Before the Storm: The Distress Caused by a Disaster Starts Beforehand

Disasters stomp across the earth and the world stage at a pace that sets our heads spinning and our hearts sinking. Survivors of such disasters as 9/11, Hurricane Katrina, or Japan’s 3/11 tsunami and nuclear catastrophe may deal with the aftermath of these events for years to come. A recent study of the Flint, Michigan, water crisis five years later provides a revealing picture of the mental health aftermath of events that seem to be occurring at an accelerating rate.

The study, “Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan,
5 Years After the Onset of the Water Crisis” was conducted by researchers from institutions that included the Medical University of South Carolina and the National Center for PTSD and was published this past week in JAMA. (1) The study investigated the prevalence of major depression and post-traumatic stress disorder, typically the two most prevalent post-disaster mental health conditions, five years after the 2014 water crisis, set off when authorities failed to treat water from the Flint River with anti-corrosives, causing lead and iron to leach into the water and lead levels to rise in children. Study subjects were also asked about how the water crisis itself affected them and about factors that might have predisposed them to post-disaster mental health problems.

Among the 1,970 community members who completed the surveys, the rates of likely past-year depression or PTSD were very high—22.1 percent and 22.4 percent, respectively (surveys can only suggest the likelihood of meeting diagnostic criteria). The surveys also indicated that 14 percent had both disorders. Participants who reported that the water crisis had health effects on them or their families or who endorsed a lack of confidence in the authorities were more likely to have depression or both disorders.

That much was well reported by local and national news outlets. But there was far more to the study. And it reveals a lot about how to cut the mental health consequences of destabilizing events.

Respondents with incomes below $25,000/year were more likely to have depression, PTSD, or both conditions. Those who had experienced a prior trauma, such as a serious accident or major illness, were nearly three times as likely than those who did not have depression, more than four times as likely to have PTSD, and five times as likely to experience both. Participants who reported a lack of social support—one of the best-known ways to cope and recover in times of trauma and chaos—were more than twice as likely as their peers to endorse depression or PTSD and nearly three times as likely to endorse both.

The likelihood of experiencing an adverse mental health consequence of a disaster is a product of the history and circumstances of the survivor and the extent of the disaster’s impact on them. Risk factors like prior traumas and resilience-promoting factors like having strong social support are a big part of the equation. (2)

Prior psychiatric problems also constitute an important predisposing factor, especially if they are undertreated or untreated. In fact, the authors of the Flint study share data that show how the lifetime prevalence of depression in Flint is higher than that of Michigan, the U.S., or the world, with a similar trend for PTSD.

There should be little doubt that the balance between the vulnerabilities and strengths that people and communities bring to a disaster could well determine their ability to weather the literal or figurative storm with expectable rather than excessive distress in the form of problems like depression and PTSD. As awful as the Flint water crisis was, and whatever lasting physical and civic consequences it may have, many factors beyond the crisis itself bear on the likelihood of developing post-traumatic mental health problems.

Having mentally healthier people and communities to start—better identifying and treating mental health problems of all kinds and reducing exposures to traumas and fostering recovery when they happen—would not only make day-to-day life safer, better, and happier but would protect communities like Flint in the event of catastrophes like the water crisis. (3)

The suffering of daily life is not as newsworthy as the distress spawned by disaster—but it is more consequential. Let’s make mental health resources readily available in communities before a crisis.