Objectives: To identify the incidence of post-traumatic stress disorder experienced by nurses as a result of a natural disaster, and its relationship to personality and coping style. Design and Sample: A descriptive correlational design was used to examine the relationships between and among the variables using an anonymous online survey. Measures: Post Traumatic Stress Disorder (PTSD) was measured using the PTSD-8 [1]. The Brief COPE [2] was used to measure coping style. Personality was measured utilizing the State Trait Personality Inventory [3]. Participants answered demographic questions such as gender and age, and how they were affected by the storm. Results: Over 19% percent of the nurse participants met the criteria for PTSD. The significant predictors of PTSD were the personality characteristics of state-anxiety, state-trait and trait depression, and the coping strategies of active coping, denial, acceptance, instrumental support, behavioral disengagement, venting and planning. The final regression model explained 90.7% of the variance in high PTSD-8 score. Conclusions: The findings of this study support the literature and the researchers’ belief, that there is a relationship among coping, personality, and PTSD. More research is needed to understand the individual coping mechanisms that nurses utilize during times of stress and how they are related to personality and PTSD.
Usually picturing themselves as caregivers, many nurses became care-recipients during Sandy putting them at risk for PTSD. The authors of this study evidenced colleagues expressing stress, depression and an inability to function when they returned to work.
On October 29, 2012 Super Storm Sandy made landfall in New Jersey (NJ) and New York (NY). Sandy struck with a storm surge never before seen in the area, the coasts taking the brunt of the assault. It resulted in the most property damage in the area ever caused by a natural disaster. According to the Federal Emergency Management Agency [
The literature supports that victims of natural disasters experience Post-Traumatic Stress Disorder (PTSD) and that there is a relationship between PTSD and coping, and PTSD and personality [
The DSM-V diagnostic criteria for PTSD stipulate that the exposure must be an inciting event that involves actual/expected death or serious injury. Symptoms include re- experiencing the traumatic event (intrusive recollection), avoiding stimuli associated with the event (avoidance/numbing), and hyper-arousal (persistent symptoms of increasing arousal) [
Over seven million American adults age 18 and older, 3.5% of people in this age group, have PTSD in a given year [
The purpose of this pilot study was to examine the incidence of post-traumatic stress disorder (PTSD) in a sample of nurses who self-reported experiencing Super Storm Sandy, and to examine the relationships between and among PTSD, personality and coping (see
What are the relationships between and among PTSD, coping, and personality in nurse survivors of Super Storm Sandy?
A pilot study was conducted using a cross-sectional, descriptive correlational design to examine the relationships between and among the variables of PTSD, coping, personality and selected demographics one year post Super Storm Sandy. The study took place over a 6 week period. Prior to the study, IRB approval was received. A convenience sample of registered nurse members of NJ or NY state nursing associations who live or work in areas affected by the storm were emailed a solicitation letter explaining the
intent, voluntary nature and ability to withdraw from the study at any point without consequences. Participants then clicked to the anonymous, on-line survey.
PTSD was measured using the PTSD-8 [
1) Recurrent thoughts or memories of the event.
2) Feelings as though the event is happening again.
3) Recurrent nightmares about the event.
4) Sudden emotional or physical reactions when reminded of the event.
5) Avoiding activities that remind you of the event.
6) Avoiding thoughts or feelings associated with the event.
7) Feeling jumpy, easily startled.
8) Feeling on guard correlation.
It had good psychometric properties in three independent studies: 1710 whiplash patients (a = 0.83), 305 rape victims (a = 0.84), and 516 disaster victims (a = 0.85) [
Coping was measured with the 28-item Brief COPE [
Personality was measured utilizing the State Trait Personality Inventory an 80-item self-report questionnaire measuring state and trait anxiety, anger, depression and curiosity [
Subjects answered demographic questions describing how they were affected by the storm including whether they were evacuated and the amount of property damage they experienced.
Analytic StrategyAnalysis was conducted in SPSS V22. The threshold of at least one symptom from each PTSD subscale (intrusion, avoidance, hypervigilance) which was equal to or greater than three was utilized to determine the score on the PTSD-8. Participants were divided into two groups: high-likelihood of PTSD (satisfying the criteria for PTSD-8 score) and low-likelihood (not satisfying the criteria for PTSD-8 score). The Pearson Correlation and Spearman Rho were utilized to determine if there was a correlation between PTSD-8 scores with demographics. Levene’s Test for Equality of Variances and Independent t-test was utilized to determine the relationship between PTSD scores and the severity of the disaster. Fischer’s Exact was utilized to determine the relationship between PTSD scores and flood insurance. Pearson Correlation and a backward stepwise logistic regression were utilized to determine the likelihood of PTSD given coping style and personality.
