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Onookome-Okome T, Hsu A, Kilpatrick DG, Moreland A, Reuben A. Association of Public Works Disasters with Substance Use Difficulties: Evidence from Flint, Michigan, Five Years after the Water Crisis Onset. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7090. [PMID: 38063520 PMCID: PMC10706393 DOI: 10.3390/ijerph20237090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
Public works environmental disasters such as the Flint water crisis typically occur in disenfranchised communities with municipal disinvestment and co-occurring risks for poor mental health (poverty, social disconnection). We evaluated the long-term interplay of the crisis and these factors with substance use difficulties five years after the crisis onset. A household probability sample of 1970 adults living in Flint during the crisis was surveyed about their crisis experiences, use of substances since the crisis, and risk/resilience factors, including prior potentially traumatic event exposure and current social support. Analyses were weighted to produce population-representative estimates. Of the survey respondents, 17.0% reported that substance use since the crisis contributed to problems with their home, work, or social lives, including 11.2% who used despite a doctor's warnings that it would harm their health, 12.3% who used while working or going to school, and 10.7% who experienced blackouts after heavy use. A total of 61.6% of respondents reported using alcohol since the crisis, 32.4% using cannabis, and 5.2% using heroin, methamphetamine, or non-prescribed prescription opioids. Respondents who believed that exposure to contaminated water harmed their physical health were more likely to use substances to the detriment of their daily lives (RR = 1.32, 95%CI: 1.03-1.70), as were respondents with prior potentially traumatic exposure (RR = 2.99, 95%CI: 1.90-4.71), low social support (RR = 1.94, 95%CI: 1.41-2.66), and PTSD and depression (RR's of 1.78 and 1.49, respectively, p-values < 0.01). Public works disasters occurring in disenfranchised communities may have complex, long-term associations with substance use difficulties.
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Affiliation(s)
- Tuviere Onookome-Okome
- Institute for the Environment, University of North Carolina Chapel Hill, Chapel Hill, NC 27517, USA
- Samuel Centre for Social Connectedness, Montréal, QC H3A 0G4, Canada
| | - Angel Hsu
- Institute for the Environment, University of North Carolina Chapel Hill, Chapel Hill, NC 27517, USA
| | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
| | - Aaron Reuben
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (D.G.K.); (A.M.)
- Department of Psychology & Neuroscience, Duke University, Durham, NC 27708, USA
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Hussein MA, Nallani R, Jenkins PM, Haake RS, Perinjelil V, Cranford J, Campbell A, Dryden A, Kenney S, Herdman K, Dombrowski A, Sachwani-Daswani G. The role of trauma services in intentional self-harm at a regional level 1 trauma center. Injury 2023; 54:110981. [PMID: 37596120 DOI: 10.1016/j.injury.2023.110981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Suicide claims many lives globally, each year. For every person that dies by suicide, multitudes more attempt it. A national shortage of psychiatrists may prevent many individuals from receiving timely mental health care. For many individuals, the primary entry point into the healthcare system is through the emergency department. The trauma service frequently treats patients with severe self-inflicted injuries and for many this is not the first time. This represents an opportunity for intervention to disrupt the cycle and prevent future death. METHODS We conducted a retrospective chart review of all patients with self-inflicted injuries, admitted to the trauma surgery service between 2012 and 2021. All patients above 10 years old were included. RESULTS Four hundred forty-one patients were admitted due to self-injurious behavior in the period under study. The majority of patients (71.9%) had a pre-existing mental health disorder. Fifty six patients suffered fatal injuries; the majority were White (78.6%), males (80.3%), and were inflicted by gunshot (71.4%). Nearly one third of patients with self-inflicted injuries had a history of self-injurious behavior with the average number of attempts being 2.7 (SD: ±3.8). CONCLUSIONS We need interdisciplinary and innovative solutions for this public health crisis. Perhaps telemedicine can be used to buttress the access to adequate mental health care. More research needs to be done to better identify the barriers individuals encounter in accessing mental health care, both pre- and post-crisis. The goal is that, by identifying the gaps, we can collaboratively bridge them to prevent a preventable death.
