Psychological distress, also known as emotional suffering, includes general symptoms of stress, anxiety, and depression. It is a transdiagnostic component of several mental disorder diagnoses, including anxiety and depression, and is linked to both mental illness ^{Reference Swartz and Jantz1} and poor health outcomes, even at low to moderate levels of distress. ^{Reference Barry, Stout and Lynch2,Reference McLachlan and Gale3} This is particularly concerning given that approximately 23% of adults in the United States have experienced some level of psychological distress in recent years ^{Reference Daly4} and have reported even higher rates during the coronavirus disease (COVID-19) pandemic. ^{Reference Twenge and Joiner5} Unfortunately, individuals with physical disabilities are even more likely to experience psychological distress, potentially because of stressors related to societal stereotypes, environmental accessibility challenges, and financial difficulties. ^{Reference Noh, Kwon and Park6,Reference Turner and McLean7}

Human-made disasters (eg, terrorism, technological) and natural disasters (eg, earthquakes, hurricanes, pandemics) can occur with little warning and result in severe consequences, including loss of life, physical injury, property damage, and psychological distress. These negative outcomes are multiplying as the frequency and severity of disasters have markedly increased this century. ^{Reference De Smet, Lagadec and Leysen8,Reference Eshghi and Larson9} Awareness of disasters and anticipation about their occurrence can also lead to significant psychological distress. ^{Reference Grupe and Nitschke10,Reference Bults, Beaujean, Richardus and Voeten11} Indeed, previous studies have found a positive association between perceived threat and distress across a variety of disaster and crisis events. ^{Reference Li and Lyu12,Reference Suzuki, Yabe and Yasumura13}

Individuals with disabilities have been disproportionately impacted by the negative effects of disasters ^{Reference Castro, Sarmiento and Edwards14–Reference Van Willigen, Edwards, Edwards and Hessee17} and often have greater difficulty recovering from disasters. ^{Reference Roubhan18,Reference Sodhi19} Thus, it is likely that individuals with disabilities may be particularly vulnerable to psychological distress when they perceive current or future disaster threats. Given that over 1 billion individuals (or 15%) across the world live with some form of disability, ²⁰ it is crucial to identify ways to impact the role of disaster threat on those individuals’ distress.

Fortunately, other disaster-related factors, such as perceived self-efficacy, may attenuate psychological distress. Self-efficacy, which refers to individuals’ belief in their ability to achieve a specific goal, can help individuals cope effectively in stressful situations. ^{Reference Bandura21,Reference Rabani Bavojdan, Towhidi and Rahmati22} Indeed, self-efficacy has been shown to have a direct negative relationship with distress ^{Reference Abramson, Stehling-Ariza, Garfield and Redlener23,Reference Duygulu, Kuruca-Ozdemir, Erdat and Kocoglu-Tanyer24} and has also been found to moderate the relationship between stressors and mental health outcomes, with better outcomes at higher levels of self-efficacy. ^{Reference Ejeta, Ardalan and Paton25–Reference Thormar, Sijbrandij and Gersons27} A disaster domain-specific type of self-efficacy—emergency preparedness self-efficacy—is defined as individuals’ perception of their ability to prepare for and deal with emergency situations ^{Reference Burns28,Reference Wirtz, Rohrbeck and Burns29} and may similarly decrease disaster-related distress. While there has been relatively little research on the role of emergency preparedness and self-efficacy among people with physical disabilities, existing research suggests that individuals with disabilities tend to have lower self-efficacy, in general, due to poor health and mobility limitations. ^{Reference Adams, Eisenman and Glik30,Reference Sullivan-Wiley and Gianotti31}

Perceived response efficacy, defined as an individual’s perception that suggested actions will be effective in achieving desired outcomes, can also impact psychological distress. Indeed, recent research has linked higher levels of response efficacy to lower psychological distress during the COVID-19 pandemic. ^{Reference Ambelu, Birhanu and Yitayih32} Similarly, Zhang et al. ^{Reference Zhang, Xiong, Zheng and Wu33} found that both response efficacy and self-efficacy mediated the relationship between perceived susceptibility to COVID-19 and anxiety, such that individuals who perceived a greater likelihood of infection believed that actions to avoid COVID-19 would be less effective, and in turn experienced greater distress. Limited research has investigated response efficacy among individuals with disabilities, but current findings suggest that this population tends to report lower levels of response efficacy with regard to disaster situations. ^{Reference Adams, Eisenman and Glik30,34} Fortunately, efficacy beliefs are malleable, ^{Reference Bandura21,Reference Bandura35} and emergency preparedness self-efficacy and response efficacy represent potential targets to decrease disaster-related psychological distress among individuals with physical disabilities.

