A volunteer unwraps cases of bottled water to distribute to residents affected by the water crisis in Flint, Mich., on March 5, 2016. File Photo by Molly Riley/UPI | License Photo
An unprecedented water crisis continues to take a heavy toll on the mental health of adults in Flint, Mich., a large survey shows.
Five years after the crisis, an estimated one in five -- about 13,600 people -- remained clinically depressed, the survey found. And about one in four -- 15,000 people -- had post-traumatic stress disorder (PTSD).
"The mental health burden of America's largest public-works environmental disaster clearly continues for many adults in Flint," said study leader Aaron Reuben, a postdoctoral scholar at Duke University in Durham, N.C.
His team found that past-year rates of depression and PTSD were three to five times higher than estimates for U.S. adults overall.
The researchers said the people of Flint likely had higher rates of mental health problems before the water crisis and they got significantly worse in its wake.
The problems began when the city of Flint began getting its water supply from the Flint River on April 25, 2014. It had previously gotten its water from Lake Huron and the Detroit River.
When the city made the switch, it did not properly treat the water supply. That allowed lead and other elements to leach out of old water pipes, exposing Flint residents to unsafe levels of bacteria, disinfection byproducts and lead, a neurotoxicant. Flint's drinking water was not declared lead-free until Jan. 24, 2017.
The crisis affected tens of thousands of children and adults, who had high levels of lead in their blood, putting them at risk for thinking and memory issues, mental health problems, and other health issues.
"We know that large-scale natural or human-caused disasters can trigger or exacerbate depression and PTSD," said senior author Dean Kilpatrick, a professor of psychiatry and behavioral sciences at Medical University of South Carolina in Charleston.
Flint had high rates of mental health problems in the first years of the crisis.
"What we did not know until now was the extent to which Flint residents continued to have mental health problems at the clinical diagnosis level five years after the crisis began," Kilpatrick said.
And some suffered more than others, the research revealed. Residents who had previously experienced physical or sexual assaults had triple the odds for depression and were more than six times more likely to have PTSD.
Flint is a predominantly low-income, Black community. Before the water crisis, residents experienced many challenges, including economic disadvantage, racism, and high exposure to potentially traumatic events, including prior physical or sexual assault. All can affect mental health.
"This highlights the importance of considering the cumulative effects of prior exposure to traumatic events when evaluating the effects of environmental disasters on mental health," Kilpatrick said.
The survey, conducted between mid-August of 2019 and mid-April of 2020, included 1,970 adults.
"The vast majority of our respondents were never offered mental health services, despite clear indication that the crisis was psychologically traumatic," Reuben said.
Most respondents who were offered services said they used and benefited from them. But the need for follow-up continues.
"Now that 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.
There is, he said, a "clear unmet need."
"Nearly 100% of surveyed Flint residents reported that they changed their behavior to avoid consuming contaminated water during the crisis, and the vast majority still worry that the exposures they had may cause future health problems for themselves or their family members," he said.
Uncertainty about future harm after environmental disasters contributes to psychological distress, Reuben said.
Depression and PTSD are also costly, adding up to $326 billion a year nationwide due to lost work hours and costs of medical care.
"We study these problems after disasters because they are common outcomes and because they are significantly impairing to individuals and communities," said study co-author Dr. Sandro Galea, a professor and dean at the Boston University School of Public Health. "But we also study these problems because we have good treatments that are effective for most people."
The findings were published online Tuesday in JAMA Network Open.
The U.S. National Institute of Mental Health has more on PTSD.
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