The sample was composed of 129 nurse respondents from the NY-NJ area affected by the storm. The majority were female (n = 123) aged 20 - 79, married (54%), and employed full time in nursing (n = 113). Almost 60% were employed in an acute care facility. Forty-five experienced evacuation, from one to 365 days.
Of the 129 respondents, 25 (19.5%) satisfied the criteria for PTSD. There was no significant correlation between PTSD score and age (rho (129) = −0.037, p = 0.674) nor years practicing nursing (r (129) = −0.026, p = 0.767). Because distribution for marital status was skewed (54% married, 22.5% single, and 23.2% other), it was divided into two groups: married and not married. There was no significant difference between the two marital groups (F (1, 127) = 0.006, p = 0.941) with PTSD.
The severity of the experience of Sandy was measured by two questions: “How long were you evacuated?” and “Did you have flood insurance?” Forty-five nurses were evacuated. The average length of evacuation was 52.87 days, the median 8 days. For the 45 evacuees, there was no significant correlation between length of evacuation and PTSD. The majority of respondents did not have flood insurance (58%). There was no significant difference in PTSD score between nurses having flood insurance (n = 14) and those without (n = 11).
There was a wide range of property damage, from none (n = 42) to totally destroyed (n = 9). Logistic regression indicated that as damage increased in intensity, the likelihood of symptoms on the PTSD-8 scale would be 1.8 times more likely to occur. However, the intensity of damage was not significantly correlated to the PTSD-8 score and was not a significant predictor of PTSD.
The most frequently used coping strategies by the entire sample (N = 129) were acceptance (n = 102), active-coping (n = 89), positive-reframing (n = 87), planning (n = 86), emotional-support (n = 85), self-distraction (n = 84) and venting (n = 80). For those who satisfied the criteria for PTSD (n = 25), acceptance, active-coping and planning were used by 96%, and self-distraction and emotional-support by 92%. See
For the entire sample (N = 129) there were high and moderate correlations for many of the coping strategies and personality traits and states. For those with a high PTSD-8 score (n = 25), there were strong positive correlations between both behavioral-diseng- agement and self-blame with state and trait anxiety and depression. The coping strategy of denial was positively and significantly correlated with state depression (see
A backward stepwise regression was run to explore a possible model using both coping strategies and personality to explain PTSD (n = 25) (see
Total (n = 129) | PTSD-8 Not Present (n = 104) | PTSD-8 Present (n = 25) | |||||||
---|---|---|---|---|---|---|---|---|---|
Mean | Std. Dev. | Median | Mean | Std. Dev. | Median | Mean | Std. Dev. | Median | |
COPE Acceptance | 5.33 | 2.16 | 6 | 5.18 | 2.27 | 6 | 5.92 | 1.53 | 6 |
COPE Active Coping | 4.41 | 2.15 | 4 | 4.17 | 2.2 | 4 | 5.40 | 1.63 | 5 |
COPE Planning | 4.36 | 2.12 | 4 | 4.07 | 2.13 | 4 | 5.60 | 1.63 | 6 |
COPE Positive Reframing | 4.22 | 2.02 | 4 | 4.05 | 1.99 | 4 | 4.92 | 2.02 | 5 |
