# Presentation: 021609

## Ronald C. Kessler, Ph.D.
Department of Health Care Policy
Harvard Medical School

June 5, 2007

- Department of Health Care Policy
- Harvard Medical School
- June 5, 2007

- The Hurricane Katrina Community Advisory Group: An Update on Results to Date

## Overview

- Each respondent agrees to participate in a series of tracking surveys carried out over a period of several years to monitor the pace of recovery efforts.
- Sample recruited using multiple frames in order to reach hard-to-reach segments of the target population

## Sample frames used to recruit the sample

- American Red Cross (ARC) relief request list     (1.4 million families)
- Consolidated set of internet safe list lists            (0.5 million individuals)
- RDD telephone sample with BellSouth forwarding to new addresses
- Sample of hotel rooms in FEMA-sponsored hotel sample

## Integration of multiple samples

- Standard capture-recapture adjustment procedures
- Post-stratification using Census data in conjunction with population change data
- Weight trimming to increase sample efficiency

## Study goals

- Assess the short-term (up to 6 months) psychological impact of the hurricane
- Assess magnitude and correlates of exposure to hurricane-related stressors
- Study vulnerability and protective factors that modify the effects of stressors on psychological reactions
- Document patterns and correlates of mental health treatment and treatment adequacy
- Monitor changes over time in mental health, treatment of mental disorders, and correlates

## The CAG Scientific Collaborators

- Chris Brewin		University College London
- Sandro Galea		University of Michigan
- Russell T. Jones	Virginia Tech University
- Rachel Kaul		Substance Abuse and Mental Health Services 				Administration
- Ronald C. Kessler	Harvard University
- David Kendrick		Center for Information Technology Leadership
- Daniel King		Boston University
- Lynda King		Boston University
- Linda Ligenza		Substance Abuse and Mental Health Services 				Administration
- Nicole Lurie		RAND

## The CAG Scientific Collaborators

- Richard J. McNally	Harvard University
- Fran Norris		Dartmouth Medical School
- Holly A. Parker		Harvard University
- Richard E. Powers	Alabama Department of Mental Health and 			Mental Retardation
- Dori Reissman		Centers for Disease Control and Prevention
- Theresa Smith		Mississippi Department of Mental Health
- Anthony H. Speier	Louisiana Office of Mental Health
- Benjamin Springgate	UCLA
- Robert Ursano		Uniformed Services University of the 				Health Sciences
- Simon Wessely		Institute of Psychiatry (London)
- Alan Zaslavsky		Harvard University

## Baseline Survey

- Information on the Hurricane Katrina Community Advisory Group is located at: _[www.HurricaneKatrina.med.harvard.edu](http://www.hurricanekatrina.med.harvard.edu/)_
- Initial analyses focused on mental health and suicidality

## Thirty-day DSM-IV mental disorders in the baseline CAG survey vs. the NCS-R 

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Serious mental illness |  |  |  |
| Mild/moderate mental illness |  |  |  |
| Any mental illness |  |  |  |

- *Significant at .05 level

## Thirty-day DSM-IV mental disorders in the baseline CAG survey vs. the NCS-R 

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Serious mental illness | 11.3 |  |  |
| Mild/moderate mental illness | 19.9 |  |  |
| Any mental illness | 31.2 |  |  |

- *Significant at .05 level

## Thirty-day DSM-IV mental disorders in the baseline CAG survey vs. the NCS-R 

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Serious mental illness | 11.3 | 6.1 |  |
| Mild/moderate mental illness | 19.9 | 9.7 |  |
| Any mental illness | 31.2 | 15.7 |  |

- *Significant at .05 level

## Thirty-day DSM-IV mental disorders in the baseline CAG survey vs. the NCS-R 

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Serious mental illness | 11.3 | 6.1 | 2.0* |
| Mild/moderate mental illness | 19.9 | 9.7 | 2.3* |
| Any mental illness | 31.2 | 15.7 | 2.4* |

- *Significant at .05 level

## Significant and insignificant predictors of Pre- (NCS-R) vs. Post- (CAG) hurricane differences in DSM-IV disorders

- Significant – Marital status (greater impact of hurricane among unmarried)
- Insignificant – Age, sex, race-ethnicity, income, education, employment status

