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Mental Health Woes Doubled After Katrina

But largest survey to date also found new resilience, sense of community

MONDAY, Aug. 28, 2006 (HealthDay News) -- Survivors of Hurricane Katrina experienced a doubling in the rate of serious mental illness in the months following the disaster, according to the largest study on the subject to date.

At the same time, however, the Harvard study also found that thoughts of suicide have actually fallen from levels recorded before the storm.

That surprising finding might be due to a high level of optimism and resiliency among survivors, the researchers said.

"The study has been very helpful in affirming a sense of health and resilience in pockets of the community," explained Anthony H. Speier, director of disaster mental health operations in the Louisiana Office of Mental Health, at a teleconference held Friday. "At the same time, we're seeing large expression of need, issues of prevalence of mental illness and request for assistance for crisis mental health services."

Speier was a co-author of the report, which was published Monday in a special online edition of the Bulletin of the World Health Organization. It is the first in a planned series of reports.

The positive findings of the document stand in contrast to previous reports, which had detailed an increase in suicides among those affected by Katrina.

According to background information in the study, Hurricane Katrina was the deadliest hurricane in the United States in 70 years, and the most costly ever. More than half a million people were evacuated, more than 90,000 square miles were declared a disaster area, and more than 1,600 people have been confirmed dead. An additional 1,000 people are still missing.

Dispersal of so many victims of the hurricane has made it impossible to carry out a comprehensive assessment of the mental health of survivors.

"This is a unique disaster. We don't have whole cities getting wiped out and whole geographical areas wiped out to the extent they did in this case," said Ronald C. Kessler, head of the survey team and a professor of health-care policy at Harvard Medical School. "It's very tough to get a portrait of the entire population that was affected by this disaster because they're scattered to the winds. Without a representative portrait, it's difficult to come up with rational public health-planning policies."

This survey, funded partly by the U.S. National Institute of Mental Health, relied on a list of 1.4 million families provided by the American Red Cross.

Between Jan. 19 and March 31, 2006, researchers interviewed 1,043 adults from this list who lived in areas affected by Katrina. Those responses were compared with results of another survey conducted in 2001 and 2003, involving a separate sample of 826 adults in the same census areas of Alabama, Louisiana and Mississippi.

Post-Katrina respondents were about twice as likely to have serious mental illness (11.3 vs. 6.1 percent) and mild to moderate mental illness (19.9 percent vs. 9.7 percent), the Harvard study found.

Among people with serious mental health problems, an estimated one-third to one-half suffer from post-traumatic stress disorder (PTSD). "For others, it's just plain-old depression, giving up on life, or generalized anxiety," Kessler said.

The prevalence of thoughts of suicide in people with mental illness, however, was significantly lower than in the pre-Katrina sample.

"The notion of resilience seemed to be at the core of this," Kessler said. "We found an extraordinarily high proportion of our sample who said that -- despite the understandable sadness of all they had lost and anxiety about the uncertainties of the future -- that they felt closer to their loved ones, felt connected to community, much more religious and had purpose in life and meaning."

"You have to have a day-to-day mentality and be happy when little things happen," added Juan Lizarraga, a New Orleans attorney who survived the hurricane and is now living in a trailer on his own property. "The battle for us is the continual battle against negativity. Bailing out is never an option."

Whether or not these feelings will persist over the long term is another issue.

"After about 18 months, people start wearing out," Kessler said. "It's the psychological equivalent of a high-adrenaline phase. That's the underbelly that we're concerned about."

The team is currently starting a six-month follow-up phase and will be conduct 12-month and 18-month follow-ups as well.

Among the survey's other findings:

  • More than one-third of people in affected areas experienced extreme physical adversity and nearly one-fourth experienced extreme psychological adversity. The vast majority (84.6 percent) experienced a significant financial, income or housing loss.
  • Seven percent of respondents reported experiencing a "seriously traumatic" event such as being rescued, a life-threatening experience or being physically or sexually assaulted.
  • Most respondents (60.4 percent) said their life was about the same as before the hurricane, 25.5 percent said worse and 13.5 percent said better.
  • Most (88.5 percent) respondents said that their Katrina experiences had helped them develop a deeper sense of meaning or purpose in life.
  • About three-quarters said that their experiences with the hurricane made them more spiritual or religious.

More information

Find the complete report at Harvard University.

SOURCES: Aug. 25, 2006, teleconference with Ronald C. Kessler, Ph.D., professor, health-care policy, Harvard Medical School, Boston; Anthony H. Speier, Ph.D., director, disaster mental health operations, Louisiana Office of Mental Health; Juan Lizarraga, New Orleans; Mental Illness and Suicidality After Hurricane Katrina
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