COPE Religion | 4.18 | 2.29 | 4 | 3.89 | 2.24 | 3 | 5.36 | 2.16 | 6 |
COPE Emotional Support | 4.02 | 1.91 | 4 | 3.75 | 1.88 | 3 | 5.16 | 1.57 | 5 |
COPE Self Distraction | 3.90 | 1.83 | 4 | 3.66 | 1.8 | 3 | 4.88 | 1.62 | 5 |
COPE Instrumental Support | 3.88 | 1.91 | 4 | 3.60 | 1.81 | 3 | 5.08 | 1.91 | 6 |
COPE Venting | 3.58 | 1.57 | 3 | 3.35 | 1.47 | 3 | 4.56 | 1.66 | 4 |
COPE Humor | 3.16 | 1.61 | 2 | 3.11 | 1.61 | 2 | 3.40 | 1.63 | 3 |
COPE Self Blame | 2.95 | 1.54 | 2 | 2.71 | 1.3 | 2 | 3.96 | 2.01 | 3 |
COPE Behavioral Disengagement | 2.50 | 0.90 | 2 | 2.34 | 0.75 | 2 | 3.16 | 1.18 | 3 |
COPE Substance Use | 2.47 | 1.23 | 2 | 2.29 | 1 | 2 | 3.24 | 1.74 | 2 |
COPE Denial | 2.36 | 0.81 | 2 | 2.17 | 0.43 | 2 | 3.16 | 1.37 | 3 |
COPE Strategy | State Anxiety | Trait Anxiety | State Curiosity | Trait Curiosity | State Anger | Trait Anger | State Depression | Trait Depression | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
All Respondents N = 129 | |||||||||||||
Self-Distraction | 0.515** | 0.346** | 0.03 | −0.036 | 0.411** | 0.336** | 0.382** | 0.343** | |||||
Active Coping | 0.387** | 0.268** | 0.002 | −0.131 | 0.267** | 0.255** | 0.256** | 0.268** | |||||
Denial | 0.365** | 0.395** | −0.236** | −0.302** | 0.287** | 0.182* | 0.461** | 0.383** | |||||
Substance-Use | 0.376** | 0.379** | −0.207* | −0.189* | 0.244** | 0.285** | 0.355** | 0.425** | |||||
Emotional-Support | 0.355** | 0.223* | 0.168 | −0.026 | 0.256** | 0.137 | 0.205* | 0.224* | |||||
Instrumental-Support | 0.345** | 0.183* | 0.087 | −0.012 | 0.265** | 0.169 | 0.219* | 0.185* | |||||
Behavioral-Disengagement | 0.559** | 0.553** | −0.309** | −0.401** | 0.532** | 0.408** | 0.599** | 0.598** | |||||
Venting | 0.423** | 0.326** | 0.027 | −0.165 | 0.381** | 0.317** | 0.335** | 0.337** | |||||
Positive-Reframing | 0.281** | 0.115 | 0.144 | −0.062 | 0.1 | 0.028 | 0.096 | 0.104 | |||||
Planning | 0.497** | 0.345** | −0.022 | −0.16 | 0.370** | 0.311** | 0.338** | 0.372** | |||||
Acceptance | 0.264** | 0.210* | 0.052 | −0.096 | 0.168 | 0.211* | 0.174* | 0.238** | |||||
Religion | 0.309** | 0.11 | 0.132 | −0.071 | 0.219* | 0.112 | 0.152 | 0.142 | |||||
Humor | 0.329** | 0.273** | 0.157 | −0.077 | 0.217* | 0.336** | 0.236** | 0.216* | |||||
Self-Blame | 0.626** | 0.600** | −0.169 | −0.249** | 0.426** | 0.402** | 0.541** | 0.589** | |||||
PTSD-8 Present n = 25 | |||||||||||||
Behavioral-Disengagement | 0.478* | 0.500* | −0.39 | −0.488* | 0.26 | 0.07 | 0.515** | 0.463* | |||||
Denial | 0.16 | 0.24 | −0.13 | −0.28 | 0.11 | −0.19 | 0.412* | 0.21 | |||||
Positive-Reframing | −0.15 | −0.11 | 0.23 | 0.02 | −0.18 | −0.398 | −0.10 | −0.27 | |||||
Self-Blame | 0.567** | 0.499* | −0.28 | −0.439* | 0.25 | 0.13 | 0.473* | 0.572** | |||||
Substance-Use | 0.402* | 0.549** | −0.39 | −0.517** | 0.15 | 0.22 | 0.35 | 0.436* | |||||
**Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).
model was significant (F (11, 13) = 11.561, p < 0.001)
Much has been written about nurses caring for disaster victims and has examined professional responses to exposure to traumatic events as part of their work or volunteerism. To the authors’ knowledge, no research has examined the nurse-as-victim of a natural disaster and its relationship among PTSD, coping and personality.