## Suicidality in the baseline CAG survey vs. the NCS-R

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Ideation |  |  |  |
| Plan |  |  |  |
| Attempt |  |  |  |

## Suicidality in the baseline CAG survey vs. the NCS-R

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Ideation | 2.9 |  |  |
| Plan | 0.7 |  |  |
| Attempt | 0.7 |  |  |

## Suicidality in the baseline CAG survey vs. the NCS-R

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Ideation | 2.9 | 2.8 |  |
| Plan | 0.7 | 1.1 |  |
| Attempt | 0.7 | 0.6 |  |

## Suicidality in the baseline CAG surveys vs. the NCS-R

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Ideation | 2.9 | 2.8 | 1.0 |
| Plan | 0.7 | 1.1 | 0.6 |
| Attempt | 0.7 | 0.6 | 1.1 |

## CAG vs. NCS-R Suicidality with controls for mental disorders

- 		 CAG	      NCS-R	   OR
- 		   _%_	          _%_
- Ideation	             .7
- Plan		             .4
- _Attempt__	__             .8                    __	__	_
- _  _

## CAG vs. NCS-R Suicidality with controls for mental disorders

- 		 CAG	      NCS-R	   OR
- 		   _%_	          _%_
- Ideation	             .7               8.4
- Plan		             .4               3.6
- _Attempt__	__             .8               2.3            __	_
- _  _

## CAG vs. NCS-R Suicidality with controls for mental disorders

- 		 CAG	      NCS-R	   OR
- 		   _%_	          _%_
- Ideation	             .7               8.4            .1*
- Plan		             .4               3.6            .1*
- _Attempt__	__             .8               2.3            .3__	__	_
- _  _

## Post-traumatic personal growth in the CAG sample

|  | % |
| --- | --- |
| Became closer to loved ones | 81.6 |
| Developed faith in ability to rebuild life | 95.6 |
| Became more spiritual or religious | 66.8 |
| Found deeper meaning and purpose in life | 75.2 |
| Discovered inner strength | 69.5 |

## Suicidal ideation among people with DSM-IV disorders in the presence vs. absence of post-traumatic personal growth1

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Presence |  |  |  |
| Absence |  |  |  |

- *Significant at .05 level
- 1Faith in own abilities and discovery of inner strength

## Suicidal ideation among people with DSM-IV disorders in the presence vs. absence of post-traumatic personal growth1

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Presence |  2.9 |  |  |
| Absence | 16.5 |  |  |

- *Significant at .05 level
- 1Faith in own abilities and discovery of inner strength

## Suicidal ideation among people with DSM-IV disorders in the presence vs. absence of post-traumatic personal growth1

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Presence |   2.9 | 14.7 |  |
| Absence | 16.5 | 14.7 |  |

- *Significant at .05 level
- 1Faith in own abilities and discovery of inner strength

## Suicidal ideation among people with DSM-IV disorders in the presence vs. absence of post-traumatic personal growth1

|  | CAG | NCS-R | OR |
| --- | --- | --- | --- |
|  | % | % |  |
| Presence |   2.9 | 14.7 | 0.2* |
| Absence | 16.5 | 14.7 | 1.1 |

- *Significant at .05 level
- 1Faith in own abilities and discovery of inner strength

## Prevalence of DSM-IV serious mental illness (SMI) and mild-moderate mental illness (MMI) 4-6 months after Hurricane Katrina

|  | New Orleans Metro  | Remainder of Affected Area |
| --- | --- | --- |
|  | % | % |
|  |  |  |
|     SMI |         17.0 |           9.8 |
|     MMI |         32.0 |         16.6 |
|     Either |         49.1 |         26.4 |
|     (N) |         (594) |         (449) |

## Prevalence of DSM-IV serious mental illness (SMI) and mild-moderate mental illness (MMI) 4-6 months after Hurricane Katrina

## Prevalence of DSM-IV post-traumatic stress disorder (PTSD) 4-6 months after Hurricane Katrina in sub-samples defined by SMI and MMI and in the total sample

|  | New Orleans Metro  | Remainder of Affected Area |
| --- | --- | --- |
|  | % | % |
|  |  |  |
|     SMI |         98.1 |         89.7 |
|     MMI |         42.5 |         30.9 |
|     Either |         30.3 |         16.3 |
|     (N) |         (594) |         (449) |

