Examining Long-Term Mental Health in a Rural Community Post-Disaster: A Mixed Methods Approach
Abstract
Psychological stressors have been observed immediately following disasters, yet less is known about the long-term effects on the mental health of vulnerable communities. In 2005, Graniteville, S.C. was ravaged by a train derailment that leaked approximately 60 tons of chlorine gas and left several people dead in the small community. The purpose of this study was to examine the mental health of Graniteville-area residents in the nine years following the train disaster using a mixed methods approach. Using the photovoice method, participants reported compromised mental health with symptoms consistent with depression, post-traumatic stress disorder, fear, and anxiety. Medical records analysis indicated that mental health-related hospital encounters generally increased post-disaster. Mental health concerns should be anticipated in the long-term aftermath of disasters. Addressing these concerns is particularly vital in resource-poor communities. Our findings can be useful in developing mental health disaster management protocols and policies for communities in the long-term post-disaster period.
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Natural hazards and man-made disasters, pandemics, and other traumatic events can lead to psychological harm.
“Natural hazards and man-made disasters (e.g., floods and mass violence; [1]), pandemics (e.g., the COVID-19 pandemic; [2]), but also other traumatic events (e.g., train accidents; [3]) can lead to psychological harm.”
Cites
Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment
Wang, C., & Burris, M. A. (1997) · Health Education & Behavior · doi:10.1177/109019819702400309 · Cited by 5,551 · see citing works
60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981–2001
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002) · Psychiatry: Interpersonal and Biological Processes · doi:10.1521/psyc.65.3.207.20173 · Cited by 3,128 · see citing works
Post-traumatic stress disorder following disasters: a systematic review
Neria, Y., Nandi, A., & Galea, S. (2008) · Psychological Medicine · doi:10.1017/s0033291707001353 · Cited by 1,429 · see citing works
Empowerment through Photo Novella: Portraits of Participation
Wang, C., & Burris, M. A. (1994) · Health Education Quarterly · doi:10.1177/109019819402100204 · Cited by 1,331 · see citing works
Designing A Mixed Methods Study In Primary Care
Creswell, J. W. (2004) · The Annals of Family Medicine · doi:10.1370/afm.104 · Cited by 980 · see citing works
Photovoice Ethics: Perspectives from Flint Photovoice
Wang, C. C., & Redwood-Jones, Y. A. (2001) · Health Education & Behavior · doi:10.1177/109019810102800504 · Cited by 805 · see citing works
Youth Participation in Photovoice as a Strategy for Community Change
Wang, C. C. (2006) · Journal of Community Practice · doi:10.1300/j125v14n01_09 · Cited by 686 · see citing works
Flint Photovoice: Community Building Among Youths, Adults, and Policymakers
Wang, C. C., Morrel‐Samuels, S., Hutchison, P., Bell, L., & Pestronk, R. M. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.6.911 · Cited by 458 · see citing works
Are rural residents less likely to obtain recommended preventive healthcare services?
