By David Brown
Washington Post Staff Writer
Tuesday, August 29, 2006

In the six months after Hurricane Katrina, the rate of serious mental illness among the storm's survivors doubled, an unusual study has found, but the number of people contemplating suicide did not budge. Most survivors, in fact, said they had found a new sense of purpose, strength and community through coping with the disaster.

Those are the early findings of a survey that will trace the emotional trajectory of Katrina's victims over at least the next two years, and possibly for decades.

Overall, the researchers found a "pervasive optimism" among hurricane survivors on the question of whether they expected to be able to rebuild their lives. Emotional resilience was as high -- and by some measures, higher -- among low-income blacks, a group that suffered some of the worst deprivations, as in the survivor population as a whole.

Nevertheless, six months after the storm, many people were still short of money, housing, security and employment. The researchers are not certain the generally encouraging psychological state of Katrina survivors will endure.

"Optimism only lasts so long," said Ronald C. Kessler, the psychologist at Harvard Medical School who heads the study. "How long? We know from survivors of other hurricanes that after about 18 months people start to wear out."

Although the Katrina study is not the first to follow survivors of a natural disaster in the United States over time, it is logistically the most complicated.

The researchers assembled what they hope is a representative group of Katrina survivors by sampling the list of 1.4 million families that applied to the Red Cross for assistance, reaching people through random-digit dialing of phone numbers along the Gulf Coast, and contacting residents of randomly selected motels housing hurricane evacuees.

"It took us three whole months to find these people because we had to look all over God's creation," Kessler said.

The 1,043 households finally chosen represent 42 percent of a larger sample. They all agreed to be interviewed repeatedly over time and collectively were named the "Hurricane Katrina Community Advisory Group," as part of their role is to provide feedback to relief agencies and government departments on their performance.

Smaller studies of Katrina survivors found much higher rates of emotional distress than did the Harvard-based survey, which presumably reached a greater variety of people.

For example, a survey in New Orleans and neighboring Jefferson Parish seven weeks after the storm conducted by the Centers for Disease Control and Prevention found that "49.8% of adults exhibited levels of emotional distress indicating a potential need for mental health services." A survey in February of families still living in trailers and motels found that 44 percent of adult caregivers had "clinically significant psychological stress."

As a measure of pre-Katrina mental health, Kessler and his colleagues used the findings from about 800 Gulf Coast residents interviewed in a national survey earlier this decade.

Before the hurricane, 16 percent of people had a diagnosable mental illness, with 6 percent having a serious one. After Katrina, 31 percent of people had a mental illness, with 11 percent serious. At both times, just under 3 percent of people admitted to having suicidal thoughts. Researchers do not yet know the suicide rate among storm survivors but plan to gather that data in the future.

Between one-third and half the people with serious mental illness have post-traumatic stress disorder "at their core," Kessler said. The rest primarily have depression and anxiety disorders.

Eighty-two percent of the sample, and 69 percent of those with serious mental illness, reported they "became closer to loved ones" after the hurricane; 75 percent and 82 percent said they "found deeper meaning in life"; and 67 percent and 73 percent said they had become "more spiritual or religious."

Asked whether the storm and flood "made you realize that you have inner strengths or competence that you did not previously know you had," 62 percent of blacks answered "a lot," compared with 36 percent of whites. Of the low-income people in the sample, 58 percent gave that answer, compared with 27 percent of those with a high income.

On other subjects, 61 percent reported financial problems, 50 percent housing problems and 37 percent employment problems six months out.

"The study is very useful in affirming a sense of resilience, but we are also seeing a large expression of need," said Anthony H. Speier, director of disaster mental health operations for the state of Louisiana and one of the researchers.

The telephone interviewers employed by the researchers asked questions that required short answers, often yes or no. They hoped to keep each call to 25 minutes. But they found that people mostly wanted to tell their stories.

Kessler and his colleagues decided to change methods. People could say what they wanted, and interviewers interjected the questions. Many calls took two or three sessions, and they averaged 90 minutes.

A sample of the narratives, from people who agreed to have them made public, can be listened to at http://www.hurricanekatrina.med.harvard.edu/ .

The study, which will cost about $2 million, is funded by the National Institute of Mental Health. It will interview the sample group every six months for two years.