In areas of Louisiana, Mississippi, and Alabama struck by Hurricane
Katrina, prevalence of mental illness has risen, but suicidality has
People in the region hit by Hurricane Katrina reported higher rates of
mental illness but fewer suicidal feelings than people surveyed in the same
region before the hurricane, according to a report in the Bulletin of the
World Health Organization.
“This is just the first of a series of efforts to do cumulative
science and ask parallel questions to coordinate with practical efforts after
a disaster,” said Ronald c. Kessler, Ph.D., a professor of health care
policy at Harvard Medical School, in an interview.
Other researchers have conducted surveys to measure the storm's effects on
the most severely affected victims, said Kessler. “But we wanted to do a
survey to characterize the entire population to help program planners get
their arms around the magnitude of the services needed.”
Survey interviews were conducted this past January to March. The
researchers plan to conduct quarterly interviews with the same group to track
their responses over time. The current sample covered 1,043 people, but
Kessler expects to include about 3,000 as funding permits.
The survey participants, termed the Hurricane Katrina Community Advisory
Group, include broad samples of people affected by Katrina: residents of the
new Orleans metropolitan area at the time of the hurricane and residents of
counties or parishes of Alabama, Louisiana, and Mississippi that were in the
path of the hurricane. Some individuals are still in their homes, but others
were temporarily or permanently living elsewhere.
The telephone survey methodology is a reasonable approach given the massive
impact of a disaster that scattered residents across the country, said Anthony
Speier, Ph.D., director of disaster operations in Louisiana's Office of Mental
“But we can't generalize to people who don't have telephones,”
said Speier. “So we need multiple data inputs to find people who need
Post-Katrina residents of Alabama, Louisiana, or Mississippi were called
through random-digit dialing and at phone numbers provided by the Red Cross.
The sample included many people who had not returned home. Only participants
who agreed to take part in the survey over a period of several years were
included. The researchers compared the data from the Katrina cohort to
existing data from the National Comorbidity Survey-Replication (NCS-R), a
face-to-face survey taken from 2001 to 2003 of adults in areas later affected
by the hurricane.
The idea for such postdisaster surveys began long before Katrina struck the
Gulf Coast, said Kessler. After the September 11, 2001, attacks, the Substance
Abuse and Mental Health Services Administration started a terrorism working
group whose goal was to develop an off-the-shelf way to do needs assessment
following a disaster. The working group had just finished the prototype when
the hurricane season began last year.
For the Katrina survey, Kessler and colleagues Sandro Galea, M.D., Dr.P.H.,
M.P.H., Russell T. Jones, Ph.D., and Holly a. Parker, Ph.D., used the K6 scale
of nonspecific psychological distress to screen for anxiety and mood disorders
occurring in the previous 30 days. They assessed people to determine if they
had one of several disorders: DSM-IV major depressive episode, panic
disorder, generalized anxiety disorder, posttraumatic stress disorder,
agoraphobia, social phobia, and specific phobia. They also asked about
lifetime occurrence of suicidal thoughts, plans, and attempts and the recency
of any such events.
The researchers also asked about aspects of personal growth that might have
helped the participants make sense of the trauma or find something positive in
the experience. These included posttraumatic increases in emotional closeness
to loved ones, developing faith in one's ability to rebuild one's life,
increased spirituality or religiosity, finding meaning or purpose in life, and
recognition of inner strength or competence.
In the 2001-2003 NCS-R survey taken before Katrina, 6.1 percent of
respondents were estimated to have had a serious mental illness, compared with
11.3 percent after the storm. Also, 9.7 percent had mild to moderate mental
illness according to the NCS-R, as opposed to 19.9 percent after Katrina.
“Suicide ideation, plans, and attempts during the 12 months before
the interview were reported in both samples almost entirely by people
estimated to have mental illness,” wrote Kessler and his team. Among
these post-Katrina participants, however, the prevalence of suicidality was
markedly lower—0.7 percent for suicidal ideation after Katrina versus
8.4 percent before, and 0.4 percent for suicidal plans compared with 3.6
percent before. Being young (18 to 39 years) or non-Hispanic white were the
only significant sociodemographic correlates of suicidal ideation.
Furthermore, large percentages of participants reported aspects of growth
since the storm (see chart). If mentally ill respondents reported a belief in
their own ability to recover or discovery of inner strength, they had lower
rates of suicidal ideation (odds ratio 0.2). Without those characteristics,
post-Katrina respondents with mental illness had results similar to those of
the NCS-R respondents.
The Hurricane Katrina Community Advisory Group survey is helpful because it
is a systematic look at loss and recovery, said Speier. “People affected
by the hurricane may have lost houses or jobs, but they are finding adaptive
ways of managing their lives.”
The data will have long-term value, he said, but because the survey was
conducted earlier this year, its findings may have less relevance in planning
programs today than current street-level information picked up by Louisiana
Spirit's outreach workers. Kessler and his team did not report on the effects
of mental health services but are now looking at whether access to the mental
health services made available to hurricane survivors had an impact on the
prevalence of psychological
The low prevalence of suicidality might be temporary, the researchers
warned. Suicidality might increase if practical problems of housing and
employment are not solved soon, they wrote. “The finding of a low
prevalence of suicidality, then, should be considered evidence of a short-term
postponement rather than of a permanent absence of suicidality in this
Primary financial support for the Hurricane Katrina Community Advisory
Group comes from the U.S. Department of Health and Human Services.
“Mental Illness and Suicidality After Hurricane Katrina”
is posted at<www.hurricanekatrina.med.harvard.edu/pdf/baseline_report%208-25-06.pdf>.▪