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Now that the winds have stopped blowing and the rains have ceased, many people who lived through the monster storms named Harvey, Irma, and Maria are facing staggering losses and severe disruption of their lives. They may also be challenged by mental health problems, such as anxiety, depression, and post-traumatic stress disorder (PTSD) brought on or exacerbated by the disaster.

Thanks to long-term studies of Hurricane Katrina survivors, we know a lot more about the mental health effects of living through catastrophic storms and their aftermath. The studies, known as the Resilience in Survivors of Katrina Project or RISK, are unique in disaster research because the researchers had fortuitously collected baseline data on the study subjects before Katrina struck.

 

The Risk studies

In 2004, a year before the hurricane, the researchers obtained funding to look at whether performance-based scholarships would help young low-income New Orleans single parents enrolled in community college increase their health and well-being. Baseline demographic, socioeconomic, and health information, including information on economic status, social support, physical and mental health, were collected on all of the 1,019 participants in the study. Because there were only 77 men in the original sample, the analysis was limited to the female participants (N=942). By the time the hurricane struck, 492 of them had completed a 12-month follow-up survey.

The original study had to be abandoned because of Katrina, but the researchers refocused their efforts to learn how survivors of the disaster had fared. They were able to locate and survey 402 of the 492, for whom they had complete data, by telephone in 2005-2006. In addition to asking the same questions that were in the pre-disaster survey, they also collected detailed information about the survivor’s hurricane experiences and included measures of post-traumatic stress disorder or PTSD. Participants were resurveyed again in 2010, and the research is still on-going, spawning a number of important peer-reviewed research papers.

 

What did they learn?

All of the study participants were affected by the storm with 80% having severe home damage and one-third experiencing the death of a family member or friend. Although 85% were evacuated, those that remained experienced the worst of the storm’s aftermath, being trapped in their homes or stuck in what the researchers describe as “the hellish environments of the Superdome or the Convention Center.”

The researchers found that at the time of the first post-Katrina survey, almost half (47.9%) of the women were found to have probable PTSD. The prevalence of mild to moderate illness (MMI) or serious mental illness (SMI) rose significantly from the baseline of 23.3% to 37.2%, and that of probable serious mental illness (SMI) doubled from 6.9% to 13.8%.

When the researchers controlled for pre-existing mental health issues, they found that the post-storm impact on mental health impact (MMI/SMI) was reduced by about 20%, but the impact on PTSD was not affected. Another important finding of the study was that only about 9% of those found to have mental health problems reported having seen a mental health professional in the year after the hurricane, including 15% of those with MMI and 16% with SMI.

Not surprisingly, they found that people who had higher baseline resources (e.g., social support, owning a car) experienced fewer hurricane-associated stressors, such as unemployment and separation from family and friends. However, participants who did experience the worse of the storm-related traumas (e.g., being trapped in their houses, seeing people die, living through the nightmare of the convention center) were at high risk of developing SMI or probable PTSD, even if they had better baseline resources.

 

10 years later

The surveys 10 years after Katrina revealed that some people had improved, but they were still not back to pre-storm levels of mental health. Almost 30% of the participants still met the criteria for probable mental illness and one-third still had symptoms suggestive of probable PTSD. Although this represented a decline from the peak rate of 36%, it is still higher than the pre-disaster level of 24%.

Survivors who had a full return to their pre-hurricane function were found to have had low levels of baseline psychological distress, increased symptoms at year one, and then a return to baseline at the ten-year mark. These people were said to have fit into what the researchers termed a resilient trajectory.

Some people went beyond resilience and actually reported post-traumatic growth (PTG). They felt that they were stronger, more spiritual, and had a greater appreciation for life as a result of having survived the disaster. Interestingly, PTG was strongly and positively associated with having had high levels of PTSD at both post-Katrina follow-ups. The reason for this finding was not known.

A sense of community turned out to be an important protective factor. For example, one congregation moved together from New Orleans to Houston, maintaining important relationships even though their surroundings were unfamiliar. People who were displaced sometimes decided to return to New Orleans, even if their living circumstances were better in their new communities. They did it because they missed their family, friends, and neighbors and, in some cases, because they preferred to live in a majority black neighborhood as opposed to the more racially diverse neighborhoods of their new communities.

 

Lessons for our current disaster responses

The RISK project is providing a rich body of scientific literature that should be used to guide how we respond to our current Hurricane disasters and those that may occur in the future. Relatively simple changes, such as evacuating neighbors to the same shelters can provide a sense of belonging that can offset, to some degree, the anxiety created by the sudden loss of so much in their lives. Calling on mental health providers to volunteer their services early on via in-person or telephonic means can provide a bridge until more permanent mental health interventions can be arranged.

It is my hope that we will learn from our past mistakes and will plan for better responses in the future, not only in terms of physical infrastructure changes (building codes, dam reinforcement, banning reconstruction in certain high-risk areas), but also in terms of physical and mental health services. Thanks to RISK, we know more about mental health after hurricanes, but we must find the collective will to do what it takes to ameliorate the factors that exacerbate mental health problems and reinforce those that foster resilience and post-trauma growth.

 

Further reading:

Waters, Mary C. Life after Hurricane Katrina: The Resilience in Survivors of Katrina (RISK) Project. Sociological Forum, 2016.

Patricia Salber MD, MBA (@docweighsin)
Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.

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