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Factors influencing vulnerability and positive post-disaster response following the Mackay

2008 and Brisbane 2011 floods.

Kelly Marea Dixon

B.Sc, B.A. (Hons. Psych), PGDip Clin Psych.

Submitted in fulfilment of the requirements for the degree of

Doctor of Philosophy

Department of Psychology and Counselling

Faculty of Health

Institute of Health and Biomedical Innovation

Queensland University of Technology

2015

POST-FLOOD ADAPTATION i

Keywords

Anxiety, Depression, Disaster, Flood, Mental Health, Posttraumatic Growth,

PTSD, Psychological Distress, Self-efficacy, Sense of Belonging, Social Support,

Stress, Stressful Life Events.

POST-FLOOD ADAPTATION ii

Abstract

Natural disasters are a common occurrence across the globe and present an

enormous mental health challenge. Posttraumatic stress disorder, depression, anxiety

and posttraumatic growth are all commonly reported following disasters, although

resilience (a brief transient stress reaction followed by stable functioning) is the

most common psychological outcome (Bonanno, Galea, Bucciarelli, & Vlahov,

2007). While a number of variables have been identified as potential risk or

protective factors, it is far from clear which of these factors are most important in

predicting positive and negative psychological outcomes. In addition, while it is clear

that it can take many months for life to return to normal following a disaster, few

studies have investigated the psychological impact of the protracted rebuilding and

recovery phase in the aftermath. The current research aimed to address these gaps by

comprehensively investigating the factors predicting both positive and negative

psychological outcomes following two Australian floods using a mixed methods

design informed by ecological and salutogenic theoretical frameworks.

The first study was a qualitative study of the Mackay, Queensland flood of

February 2008 that aimed to identify the factors flood survivors experienced as most

stressful and most protective. Semi-structured interviews were conducted with 16

adults (10 females and 6 males) whose homes were inundated due to unusually heavy

monsoonal rain, a year and a half post-flood. Thematic analysis identified themes

concerning positive and negative outcomes; day of the flood stressors and aftermath

stressors; coping strategies; and social support. The major findings were that stress in

POST-FLOOD ADAPTATION iii

the aftermath of the flood and the quality of social support received were key factors

determining post-flood adaptation.

Themes identified in the qualitative study, along with key risk and protective

factors identified in the literature, informed the development of a questionnaire to be

used in the second study. The Flood Experience Questionnaire (FEQ) was designed

to assess flood and aftermath related stressors, a range of exposure severity variables,

as well as demographic and contextual information. Additional measures were

included to assess giving and receiving emotional and instrumental support (2-Way

Social Support Scale, Shakespeare-Finch & Obst, 2011), sense of belonging (Sense

of Belonging Inventory, Hagerty and Patusky, 1995), and general perceived self-

efficacy (General Percieved Self-efficacy Scale, Scholz, Dona, Sud, & Schwarzer,

2002). The dependent variables were posttraumatic stress symptoms, measured by

the Impact of Events Scale Revised (Weiss & Marmar, 1997); depression, anxiety

and stress as measured by the Depression Anxiety Stress Scales -21 (Lovibond &

Lovibond, 1995); psychological distress measured by the General Health

Questionnaire 12 (Goldberg & Williams, 1988) and posttraumatic growth

measured by the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996).

Survey packs and an online survey were distributed to homes in flood-

affected areas of Brisbane and Mackay and completed by 158 adults (112 females

and 46 males). Brisbane residents received their surveys 7-9 months post-flood and

Mackay residents received theirs 3.5 years post-flood. Principal components analysis

of the FEQ revealed six factors: Aftermath Stress, Support, Coping Strategies,

Insurance Experience, Psychological Growth and Unrelated Stress. A series of

hierarchical multiple regressions found that Aftermath Stress, Receiving Support and

