Data from the largest community mental health survey in Flint, Michigan, show that one in five adults, or approximately 13,600 people, are believed to have clinical depression, and one in four, or 15,000 people, was assessed for post-traumatic stress disorder five years after the water crisis began.
“The mental health burden of America’s largest public works-related environmental disaster clearly continues for many adults in Flint,” said Aaron Reuben, a postdoctoral fellow at Duke University who led the study, which appears Sept. 20 in JAMA Network Open.
On April 25th, 2014, the city of Flint switched its water supply from Lake Huron and the Detroit River to the Flint River and failed to properly treat the water supply to prevent lead and other elements from leaching from the city’s old water pipes. Virtually all Flint residents were subsequently exposed to drinking water with dangerous levels of bacteria, disinfection byproducts and lead, a neurotoxicant.
Flint drinking water was not declared lead-free until January 24, 2017. During the crisis, tens of thousands of children and adults in Flint developed high blood lead levels, putting them at greater risk for cognitive deficits, mental health problems and other health problems problems later in life.
We know that large-scale natural or man-made disasters can trigger or exacerbate depression and PTSD.”
Dean Kilpatrick, PhD, University Professor Emeritus, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and senior author of the study
Kilpatrick noted that there was clear evidence of high rates of mental health problems in the Flint community during the early years of the crisis. “What we didn’t know until now was the extent to which Flint residents continued to have clinically diagnosed mental health problems five years after the crisis began.”
According to Kilpatrick, the past-year rates of depression and PTSD identified in Flint today are three to five times higher than national estimates among U.S. adults overall, and are likely the result of a combination of higher baseline rates of mental health problems in Flint and before the crisis as a significant exacerbation of the problems arising from the crisis.
“The majority of our respondents were never offered mental health services,” Ruben said, “despite the clear indication that the crisis was psychologically traumatic.” Most Flint residents who were offered mental health services used and benefited from them. “Now that the pipes are being replaced, the time is right to begin a second phase of recovery from the water crisis — one that focuses on providing additional resources to heal psychological wounds,” Reuben said.
Kilpatrick said residents of Flint, a predominantly black, low-income community, faced many challenges before the water crisis that could undermine mental health, including socioeconomic disadvantage, racism and high exposure to potentially traumatic events. including previous physical or sexual abuse.
Particularly striking was the finding that those with a history of physical or sexual abuse were more than three times more likely to have depression and more than six times more likely to have PTSD than those without such a history. “This highlights the importance of considering the cumulative effects of prior exposure to traumatic events when assessing the effects of environmental disasters on mental health,” Kilpatrick said.
Depression and PTSD are among the most prevalent and disabling mental disorders, costing America more than $326 billion annually in lost work time and medical care costs.
“We study these problems after disasters because they are common outcomes and because they significantly harm individuals and communities,” said Sandro Galea, MD, DrPH, Robert A. Knox Professor and Dean of the Boston University School of Public Health, et al. – author of the study. “But we also study these problems because we have good treatments that work for most people.”
The results of the study show that more needs to be done to provide mental health treatment to Flint residents.
“There is a clear unmet need,” said Ruben, who is also a postdoctoral fellow at MUSC. “Nearly 100% of Flint residents surveyed report that they have changed their behavior to avoid consuming contaminated water during the crisis, and the majority are still concerned that the exposures they have had could cause future health problems for them or their family members.’
According to Reuben, uncertainty about exposures and future harm significantly contributes to psychological distress after environmental disasters, and the study found that adults who believed that exposure to contaminated water had harmed their health or the health of a family member were significantly more likely to have depression since last year and PTSD. .
The survey, funded by a grant to MUSC from the U.S. Department of Justice’s Office of Victims of Crime, surveyed a household probability sample of 1,970 Flint adults between August 13, 2019 and April 10, 2020. The surveys were conducted online and by mail by Abt Associates, a national research firm. Rothbaum was also supported by a grant from the National Institute of Mental Health (T32-MH018869)
Data were collected on perceived exposure to contaminated water, past-year prevalence of depression and PTSD using DSM-5 diagnostic criteria, and potential risk factors for depression and PTSD, including prior exposure to potentially traumatic events, prior physical or sexual violence and low social support. Adults were also if they had ever been offered or received mental health services.
Ruben, A., et al. (2022) Prevalence of depression and PTSD in Flint, Michigan, 5 years after the onset of the water crisis. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.32556.