The study of growth and perceived benefit after traumatic events has been hailed as one of the most promising directions for stress research. This research, however, has been limited by several methodological limitations. These limitations are addressed in this prospective study, which examines perceived benefit and mental health adjustment after 3 different types of disaster. Survivors of a tornado in Madison, Florida, had the highest rates of perceived benefit, followed by survivors of a mass killing in Killeen, Texas, and survivors of a plane crash in Indianapolis, Indiana. Perceived benefit 4-6 weeks postdisaster predicted posttraumatic stress disorder 3 years later. Perceived benefit moderated the effect of severity of disaster exposure on mental health diagnosis change over time. Without perceived benefit, as exposure severity increased, the amount of recovery decreased. If benefit was perceived, as exposure severity increased, the amount of recovery increased. Implications for clinical interventions and future research are discussed.

The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem.

Studies have not previously considered postdisaster adjustment in the context of psychiatric disorders. After the Oklahoma City bombing, a volunteer sample of 181 firefighters who served as rescue and recovery workers was assessed with a structured diagnostic interview. The firefighters had relatively low rates of posttraumatic stress disorder (PTSD) and described little functional impairment, positive social adjustment, and high job satisfaction. PTSD was associated with reduced job satisfaction and functional impairment, providing diagnostic validity. Turning to social supports, seeking mental health treatment, and taking medication were not widely prevalent coping responses. Postdisaster alcohol use disorders and drinking to cope were significantly associated with indicators of poorer functioning. Surveillance for problem drinking after disaster exposure may identify useful directions for intervention.

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Drunk-driving offenders need assessment and treatment services not only for alcohol problems but also for drug use and the other psychiatric disorders that commonly accompany alcohol-related problems.

The incidence and comorbidity of posttraumatic stress disorder (PTSD) are addressed in a study of 130 Northridge, California, earthquake survivors interviewed 3 months post-disaster. Only 13% of the sample met full PTSD criteria, but 48% met both the re-experiencing and the arousal symptom criteria, without meeting the avoidance and numbing symptom criterion. Psychiatric comorbidity was associated mostly with avoidance and numbing symptoms. For moderately severe traumatic events, re-experiencing and arousal symptoms may be the most "normal," and survivors with a history of psychiatric problems may be those most likely to develop full PTSD. A system that considers people who meet all three symptom criteria to have a psychiatric disorder yet recognizes the distress of other symptomatic survivors may best serve traumatized populations.

Homeless women are very different from homeless men, but few studies have reported data separately on them or compared them directly with men. This report on a study of 600 homeless men and 300 homeless women in St. Louis presents comparison data on these populations. The pivotal difference between homeless men and women was that unlike men, most women had young children in their custody. The women were also younger than men, more likely to be members of a minority group, and more often dependent on welfare. They had been homeless for a shorter period and spent less time in unsheltered locations. Compared to men, they had less frequent histories of substance abuse, incarceration, and felony conviction. Solitary women (without children with them), compared to women with children in their custody, were more likely to be white, had been homeless longer, and more often had a history of alcoholism or schizophrenia. On most variables, values for solitary women lay somewhere between those for men and for women with children. The population of homeless women is therefore heterogeneous, with at least two subgroups. These groups are likely to benefit from intervention programs that are designed to address their specific problems and needs, which are not necessarily the same as those of homeless men.

This study examined individuals either personally or indirectly exposed to disaster and hypothesized that social involvement would differentially mediate the effect of exposure on the mental health of male and female victims. The study reinterviewed individuals previously interviewed just prior to disastrous floods and the discovery of unsafe levels of dioxin. Results indicated that males and females differ in their response to disaster exposure. Males showed increased symptoms of alcohol abuse and depression as a result of either personal, or both personal and indirect, exposure to disaster. In contrast, females' s]ymptomatology was not directly elevated by personal disaster exposure. Both sexes were sensitive to demands for support as a mediator of disaster effects. That is, victims both personally exposed to disaster and heavily relied upon by network members were far more likely to somatize (females) or abuse alcohol (males) than personally exposed individuals subject to more moderate network demands. Although excellent spouse support attenuated male symptomatology, its presence was associated with an exacerbation of symptoms in personally exposed females. Results suggest the importance of considering both the positive and negative consequences of social involvement because, for women in particular, very strong social ties may be more burdensome than supportive in times of extreme stress.