The Necessity of a Longitudinal Public Health Approach to Responding to Disasters: An All-Hazards Model of Resilience to Pervasive Adversities Abstract The most common and widespread conceptualization of how people are affected by disasters is based on a theory that traumatic stress reliably induces pervasive impairment of psychological and emotional functioning (e.g., PTSD). There is no consistent evidence for this proposition. Rather, as have often been stated by empirical researchers, most people recover without ever exhibiting symptomatology of psychopathology. From this perspective, many go on to conclude that most disaster survivors recover rapidly and completely without substantive impairment for any significant period of time. There is also no evidence for this rosy perspective of the profound resiliency of the majority. The more accurate perspective appears to fall between these darker and lighter extremes. Many survivors report struggling for some extended time to cope with immediate and subsequent stressors, and that the grieving process is episodic across time in an ebb and flow of loss saliency. A clinical perspective on these phenomena is misdirected to the extent it is categorical in dealing with phenomena that appear to be more dimensional across time and levels of burden. It also appears to err on the side of unfoundedly specific inferences as a function of the causal nature of the events themselves, leading to overemphasis on categories of potentially traumatic events. A public health model can address this by investigating the ecological and personal factors that elevate risks and by discerning the common-factor risks from those that may be situation-specific. Moreover, by monitoring and responding to events across time and development, we can better understand the dynamic and evolving nature of post-disaster psychosocial needs. This presentation describes a model of monitoring and responding to all-hazards of disastrous events across time with an emphasis on subclinical manifestations of pain, stress, and adaptation. Recommendations will be made for avoiding conceptual traps that detract from accurate investigation of these phenomena and methods of better engaging the affected populations on behalf of ensuring their own health and that of those for whom they care.
