Katrina survey shows many suffered extreme adversity and show signs of post-traumatic stress

Large majority also now have a deeper sense of meaning or purpose in life

Boston, MA--According to the most comprehensive survey of people affected by Hurricane Katrina, the vast majority of pre-hurricane residents of the affected areas in Alabama, Louisiana, and Mississippi experienced a significant loss in one or more of the areas of finances, income, and housing. More than one-third experienced extreme physical adversity and nearly one-fourth experienced extreme psychological adversity. At the same time, evidence was found of an enormous amount of strength and personal growth in the sample, with the vast majority of survey respondents saying that their experiences with the hurricane helped them develop a deeper sense of meaning or purpose in life.

These and other survey results come from baseline interviews with the Hurricane Community Advisory Group, a statistically representative sample of hurricane survivors assembled to provide information in a series of ongoing tracking surveys about the pace of recovery efforts and the mental health effects of these efforts on hurricane survivors. The study is led by researchers from Harvard Medical School and is funded by the National Institute of Mental Health and the Office of the Assistant Secretary of the Department of Health and Human Services for Planning and Evaluation.

"It is important for mental health policy planners to have accurate information about the size of the problem they are trying to address among survivors of Hurricane Katrina. Our tracking surveys are designed to provide that information," says Ronald Kessler, Professor of Health Care Policy at Harvard Medical School and director of the study.

Hurricane Katrina was the deadliest United States hurricane in seven decades, and the most expensive natural disaster in U.S. history. Over 500,000 people were evacuated, and nearly 90,000 square miles were declared a disaster area (roughly equal to the land mass of the United Kingdom).

The Hurricane Katrina Community Advisory Group initiative was launched to provide an ongoing tracking survey of the mental health of those affected. The data will help support public health decisions.

The survey data presented in the report released today come from a baseline survey. A series of follow-up surveys are planned for the future. A total of 1,043 people agreed to join the survey panel and to participate in repeated surveys over several years. The respondents were all pre-hurricane residents of Alabama, Louisiana, and Mississippi, with an over-sampling from New Orleans.

This first report covers the following areas from the baseline survey: recollections of evacuation preparations, post-evacuation stressful experiences, current practical problems and proposed solutions, rating the helper agencies and organizations, residential mobility plans, post-traumatic stress reactions, post-traumatic personal growth, and long-term perspective. The baseline survey was conducted between January 19 and March 31, 2006.

Overview of Baseline Survey Results: Hurricane Katrina Community Advisory Group

Evacuation Preparations

  • Close to 90 percent of respondents heard about the hurricane more than a day before it hit, and the majority at least three days before it hit.

  • The vast majority of respondents heard the mass media messages about the key aspects of evacuation preparation.

  • Three-fourths of those in the New Orleans Metropolitan Area and nearly one-third of those in the other areas evacuated prior to the time Katrina hit.

  • Residents who did not evacuate reported that they didn't do so because they did not want to go (35.9-42.2 percent) or because they were unable to go (38.7-45.5 percent).

  • Low-income people were considerably more likely to report not being able to go (40.2 percent) than were people with high incomes (6.4 percent).

  • Sixty-two percent of the people who did not evacuate on their own volition said they didn't think the storm would be that bad. The next most common reason was that the respondent wanted to stay with family or friends (18.5 percent).

Post-evacuation stressful experiences

  • Seven percent of respondents reported experiencing an event that would be considered seriously traumatic (had to be rescued, any life-threatening experience, being physically or sexually assaulted), and 18.7 percent reported that a traumatic event of this sort (including death) occurred to someone close to them.

  • The vast majority (84.6 percent) of respondents experienced a significant financial, income, or housing loss. More than one-third of respondents (36.3 percent) experienced extreme physical adversity and nearly one-fourth (22.8 percent) experienced extreme psychological adversity.

Current practical problems and proposed solutions

  • Respondents were asked whether their current living situation was better, worse, or about the same as before the hurricane. About one-third (36.4 percent) said worse, half (52.6 percent) the same, and the remainder (11.1 percent) said better.

  • Respondents were asked whether their life as a whole was currently better, worse, or about the same as before the hurricane. Surprisingly, only about one-fourth (25.5 percent) said worse, while the majority (60.4 percent) said about the same and 13.5 percent said better.

Rating the helper agencies and organizations

  • The agencies and organization with the highest proportion rates excellent were the National Guard and Armed forces (32 percent) and the American Red Cross (31.9 percent).

  • The agencies and organizations with the lowest proportions rated excellent and the highest proportions rated either poor or very poor were the insurance industry (3.6 percent excellent, 54.8 percent poor or very poor), FEMA (6.4 percent excellent, 47 percent poor or very poor), and the rest of the federal government (7.1 percent excellent, 37.1 percent poor or very poor).

Residential mobility plans

  • Respondents were asked if they planned to continue to live permanently in the town where they lived at the time of interview. Some 71.2 percent said yes, but this was most true for people who were living in their pre-hurricane homes (76.3 percent). Strikingly, this means that nearly one in four people who are living in their pre-hurricane homes plan not to remain in the town permanently.

  • 22.3 percent of respondents said they planned to continue to live permanently in the county or parish they relocated to since the storm and at the time of the interview.

Post-traumatic stress reactions

  • A substantial proportion of respondents reported having emotional problems related to their experiences in the hurricane.

  • The proportion of respondents who screen positive for a clinically significant anxiety or mood disorder was double the number in a comparable survey carried out two years before the hurricane.

  • A full one-fourth (25.3 percent) of survey respondents reported having nightmares about their experiences in the hurricane in the past month.

  • Nightmares were reported by 49.6 percent of the respondents who were pre-hurricane residents of New Orleans City.

  • While more than half (51.8 percent; 79.4 percent of those from New Orleans City) reported being more irritable or angry than usual.

Post-traumatic personal growth

  • At the same time, evidence was found of an enormous amount of strength and personal growth.

  • 88.5 percent of respondents said that their experiences with the hurricane helped them develop a deeper sense of meaning or purpose in life.

  • Three-fourths of all respondents (77.3 percent and 71.8 percent of those from New Orleans City) said that their experiences with the hurricane made them more spiritual or religious.

  • Close to half of respondents (45 percent of all respondents and 41.5 percent of those from New Orleans City) rated this discovery on inner strength as having happened "a lot." Discovering "a lot" of inner strength was especially common among Non-Hispanic Blacks (62.4 percent) and people with low pre-hurricane incomes (57.8 percent).

  • Further evidence of this strength in the face of adversity is indicated by the fact that the vast majority of respondents (83.4 percent of the total sample and 73.8 percent of those from New Orleans City) reported that they had "a lot" of faith in their own abilities to rebuild their life.

The long-term perspective

  • The post-traumatic growth might be protective against suicidal ideation, suicide plans, and suicide attempts among Katrina survivors with clinically significant anxiety and depression.

  • The causal processes underlying this pattern presumably involve the creation of positive future orientations that provide psychological scaffolding protecting against the suicidality often associated with extreme distress.

  • This is an extremely encouraging finding. However, an implicit caution in the result also has to be pointed out: that the low suicidality might be temporary.

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A complete copy of the report can be found at www.hurricanekatrina.med.harvard.edu/baseline.php.

HARVARD MEDICAL SCHOOL

http://hms.harvard.edu/

Harvard Medical School has more than 7,000 full-time faculty working in 10 academic departments housed on the School's Boston quadrangle or in one of 48 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and the VA Boston Healthcare System.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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