Water crisis aftermath: 1 in 5 adults with depression, 1 in 4 with PTSD in Flint, MI

JAMA Network OPEN publishes paper examining mental health five years later

CHARLESTON, S.C. (Sept. 20, 2022) – Data from the largest mental health survey of the Flint, Michigan, community, conducted five years after the water crisis began, indicate that 1 in 5 Flint adults, or roughly 13,600 people, were estimated to have past-year clinical depression, and 1 in 4, or 15,000 people, were estimated to have past-year PTSD. The mental health burden of America’s largest public-works environmental disaster clearly continues for many adults in Flint.

On April 25, 2014, the city of Flint switched its water supply from Lake Huron and the Detroit River to the Flint River and failed to treat the water supply properly to prevent lead and other elements from leaching out of the city’s old water pipes. Virtually all Flint residents were consequently exposed to drinking water with unsafe levels of bacteria, disinfection byproducts and lead, a neurotoxicant. 

Flint drinking water was not declared lead-free until Jan. 24, 2017. During the crisis, tens of thousands of children and adults in Flint developed high blood-lead levels, putting them at greater risk for cognitive deficits, mental health problems and other health problems later in life. 

“We know that large-scale natural or human-caused disasters can trigger or exacerbate depression and PTSD,” said Dean Kilpatrick, Ph.D., Distinguished University Professor in the MUSC Department of Psychiatry and Behavioral Sciences and senior author of the study. Kilpatrick noted that there was clear evidence of high rates of mental health problems in the Flint community during 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.” 

According to Kilpatrick, past-year rates of depression and post-traumatic stress disorder(PTSD) identified in Flint today are 3 to 5 times greater than national estimates among U.S. adults overall and likely result from a combination of higher base rates of mental health problems in Flint before the crisis and a significant exacerbation of problems resulting from the crisis. He noted that residents of Flint, a predominantly low-income Black community, faced many challenges before the water crisis that could have eroded mental health, including socioeconomic disadvantage, racism and high exposure to potentially traumatic events, including prior physical or sexual assault. Particularly striking was the finding that those with prior physical or sexual assault were more than 3 times more likely to have depression and more than 6 times more likely to have PTSD than those without this history. “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,” said Kilpatrick.

Depression and PTSD are among the most common and impairing of mental disorders, costing well over $236 billion a year in America 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 Sandro Galea, M.D., DrPH, the Robert A. Knox Professor and dean of the Boston University School of Public Health and a co-author on the study. “But we also study these problems because we have good treatments that are effective for most people.”

Study findings suggest that more should be done to provide mental health treatment for residents of Flint. “There is a clear unmet need,” said Aaron Reuben, Ph.D., a postdoctoral scholar in neuropsychology at Duke University and MUSC and first author of the study. “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.” According to Reuben, uncertainties about exposures and future harms meaningfully contribute to psychological distress after environmental disasters, and the study found that adults who thought exposure to contaminated water had harmed their health or that of a family member  were significantly more likely to have past-year depression and PTSD.  

The study, funded by a grant to MUSC from the U.S. Department of Justice Office for Victims of Crime, surveyed a household probability sample of 1,970 adults from Flint between Aug. 13, 2019, and April 10, 2020. Surveys were conducted online and via mail by Abt Associates, a national survey research firm. Data was collected on perceived exposure to contaminated water, past-year prevalence of depression and PTSD using DSM-5 diagnostic criteria and potential risk factors for depression and PTSD, including prior exposure to potentially traumatic events, prior physical or sexual assault and low social support. Adults were also included if they ever were offered or received mental health services. 

“The vast majority of our respondents were never offered mental health services,” said Reuben, “despite clear indication that the crisis was psychologically traumatic.” He explained that most Flint residents who were offered mental health services went on to use and benefit from them. “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.”

Link to the article can be found HERE. 

CITATION: “Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis,” Aaron Reuben, Angela Moreland, Salma M. Abdalla, Gregory H. Cohen, Matthew J. Friedman, Sandro Galea, Alex O. Rothbaum, Michael G. Schmidt, John E. Vena, and Dean G. Kilpatrick. JAMA Network Open, September, 20, 2022. DOI: TBD. 

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