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Affiliation(s)
- Mohamed A Hussein
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Rohit Nallani
- College of Human Medicine, Michigan State University, MI, USA
| | - Phillip M Jenkins
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Robert Stephen Haake
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Vinu Perinjelil
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - James Cranford
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA; Department of Emergency Medicine, University of Michigan Medicine, MI, USA
| | - Amber Campbell
- College of Human Medicine, Michigan State University, MI, USA
| | - Arriona Dryden
- College of Human Medicine, Michigan State University, MI, USA
| | - Sarak Kenney
- College of Human Medicine, Michigan State University, MI, USA
| | - Kaitlin Herdman
- College of Human Medicine, Michigan State University, MI, USA
| | - Amber Dombrowski
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Gul Sachwani-Daswani
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA.
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Roy S, Petrie KJ, Gamble G, Edwards MA. Did a nocebo effect contribute to the rise in special education enrollment following the Flint, Michigan water crisis? CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e9577. [PMID: 37065004 PMCID: PMC10103158 DOI: 10.32872/cpe.9577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Background
Exposure to waterborne lead during the Flint Water Crisis during April 2014-October 2015 is believed to have caused increased special education enrollment in Flint children.
Method
This retrospective population-based cohort study utilized de-identified data for children under six years of age who had their blood lead tested during 2011 to 2019, and special education outcomes data for children enrolled in public schools for corresponding academic years (2011-12 to 2019-20) in Flint, Detroit (control city) and the State of Michigan. Trends in the following crisis-related covariates were also evaluated: waterborne contaminants, poverty, nutrition, city governance, school district policies, negative community expectations, media coverage and social media interactions.
Results
Between 2011 and 2019, including the 2014-15 crisis period, the incidence of elevated blood lead in Flint children (≥ 5µg/dL) was always at least 47% lower than in the control city of Detroit (p < .0001) and was also never significantly higher than that for all children tested in Michigan (p = 0.33). Nonetheless, special education enrollment in Flint spiked relative to Detroit and Michigan (p < .0001). There is actually an inverse relationship between childhood blood lead and special education enrollment in Flint.
Conclusion
This study failed to confirm any positive association between actual childhood blood lead levels and special education enrollment in Flint. Negative psychological effects associated with media predictions of brain damage could have created a self-fulfilling prophecy via a nocebo effect. The findings demonstrate a need for improved media coverage of complex events like the Flint Water Crisis.
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Kim W, Groden SR. Stress and Health Status Among Members of a Disadvantaged Community in Flint, Michigan in the Early Phase of the COVID-19 Pandemic. J Community Health 2022; 47:894-901. [PMID: 35904712 PMCID: PMC9334972 DOI: 10.1007/s10900-022-01120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic creates psychological concerns and stress and its impacts are more extreme for those with health concerns residing in socially and economically disadvantaged communities, such as residents of Flint, Michigan. This study assesses the stress level among people who received community assistance in the first 3 months of COVID lockdowns. Further, it examines associations between stress and physical and mental health status. We measured perceived stress, health concerns, mental distress, and perceived physical and mental health from 106 survey respondents. Comparisons of stress levels by demographics showed that females, high school graduates, and homeowners had higher stress levels than its counterparts. Results from general linear models showed that stress was highest among those with high levels of psychological distress, perceived poor mental health, and more health concerns. The associations between poor perceived physical health and stress were marginal. Homeowners and high school diploma holders showed lower stress levels. This research suggests community health practices tailored to community characteristics and culture will have the greatest impact on stress and health problems in underserved communities.
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Affiliation(s)
- Woojong Kim
- Social Work Department, University of Michigan-Flint, 303 E. Kearsley Street, Flint, MI, 48502, USA.