## Prevalence of DSM-IV post-traumatic stress disorder (PTSD) 4-6 months after Hurricane Katrina in sub-samples defined by SMI and MMI and in the total sample

## Demographic correlates of PTSD and other DSM-IV mental disorders

|  | New Orleans Metro |  | Remainder of 
Affected Area |  |
| --- | --- | --- | --- | --- |
|  | PTSD | Other | PTSD | Other |
|  |  |  |  |  |
| Age < 60 | x |  |  | x |
| Previously
Married | x |  | x | x |
| Non-Hispanic 
White |  | x | x |  |
| Pre-hurricane
Unemployed | x |  | x | x |

## Demographic non-correlates of PTSD and other DSM-IV mental disorders

- Sex
- Income
- Education

## Prevalence of trauma stressors

|  |  | New Orleans Metro
% | Remainder of 
Affected Area
% |
| --- | --- | --- | --- |
|  |  |  |  |
| Had to be rescued |  |   1.1 | 0.9 |
| Victimized |  | 11.8 | 5.4 |
| Death of friend or family member |  | 21.3 | 7.4 |
| Friend or family member victimized |  | 19.3 | 9.3 |
| Any trauma  |  | 39.2 | 17.0 |
|  |  |  |  |
| (N) |  | (594) | (449) |

## Prevalence of trauma stressors

## Prevalence of other stressors

|  |  | New Orleans Metro
% | Remainder of 
Affected Area
% |
| --- | --- | --- | --- |
|  |  |  |  |
| Property loss |  | 70.2 | 47.8 |
| Income loss |  | 28.3 | 20.0 |
| Housing adversity |  | 71.7 | 34.1 |
| Physical adversity |  | 46.3 | 33.6 |
| Psychological adversity   |  | 29.2 | 21.1 |
| Any other stressor |  | 90.0 | 79.0 |
|  |  |  |  |
| (N) |  | (594) | (449) |

## Prevalence of other stressors

## Distribution of stressors

|  |  | New Orleans Metro
% | Remainder of Affected Area
% |
| --- | --- | --- | --- |
|  |  |  |  |
| One or more |  | 91.9 | 81.7 |
| 0 |  |   8.1 | 18.3 |
| 1 |  | 12.8 | 31.7 |
| 2 |  | 19.5 | 22.5 |
| 3   |  | 16.4 |   9.9 |
| 4 |  | 15.4 |   7.6 |
| 5 |  | 27.8 | 10.1 |
|  |  |  |  |
| (N) |  | (594) | (449) |

## Distribution of stressors

## Dissociations (odds-ratio) of stressor exposure with odds of PTSD and other DSM-IV mental illness 4-6 months after Hurricane Katrina

|  |  | PTSD | OTHER |
| --- | --- | --- | --- |
|  |  | OR | OR |
| I.  New Orleans Metro |  |  |  |
|             Any stressor  |  | 3.5 | 6.2* |
|             Illness / injury |  |  2.7* | 7.4* |
|             Physical adversity |  |  7.9* | 3.2* |
|  |  |  |  |
| II. Remainder of Affected Area |  |  |  |
|             Any stressor |  | 1.7 | 1.5 |
|             Property loss |  |  5.6* |  2.9* |
|  |  |  |  |
|        * Significant at the .05 level, two-sided test |  |  |  |

## Specifications

- No evidence that differential exposure to stressors explains demographic associations
- No consistent evidence of differential vulnerability to stressor effects on PTSD or other DSM-IV mental illness as a function of demographics

## Next Steps

- Differential vulnerability to stressor effects due to pre-existing vulnerability assessed at baseline (diagnosis of mental illness, low social support, personality)
- Effects of stressor exposure on course of mental illness (in follow-up surveys)

## Weighted distribution of Katrina respondents by counselor type and mental illness

- 		                       SMI     MMI    Neither   Total
- 					_%_        _%_         _%_           _%_
- Prevalence of disorder
- MH Specialty
- General Medical
- Human Services
- Any

## Weighted distribution of Katrina respondents by counselor type and mental illness

- 		                       SMI     MMI    Neither   Total
- 					_%_        _%_          _%_          _%_
- Prevalence of disorder     11.3    19.9       68.8	 100.0
- MH Specialty
- General Medical
- Human Services
- Any

