Examining the Dose–Response Relationship: Applying the Disaster Exposure Matrix to Understand the Mental Health Impacts of Hurricane Sandy

Disaster exposure is a strong predictor of survivor mental health following large-scale disasters. However, there is continued debate regarding how disaster exposure should be measured and quantified, as well as whether specific types of disaster exposure are more likely to influence certain mental health outcomes like psychological distress or post-traumatic stress disorder (PTSD). In this article, we propose the Disaster Exposure Matrix to explain how specific types and levels of disaster exposure are associated with particular mental health outcomes. We use data from the Sandy Child and Family Health study—an observational cohort study of 1000 randomly selected New Jersey residents who were living in the nine counties most-affected by Hurricane Sandy (2012)—to examine how direct and indirect disaster exposure at both the individual and community levels influence the likelihood of experiencing psychological distress and probable PTSD in the two years after Hurricane Sandy. Weighted logistic regression models demonstrate that particular measures of individual-level direct and indirect exposure uniquely influence probable PTSD and psychological distress, respectively. Community-level indirect exposure is significantly associated with psychological distress but not with probable PTSD. Findings highlight the importance of specificity when measuring the effects of disaster exposure on mental health, including separating exposures that occur at the individual and community level, as well as distinguishing those that are experienced directly from the event from those that are indirect and experienced after the meteorological or geophysical event has passed.