Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis.
Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis.
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DOI：
10.1001/jamanetworkopen.2022.32556
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发表时间：
2022-09-01
影响因子：
13.8
通讯作者：
Kilpatrick, Dean G.
中科院分区：
文献类型：
--
作者：
Reuben, Aaron;Moreland, Angela;Abdalla, Salma M.;Cohen, Gregory H.;Friedman, Matthew J.;Galea, Sandro;Rothbaum, Alex O.;Schmidt, Michael G.;Vena, John E.;Kilpatrick, Dean G.
环境灾难（如弗林特水危机）的长期精神后果是什么？在这项对1970名生活在密歇根州弗林特的成年人进行的横断面家庭概率抽样调查中，超过五分之一的人在水危机发生后5年符合推定的过去一年抑郁症的标准，近四分之一的人符合推定的过去一年创伤后应激障碍的标准，超过十分之一的人在水危机发生后5年符合这两种疾病的标准。只有34.8%的人曾经提供心理健康服务，以协助与水危机有关的精神症状;大多数（79.3%）谁提供的服务利用它们。这些研究结果表明，公共工程的环境灾害，如弗林特水危机有持久的心理后遗症，可能需要扩大精神卫生服务，以满足长期的精神需求。这项横断面研究调查了水危机发生5年后，密歇根州弗林特市居民中目前推定诊断水平的重度抑郁症和创伤后应激障碍（PTSD）的患病率和相关因素。环境灾害，如密歇根州弗林特市的水危机，是潜在的创伤性事件（PTE），可能会导致长期的精神疾病。水危机与弗林特社区精神健康问题的急性升高有关，但长期的精神后遗症尚未使用标准化的诊断措施进行评估。调查危机发生5年后弗林特居民中目前推定诊断水平的重性抑郁症和创伤后应激障碍（PTSD）的患病率和相关因素。在这项横断面研究中，家庭概率样本的1970年成年人生活在弗林特，密歇根州，在危机期间进行了调查，他们的危机经验，他们的心理症状5年后，他们的访问和使用的心理健康服务在干预年。对分析进行加权，以产生具有人口代表性的估计数。精神疾病推定诊断和统计手册（第五版）（DSM-5）诊断水平的过去一年的抑郁症和创伤后应激障碍。在1970名受访者中，1946名报告性别的受访者中有1061名（54.5%）为女性; 1951名报告种族的受访者中有1043名（53.5%）为黑人或非裔美国人，829名（42.5%）为白色; 1946名报告种族的受访者中有1895名（97.4%）为非西班牙裔。总体而言，435（22.1%）符合DSM-5标准的推定过去一年抑郁症，480（24.4%）推定过去一年创伤后应激障碍，276（14.0%）这两种疾病。认为自己或家人的健康受到污染水损害的居民（例如，抑郁症的风险比[RR]：2.23; 95% CI，1.80-2.76），对公共-官方信息的信心较低（例如，PTSD的RR，1.44; 95% CI，1.16-1.78），既往暴露于PTE（例如，两种疾病的RR：5.06; 95% CI，2.99-8.58），或报告社会支持低的患者（例如，PTSD的RR，2.58; 95%CI，1.94-3.43）有抑郁症，PTSD和合并症的风险显着较高。涉及既往身体或性侵犯的PTE是特别有效的风险因素（例如，两种疾病：RR，7.30; 95%CI，4.30-12.42）。只有685名受访者（34.8%）曾经提供心理健康服务，以协助与水危机有关的精神症状;大多数（543 [79.3%]）谁提供的服务利用它们。在密歇根州弗林特的精神障碍的横断面研究中，假定抑郁症和创伤后应激障碍在水危机发生5年后非常普遍。这些研究结果表明，公共工程环境灾害具有大规模，长期的心理后遗症。弗林特社区可能需要扩大精神卫生服务，以满足持续的精神病需求。国家灾害准备和响应计划应考虑精神病学的结果。
What are the long-term psychiatric outcomes of environmental disasters, such as the Flint water crisis? In this cross-sectional household probability sample survey of 1970 adults living in Flint, Michigan, during the water crisis, more than one-fifth met criteria for presumptive past-year depression, nearly one-quarter for past-year presumptive posttraumatic stress disorder, and more than one-tenth for both disorders 5 years after the onset of the water crisis. Only 34.8% were ever offered mental health services to assist with water-crisis–related psychiatric symptoms; most (79.3%) who were offered services utilized them. These findings suggest that public-works environmental disasters such as the Flint water crisis have lasting psychological sequelae and may require expanded mental health services to meet long-term psychiatric need. This cross-sectional study investigates the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among residents of Flint, Michigan, 5 years after the onset of the water crisis. Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using standardized diagnostic measures. To investigate the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among Flint residents 5 years after the onset of the crisis. In this cross-sectional study, a household probability sample of 1970 adults living in Flint, Michigan, during the crisis were surveyed about their crisis experiences, their psychological symptoms 5 years later, and their access to and use of mental health services in the intervening years. Analyses were weighted to produce population-representative estimates. Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD. Among 1970 respondents, 1061 of 1946 reporting sex (54.5%) were women; 1043 of 1951 reporting race (53.5%) were Black or African American and 829 (42.5%) were White; and 1895 of 1946 reporting ethnicity (97.4%) were non-Hispanic. Overall, 435 (22.1%) met DSM-5 criteria for presumptive past-year depression, 480 (24.4%) for presumptive past-year PTSD, and 276 (14.0%) for both disorders. Residents who believed that their or their family’s health was harmed by contaminated water (eg, risk ratio [RR] for depression: 2.23; 95% CI, 1.80-2.76), who had low confidence in public-official information (eg, RR for PTSD, 1.44; 95% CI, 1.16-1.78), who had previous exposure to PTEs (eg, RR for both disorders: 5.06; 95% CI, 2.99-8.58), or who reported low social support (eg, RR for PTSD, 2.58; 95% CI, 1.94-3.43) had significantly higher risk for depression, PTSD, and comorbidity. PTEs involving prior physical or sexual assault were especially potent risk factors (eg, both disorders: RR, 7.30; 95% CI, 4.30-12.42). Only 685 respondents (34.8%) were ever offered mental health services to assist with water-crisis–related psychiatric symptoms; most (543 [79.3%]) who were offered services utilized them. In this cross-sectional study of psychiatric disorder in Flint, Michigan, presumptive depression and PTSD were highly prevalent 5 years after the onset of the water crisis. These findings suggest that public-works environmental disasters have large-scale, long-term psychological sequelae. The Flint community may require expanded mental health services to meet continued psychiatric need. National disaster preparedness and response programs should consider psychiatric outcomes.
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