Dawnene Harper often finds herself looking for something - a book, a photo album, a kitchen tool - before she remembers. "Oh, right," the New Orleans resident has to remind herself. "I don't have that anymore. I lost it in the storm."
Harper is one of thousands of people affected by Hurricane Katrina, which struck in August 2005 and was one of the strongest storms to impact the United States coast during the last 100 years. More than 1,800 people died in the storm or subsequent floods, and many more lost their homes.
"Sometimes - actually many times - the whole thing seems very surreal, like something I've read about but not actually experienced," says Harper, who lost her home and all her possessions in Katrina. "However, there are many homes on my street and neighborhood that have never been rebuilt since Katrina, so it is a daily reminder for me."
With sustained winds during landfall of 125 mph, Katrina caused widespread devastation along the central Gulf Coast states of the US. Cities such as New Orleans, LA, Mobile, AL, and Gulfport, MS bore the brunt of Katrina's force in what the National Oceanic and Atmospheric Administration called "one of the most devastating natural disasters in recent U.S. history."
In New Orleans, the residents refer to two cities: the one that existed before Katrina, and the one after. Hurricane Katrina was the costliest natural disaster in the history of the United States, with property damages estimated at $81 billion.
But the cost was much more than monetary; the lasting effects on the mental health of survivors like Harper have been significant.
The Toll on Mental Health
At Princeton University, Professor Christina Paxson led a study that showed that survivors of Katrina have continued to struggle with poor mental health even now, more than six years after the devastating storm.
Many of those who were affected by the tragedy are still showing high levels of post-traumatic stress symptoms (PTSS), and were not back to baseline health. This is especially true for low-income people.
What is unique and particularly compelling about the results of the Princeton study is that the data actually began being collected before Katrina ever struck. The project began in 2003 as a study of low-income adults enrolled in community college around the country, including three sites in New Orleans. The initial questionnaire contained questions about education, income, families and health.
After Hurricane Katrina, some of the researchers decided to try to continue to track the New Orleans-based participants. "I realized right away that the kinds of information we had on mental and physical health were very rare in disaster studies," said Mary Waters, a co-author of the study from Harvard University.
"Researchers never know if people are suffering because of the disaster or if they had underlying conditions that would have led to depression or poor health even before the disaster hit."
Waters and Paxson, along with Elizabeth Fussell of Washington State University and Jean Rhodes of the University of Massachusetts, began working with a group of 532 low-income mothers. The average age of the study participants was 26, and most were African-American. The women were interviewed in two follow-up surveys - the first 11 months after Katrina, and another nearly five years later.
The surveys rated the women on two signs of poor mental health: psychological distress and PTSS, using a series of questions to screen for anxiety and mood disorders and a test designed to identify people at high risk for post-traumatic stress disorder. Even more than four years later, the researchers found that 33 percent of the women had PTSS and 30 percent exhibited psychological distress. The later surveys did show lessened levels for both conditions from the first survey, but were not back to pre-hurricane levels.
The Lingering Trauma
One thing the women in the Princeton study were asked about, as part of rating their PTSS, was how often they thought about the hurricane or if they had thoughts about it that they couldn't suppress. Participants who had experienced more significant stressors during Katrina, such as the loss of a loved one or significant home damage or loss, showed more chronic, long-term PTSS and psychological distress.
Harper can relate. "I still struggle in the aftermath of Katrina with nightmares and anxiety. When you have gone through something as dramatic as Hurricane Katrina - lose everything you own and have to start from the ground up to rebuild you life, it really has an impact on a person." She especially struggles around the first of June, when hurricane season starts. "I wonder, is this going to be the year we get it again?"
Harper knows people who were so traumatized by Hurricane Katrina that they took their own lives in the aftermath. And her own daughter, who was 17 when the storm happened, still struggles emotionally as well.
Paxson says that Katrina is different from many other natural disasters in the sense that it completely upended most people's lives. Of the participants her team studied, about two-thirds of them are back in the New Orleans area; but almost none of them lives in their old home. "They've been disrupted from their friends and their families. The whole fabric of their lives has really been changed."
She cautions that the findings from the Princeton study can't be assumed to apply to the population as a whole, since the team looked at such a specific group of people in young, low-income mothers. However, she says that the results do shed light as a whole, on the effect of a natural disaster on vulnerable groups.
Robin English, M.Ed., LPC, is not surprised by the Princeton findings. "Because baseline data existed prior to Katrina and the follow up is almost 5 years later, the outcomes are meaningful," she says. English herself was in New Orleans during the aftermath of the 2005 storm, helping with Red Cross efforts. "I have treated Katrina survivors with similar symptoms long after the one year mark with serious mental health disorders that will likely require ongoing treatment for themselves and their families."