For Hurricane Katrina survivors, COVID-19 brings a new mental health toll

As a graduate student in 2006, Sarah Lowe, Ph.D. joined a group of researchers following low-income, unmarried mothers who were living in New Orleans when Hurricane Katrina struck the area the previous year.

"I was interested in how major collective events impact [health] disparities," said Lowe, now a clinical psychologist and associate professor in the Department of Social and Behavioral Sciences at Yale School of Public Health. Lowe is also associate professor of psychiatry at Yale School of Medicine and associate clinical professor of nursing.

Lowe and the other researchers surveyed the women over the next 15 years, noting both the continued negative impact of the hurricane on the women's lives and their overall resilience to the setback, with many earning college degrees, finding stable housing, and successfully raising their children despite the trauma of Katrina.

Then came another trauma: COVID-19.

"When the pandemic hit, it became very clear that it was not going to affect all subpopulations equally," Lowe said. "Individuals who shared characteristics with our Katrina sample—being Black, experiencing systemic racism and health disparities, being low income, being single parents—were at increased risk for getting COVID, having severe cases of COVID, and suffering from the myriad economic impacts of the pandemic."

The researchers noted their unique opportunity to study how the pandemic would impact a vulnerable group—the Katrina survivors—who had previously experienced another collective trauma. They surveyed approximately 400 women in 2021, publishing the first paper from their results in February 2023 in SSM—Mental Health. The paper's lead authors are Meghan Zacher, assistant professor of population studies at Brown University, and Ethan J. Raker, assistant professor of sociology at the University of British Columbia. Lowe is the senior author of the paper.

The results, which compared the mental health impact of Hurricane Katrina to the COVID-19 pandemic, surprised Lowe: Nearly 42% of the Katrina survivors experienced post-traumatic stress symptoms one year into the pandemic—almost the exact percentage that had experienced those symptoms a year after the hurricane. Almost half of the respondents (48%) were experiencing psychological distress a year into the pandemic, compared with just over one-third (37%) a year post-Katrina.

For these women, the COVID-19 pandemic was associated with the same, or worse, mental health impacts as Hurricane Katrina—one of the worst national disasters in U.S. history. "This speaks to the differences in the Katrina experience," Lowe said, "versus the pandemic experience."

Hurricane Katrina took place over a shorter time period and was geographically constrained, Lowe says, meaning the rest of the country could channel resources to the Gulf Coast. But everyone experienced the COVID-19 pandemic—the widespread illness and death lasted longer and the economic impacts were graver. "This longer duration of trauma, combined with resources being constrained," Lowe said, "most likely led to distress."

Though the survey focused on a specific subpopulation, Lowe says it offers insights for the general population. The researchers' prior work showed that, for some people, the mental health experiences of collective trauma will cause long-term impacts. "We shouldn't forget that moving forward," Lowe said. "Just because cases and deaths are down, does not mean people aren't continuing to struggle."

Trauma survivors might be at greater risk for adversity during collective traumas, Lowe said. "People don't typically habituate to trauma," she said. "There's a wear-and-tear on folks, even as they cope and grow and learn from their experiences."

Continued support for vulnerable survivors of collective trauma is key, Lowe said. Collective trauma can emerge from any tragic event including extreme weather events, outbreaks of disease, mass shootings, fatal fires, and multiple-victim auto accidents.

Lowe said the study's findings provide new insights into collective trauma and may support proposals to amend the current definition of trauma in the Diagnostic and Statistical Manual of Mental Disorders, the authoritative handbook of mental health disorders. The manual's current definition of trauma, Lowe said, doesn't account for the myriad struggles people experiencing collective trauma can face, such as financial strain, housing instability, and discrimination. Some health care professionals believe it should. A definition change, Lowe said, could make it easier for people with trauma-related symptoms to access mental health care.

Lowe and her co-researchers are continuing to sift through their survey results, and expect to publish follow-up papers on their findings.