Nurses in the current study were not exempt from the ravages of Super Storm Sandy: 45 indicated that they were evacuated from their homes, eight for 150 days or more. Nine experienced major damage, some lost their homes entirely. Nurses who view themselves as caregivers now became care-recipients. This experience led nurses, like other storm survivors, to undergo psychological stress. For 19% (n = 25) of the nurses, this experience led to PTSD. This number is higher than the reported prevalence of PTSD for American adults aged 18 and older (3.6%), or for American women (9.7%) [
Pearson Correlation | Sig. (2-tailed) | |
---|---|---|
COPE Behavioral-Disengagement | 0.547** | 0.00 |
COPE Self-Blame | 0.474* | 0.02 |
COPE Substance-Use | 0.21 | 0.30 |
COPE Religion | 0.2 | 0.35 |
COPE Denial | 0.07 | 0.74 |
COPE Humor | 0.03 | 0.89 |
COPE Instrumental-Support | 0.02 | 0.94 |
COPE Positive-Reframing | −0.01 | 0.98 |
COPE Self-Distraction | −0.07 | 0.74 |
COPE Active Coping | −0.1 | 0.64 |
COPE Emotional Support | −0.12 | 0.57 |
COPE Planning | −0.12 | 0.57 |
COPE Venting | −0.13 | 0.54 |
COPE Acceptance | −0.28 | 0.17 |
State Anxiety Score | 0.607** | 0.00 |
State Curiosity Score | −0.506** | 0.01 |
State Depression Score | 0.500* | 0.01 |
State Anger Score | 0.23 | 0.26 |
Trait Anxiety Score | 0.468* | 0.02 |
Trait Depression Score | 0.438* | 0.03 |
Trait Anger Score | 0.05 | 0.80 |
Trait Curiosity Score | −0.37 | 0.06 |
**Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).
Unstandardized Coefficients | Standardized Coefficients | t | Sig. | Collinearity Statistics | |||
---|---|---|---|---|---|---|---|
B | Std. Error | Beta | Tolerance | VIF | |||
(Constant) | 5.265 | 3.316 | 1.588 | 0.136 | |||
State Anxiety Score | 0.535 | 0.115 | 0.740 | 4.645 | 0.000 | 0.281 | 3.555 |
State Anger Score | 0.193 | 0.075 | 0.386 | 2.561 | 0.024 | 0.314 | 3.183 |
Trait Anger Score | −0.431 | 0.108 | −0.597 | −3.997 | 0.002 | 0.320 | 3.126 |
Trait Depression Score | 0.341 | 0.102 | 0.561 | 3.349 | 0.005 | 0.254 | 3.934 |
COPE Active Coping | 2.429 | 0.443 | 1.002 | 5.480 | 0.000 | 0.213 | 4.686 |
COPE Denial | −1.451 | 0.322 | −0.504 | −4.504 | 0.001 | 0.570 | 1.754 |
COPE Instrumental Support | 1.197 | 0.323 | 0.578 | 3.699 | 0.003 | 0.292 | 3.425 |
COPE Behavioral Disengagement | 1.111 | 0.397 | 0.331 | 2.797 | 0.015 | 0.510 | 1.960 |
COPE Venting | −0.777 | 0.334 | −0.326 | −2.327 | 0.037 | 0.364 | 2.748 |
COPE Planning | −3.416 | 0.640 | −1.409 | −5.336 | 0.000 | 0.102 | 9.772 |
COPE Acceptance | 1.015 | 0.339 | 0.391 | 2.989 | 0.010 | 0.417 | 2.398 |
Mason et al. (2010) [
Surprisingly in the current study, the number of nurses experiencing PTSD was not significantly correlated to their amount of property damage, whether a nurse was evacuated or the amount of time evacuated. These findings are different from those of David et al. (1996) [
Declercq, Meganck, Deheegher, and Van Hoorde (2011) [
Carver (1997) [
All three types of coping strategies were found to explain the current model, however, the results were not as expected. Use of the positive-coping strategies of active-cop- ing and instrumental-support increased the PTSD score by 2.429 and 1.197 respectively, while the positive-coping mechanism of planning decreased it by 3.416. Emotion- focused coping was unexpected in that acceptance increased the PTSD score by 1.015 while denial was somewhat protective, decreasing the score by 1.451. Review of the less useful coping strategies of behavior-disengagement and venting indicated a variance in that while venting was somewhat protective in reducing the PTSD score (−0.777), and behavioral disengagement was not (1.111).