Recent research has adapted Protection Motivation Theory (PMT) when modeling the additive effects of perceived threat, self-efficacy, and response efficacy on emotional responses. In its original formulation, PMT provides a basic model for understanding how individuals’ appraisals of risk and efficacy result in protective actions. ^{Reference Maddux and Rogers36} According to the PMT, an assessment of threat (severity and vulnerability) and efficacy (response and self-efficacy) operates on protection motivation additively. Kim et al.’s ^{Reference Kim, Yang, Min and White37} work extended the PMT by proposing that such appraisals can elicit emotional responses such as hope or fear, which in turn can influence future protective behavior. In line with this suggestion, a recent study found that college students who perceived greater susceptibility to COVID-19 also reported lower perceived efficacy to cope with this threat, which in turn predicted higher levels of anxiety. ^{Reference Zhang, Xiong, Zheng and Wu33}

The current research seeks to extend past work on the PMT by examining the relationship between disaster-related cognitive appraisals and negative affective responses in greater detail. Research to date linking perceived threat, self-efficacy, and response efficacy to psychological distress has been exclusively correlational, which can only suggest causal relationships. Findings may guide future interventions to mitigate disaster-related psychological distress among individuals with disabilities. Therefore, the present research used structural equation modeling to examine a 2-wave longitudinal model of these linkages among 106 individuals with physical disabilities (Figure 1). That model was used to test the following research questions and hypotheses:

Figure 1. The proposed model.

Results

Sociodemographic Characteristics of the Sample

Demographic characteristics of the sample are presented in Table 1. At the time of interview completion, the sample was predominantly single (59%), lived in a suburban area (49%), identified as female (74%), owned their home (58%), lived with others (71%), was not a parent (58%), had earned at least a bachelor’s degree (68%), earned at least $35 000 (38%), had no children living with them (79%), and was white (89%). The average age was 46. The average general disability severity within the sample was mild to moderate (mean = 2.25, SD = 0.66). The average mobility-related impairment was moderate (mean = 2.92, SD = 0.96).

Table 1. Sample Characteristics

¹Respondents could specify more than one ethnicity.

Univariate Characteristics and Bivariate Relationships Among Key Study Variables

Means, standard deviations, and bivariate relationships among the central variables employed in the study are presented in Table 2. Increased averages from Wave 1 to Wave 2 were observed in perceived threat (difference = 0.26, t = 3.70, P < 0.001), perceived self-efficacy (difference = 1.33, t = 2.80, P < 0.01), response efficacy (difference = 0.28, t = 1.01, P > 0.05), and psychological distress (difference = 0.80, t = 2.02, P < 0.05). Positive Wave 1 to Wave 2 correlations were found for perceived threat (r = 0.41, P < 0.001), perceived self-efficacy (r = 0.57, P < 0.001), response efficacy (r = 0.40, P < 0.001), and psychological distress (r = 0.58, P < 0.001).

Table 2. Descriptive Statistics and Bivariate Correlations

Note: * p<.05 **p<.01 ***p<.001.

At Wave 1, psychological distress was positively correlated with perceived threat (r = 0.28, P < 0.01) and negatively correlated with perceived response efficacy (r = −0.20, P < 0.05) and self-efficacy (r = −0.40, P < 0.001). At Wave 2, perceived threat (r = 0.27, P < 0.01) and self-efficacy (r = −0.45, P < 0.001) showed significant correlations with psychological distress. In contrast, the correlation between psychological distress and response efficacy (r = −0.16), which was statistically significant at Wave 1, dropped to non-significance (P > 0.05) at Wave 2, suggesting the possibility of non-stability in that relationship across time.

RQ1 and RQ2: Do Threat, Self-Efficacy, and Response Efficacy Each Independently Relate to Psychological Distress, and Are These Relationships Stable Across Time?

Standardized parameter estimates of psychological distress regressed on perceived threat, response efficacy, and self-efficacy are presented in Table 3, separately by wave. The estimate for perceived threat at the first (b = 0.27, P < 0.001) and second (b = 0.25, P < 0.001) waves were very similar. This similarity extended to the estimates for self-efficacy at Wave 1 (b = −0.28, P < 0.001) and at Wave 2 (b = −0.32, P < 0.001). However, the significant estimate for response efficacy at Wave 1 (b = −0.19, P < 0.05) dissipated to non-significance at Wave 2 (b = −0.04, P > 0.05), suggesting the possible instability of this effect across time.

Table 3. Parameter Estimates: Cotemporaneous Model

RQ3: Is Change in Perceived Threat, Self-Efficacy, and Response Efficacy Related to Change in Psychological Distress?

In order to address Research Question 3, the difference in psychological distress (Wave 2–Wave 1) was regressed on the difference in perceived threat, the difference in response efficacy, and the difference in self-efficacy. The results revealed that, on average, the difference in psychological distress was positively associated with the difference in perceived threat (b = 1.95, P < 0.001) and negatively associated with the difference in self-efficacy (b = −0.21, P < 0.01) but not significantly related to the difference in response efficacy (b = −0.10, P > 0.05).

RQ4: Are There Distal (that is, cross-wave) Effects of Threat, Self-efficacy, and Response Efficacy on Psychological Distress, Independent of Any Proximal (that is, within-wave) Effects?

In order to address Research Question 4, the full structural equation model depicted in Figure 1 was examined and tested. The results are presented in Table 4 and summarized in Figure 2. Of the 4 primary measures (psychological distress, perceived threat, response efficacy, and self-efficacy), only psychological distress (b = 0.57, P < 0.0001) and perceived threat (b = −0.20, P = 0.017) from Wave 1 were found to independently relate to Wave 2 psychological distress. Proximal Wave 2 measures of perceived threat (b = 0.26, P < 0.002) and self-efficacy (b = −0.31, P < 0.001) were also found to be significantly related to Wave 2 psychological distress.

Table 4. Parameter Estimates: Full Model

Figure 2. Final model.