Casey, M., Call, K. T., & Klingner, J. (2001) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(01)00349-x · Cited by 421 · see citing works
Distance and health care utilization among the rural elderly
Nemet, G. F., & Bailey, A. J. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(99)00365-2 · Cited by 400 · see citing works
Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment
Nykiforuk, C. I. J., Vallianatos, H., & Nieuwendyk, L. (2011) · International Journal of Qualitative Methods · doi:10.1177/160940691101000201 · Cited by 347 · see citing works
Brackbill, R. M. (2009) · JAMA · doi:10.1001/jama.2009.1121 · Cited by 345 · see citing works
A 25 Year Retrospective Review of the Psychological Consequences of the Chernobyl Accident
Bromet, E. J., Havenaar, J. M., & Guey, L. T. (2011) · Clinical Oncology · doi:10.1016/j.clon.2011.01.501 · Cited by 271 · see citing works
Microbiological, Biological, and Chemical Weapons of Warfare and Terrorism
Greenfield, R. A., Slater, L. N., Bronze, M. S., Brown, B. R., Jackson, R., IANDOLO, J. J., & Hutchins, J. B. (2002) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200206000-00005 · Cited by 250 · see citing works
Grattan, L. M., Roberts, S. M., Mahan, W. T., McLaughlin, P. K., Otwell, W. S., & Morris, J. G. (2011) · Environmental Health Perspectives · doi:10.1289/ehp.1002915 · Cited by 185 · see citing works
Acute health effects after exposure to chlorine gas released after a train derailment
Sickle, D. V., Wenck, M. A., Belflower, A., Drociuk, D., Ferdinands, J. M., Holguín, F., Svendsen, E. R., Bretous, L., Jankelevich, S., Gibson, J. J., et al. (2008) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2007.12.006 · Cited by 171 · see citing works
Posttraumatic stress disorder following an air disaster: a prospective study
Epstein, R. S., Fullerton, C. S., & Ursano, R. J. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.7.934 · Cited by 170 · see citing works
The Impact of Disasters on Populations With Health and Health Care Disparities
Runkle, J. D., Wilson, S., Brock‐Martin, A., Glover, S. H., & Svendsen, E. R. (2010) · Disaster Medicine and Public Health Preparedness · doi:10.1017/s1935789300002391 · Cited by 131 · see citing works
Runkle, J. D., Brock‐Martin, A., Karmaus, W. J. J., & Svendsen, E. R. (2012) · American Journal of Public Health · doi:10.2105/ajph.2012.301027 · Cited by 120 · see citing works
Mental Health Needs in New York State Following the September 11th Attacks
Herman, D. B. (2002) · Journal of Heredity · doi:10.1093/jurban/79.3.322 · Cited by 117 · see citing works
The Integration of Mental and Behavioral Health Into Disaster Preparedness, Response, and Recovery
Pfefferbaum, B. J., Flynn, B. W., Schonfeld, D. J., Brown, L. M., Jacobs, G. A., Dodgen, D. W., Donato, D., Kaul, R. E., Stone, B., Norwood, A. E., et al. (2012) · Disaster Medicine and Public Health Preparedness · doi:10.1001/dmp.2012.1 · Cited by 100 · see citing works
Quality‐of‐Care Challenges for Rural Health
Moscovice, I., & Rosenblatt, R. A. (2000) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2000.tb00451.x · Cited by 88 · see citing works
Raviola, G. J., Eustache, E., Oswald, C., & Belkin, G. S. (2012) · Harvard Review of Psychiatry · doi:10.3109/10673229.2012.652877 · Cited by 72 · see citing works
The course of mental health disorders after a disaster: Predictors and comorbidity
Meewisse, M., Olff, M., Kleber, R. J., Kitchiner, N., & Gersons, B. P. R. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20663 · Cited by 72 · see citing works
Wenck, M. A., Sickle, D. V., Drociuk, D., Belflower, A., Youngblood, C., Whisnant, M. D., Taylor, R., Rudnick, V., & Gibson, J. J. (2007) · Public Health Reports · doi:10.1177/003335490712200610 · Cited by 68 · see citing works
Designating Places and Populations as Medically Underserved: A Proposal for a New Approach
Ricketts, T. C., Goldsmith, L. J., Holmes, M., Randy, M. R. P. R., Lee, R. E., Jr., Taylor, D. H., & Ostermann, J. (2007) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2007.0065 · Cited by 64 · see citing works
Ingram, L. A., Wilson, S., Tinago, C. B., Sanders, L. W., Bevington, T., Carlos, B., Cornelius, E., & Svendsen, E. R. (2015) · Qualitative Health Research · doi:10.1177/1049732315576495 · Cited by 63 · see citing works
Mental health services for victims of disasters.
