Some Find Silver Lining In Hurricane Clouds

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 Health.

“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 help.”

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 problems.

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 population.”

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>.▪