HOW EVACUEES RESPOND WHILE EXPERIENCING TRAUMA
Trauma and Stress Response Among Hurricane Katrina Evacuees
Mary Alice Mills, BA, Donald Edmondson, MA, and Crystal L. Park, PhD Additional article information
Objectives. Hurricane Katrina’s impact on public health has been significant and multifaceted, with trauma-related psychological sequelae likely to result in a sizable burden of disease. Data were collected that assessed acute stress disorder (ASD) prevalence and factors related to ASD symptomatology among sheltered evacuees. Methods. On days 12 to 19 after Katrina, evacuees at a major emergency shelter completed surveys that assessed demographics, Katrina-specific experiences, and ASD symptomatology. Results. Sixty-two percent of the sample met ASD threshold criterion. Projections based on the predictive power of ASD to posttraumatic stress disorder (PTSD) suggest that 38% to 49% of the sample will meet PTSD criteria 2 years post-disaster. Female gender (odds ratio [OR] = 4.08), positive psychiatric history (OR=5.84), injury (OR=2.75), increased life-threat perception (OR=1.37), and decreased sense of personal control (OR=1.56) were significantly related to ASD. Black race was associated with greater symptom severity (B=7.85, SE[B]=3.50). Conclusions. Katrina-related trauma and its psychological sequelae will remain a significant public health issue for years to come. The identification of several vulnerability factors related to ASD and PTSD provides a brief sketch of those at greatest risk. Between late August and September 4, 2005, the Red Cross operated 470 shelters and evacuation centers across the nation to accommodate survivors of Hurricane Katrina.1 More than 386000 evacuees received medical or mental health services from such shelters,2 and survivors remained widely dispersed for significant periods, temporarily residing in all 50 US states and the District of Columbia.3 Common evacuee health care concerns include poor sleep quality,4depressed immune functioning,5,6 increases in negative health behaviors (e.g., alcohol and cigarette use),7 and elevated relapse rates for pre-existing health conditions.8 Although primary care physicians and other health care providers are often well prepared to manage physical needs in the immediate wake of disaster, their role as sole treatment contact9,10 for the more than 50% of evacuees who will experience persistent and severe psychological consequences is likely less familiar. Given the mental health repercussions of Hurricane Katrina projected to emerge in the coming years, including depression, anxiety, and post-traumatic stress disorder (PTSD),11,12 physician and health care provider familiarity with trauma-related symptoms and differential risk profiles is crucial. Multiple vulnerability factors have combined in the case of Hurricane Katrina to heighten survivors’ risks of long-term difficulties. The high rate of poverty in New Orleans (close to 28%) amplified disaster impact on individuals through increased exposure, decreased disaster preparedness, and a lack of resources to offset losses.13 Also, the largely Black population of New Orleans bore a disproportionately heavy burden of predisaster chronic disease complicated by inadequate health care access.14 Minority status itself has been shown to increase the risk of PTSD after trauma,13,15although this effect may be largely because of differential exposure to poverty and violence.16,17Also, previous disaster research has shown that separation from family18 and relocation19 elevate risk for postdisaster mental health problems. A recent meta-analysis investigating the effects of displacement on mental health outcomes indicated that displaced persons evince worse mental health than nondisplaced comparison groups and that internally displaced persons (displaced within their own country) experience worse outcomes than refugees relocated to...
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