Community destruction and traumatic stress in post-tsunami Indonesia.

How are individuals affected when the communities they live in change for the worse? This question is central to understanding neighborhood effects, but few study designs generate estimates that can be interpreted causally. We address issues of inference through a natural experiment, examining post-traumatic stress at multiple time points in a population differentially exposed to the 2004 Indian Ocean tsunami. The data, from the Study of the Tsunami Aftermath and Recovery, include interviews with over 16,000 Indonesian adults before and after the event. These data are combined with satellite imagery, direct observation, and informant interviews to examine the consequences of community destruction for post-traumatic stress. Using multilevel linear mixed models, we show that community destruction worsens post-traumatic stress, net of rigorous controls for individual experiences of trauma and loss. Furthermore, the effect of community destruction persists over time and extends across a wide range of community types.