Report-on-a-Report of Before/After Epidemiology
Hurricane Katrina, which was the great storm of last August affecting-and-dislocating thousands of people in Southern Alabama, Mississippi, and Louisiana, was predicted to potentiate psychiatric crisis from its inception. For a time, I collected carefully the articles that I could glean from Internet and from the newspapers about the mental-health impact of this storm, anticipating that the aftermath of the temporary near-complete degradation of the city of New Orleans and Gulfport, Mississippi would have substantive collective changes in the morale, and thus the mental health of the victimized.
Of late, epidemiological work on this topic of good-enough quality to surpass the "journalistic level" to which I had been strapped has surfaced. This day I would like to review and opine on one such report, published as a PDF document by the World Health Organization in August, 2006: i.e. "Mental Illness and Suicidality after Hurricane Katrina," by Ronald C. Kessler, et al., Bulletin of the World Health Organization ID # 06-033019, published online at http://www.who.int/bulletin/volumes/84/10/06-033019.pdf .
This may have been the first article to systematically examine the before/after effects of this "big blow", using methods that are relatively satisfactory for empirical analysis. [The "journalistic" approach-- collecting "gee-whiz" articles from newspapers, etc.-- is biased from several standpoints, including the lack of systematization, randomization-of-survey, and the inherent desire of the journalistic publication to "tell a good story."] I encountered the Kessler, et al. article just today, on a Dogpile.com search, and felt immediately that here was material that could be shared with my readership.
Essentially, this study found that the sundry dislocations of Katrina potentiated mental illness in the affected population, but not "suicidality"-- a technical term implying the presence of suicidal ideation, preoccupation, or a 'plan' to kill oneself, as well as actual suicide attempts. Whereas of the 1043 respondants screened on a brief mental health survey [the "K6"-- c.f. note #23 of this report for R.C. Kessler, et al., "Screening for Serious Mental Illness in the General Population," Archives of General Psychiatry 60:184-189, 2006] there was a 5.2% increase in "serious mental illness" and 10.2% increase in "mild-moderate mental illness," significant that is in extremis statistically; there was almost no effect in the tendency to suicide in the population, even to the point that there was a slight decrease in the rate of suicide attempts.
The authors conject that something about the elan-of-crisis in these communities, through the mediating effects of enhanced ties to family/loved-ones, faith in the ability to rebuild [one's] life, spirituality and increased interest in religion, and deepening sense of inner strength-- all contributed to this surprising reduction in suicidal preoccupation. This was consistent with a finding of a WHO study from Lebanon during the Lebanon-Israel war [of some several years ago] where it was found that while depression [ ? and other psychopathology ? ] increased during this social upheaval, suicide and suicidal ideation were comparatively less-common.
I for one can identify, on the level of my individual experience, the main features of the conclusions the authors in this report reach. I have been uprooted-- as a mental health consumer on psychiatric disability-- about four (4) times by eviction (some of which I must say were defensible on the part of landlords but unforgiving of my bipolar condition and others of which were strictly high-handed, done for no other reason, it would appear, than to "give me a hard way to go.") I have kept a record of both the hospitalizations during these periods in a time-series with other factors, and in graphic form -- in a way that is clearly significant clinically and statistically-- being dislocated-from-domicile is associated with psychiatric institutionalization. Yet suicide was not a part of my bipolarity at that time: instead I was suicidal only in stresses associated with an unpleasant divorce and incipient vocational/occupational difficulties. The crazy times of being homeless are nonetheless exhilarating, not per se conducive to the thought-processes accompanying suicidality: it's the situation that is deformed when you "get homeless," and not you-yourself.
This is not to say that perils-to-life are absent when one is homeless/dislocated: you can freeze to death in wintertime in most of North America, and here in Kentucky the presence of rain can beget hypothermia, which is in its way even more pervasively lethal to the homeless than a "solid freeze" ( which inevitably betokens a time when the extant missions and (sometimes) the jails and healing-places will let you come in and "warm up.") But what you want more than all else at such homeless times as a mental health consumer is to be comfortable physically; therefore it is not surprising to me that even those predisposed to mental illness would not resort to suicide at such times. In fact, one's morale, given such vital problems, may "perk up" during such a tail-spin; many folks reach out to "help," and "you feel like putting up the good fight." Yes, there can be a " + " side to homelessness!
The study I report on this day is a "macro" view of what becomes quite personal per individual living for the mental health consumer: suicide and suicidality is the product of another existential mode-- frequently-- than being uprooted by homelessness or other socio-economic crisis; other psychiatric sequelae do occur in such hard times, and these need to be treated accordingly.
Thus, I recommend this study to the reader's rapt attention, for it "speaks to my condition" as it will to many affected and concerned about mental illness.
--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
E-Mail: freethink@bellsouth.net
posted by Louisville Hermitage @ 3:08 PM
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