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Hurricanes Katrina and Rita have left thousands of displaced Americans at high risk for mental disorders that could long outlast the emergency care they're getting now, evidence from studies of disaster survivors suggests.
The chaos after the storms has several hallmarks that can delay trauma recovery or increase odds of people developing serious disaster-related mental illness, says Daniel Nelson, a child psychiatrist at Cincinnati Children's Hospital Medical Center.
"It's troubling because some of the things that buffer people from effects of trauma are just not here, and there are danger signs instead," says Nelson, who counseled adults and children after the 1995 Oklahoma City bombing.
Those who fare best after disasters have ample money and can return to their routines quickly with family and friends nearby. But evacuees are disproportionately poor, and many cannot get back to their routines and locales easily, Nelson says.
Those with pre-existing mental illness or earlier traumas, such as rapes or recent family deaths, are the most vulnerable, he says.
The Buffalo Creek story
The U.S. disaster that most resembles the hurricanes may be the Buffalo Creek dam collapse caused by flooding in Logan County, W.Va. Communities along the creek were wiped out in 1972, and thousands of poor residents were displaced, says psychologist Bonnie Green of Georgetown University School of Medicine. She tracked the mental health of several hundred survivors for up to 17 years.
Children fared better than adults, and everyone improved over time. But more than a dozen years later, Buffalo Creek adult survivors had far worse mental health than residents of a similar community not affected by the flood, Green says. Among Buffalo Creek adults compared with the similar community:
*21% had major depression vs. 2%.
*18% had generalized anxiety disorder vs. 2%.
*63% had a lifetime history of post-traumatic stress disorder vs. 24%.
Most children recovered well, Green says. "What really frightened them was being separated from their parents, and that's what's scary about the hurricanes. You see missing kids on CNN, and the guy asks them, 'What's your mom's name?' and the kid answers, 'It's Mom.' What's going to happen to these kids?"
Nobody knows exactly how many there are, but it is "a significant number," says Richard Klomp of a mental health team from the Centers for Disease Control and Prevention. The National Center for Missing & Exploited Children said last week that more than 2,300 children are still reported missing or are searching for their parents along the Gulf Coast. Private and public agencies are trying to reunite families speedily, Klomp says.
One big difference since Buffalo Creek is that mental health agencies, private and public, have rushed in to help evacuees. Shelters are staffed with counselors, most of them volunteers.
"Much of what we're doing is triage, referring the sickest to hospitals, making sure others get the medications they need," says Chris Rule, a social worker who volunteers at a shelter in Hot Springs, Ark. "A lot of people are just paralyzed with anxiety. They don't know what the heck's going to happen to them or where they're going to go."
Some are having painful flashbacks to Katrina, says Nancy Smyth, another shelter volunteer and dean of the University at Buffalo School of Social Work. Several women who had been raped in the past felt their old terrors resurface because disasters can trigger symptoms from earlier traumas, Smyth says.
Sooner the better for treatment
Many survivors are still in a "honeymoon" period, grateful to be alive, says Anita Laffey, supervisor of mental health services for the Red Cross of San Antonio. "Still, you see a lot of depression. You see people not sleeping well, walking the halls at every hour of the night. We've had people crying all the time, disturbing their neighbors."
Many housed at the Astrodome had pre-existing mental illness, says Stuart Yudofsky, psychiatry department chair at Baylor College of Medicine and Methodist Hospital in Houston.
"It's been like a one-two punch with Katrina and Rita, exacerbating their condition. ... A young schizophrenic mother went into a catatonic state and just stood there holding onto her 2-year-old." The mother was hospitalized, he says.
When evacuees leave the shelters, they're given referrals to low-cost mental health services in the Houston area, Yudofsky says.
The sooner survivors can get jobs and housing and have their children settled in schools, the better their chances of avoiding long-term mental disorders, says Robert Pynoos, co-director of the UCLA-Duke National Center for Child Traumatic Stress.
The center, along with the National Center for Post-Traumatic Stress Disorder, just issued state-of-the-art guidelines for "psychological first aid" to help disaster survivors.
Schools are a key place to detect such problems, Pynoos says. The Louisiana Office of Mental Health is applying for emergency federal money for school and day care programs that would train employees to recognize hurricane-related mental health problems early and provide treatment, says New Orleans psychologist Joy Osofsky.
Despite the widespread concern, no one can predict the exact mental health toll the hurricanes will take, Pynoos says.
"We absolutely have to be humble about this," he says. "If we move in early to help people, it could make a big, positive difference."
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