| | - Sheryl Renee Groden
- Social Work Department, University of Michigan-Flint, 303 E. Kearsley Street, Flint, MI, 48502, USA
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Reuben A, Moreland A, Abdalla SM, Cohen GH, Friedman MJ, Galea S, Rothbaum AO, Schmidt MG, Vena JE, Kilpatrick DG. Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis. JAMA Netw Open 2022; 5:e2232556. [PMID: 36125808 PMCID: PMC9490512 DOI: 10.1001/jamanetworkopen.2022.32556] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE 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. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS 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. MAIN OUTCOMES AND MEASURES Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD. RESULTS 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. CONCLUSIONS AND RELEVANCE 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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Affiliation(s)
- Aaron Reuben
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Salma M. Abdalla
- School of Public Health, Boston University, Boston, Massachusetts
| | - Gregory H. Cohen
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Matthew J. Friedman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- National Center for PTSD, US Department of Veterans Affairs, Washington, DC
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
| | - Alex O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michael G. Schmidt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Parker S, Johnson-Lawrence V. Addressing Trauma-Informed Principles in Public Health through Training and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148437. [PMID: 35886289 PMCID: PMC9319668 DOI: 10.3390/ijerph19148437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
The increasing prevalence of traumatic events requires our public health workforce to be knowledgeable about ways trauma influences population and individual health. There is a gap in student training about the various ways that traumatic events affect their capacity to perform public health work and the communities they serve. While other human services disciplines explicitly use trauma-informed terminology and concepts in student training, references to trauma-informed approaches are more implicit in public health curricula. This study examined trauma-informed principles and related terminology for use in public health coursework in the context of a community-wide water contamination public health crisis in Flint, Michigan, USA. We addressed the principles of trauma-informed approaches across key competency areas common to USA public health accredited programs, including discussion to support student understanding of the principle in action. Using trauma-informed language (1) enhances our capacity to name and respond empathetically in traumatized communities, (2) provides guiding principles for less community-engaged efforts, and (3) fosters stronger relationships for more community-engaged initiatives by providing areas of accountability for unintended consequences throughout the program’s development and implementation processes. Rising public health professionals equipped with knowledge of trauma-informed approaches can more intentionally minimize unintended negative consequences of public health initiatives.
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Affiliation(s)
- Shan Parker
- Department of Public Health and Health Sciences, University of Michigan-Flint, Flint, MI 48502, USA
- Correspondence:
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A Population-Based Assessment of Physical Symptoms and Mental Health Outcomes Among Adults Following the Flint Water Crisis. J Urban Health 2021; 98:642-653. [PMID: 33788147 PMCID: PMC8566686 DOI: 10.1007/s11524-021-00525-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
Little is known about the physical and mental health outcomes of adults in the low-income, predominantly Black city of Flint, Michigan, following the city's water crisis which began in April 2014 after austerity policies led to the city switching its water source. We investigate these dynamics using data from a longitudinal community-based cohort in Flint. Between June and November 2019, surveys were administered at nine public sites across Flint. Nested models were employed to assess relationships between respondent demographics, including race/ethnicity, and self-report of clinician-diagnosed blood lead levels (BLLs) and various physical symptoms and mental health outcomes, including depression/anxiety (PHQ-4) and psychological trauma (PC-PTSD-5). Of the 331 respondents (mean age: 47.9 + 16.5), most were women (58.6%) and Black (57.7%). In total, 10.0% self-reported elevated BLLs, with borderline significantly higher reports among Blacks (p = 0.07). Skin rashes (58.1% vs. 33.9%, p < 0.01), hair loss (45.5% vs. 30.3%, p = 0.01), and nausea (35.6% vs. 20.2%, p = 0.1) were significantly higher among Blacks versus Whites. Additionally, 29.0% and 26.3% of respondents met trauma and depression/anxiety criteria, respectively. Increasing physical symptoms was associated with psychological trauma (OR 2.1, p < 0.01) and depression/anxiety (OR 1.9, p < 0.01). In closing, Flint adults, particularly Blacks, experienced deleterious physical and mental health outcomes following the city's water crisis that appear to represent a substantial burden of excess cases. Further research is needed on how austerity impacts community health in economically distressed urban cities and ways to generate capacity to identify and curb adverse consequences.
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Psychological Consequences of the Flint Water Crisis: A Scoping Review. Disaster Med Public Health Prep 2021; 16:1259-1269. [PMID: 33958025 DOI: 10.1017/dmp.2021.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To summarize existing literature on the mental health impact of the Flint Water Crisis. METHODS In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted. RESULTS 32 citations were screened and 11 included in the review. Results suggest a negative psychological effect caused by the water crisis, including anxiety and health worries, exacerbated by lowered trust in public health officials, uncertainty about the long-term impacts of the crisis, financial hardships, stigma, and difficulties seeking help. There was evidence that concerns about tap water continued even after the state of emergency was lifted. CONCLUSIONS With a possible compound effect to residents of Flint with the recent COVID-19 pandemic, the results highlight the need for more resources for psychological health interventions in Flint as well as a need for local governments and health authorities to regain the trust of those affected by the Flint Water Crisis.
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Wutich A, Brewis A, Tsai A. Water and mental health. WIRES WATER 2020; 7. [DOI: 10.1002/wat2.1461] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023]
Abstract
AbstractThere is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.This article is categorized under:
Engineering Water > Water, Health, and Sanitation
Human Water > Water as Imagined and Represented
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Affiliation(s)
- Amber Wutich
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexandra Brewis
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexander Tsai
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
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