster mental health services following the 1995 Oklahoma City bombing: modifying approaches to address terrorism.

How did the 1995 Oklahoma City bombing differ from prior disasters and what implications did it have for disaster mental health services and service delivery? The federal disaster mental health approach in this country developed largely out of experiences with natural disasters. The 1995 Oklahoma City bombing differed in several important ways, including the large number of human casualties, higher rates of psychopathology, and an extended period of concern due to the criminal investigation and trials, which suggested the need to consider modifications in the program. Outreach was extensive, but psychiatric morbidity of direct victims was greater than that of victims of natural disasters, emphasizing the need for attention to the triage and referral process. Other concerns that warrant consideration include practices related to record keeping and program evaluation.

Journal Article↗
PubMed2002

Disasters in urban context.

This article provides a brief overview of the field of disaster research, summarizing what is known at present about the prevalence of disasters, the range of stressors and outcomes experienced, and sample-, event-, and individual-level risk factors for poor health and mental health outcomes. Prior research does not suggest that an urban context either enhances or reduces risk for individual survivors. It is argued, however, that the influence of extraindividual exposure, ethnic diversity, and support deterioration may be especially salient for understanding urban disasters. Investigators of urban disasters are especially well situated to expand knowledge of ecological and collective aspects of disaster response and recovery.

Disasters↗
PubMed2002

60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001.

Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article (Norris, Friedman, and Watson, this volume).

Databases, Factual↗
PubMed2002

60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research.

On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.

Age Factors↗