Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis

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, duringthe 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.

Automated summary

The Flint, Michigan water crisis has led to a high prevalence of psychiatric disorders, including major depression and posttraumatic stress disorder (PTSD). Factors such as exposure to contaminated water, low confidence in public-official information, previous traumatic experiences, and lack of social support are associated with increased risk for these disorders.