Preexisting Mental Illness and Risk for Developing a New Disorder After Hurricane Katrina

∥Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
The Journal of nervous and mental disease (Impact Factor: 1.69). 02/2013; 201(2):161-166. DOI: 10.1097/NMD.0b013e31827f636d
Source: PubMed


To investigate predisaster mental illness as a risk factor of poor postdisaster mental health outcomes, veterans with (n = 249) and without (n = 250) preexisting mental illness residing in the Gulf Coast during Hurricane Katrina were surveyed after Katrina and screened for posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder, and panic. Logistic regression examined the association between preexisting mental disorders and positive screens after the hurricane, adjusting for demographics and exposure to hurricane-related stressors. The odds of screening positive for any new mental disorder were 6.8 times greater for those with preexisting mental illness compared with those without preexisting mental illness. Among those with preexisting PTSD, the odds of screening positive for any new mental illness were 11.9 times greater; among those with schizophrenia, 9.1 times greater; and among those with affective disorders, 4.4 times greater. Persons with preexisting mental illnesses, particularly PTSD, should be considered a high-risk group for poor outcomes after a disaster.

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    • "First, most were cross-sectional and unable to examine GxE at different time points post-disaster. Second, all lacked pre-disaster data, even though prior studies have shown that pre-disaster factors (e.g., mental health status, degree of social support) are among the strongest predictors of post-disaster psychological responses (Ginexi et al., 2000; Norris et al., 2002; Sullivan et al., 2013). As a result, it remains unclear to what extent GxE predicts psychopathology beyond pre-disaster factors. "
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    ABSTRACT: There is considerable variation in psychological reactions to natural disasters, with responses ranging from relatively mild and transitory symptoms to severe and persistent posttraumatic stress (PTS). Some survivors also report post-traumatic growth (PTG), or positive psychological changes due to the experience and processing of the disaster and its aftermath. Gene-environment interaction (GxE) studies could offer new insight into the factors underlying variability in post-disaster psychological responses. However, few studies have explored GxE in a disaster context. We examined whether ten common variants in seven genes (BDNF, CACNA1C, CRHR1, FKBP5, OXTR, RGS2, SLC6A4) modified associations between Hurricane Katrina exposure and PTS and PTG. Data were from a prospective study of 205 low-income non-Hispanic Black parents residing in New Orleans prior to and following Hurricane Katrina. We found a significant association (after correction) between RGS2 (rs4606; p=0.0044) and PTG, which was mainly driven by a cross-over GxE (p=0.006), rather than a main genetic effect (p=0.071). The G (minor allele) was associated with lower PTG scores for low levels of Hurricane exposure and higher PTG scores for moderate and high levels of exposure. We also found a nominally significant association between variation in FKBP5 (rs1306780, p=0.0113) and PTG, though this result did not survive correction for multiple testing. Although the inclusion of low-income non-Hispanic Black parents allowed us to examine GxE among a highly vulnerable group, our findings may not generalize to other populations or groups experiencing other natural disasters. Moreover, not all participants invited to participate in the genetic study provided saliva. To our knowledge, this is the first study to identify GxE in the context of post-traumatic growth. Future studies are needed to clarify the role of GxE in PTS and PTG and post-disaster psychological responses, especially among vulnerable populations.
    Full-text · Article · Oct 2013 · Journal of Affective Disorders
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    ABSTRACT: Importance There has been growing research into the mental health consequences of major disasters. Few studies have controlled for prospectively assessed mental health. This article describes a natural experiment in which 57% of a well-studied birth cohort was exposed to a major natural disaster (the Canterbury, New Zealand, earthquakes in 2010-2011), with the remainder living outside of the earthquake area.Objective To examine the relationships between the extent of earthquake exposure and mental health outcomes following the earthquakes—net of adjustment for potentially confounding factors related to personal circumstances, prior mental health, and childhood family background.Design, Setting, and Participants Data were gathered from the Christchurch Health and Development Study, a 35-year longitudinal study of a birth cohort of New Zealand children (635 males and 630 females). This general community sample included 952 participants with available data on earthquake exposure and mental health outcomes at age 35 years.Exposures A composite measure of exposure to the events during and subsequent to the 4 major (Richter Scale >6.0) Canterbury earthquakes during the years 2010-2011.Main Outcomes and Measures DSM-IV symptom criteria for major depression; posttraumatic stress disorder; anxiety disorder; suicidal ideation/attempt; nicotine dependence; alcohol abuse/dependence; and illicit drug abuse/dependence. Outcomes were measured approximately 20 to 24 months after the onset of exposure to the earthquakes and were assessed using DSM-IV diagnostic criteria and measures of subclinical symptoms.Results After covariate adjustment, cohort members with high levels of exposure to the earthquakes had rates of mental disorder that were 1.4 (95% CI, 1.1-1.7) times higher than those of cohort members not exposed. This increase was due to increases in the rates of major depression; posttraumatic stress disorder; other anxiety disorders; and nicotine dependence. Similar results were found using a measure of subclinical symptoms (incidence rate ratio, 1.4; 95% CI, 1.1-1.6). Estimates of attributable fraction suggested that exposure to the Canterbury earthquakes accounted for 10.8% to 13.3% of the overall rate of mental disorder in the cohort at age 35 years.Conclusions and Relevance Following extensive control for prospectively measured confounding factors, exposure to the Canterbury earthquakes was associated with a small to moderate increase in the risk for common mental health problems.
    No preview · Article · Jul 2014 · JAMA Psychiatry
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    ABSTRACT: This chapter reviews the prevalence and risk factors associated with violence during the life course of the elderly, including its short and long-term consequences. As violence is highly prevalent in many societies individuals who have been exposed to violence have also grown old. There is limited knowledge about the long-term implications of early exposure into late life. Elder abuse has become a major issue in public health; however, the elderly are also victims to crime, war, atrocities in society, and trauma from disasters. The mental health implications of exposure to violence are reviewed, in particular post-traumatic stress disorder. Controlled studies on treatment of older individuals exposed to violence are rare. The findings suggest that exposure to violence in childhood, as a young adult or as an elder all have adverse effects on mental health in old age. The trajectory of these mental health outcomes suggests that the elderly may have a path of resilience.
    No preview · Article · Jan 2015
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