## Weighted distribution of Katrina respondents by counselor type and mental illness

- 		                       SMI     MMI    Neither   Total
- 					_%_        _%_          _%_          _%_
- Prevalence of disorder     11.3    19.9       68.8	 100.0
- MH Specialty
- General Medical
- Human Services
- _Any__	__	__	__         46.5    23.0       8.6        15.7_

## Weighted distribution of Katrina respondents by counselor type and mental illness

- 		                       SMI     MMI    Neither   Total
- 					_%_        _%_          _%_          _%_
- Prevalence of disorder     11.3    19.9       68.8	 100.0
- MH Specialty		         19.5     4.7         1.8        4.4
- General Medical
- Human Services
- _Any__	__	__	__         46.5    23.0       8.6        15.7_

## Weighted distribution of Katrina respondents by counselor type and mental illness

- 		                       SMI     MMI    Neither   Total
- 					_%_        _%_          _%_          _%_
- Prevalence of disorder     11.3    19.9       68.8	 100.0
- MH Specialty		         19.5     4.7         1.8        4.4
- General Medical               28.4    19.5        5.7       11.0
- Human Services
- _Any__	__	__	__         46.5    23.0       8.6        15.7_

## Weighted distribution of Katrina respondents by counselor type and mental illness

- 		                       SMI     MMI    Neither   Total
- 					_%_        _%_          _%_          _%_
- Prevalence of disorder     11.3    19.9       68.8	 100.0
- MH Specialty		         19.5      4.7        1.8         4.4
- General Medical                28.4   19.5        5.7       11.0
- Human Services               10.9      3.1        1.5         2.9
- _Any__	__	__	__         46.5    23.0        8.6       15.7_

## Treatment patterns for emotional problems since Hurricane Katrina as a function of 30-day mental illness

- 			            SMI      MMI      Neither      Total
- 			                 _%_          _%_             _%_             _%_
- Psychotherapy only        9.2        4.7	  2.5           3.7
- Pharmacotherapy only  22.5      11.6         5.8           8.8
- Both			      14.8       6.6          0.6           3.4
- _Either                            46.5       23.0         8.9         15.9_

## Current continuation of psychotherapy for emotional problems since Hurricane Katrina as a function of 30-day mental illness

- 			            SMI      MMI      Neither      Total
- 			                 _%_          _%_             _%_             _%_
- Psychotherapy only      17.9      73.0	  6.7          26.4
- Both			     87.3      18.9         29.9         53.9
- _Either                            60.8      41.0         10.9         39.5_

## Current continuation of pharmacotherapy since Hurricane Katrina as a function of 30-day mental illness

- 			             SMI      MMI      Neither      Total
- 			                  _%_          _%_             _%_             _%_
- Pharmacotherapy only  95.5     96.8	  95.0         95.6
- Both			      71.1     86.9         97.4          80.3
- _Either                             85.9     93.2         95.2          91.4_

## Current continuation of any therapy since Hurricane Katrina as a function of 30-day mental illness

- 			             SMI      MMI      Neither      Total
- 			                  _%_          _%_             _%_             _%_
- Ever used both, still
- using either or both       100.0     87.9	  100.0        95.3
- Ever used either, still
- _using either or both         74.6     74.4         77.1         82.9_

## Pharmacotherapy for emotional problems since Hurricane Katrina as a function of 30-day mental illness

**	****	****	****	****	****SMI****	****MMI****	****Neither****	****    Total**
**	****	****	****	****	****  **_**%**_**             **_**%**_**               **_**%**_**               **_**%**_
**I. Medications for emotional **
**problems**
**	****Any medication**
**II. Proportional distribution of**
**medication among those taking**
**	****Anti-depressants**
**	****Anti-psychotics**
**	****Benzo**
**	****Mood stabilizer**
**	****Non-benzo anxiolytic**
**	****Non-benzo hypnotic**
**	****Other**

## Pharmacotherapy for emotional problems since Hurricane Katrina as a function of 30-day mental illness

**	****	****	****	****	****SMI****	****MMI****	****Neither****	****    Total**
**	****	****	****	****	****  **_**%**_**             **_**%**_**               **_**%**_**               **_**%**_
**I. Medications for emotional **
**problems**
**	****Any medication****	****	**** 37.4****	****18.3             6.3****	****     12.2 **
**II. Proportional distribution of**
**medication among those taking**
**	****Anti-depressants**
**	****Anti-psychotics**
**	****Benzo**
**	****Mood stabilizer**
**	****Non-benzo anxiolytic**
**	****Non-benzo hypnotic**
**	****Other**

