Anxiety or mood disorders were nearly twice as common among Hurricane
Katrina survivors from New Orleans compared with people who had lived in other
storm-affected areas, according an ongoing community survey.
A related analysis found that 1 in 5 persons who had mental disorders
before the storm, and others who developed symptoms only afterward, had
trouble continuing or finding treatment.
Both reports are based on findings from the Hurricane Katrina Community
Advisory Group. The group surveyed a representative sample of 1,043
prehurricane residents of Alabama and Mississippi counties and Louisiana
parishes directly affected by Hurricane Katrina in 2005. Researchers
telephoned respondents five to seven months later and used the K6 screening
scale to identify types and intensity of nonspecific psychological
The first study found that 31 percent of the entire sample reported a mood
or anxiety disorder in the 30 days prior to answering the survey. That figure
masked differences between the New Orleans metropolitan area and everywhere
else, wrote Sandro Galea, M.D., Dr.P.H., of the Department of Epidemiology at
the University of Michigan School of Public Health, and colleagues, in the
December 2007 Archives of General Psychiatry. A closer look revealed
that 49 percent of respondents who had lived in New Orleans before the storm
reported a mood or anxiety disorder compared with 26 percent among residents
in the other areas. Posttraumatic stress disorder (PTSD) rates were 30 percent
among New Orleanians, but less than 13 percent of the others.
Property destruction, as in New Orleans' Lower Ninth Ward played a
lesser role in residents' post-Katrina mental illness than injury or physical
Credit: Aaron Levin
The survey inquired about 10 hurricane-related stressors and related them
to mood and anxiety disorders. These, too, differed geographically. Physical
illness or injury and physical adversity (like lacking food or sleeping in a
church basement) most strongly raised the odds for a mental disorder among
those from New Orleans, while financial loss was the key factor among people
in other areas.
Perhaps in New Orleans, coping with death, injury, physical adversity, and
geographic displacement may have made property loss seem relatively less
significant, speculated Galea and colleagues.
Why hurricane-related stressors correlated more strongly with anxiety and
mood disorders among New Orleanians than people living elsewhere was unclear,
wrote Galea and colleagues, although they suggest that "undetermined
vulnerability or contextual factors" were responsible.
The researchers also noted that sociodemographic factors seemed to play
little or no role in who was affected by hurricane-related stressors.
"Increased mental illness in the wake of the hurricane must address
the needs of persons in all segments of society rather than target specific
population segments," they concluded.
If physical adversity were traceable to the "slow government response
to Hurricane Katrina," then better material assistance after future
disasters would make sense not only on humanitarian grounds, they wrote,"
but also as a way to minimize the adverse mental health effects of
The second study found that although nearly half of individuals with a
preexisting mental disorder received some kind of treatment after the storm,
23 percent had trouble continuing treatment, either because their treatment
was reduced (said 10 percent of those surveyed) or terminated (said 13
percent), wrote the study authors in the January American Journal of
Psychiatry. The authors were Philip Wang, M.D., Ph.D., of the Division of
Services and Intervention Research at the National Institute of Mental Health,
Ronald Kessler, Ph.D., of the Department of Health Care Policy at Harvard
Medical School, and colleagues.
Reconstruction is proceeding faster in middle-class areas like Lakeview
(above), but research shows no sociodemographic differences in effects of
Credit: Aaron Levin
About 19 percent of respondents without a pre-Katrina psychiatric diagnosis
met criteria for at least one in the survey, but only 19 percent of that group
received any treatment for their conditions.
The reasons for not getting treatment differed between the two groups.
Financial barriers, lack of services, and transportation problems hindered
treatment for persons diagnosed before the storm. These factors proved more
common among people from the New Orleans area than other devastated areas.
However, people with new-onset disorders more often believed that symptoms
would get better on their own as time passed and so did not see a need for
Katrina destroyed mental health facilities and drove many health providers
from the region. The storm also closed businesses, leading to a loss of income
and health insurance for many people. As a result, many people lost their
opportunities for mental health treatment.
About 18 percent of respondents were treated by psychiatrists after the
hurricane, including 7 percent seen only by a psychiatrist, while 65 percent
were seen only by a primary care physician.
"While psychiatrists saw only a small proportion of cases overall,
they had provided treatment to nearly half of those with preexisting cases
experiencing posthurricane disruptions in care," wrote Wang and
Pharmacotherapy was the most common form of treatment among both
psychiatrists (52 percent) and other clinicians (65 percent). Psychiatrists
provided psychological counseling (defined as eight or fewer sessions, or
sessions lasting less than 30 minutes) more often (64 percent) than other
clinicians (33 percent).
Psychiatrists might use this counseling dimension of their training to
ensure treatment of patients during disasters, wrote Wang.
Kessler also reported his findings to the Senate Ad Hoc Subcommittee on
Disaster Recovery in Washington, D.C., last November. Finding better ways to
cope with the mental health demands caused by disasters like Katrina requires
more research, not just resources for helping survivors, he said.
"We don't have a lot of things in our bag of tricks," he told
senators, including Mary Landrieu, (D-La.). "We know that emergency
psychiatric medicine has lagged."
Kessler cited the uncritical rush to adopt critical incident stress
debriefing, which was later discredited in controlled trials as useless or
harmful, as an example of how not to improve care for storm victims.
In future crises, he said, the government should commit some increment of
the resources expended—he suggested 1 percent—to research and
planning for future disasters.
"We should be thinking creatively about things we're not sure will
work but might be worth looking at, and thinking about what works and what
doesn't," he said. Ideas to test might include having psychiatrists or
psychologists donate a couple of hours a week to counsel survivors by phone or
arranging for a psychiatrist to serve as a consultant or collaborator with
primary care doctors in order to expand opportunities for care.
"Exposure to Hurricane-Related Stressors and Mental Illness
After Hurricane Katrina" is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/64/12/1427>."
Disruption of Existing Mental Health Treatments and Failure to Initiate
New Treatment After Hurricane Katrina" is posted at<ajp.psychiatryonline.org>
under the January issue. ▪