Journal of Nursing Scholarship First Quarter 2002 11 Clinical Scholarship Factors Associated with Distress in Urban Residential Fire Survivors Anne Keane, Arlene D. Houldin, Paul D. Allison, Christopher Jepson, Justine Shults, Isaac F. Nuamah, Ann Marie Walsh Brennan, Barbara J. Lowery, Ruth McCorkle Purpose: To identify factors associated with recovery in a sample of urban residential fire survivors. Design and Methods: 440 survivors of residential fires were interviewed at approximately 3, 6, and 13 months after the fire to measure psychological distress. A set of factors was identified that correlated with survivors’ ability to recover from the fire event. Potential predictors of increased distress were identified. Hypotheses were that participants who were lower in socioeconomic status, who were minority members, who had less social support, who engaged in attributional thinking, and had greater concurrent life stresses would have greater psychological distress in response to a residential fire and would be less able to recover from the fire event. Findings: Distress after fire was high at 3 months and decreased for the majority of participants, although one-third of survivors had higher distress at 13 months than at 3 months. Loss of control and attributional variables had the strongest influence on psychological distress over time. Conclusions: The findings are consistent with stress-response tendencies expected after a stressful event. A set of predictor variables was identified to help clinicians target survivors at high risk for psychological distress after a residential fire. JOURNAL OF NURSING SCHOLARSHIP, 2002; 34:1, 11-17. ©2002 SIGMA THETA TAU INTERNATIONAL. [Key words: residential fires, psychological distress, loss, attributions] * * * L ife after a residential fire is difficult for most survivors. Personal losses may be considerable, life adjustments substantial, and the perception that one’s home is a place of sanctuary and safety may be seriously threatened. Survivors may be fearful, guilty, grieving, angry, blaming, and resentful. Whatever the degree of loss or inconvenience caused by the fire, survivors must begin to rebuild their lives, restructure their environment, and support family members as they do so. After a short period, social norms direct fire survivors to rebuild and get on with their lives. Unfortunately, many survivors face a period of recovery that is fairly long term, while friends, neighbors, and support agencies are geared to more immediate, short-term responses. These issues and their resolution are important community and public health problems in the United States, a country with one of the highest per capita fire death rates in the world and annual $8.6 billion fire-related losses (Federal Emergency Management Agency, 1993). Background From a theoretical perspective Horowitz’s stress response theory (1976) provides a useful framework for this study. The theory builds upon Seyle’s work (1956), includes a psychophysiologic basis for understanding an individual’s response to an overwhelmingly stressful life event, and indicates how that response is related to psychological processes (Bloom, 1999). Horowitz’s model shows that natural stress response tendencies are: compulsive repetition, Anne Keane, EdD, FAAN, Alpha Nu, Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia; Arlene D. Houldin, RN, PhD, Xi, Associate Professor of Psychosocial Oncology Nursing, School of Nursing, University of Pennsylvania, Philadelphia; Paul D. Allison, PhD, Professor of Sociology, University of Pennsylvania, Philadelphia; Christopher Jepson, PhD, Manager Research Projects, General Internal Medicine, University of Pennsylvania, Philadelphia; Justine Shults, PhD, Assistant Professor, Biostatistics, University of Pennsylvania, Philadelphia; Isaac F. Nuamah, PhD, Statistician, Bristol Myers Squibb, Princeton, NJ; Ann Marie Walsh Brennan, RN, PhD, Alpha Nu, Lecturer, School of Nursing, University of Pennsylvania, Philadelphia; Barbara J. Lowery, EdD, FAAN, Alpha Nu, Independence Professor of Nursing, Associate Provost, University of Pennsylvania, Philadelphia; Ruth McCorkle, PhD, FAAN, Delta Nu, Professor, School of Nursing, Yale University, New Haven, CT. This research was supported by Grant No. MH 45139 from the National Institute of Mental Health, Anne Keane, Principal Investigator and Grant No. P50 NR0234 from the National Institute of Nursing Research, Ruth McCorkle, Director, and Barbara Lowery, Co-Director. Correspondence to Dr. Keane, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-6096. E-mail: akeane@nursing.upenn.edu Accepted for publication September 20, 2001.