## Pharmacotherapy for emotional problems since Hurricane Katrina as a function of 30-day mental illness

**	****	****	****	****	****SMI****	****MMI****	****Neither****	****    Total**
**	****	****	****	****	****  **_**%**_**             **_**%**_**               **_**%**_**               **_**%**_
**I. Medications for emotional **
**problems**
**	****Any medication****	****	**** 37.4****	****18.3             6.3****	****     12.2 **
**II. Proportional distribution of**
**medication among those taking**
**	****Anti-depressants****	****	****37.6          79.8            65.7           60.2**
**	****Anti-psychotics****	****	****  5.1            3.0              0.0             2.7**
**	****Benzo                                                34.5         17.9            35.9           30.1**
**	****Mood stabilizer                                 14.3           2.6              0.3             5.8**
**	****Non-benzo anxiolytic                         0.0           0.4              0.3             0.2**
**	****Non-benzo hypnotic****	**** ****	****   8.2           6.7              0.9             5.1**
_**	**__**Other**__**	**__**	**__**	**__**	**__**   0.0           0.0             11.1            4.0**_

## Continuation of psychotherapy as a function of length of visits, number of visits, and presence of pharmacotherapy

- 	Proportion of psychotherapy cases by length and number of visits
- 			Number of Psychotherapy Visits
- 			     1-2	  3-7	8+      Total
- 			      _%_       _%_       _%_         _%_
- _Length of visits_
- < 10 Minutes
- 10-29 Minutes
- 30+ Minutes
- Total

## Continuation of psychotherapy as a function of length of visits, number of visits, and presence of pharmacotherapy

- 	Proportion of psychotherapy cases by length and number of visits
- 			Number of Psychotherapy Visits
- 			     1-2	  3-7	8+       Total
- 			      _%_       _%_       _%_          _%_
- _Length of visits_
- < 10 Minutes
- 10-29 Minutes
- 30+ Minutes
- _Total                      63.8    27.3    8.9     100.0_

## Continuation of psychotherapy as a function of length of visits, number of visits, and presence of pharmacotherapy

- 	Proportion of psychotherapy cases by length and number of visits
- 			Number of Psychotherapy Visits
- 			     1-2	  3-7	8+       Total
- 			      _%_       _%_       _%_          _%_
- _Length of visits_
- < 10 Minutes			             7.9
- 10-29 Minutes			           21.2
- 30+ Minutes                                            70.9
- _Total                      63.8    27.3    8.9     100.0_

## Continuation of psychotherapy as a function of length of visits, number of visits, and presence of pharmacotherapy

- 	Proportion of psychotherapy cases by length and number of visits
- 			Number of Psychotherapy Visits
- 			     1-2	  3-7	8+       Total
- 			      _%_       _%_       _%_          _%_
- _Length of visits_
- < 10 Minutes	      7.4     0.4	0.0         7.9
- 10-29 Minutes	    15.9	   3.3	1.9       21.2
- 30+ Minutes          40.5    23.5    7.0       70.9
- _Total                      63.8    27.3    8.9     100.0_

## Weighted distribution of Katrina respondents who felt they may need professional counseling by mental illness and reasons

- 				  SMI	  MMI	  Neither     Total
- 				   _%_          _%_             _%_	        _%_
- Need Treatment
- _Reasons not_
- Any Need
- Any Enabling
- Any Predisposing
- Total

## Weighted distribution of Katrina respondents who felt they may need professional counseling by mental illness and reasons

- 				  SMI	  MMI	  Neither     Total
- 				   _%_          _%_             _%_	        _%_
- Need Treatment              47.9       35.9         5.0          13.7
- _Reasons not_
- Any Need
- Any Enabling
- Any Predisposing
- Total

## Weighted distribution of Katrina respondents who felt they may need professional counseling by mental illness and reasons

- 				  SMI	  MMI	  Neither     Total
- 				   _%_          _%_             _%_	        _%_
- Need Treatment              47.9       35.9         5.0          13.7
- _Reasons not_
- Any Need		 10.0
- Any Enabling		 86.4
- Any Predisposing            19.8
- Total			 97.8