Cohen, R. E. (2002) · PubMed · Cited by 51 · see citing works
Goldsteen, R. L., & Schorr, J. K. (1982) · Disasters · doi:10.1111/j.1467-7717.1982.tb00744.x · Cited by 35 · see citing works
The Public Health Consequences From Acute Chlorine Releases, 1993???2000
Horton, D. K., Berkowitz, Z., & Kaye, W. (2002) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-200210000-00008 · Cited by 31 · see citing works
Toxic inhalational injury: gas, vapor and vesicant exposure
Parrish, S., & Bradshaw, D. (2004) · Respiratory Care Clinics · doi:10.1016/s1078-5337(03)00048-0 · Cited by 27 · see citing works
Triple Threat Trauma: Evidence-Based Mental Health Response for the 2011 Japan Disaster
Shultz, J. M., Kelly, F., Forbes, D., Verdeli, H., Leon, G. R., Rosen, A., & Neria, Y. (2011) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x11006364 · Cited by 23 · see citing works
Tseng, K.-C., Hemenway, D., Kawachi, I. I., Subramanian, S. V., & Chen, W. J. (2009) · Community Mental Health Journal · doi:10.1007/s10597-009-9267-7 · Cited by 17 · see citing works
Ruckart, P. Z., Wattigney, W. A., & Kaye, W. (2004) · Environmental Health · doi:10.1186/1476-069x-3-10 · Cited by 15 · see citing works
Ingram, L. A., Tinago, C. B., Estrada, R., Wilson, S., Sanders, L. W., Bevington, T., Carlos, B., Cornelius, E., Svendsen, E. R., & Ball, J. (2016) · Rural and Remote Health · doi:10.22605/rrh3906 · Cited by 6 · see citing works
Ernst, K. P., Wattigney, W. A., & Kaye, W. (2005) · Journal of Occupational and Environmental Medicine · doi:10.1097/01.jom.0000155713.32644.1e · Cited by 4 · see citing works
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Lotzin, A., Franc de Pommereau, A., & Laskowsky, I. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075339 · Cited by 25 · see citing works
“, train accidents; [3]) can lead to psychological harm.”
BackgroundTorres-Mendoza, Y., Kerr, A., Schnall, A. H., Blackmore, C., & Hartley, S. D. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7026a1 · Cited by 14 · see citing works
Madani, S. M. S., Bahramnejad, A., Farsi, Z., Alizadeh, A., Rajai, N., & Azizi, M. (2023) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2023.81 · Cited by 11 · see citing works
The Long-Term Impact of Famine Experience on Harvest Losses
Zhang, K., Luo, Y. M., & Han, Y. (2023) · Agriculture · doi:10.3390/agriculture13061128 · Cited by 8 · see citing works
DPO membership has immediate transactional benefits as well as personal impact
Butcher, N., Singh, P., Grills, N., & Soji, F. (2021) · The review of disability studies/Review of disability studies · Cited by 1 · see citing works
Magny‐Normilus, C., Whittemore, R., Schnipper, J. L., & Grey, M. J. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02309-9
- Authors
- Ingram, L. A., Tinago, C. B., Cai, B., Sanders, L. W., Bevington, T., Wilson, S., Magruder, K. M., & Svendsen, E.
- Venue
- Journal of Health Care for the Poor and Underserved
- Publisher
- Project MUSE
- Published
- 2018
- Volume
- 29
- Issue
- 1
- Pages
- 284-302
- ISSN
- 1049-2089 (ISSN-L)
- 1548-6869
- OpenAlex
- W2788973202
- Cited by
- 6
- References
- 36
- Citations by year
- 2025: 1 · 2023: 3 · 2021: 2
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health Care for the Poor and Underserved (publishedVersion)
- PubMed (publishedVersion)
- Project Muse (Johns Hopkins University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Social Sciences › Sociology and Political Science › Disaster Management and Resilience
- Keywords
- long-term mental health, disaster mental health, chlorine gas release, rural communities, depression, post-traumatic stress disorder, anxiety, fear, resource-poor communities, photovoice
- MeSH terms
- Accidents, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Depression, Disasters, Fear, Female, Humans, Male, Medical Records, Mental Health, Middle Aged, Railroads, Rural Population, South Carolina, Stress Disorders, Post-Traumatic, Time Factors, Qualitative Research, Young Adult
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