Emotional resilience seems to be helping some Hurricane Katrina survivors cope in the storm’s wake.

That resilience comes despite a near doubling in the prevalence of serious mental illness among Gulf Coast residents.

That’s the key finding from a mental health study of more than 800 residents of Alabama, Louisiana and Mississippi affected by Hurricane Katrina last year.

Harvard Medical School’s Ronald Kessler, Ph.D, and colleagues conducted the study five to eight months after Katrina.

They compared their data to mental health studies done in the same region in 2001-2003.

The prevalence of any mental illness rose from nearly 16 percent before Katrina to about 31 percent after the storm.

Serious mental illness, such as major depression, panic disorder, anxiety, and posttraumatic stress disorder, rose from 6 percent to 11 percent. Less severe cases also increased.

Despite those increases, the study shows no rise in suicidal thinking after Katrina.

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Resilient Response

Resilience appears to be the reason why suicidal thinking didn’t rise after Hurricane Katrina, the researchers report.

“This sense of resilience, inner strength, is really just quite extraordinary,” Kessler told reporters, in a media teleconference.

“We found an extraordinarily high proportion of our sample who said that despite the understandable sadness with all they lost and the understandable anxiety about the uncertainties of the future, [they] said that they felt closer to their loved ones, they felt connected to the community in a way they didn’t before, they felt much more religious, they felt that they had purpose in their life and a meaning, that they were kind of drifting around but now they knew where they were going and they were going to lick this thing,” Kessler says.

Kessler’s team checked that the survey participants mirrored the area’s pre-Katrina population as closely as possible. The researchers weighted the data to make up for any differences in the prestorm and poststorm groups.

Data on completed suicides after Hurricane Katrina aren’t available yet.

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Survivor’s Story

Juan Lizarraga, a lawyer in New Orleans, now living in a FEMA trailer in his front yard, joined Kessler in the teleconference.

“I think what has been hardest, of course, is just to develop a sense of patience and the recognition that things do not happen nearly as quickly as we would like them to happen,” Lizarraga says.

“But you have to develop almost a day-to-day mentality and be happy when little things happen, because of the vastness of this disaster,” Lizarraga continues.

“The battle for us is a continual battle against negativity,” he adds.

“I believe the question was asked to me once, ‘What if you rebuild and nobody else in your block rebuilds?’ And our answer at the time was, ‘Somebody has to start,’” he says.

“Believe me, I’ve been through many hurricanes before Katrina. So it’s something we have learned to live with,” says Lizarraga.

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Who Shows Resiliency?

Low-income people were particularly likely to report resiliency after Hurricane Katrina.

That may be because they were most likely to have had the most traumatic experiences during and after the storm.

“People who have these kind of epiphany experiences are often the ones who had the most terrible stresses,” Kessler says.

“The fact that poor people were much more exposed to these terrible, terrible kinds of experiences could well account for the fact that they were the ones that were more likely to say my life has been transformed,” he adds.

“But other than that, we find [resiliency] across the board -- young and old, male and female,” Kessler says.

“There’s more of it in the New Orleans area because there was more terrible, terrible kind of stuff that people were exposed to, but it’s pretty pervasive throughout the area,” Kessler says.

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Transforming Experiences

For some Gulf Coast residents, the storm changed the way they see themselves.

“We had a substantial number of people who said, ‘You know, I did something that I just never thought that I would do. I went out and saved this kid. And it makes me feel like I’m a different kind of person than I was before. I jumped into the water and I pulled him out. There’s a life that’s there that wouldn’t be there if it wasn’t for me,’” Kessler says.

“There were those kind of experiences that were interspersed with all this terrible stuff that happened to people,” Kessler says. “That’s something that makes them feel connected in a way that very often they didn’t feel before.”

“Few of us, as you know, have the experience in our lives where we’re confronted with a situation where we’ve got to jump in and save the kid or not. It’s nice that we can say, ‘Well, I always knew I would do that kind of stuff.’ [With] these people, it actually happened. And in many cases, it’s a life-transforming experience,” Kessler says.

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Weariness Ahead?

“There’s a lot of hope for the future,” Kessler says. But there’s also the risk of burnout, Kessler notes.

“Whether that hope for the future is going be something that’s there for the long term, if recovery efforts don’t keep pace with the relatively high expectations that people seem to have … that’s obviously a nagging concern that we have in looking at these kinds of data,” Kessler says.

He and his colleagues will follow about 1,000 Katrina survivors for two years after the storm to see how they fare.

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: Kessler, R. Bulletin of the World Health Organization, Aug. 28, 2006; online edition. Ronald Kessler, PhD, Department of Health Care Policy, Harvard Medical School. Juan Lizarraga, New Orleans resident. News release, Harvard Medical School.