Study led by MUSC researchers finds long-term mental health issues following Flint water crisis

September 20, 2022
Brown colored pipes piled up in Flint, Michigan.
Lead pipes being removed in Flint, Michigan.

A study led by researchers at the Medical University of South Carolina five years after the onset of the water crisis in Flint, Michigan, found a continuing “large unmet mental health need.” Dean Kilpatrick, Ph.D., principal investigator of the study, said past-year estimates of post-traumatic stress disorder and depression in Flint were substantially higher than those in Michigan, the U.S. and more than 20 nations included in an international study of PTSD and depression.

The resulting research article on Flint appears in JAMA Network Open, a peer-reviewed, open access journal published by the American Medical Association. The findings in that article are stark. One in five Flint residents surveyed, age 18 and older, suffered from major depression over the past year. One in four had PTSD. And one in 10 had both.

“If you still have PTSD or depression five years after something happens, it’s pretty much evidence that you either didn’t get the right treatment or you still need more treatment,” said Kilpatrick, a distinguished university professor in the Department of Psychiatry and Behavioral Sciences.

Or any treatment, period. Fewer than 35% of the people surveyed said they’d been offered mental health services related to the water crisis.

The team studying the long-term effects of that crisis included scientists from the departments of Psychiatry and Behavioral Sciences, Microbiology and Immunology and Public Health Sciences at MUSC along with researchers from Boston University and Dartmouth University.

Dr. Dean Kilpatrick headshot. He's wearing a suit and tie. 
Dr. Dean Kilpatrick

They surveyed 1,970 people in Flint about the water crisis that began in 2014 when the city switched its water supply from Lake Huron and the Detroit River to the Flint River and failed to add anti-corrosives to the water. This caused lead and iron from old pipes to get into the water supply.

People immediately started complaining that the water smelled, tasted and looked bad, but authorities told the public the water was safe to drink for more than a year. It wasn’t.

Doctors found high levels of lead in children, which can damage the central and peripheral nervous system, cause learning disabilities, affect growth, impair hearing and affect both the formation of blood cells and how they work, according to the Environmental Protection Agency.

The researchers found the contaminated water took a psychological toll as well. People worried about the effects on their health and the health of family and friends. And they weren’t sure how much lead they might have been exposed to.

“Just the very notion that ‘I may have been exposed and that I don’t know what the health effects are, but they may be bad and long-term’ – that’s enough to freak people out and create mental as well as physical stress,” Kilpatrick said.

Almost everyone surveyed had taken steps to reduce their risks from contaminated water – almost 80% avoided drinking it – but most still worried about health effects, including long-term implications.

Another key stress factor: People lost faith in their leaders. “Government officials were reluctant to recognize the fact that they had a widespread problem. And so they reassured people the water was safe, which basically turns out to be what many government officials tend to do. They often have difficulty initially admitting to themselves that they’ve got possibly a huge problem on their hands,” Kilpatrick said.

“So they try to deny it as long as they possibly can until confronted by it. And then they finally do announce it. But by that point, since they’ve told people, ‘You’re safe, don’t worry about it,’ for a good, long period of time, people have difficulty believing them.”

Early surveys by other researchers during and soon after the crisis began found raised levels of PTSD, stress, anxiety and depression symptoms. A pair of small surveys in 2018 and 2019 found mental health issues remained.

But the researchers in the MUSC-led study wanted more data to see just how serious the long-term problems might be. So with funding from the federal Department of Justice Office for Victims of Crime to the MUSC-based National Mass Violence Victimization Resource Center, they set out to evaluate ongoing psychiatric issues in Flint residents, using standardized diagnostic measures. The NMVVRC played a role because the Office for Victims of Crime specifically identified the need for better information about large events, such as the Flint water crisis, that aren’t mass violence but may result in criminal charges.

They also looked at how previous exposures to stressful events affected people’s reaction to the Flint water crisis. That included a life-threatening illness, serious accident, previous disaster and/or physical or sexual assault. The study found these factors significantly increased the risk for suffering from mental disorders.

“Exposure to traumatic events is cumulative over time. So if you’ve had several of these highly stressful things in the past, that probably sets you up to respond more in the way of either developing PTSD or depression to some new stressor or making these problems worse if you’ve had these problems in the past,” Kilpatrick said.

People in lower income brackets and people who lacked social support were also more likely to struggle, the study found.

The scientists hope their findings will help guide what happens next for people suffering in Flint. “We’re going to set up a basic research program here at MUSC that looks at the effects of cumulative lead exposure by first integrating it with some other research that’s going on. But it looks like cumulative lead exposure affects not only kids, in terms of their cortical development, but it may well affect adults, particularly if lead stored in the bones starts leaching out of the bones and into the rest of the body. It can affect your cortical functioning at that point, possibly leading to early dementia and things like that, as well as other health problems,” Kilpatrick said.

“Through this Flint study, we’ve gotten interested in this whole area of integrating measures of cumulative lead exposure into other studies that look at potentially traumatic events, that look at your exposure to various kinds of things. How do all of those things interact, maybe, to increase the likelihood that you’ll have some mental health disorders, not to mention some of the cognitive functioning disorders or other health problems?”

He said study findings also make it clear that local, state and federal governments need to work together to offer more mental health services in Flint.

But he said the researchers also noticed something positive that speaks to the strength of Flint, a city that’s been through a lot in recent years and has seen people pull together. “It’s important to point out that not everybody got PTSD or depression, and not everybody still has it. So that shows the resilience of a lot of people in Flint who are able, despite all of this adversity, to manage to get the help they need, maybe from other friends, from family, from the community.”

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