## Weighted distribution of Katrina respondents who felt they may need professional counseling by mental illness and reasons

- 				  SMI	  MMI	  Neither     Total
- 				   _%_          _%_             _%_	        _%_
- Need Treatment              47.9       35.9         5.0          13.7
- _Reasons not_
- Any Need		 10.0  	  20.8
- Any Enabling		 86.4       68.5
- Any Predisposing            19.8	  18.7
- Total			 97.8       88.6

## Weighted distribution of Katrina respondents who felt they may need professional counseling by mental illness and reasons

- 				  SMI	  MMI	  Neither     Total
- 				   _%_          _%_             _%_	        _%_
- Need Treatment              47.9       35.9         5.0          13.7
- _Reasons not_
- Any Need		 10.0  	  20.8	    37.3 	       22.6
- Any Enabling		 86.4       68.5        35.8         64.1
- Any Predisposing            19.8	  18.7        27.4         21.4
- _Total__	__	__	__ 97.8       88.6        99.1         93.8_

## Weighted distribution of Katrina respondents who dropped out of receiving psychotherapy by mental illness and reasons

- 				      SMI	      MMI	         Neither        Total
- 				        _%_          _%_              _%_	      _%_
- Dropped out of treatment
- _Reasons for dropping out_
- Any Need
- Any Enabling
- Any Predisposing
- Total

## Weighted distribution of Katrina respondents who dropped out of receiving psychotherapy by mental illness and reasons

- 				      SMI	      MMI	         Neither        Total
- 				        _%_          _%_              _%_	     _%_
- Dropped out of treatment     39.2      59.0          89.1            60.5
- _Reasons for dropping out_
- Any Need
- Any Enabling
- Any Predisposing
- Total

## Weighted distribution of Katrina respondents who dropped out of receiving psychotherapy by mental illness and reasons

- 				      SMI	      MMI	         Neither        Total
- 				        _%_          _%_              _%_	     _%_
- Dropped out of treatment     39.2      59.0          89.1            60.5
- _Reasons for dropping out_
- Any Need                              0.0
- Any Enabling                       89.3
- Any Predisposing                11.1
- Total                                    94.2

## Weighted distribution of Katrina respondents who dropped out of receiving psychotherapy by mental illness and reasons

- 				      SMI	      MMI	         Neither        Total
- 				        _%_          _%_              _%_	     _%_
- Dropped out of treatment     39.2      59.0          89.1            60.5
- _Reasons for dropping out_
- Any Need                              0.0       60.8
- Any Enabling                       89.3      31.8
- Any Predisposing                11.1        3.5
- Total                                    94.2      96.2

## Weighted distribution of Katrina respondents who dropped out of receiving psychotherapy by mental illness and reasons

- 				      SMI	      MMI	         Neither        Total
- 				        _%_          _%_              _%_	     _%_
- Dropped out of treatment     39.2      59.0          89.1            60.5
- _Reasons for dropping out_
- Any Need                              0.0       60.8	          75.7	   52.3
- Any Enabling                       89.3      31.8	          22.3	   41.9
- Any Predisposing                11.1        3.5           1.1              4.4
- _Total                                    94.2      96.2           98.4            96.7_

## Predictors of obtaining and staying in treatment

-     A number of demographic variables are related both to a low probability of obtaining treatment and to a high probability of dropping out of treatment once treatment is obtained, leading to very low rates of current treatment compared to other people with comparable need.  These include:
- Young age (18-39)
- Racial-ethnic minority status
- Never married

## Predictors of obtaining and staying in treatment

-      A number of other demographic variables are, somewhat surprisingly, not related to either probability of obtaining treatment or to dropping out of treatment.  These include:
- Gender
- Income
- Pre-hurricane residence (New Orleans Metro, Other Louisiana, Alabama, Mississippi)
- Post-hurricane residential change (residing in same town as before hurricane, same county, same state, different state)

## Predictors of obtaining and staying in treatment

- Although people with insurance are more likely than those without to obtain treatment
- People in treatment with insurance are more likely than those without to drop out of treatment.  It is unclear why this is the case.

## 

www.HurricaneKatrina.med.harvard.edu

- www.HurricaneKatrina.med.harvard.edu