摘要：Objectives. Hurricane Katrina’s impact on public health has been significant and multifaceted, with trauma-related psychological sequelae likely to result in a sizable burden of disease. Data were collected that assessed acute stress disorder (ASD) prevalence and factors related to ASD symptomatology among sheltered evacuees. Methods. On days 12 to 19 after Katrina, evacuees at a major emergency shelter completed surveys that assessed demographics, Katrina-specific experiences, and ASD symptomatology. Results. Sixty-two percent of the sample met ASD threshold criterion. Projections based on the predictive power of ASD to posttraumatic stress disorder (PTSD) suggest that 38% to 49% of the sample will meet PTSD criteria 2 years post-disaster. Female gender (odds ratio [OR] = 4.08), positive psychiatric history (OR=5.84), injury (OR=2.75), increased life-threat perception (OR=1.37), and decreased sense of personal control (OR=1.56) were significantly related to ASD. Black race was associated with greater symptom severity (B=7.85, SE[B]=3.50). Conclusions. Katrina-related trauma and its psychological sequelae will remain a significant public health issue for years to come. The identification of several vulnerability factors related to ASD and PTSD provides a brief sketch of those at greatest risk. Between late August and September 4, 2005, the Red Cross operated 470 shelters and evacuation centers across the nation to accommodate survivors of Hurricane Katrina. 1 More than 386000 evacuees received medical or mental health services from such shelters, 2 and survivors remained widely dispersed for significant periods, temporarily residing in all 50 US states and the District of Columbia. 3 Common evacuee health care concerns include poor sleep quality, 4 depressed immune functioning, 5 , 6 increases in negative health behaviors (e.g., alcohol and cigarette use), 7 and elevated relapse rates for pre-existing health conditions. 8 Although primary care physicians and other health care providers are often well prepared to manage physical needs in the immediate wake of disaster, their role as sole treatment contact 9 , 10 for the more than 50% of evacuees who will experience persistent and severe psychological consequences is likely less familiar. Given the mental health repercussions of Hurricane Katrina projected to emerge in the coming years, including depression, anxiety, and post-traumatic stress disorder (PTSD), 11 , 12 physician and health care provider familiarity with trauma-related symptoms and differential risk profiles is crucial. Multiple vulnerability factors have combined in the case of Hurricane Katrina to heighten survivors’ risks of long-term difficulties. The high rate of poverty in New Orleans (close to 28%) amplified disaster impact on individuals through increased exposure, decreased disaster preparedness, and a lack of resources to offset losses. 13 Also, the largely Black population of New Orleans bore a disproportionately heavy burden of predisaster chronic disease complicated by inadequate health care access. 14 Minority status itself has been shown to increase the risk of PTSD after trauma, 13 , 15 although this effect may be largely because of differential exposure to poverty and violence. 16 , 17 Also, previous disaster research has shown that separation from family 18 and relocation 19 elevate risk for postdisaster mental health problems. A recent meta-analysis investigating the effects of displacement on mental health outcomes indicated that displaced persons evince worse mental health than nondisplaced comparison groups and that internally displaced persons (displaced within their own country) experience worse outcomes than refugees relocated to other countries. Living in institutional accommodations, as opposed to private housing, and experiencing restricted economic opportunity are also consistently associated with worse mental health. 20 After Cyclone Tracy devastated the community of Darwin, Australia, a study of survivors found that evacuees who did not return to the community within 1 year fared worse in terms of somatic complaints, depression, and worry than did both individuals who evacuated but returned and those who had never evacuated during the disaster. 21 , 22 In a recent review of the displacement literature, the authors suggested that the negative effects of forced relocation spring largely from the loss of social ties and support systems. 23 With hundreds of thousands of evacuees dislocated all over the country, Hurricane Katrina has set the stage for a public mental health crisis that may unfold for years to come. In post-Katrina New Orleans, the outlook may be no better for evacuees with the means and desire to return to their communities. A recent New York Times report illustrated the multitude of mental health consequences that have accompanied the disaster and rebuilding. 24 The suicide rate in the area tripled in the first 4 months and remains significantly higher than the pre-Katrina rate; substance abuse and mental health needs have reached unprecedented levels; and many feel that the rest of the country has lost interest. Complicating this crisis, more than half of New Orleans’ mental health professionals have relocated elsewhere, and only 60 of the city’s hospital beds are available for psychiatric patients. 24 We sampled residents of New Orleans and surrounding parishes who were evacuated to the major Red Cross shelter in Austin, Tex, within the first 2 weeks of the Katrina disaster. Our study is the first, to our knowledge, to examine how demographic and disaster-related experiences predict acute stress symptomatology among Katrina’s evacuees. Acute stress disorder (ASD), a major stress response in the first month posttrauma, or “early PTSD,” was chosen as the mental health outcome of interest because of its use in predicting PTSD up to 2 years postevent. 25 , 26
