Katrina’s Two-Sided Impact: Survey finds disorders, resilience after tragedy

In the year following the devastation of Hurricane Katrina, rates of serious mental disorders roughly doubled among survivors from Alabama, Louisiana, and Mississippi, a new survey indicates.

During that same time, however, the proportion of Gulf Coast residents with mental ailments who also talked of wanting to kill themselves or of making suicide attempts dropped sharply, says a team led by psychiatric epidemiologist Ronald C. Kessler of Harvard Medical School in Boston.

While many Katrina survivors feel depressed by their losses and anxious about their futures, they have also cultivated a sense of inner strength and optimism about their ability to rebuild their lives, Kessler and his coworkers conclude.

“There’s a lot of hope for the future among Katrina survivors, although we don’t know how long it will last,” Kessler says.

The new survey will appear in the Bulletin of the World Health Organization.

Kessler’s group recruited 1,043 adults for a long-term study of mental health. The researchers contacted people who live in the same homes as they did before the hurricane as well as people now living in other states or in federally subsidized housing.

Initial psychiatric interviews occurred from January through March, 5 to 7 months after Katrina hit. For comparison, the scientists consulted mental-health data collected as part of a national survey from 2001 to 2003 for 826 adults from Gulf Coast areas. None of them participated in the 2006 survey.

The two surveys indicate that 6 percent of the Gulf population displayed mental illnesses requiring immediate treatment before Katrina. The most-common diagnoses were major depression, post-traumatic stress disorder, and other anxiety-related conditions. After the hurricane, that proportion reached 11 percent, the investigators say.

Mild or moderate cases of depression and anxiety increased from 10 percent before Katrina to 20 percent afterward.

Yet among people with those mental disorders, reports of thinking about, planning, or attempting suicide plummeted from a rate of more than 8 percent before Katrina to less than 1 percent after the hurricane.

Around three-quarters of all the Katrina survivors surveyed reported becoming closer to loved ones, developing faith in their ability to rebuild their lives, and other signs of resilience.

Those positive reactions, however, may be short-lived. Prior studies suggest that if external conditions don’t substantially improve within about 18 months of a major disaster, “people start wearing out emotionally and lose their resolve,” Kessler says.

Richard H. Weisler, a psychiatrist at the University of North Carolina at Chapel Hill and Duke University Medical Center in Raleigh, welcomes the new evidence on resilience in Katrina survivors but suspects that particularly despairing individuals refused to be interviewed. Indeed, about 60 percent of those contacted by Kessler’s team declined to participate in the survey.

In the Aug. 2 Journal of the American Medical Association, Weisler and his colleagues described evidence for substantial increases after Katrina in completed suicides in New Orleans and for hikes in substance abuse and calls to mental-health crisis lines in affected parts of Mississippi.

The survey by Kessler’s team underscores that regardless of whether or not people contemplate suicide, rates of mental disorders spiked after the storm, remarks New Orleans psychiatrist James G. Barbee IV. “I can’t communicate strongly enough how rough this experience has been on people who live here,” he says.