A Population-Based Assessment of Physical Symptoms and Mental Health Outcomes Among Adults Following the Flint Water Crisis

Ezell, Jerel M.; Chase, Elizabeth C.

doi:10.1007/s11524-021-00525-2

Cited by 24 publications

(16 citation statements)

References 52 publications

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“…15 In 2015 to 2016, 20.4% of Flint residents were estimated to meet screening criteria for current PTSD (past month), 11 a number that increased to 29.0% by 2019. 14 Our estimates are also lower than those reported among other communities exposed to neurotoxicants through human-caused technological disasters, including residents of a town exposed to a severe chlorine gas disaster (36.9% screened positive for PTSD within 1 year of the disaster) 33 and of a town exposed to widespread methyl parathion contamination (55.0% screened positive for depression within 1 year of disaster identification). 34 Second, a Flint resident's risk of having presumptive depression or PTSD half a decade after the water crisis began was significantly associated with their experiences, thoughts, and beliefs concerning the water crisis.…”

Section: Jama Network Open | Psychiatrycontrasting

confidence: 54%

“…12,13 Two small but representative surveys conducted in 2018 and 2019 suggested that mental health problems remained elevated, with high rates of probable PTSD symptoms (29.0%) and depression and anxiety disorder (between 13.1% and 26.3%) identified through Flint residents' reports on brief (2-to 5-item) screening questionnaires. 14,15 To our knowledge, no study to date has provided estimates of the long-term prevalence of depression or PTSD at the full DSM-5 diagnostic level using standardized interviews. This article reports survey results from a household probability sample of adults in Flint, Michigan, conducted 5 years after the onset of the water crisis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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ImportanceEnvironmental 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.ObjectiveTo 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 ParticipantsIn 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 MeasuresPresumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD.ResultsAmong 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 RelevanceIn 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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Section: Jama Network Open | Psychiatrycontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Although the use of water filtration may help alleviate concerns of water quality and appeal, intervention efforts should consider structural disparities related to race/ethnicity, household income, and food insecurity that might impact individuals to prioritize water filters over other necessary expenses. Furthermore, it is possible that recent drinking water crises (e.g., Flint, Michigan, Elk River in West Virginia) might have a disproportionately negative impacts on individuals of color or rural communities [40][41][42] and could result in avoidance of tap water regardless of whether they have a water filter at home.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to Water Filter Use for Drinking Tap Water at Home and Its Association With Consuming Plain Water and Sugar-Sweetened Beverages Among U.S. Adults

et al. 2022

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Objective: To examine factors associated with water filter use (WFU) for drinking tap water at home and its association with consuming plain water and sugar-sweetened beverages (SSBs). Design: Quantitative, cross-sectional study. Setting: The 2018 SummerStyles survey data. Subjects: U.S. adults (≥18 years; N=4,042). Measures: Outcomes were intake of plain water (tap/bottled water) and SSBs. Exposure was WFU (yes, no, not drinking tap water at home). Covariates included sociodemographics, weight status, Census regions, and home ownership status. Analysis: We used multivariable logistic regressions to estimate adjusted odds ratios (AOR) and 95% confidence interval (CI) for consuming tap water, bottled water, or total plain water >3 cups/day (vs. ≤3 cups) and SSBs ≥1 time/day (vs. <1 time) by WFU. Results: Overall, 36% of adults reported using a filter for drinking tap water at home; 14% did not drink tap water at home. Hispanics had significantly higher odds of using a water filter (AOR=1.50, 95%CI=1.14–1.98) vs. non-Hispanic White. Factors significantly associated with lower odds of WFU were lower education (AOR=0.69, 95%CI=0.55–0.86 for ≤high school; AOR=0.78, 95%CI=0.64–0.95 for some college, vs. college graduate), not being married (AOR=0.81, 95%CI=0.66–0.98, vs. married/domestic partnership) and lower household income (AOR=0.68, 95%CI=0.68–0.90 for <$35,000, vs. ≥$100,000). Using a water filter was associated with higher odds of drinking >3 cups/day of tap water (AOR=1.33, 95%CI=1.13–1.56) and lower odds of SSBs ≥1 time/day (AOR=0.76, 95%CI=0.62–0.92). Not drinking tap water at home was associated with higher odds of drinking >3 cups/day bottled water (AOR=3.46, 95%CI=2.70–4.44). Conclusions: WFU was associated with higher tap water intake and lower SSB intake among U.S. adults. WFU was higher among Hispanics, but lower among those with lower education and income and not married adults. While WFU was associated with healthful beverage habits, additional considerations for WFU may include source water quality, oral health, cost, and proper use.

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“…A February 2017 report from the Michigan Civil Rights Commission substantiated this claim, concluding that racist policies and practices in employment, housing, and education, as well as racially disparate effects of the state's emergency manager law, contributed to the FWC ( 79 ). Additionally, local members of the Flint community have attributed the FWC to structural racism ( 94 , 106 , 116 , 117 ). Thus, we hypothesized that Black people in Michigan communities outside of Flint also may have attributed the water crisis to racism and that witnessing the effects of structural racism on members of their own racial/ethnic group in Flint, a majority-Black community, negatively affected their well-being and the health of their offspring via stress-related mechanisms ( 20 , 105 ).…”

Section: Discussionmentioning

confidence: 99%

Vicarious structural racism and infant health disparities in Michigan: The Flint Water Crisis

Allgood

Mack

Novak

et al. 2022

Front. Public Health

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Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: −0.09, −0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: −0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.

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A Population-Based Assessment of Physical Symptoms and Mental Health Outcomes Among Adults Following the Flint Water Crisis

Cited by 24 publications

References 52 publications

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

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

Factors Related to Water Filter Use for Drinking Tap Water at Home and Its Association With Consuming Plain Water and Sugar-Sweetened Beverages Among U.S. Adults

Vicarious structural racism and infant health disparities in Michigan: The Flint Water Crisis

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