Sense of Belonging were the strongest predictors of psychological outcomes. The

POST-FLOOD ADAPTATION iv

severity of stress in the aftermath of the flood correlated moderately with all

dependent variables, and remained a significant predictor of posttraumatic stress and

posttraumatic growth when all other independent variables were controlled for,

including objective disaster exposure and subjective trauma severity. Receiving

social support was the strongest predictor of all dependent variables, when all other

variables except sense of belonging were controlled for. Sense of belonging was the

strongest predictor of depression, anxiety, stress, and psychological distress, but not

posttraumatic stress or growth. In addition, a negative experience with an insurance

company correlated with posttraumatic stress symptoms, depression, stress and

psychological distress, and remained significantly predictive of posttraumatic stress

symptoms after all other variables except social support were controlled for.

In conclusion, this research confirms that stress during the protracted

rebuilding phase in the aftermath of a disaster where homes are damaged is an

overlooked predictor of vulnerability to poor mental health outcomes, and a variable

that many flood survivors describe as being the most difficult aspect of their

experience. Despite this, many flood victims reported psychological growth as well

as distress. Implications for post-disaster community recovery include the findings

that effective support services will reinforce and enhance existing social networks,

will continue until the rebuilding phase is completed, will be respectful of disaster

victims sense of control in the situation, and will endeavour to target people with

poor social networks. Implications for insurance companies include the

recommendations that policies be clearly worded and procedures be streamlined to

reduce undue stress on disaster victims.

POST-FLOOD ADAPTATION v

Conference Presentations on PhD Project Outcomes

Dixon, K.M., Shochet, I.M. and Shakespeare-Finch, J. (2014). Factors influencing

mental health following two Australian flood disasters. The 28th

International

Congress of Applied Psychology, Paris, France, 12th

July 2014.

Dixon, K.M., Shochet, I.M. and Shakespeare-Finch, J. (2014). Posttraumatic growth

following the experience of being flooded. The 28th

International Congress of

Applied Psychology, Paris, France, 12th

July 2014.

Dixon, K.M., Shochet, I.M. and Shakespeare-Finch, J. (2012). A comparison of two

flood events The impact on wellbeing of contextual similarities and

differences between the Brisbane 2011 flood and the Mackay 2008 flood. The

17th

Australasian Conference on Traumatic Stress, Perth, WA, 8th

September

2012.

Posters:

Dixon, K.M., Shochet, I.M. and Shakespeare-Finch, J. (2012). Recovering from

Flood - Experiences of People Affected by the Mackay 2008 Flood, Three and a

Half Years On. The 17th Australasian Conference on Traumatic Stress, Perth,

WA, 8th

September 2012.

Dixon, K.M., Shochet, I.M. and Shakespeare-Finch, J. (2010). Being Flooded: A

qualitative study of the experiences of people affected by the Mackay 2008

flood. The 16th Australasian Conference on Traumatic Stress, Brisbane, Qld.,

September 2010.

POST-FLOOD ADAPTATION vi

Dixon, K.M., Shochet, I.M. and Shakespeare-Finch, J. (2010). Being Flooded: A

qualitative study of the experiences of people affected by the Mackay 2008

flood. The 27th

International Congress of Applied Psychology, Melbourne, Vic.

July 2009.

POST-FLOOD ADAPTATION vii

Research Funding/ Scholarships Relevant to the PhD

Smart Futures PhD Scholarship, Queensland Government (2009-2012)

QUT Deputy Vice-Chancellor's Initiative Scholarship (2009-2012)

QUT Faculty of Health Top-Up Scholarship (2009-2012)

Australian Postgraduate Award (APA) Scholarship for PhD (2009 - 2012).

POST-FLOOD ADAPTATION viii

Table of Contents

Factors influencing vulnerability and positive post-disaster response following the Mackay 2008 and

Brisbane 2011 floods. .............................................................................................................................. 1

Keywords .................................................................................................................................................i

Abstract .................................................................................................................................................. ii