Depression, PTSD Persist Five Years After Flint Water Crisis

Five years after the water crisis in Flint, Mich., residents of the community had higher rates of past-year depression and posttraumatic stress disorder (PTSD) compared with the rest of the nation, a study in JAMA Network Open has found. During the crisis, which began in April 2014, many residents were exposed to drinking water with unsafe levels of bacteria, disinfection byproducts, and lead after the city switched its drinking water supply from Lake Huron to the Flint River. State and city officials ignored complaints about the water quality and denied that there was a problem for several months, until testing revealed high levels of lead in the blood of Flint children. Although the water supply was switched back to Lake Huron in October 2015, the level of lead in the water did not meet federal requirements until January 2017, thus leaving residents exposed to unsafe drinking water for nearly three years.

“That there was a higher prevalence of these conditions so many years after the crisis suggests that we can’t take our eye off the ball for these kinds of disasters,” lead author Aaron Reuben, Ph.D., M.E.M., told Psychiatric News. He is a postdoctoral scholar at Duke University and the Medical University of South Carolina. “There are likely to be long-range psychological problems that are unlikely to resolve on their own.”

Reuben and colleagues analyzed data from a survey of 1,970 adults who lived in Flint during the crisis. The survey was conducted from August 13, 2019, through April 20, 2020, with 98% of data collected before the COVID-19 pandemic (that is, before the March 11, 2020, World Health Organization pandemic declaration and before the March 10, 2020, confirmation of Michigan’s first COVID-19 cases). It asked participants about their crisis experiences, their mental health symptoms five years later, and their access to and use of mental health services in the intervening years. Among respondents, 53.5% identified as Black or African American, 42.5% identified as White, 97.4% identified as non-Hispanic, and 56.8% reported earning less than $25,000 a year.

Overall, 22.1% of participants had symptoms of past-year depression compared with an estimated 7.8% nationwide, and 24.4% had symptoms of past-year PTSD compared with an estimated 4.7% nationwide. Fourteen percent of the participants had symptoms of both conditions. Participants who believed that their or their family’s health was moderately or greatly harmed by the water crisis were 123% more likely than their peers to have symptoms of depression, 66% more likely to have symptoms of PTSD, and 106% more likely to have symptoms of both conditions. Participants who had a history of potentially traumatic events such as a life-threatening illness, serious accident, or previous disaster were 173% more likely than their peers to have symptoms of depression and 355% more likely to have symptoms of PTSD.

Reuben said that Flint faced a host of challenges before the water crisis and that the crisis shed light on racial, economic, and institutional disparities and their impact on mental health.

“The residents were already under stress and had been through a lot of adversity because of systemic racism and years of underinvestment in their community,” Reuben said.

That government officials misled the community about the safety of the water for several months likely exacerbated the level of stress Flint residents faced, said Joshua Morganstein, M.D., chair of APA’s Committee on the Psychiatric Dimensions of Disasters.

“It’s a highly distressing thing to know that you were misled by people in power,” said Morganstein, who was not involved in the research. “When you combine that with existing disparities among marginalized groups in a community that consists largely of people of color, it feeds into a larger narrative that White people in power will lie to people of color even if it means harming them and their children. It fractures communities.”

The way the crisis was handled by local officials offers important lessons to psychiatrists and mental health professionals who want to assist their communities in the aftermath of a disaster, Morganstein added.

“Outsiders shouldn’t be telling a community what they will do for it. They should be asking what the community needs,” Morganstein said. “It is the job of the people coming in to anticipate mistrust, anger, rage, and grief. Be prepared to spend time learning, gaining trust, and establishing credibility. I would reach out to chaplains, coaches, teachers, business owners, and parents and chat with them about what they are hearing and seeing.”

Members of a disaster-struck community may very well express a need for mental health services: Although only 34.8% of survey respondents in the study reported ever being offered mental health services to help address problems associated with the Flint water crisis, 79.3% of those who were offered mental health services used them.

“That most people took the help when it was offered says that they wanted the services and made time to seek them out,” Reuben said. “My intuition is they were aware there was a need, they knew they were not doing as well as they wanted, and they thought the services might benefit them. It’s a sign that if we offered more services, people would use them.”

This study was funded by the U.S. Department of Justice. One of the researchers was also supported by a grant from the National Institute of Mental Health. ■