Carver et al. (1989) [
Folkman & Lazarus (1980) [
More research is needed on the use of instrumental support and its effect on PTSD symptoms. Oni et al. (2012) [
The emotion-focused coping strategy of positive-reframing was the 3rd highest coping strategy used by the entire sample, used by 67% of all participants. And while 80% (n = 20) of those with high PTSD-8 scores used this strategy, it was not found to explain the final model. Different results were found by Borja and Callahan (2008) [
The researchers also theorized that personality was related to the type of coping strategies that nurses would use, and that adaptive coping strategies would be negatively correlated with personality traits and states of anxiety, anger and depression. Surprisingly, most of coping strategies were positively correlated with these personality domains. More research is clearly needed on this finding. Do nurses, because of their education and experience, utilize all types of coping strategies regardless of personality traits or the situation in which they find themselves in order to be able to function for the good of others?
The literature varies in findings of PTSD found in health care providers working during or after a disaster. Stewart, Mitchell, Wright and Loba (2004) [
The relationship theorized by the researchers that personality and coping strategies would be related to PTSD was found. The final model (n = 25), using coping strategies and personality traits and states, explained 90.7% of the variance to predict a high PTSD-8 score. Predictors included trait and state anger, trait depression and state anxiety. Studies of PTSD have found anger as the major symptom in predicting PTSD. Novaco and Chemtob (2002) [
Gros et al. (2010) [
State anxiety had the highest correlation with PTSD of all the personality domains (B = 0.535, p = 0.000). It is not unexpected that victims of Sandy would have a high level of state anxiety in the current situation, and that it would increase PTSD symptomology. The severity of PTSD symptoms increased as anxiety in the current situation increased. But unlike Weems et al. (2007) [
This is a pilot study and thus has limited generalizability. The lack of statistical significance in demographic questions, particularly the relationship between property damage, evacuation and PTSD may be due to the small number of subjects who experienced a major loss or evacuation. The sample was predominately female with only six men responding. Eighty-eight percent of respondents were employed in acute care settings so that generalizing these results to all nurses must be done cautiously.
Based on the findings of this pilot study, more research on nurses-victims of a disaster and the relationship of PTSD to coping strategies and personality in this population is indicated. The majority of coping strategies that the subjects employed were positively correlated with state and trait personality domains regardless of the strategies being considered adaptive or maladaptive.
More study is indicated regarding coping mechanisms in different populations. The findings that instrumental support, used by 80% of the 25 nurses who scored high for symptoms of PTSD and increased the severity of PTSD symptoms, deserves further inquiry. Carver et al. (1989) [
The number of nurses who scored high on the PTSD-8 was higher than the average found in the general population but lower than that found in other victims of disasters. Was this number related to the response rate or to a characteristic of nurses? Are nurses more resilient because of their education and practice experience? How does work-life and setting impact a nurse’s ability to withstand a natural disaster?
This study supports the use of short assessment tools. The PTSD-8 involves little participant burden and makes research immediately after a stressful event more feasible. It allows identification of responders quickly after a stressful situation and affords them the opportunity to for immediate support.
Similarly, the Brief COPE showed good reliability. Additional research with this short tool regarding the individual strategies, as well as the entire tool as a composite score, will allow study of this concept with less burden for users.
This study found that personality was correlated with coping and PTSD. It is common practice to look at personality styles of management staff to support them in being more effective in their positions. Development of short personality tools, as was done with the PTSD-8 to assess PTSD, would allow nurses at all levels of practice to understand more about themselves and how they function in everyday life and in stressful situations. In a study of 248 emergency room nurses exposed to traumatic work events, not related to a disaster, Adriaenssens, de Gucht and Maes (2012) [
It is important to remember that nurses, when faced with difficult personal or professional situations, are at risk for unresolved stress. When faced with massive natural disasters such as Super Storm Sandy, nurses go into high-gear helping others. They need to know to take care of themselves. Disaster preparedness programs prepare nurses for their professional role. Expansion of these, to help nurses understand their risk factors based on personality traits and the coping measures that might be most helpful to reduce stress is indicated. Additional research to better understand how nurses are affected during stressful times will help nursing managers plan for staffing during times of disasters and oversee their staff during these difficult situations. Finally, in depth qualitative inquiry, giving voice to nurses’ experiences would help provide additional understanding about what the ravages of this storm meant to participants.
Roberts, M.E., Caruso, J.T., Toughill, E.H. and Sturm, B.A. (2016) Coping, Personality and Post Traumatic Stress Disorder in Nurses Affected by Super Storm Sandy. Open Journal of Nursing, 6, 643-657. http://dx.doi.org/10.4236/ojn.2016.69068