In April 2010, the BP Deepwater Horizon oil platform exploded in the Gulf of Mexico, killing 11 people and unleashing the worst oil spill in U.S. history. Over the next five months, the damaged well spewed more than 200 million gallons of oil into the Gulf. That oil washed up on more than 600 miles of shoreline.
Fisheries were closed and tourism suffered, dealing an economic blow to Gulf Coast communities. Four years on, the economic and environmental effects linger. Psychologists are among those scrutinizing the mental health and behavioral effects of the disaster.
As part of the Deepwater Horizon Research Consortium, research groups at Louisiana State University, Tulane University, the University of Florida and the University of Texas Medical Branch at Galveston are studying the recovery and resiliency of individuals and communities affected by the spill. The five-year, $25.2 million program is funded by the National Institute of Environmental Health Sciences (NIEHS).
Unsurprisingly, a number of those projects center around physical health; as millions of barrels of oil spread through the Gulf, residents worried about the safety of the seafood they ate and the air they breathed. But it was clear from the outset that mental health was also at risk.
"We believe the biggest health impacts of the oil spill have been psychological," says Lynn Grattan, PhD, a psychologist at the University of Maryland who is leading a project for the University of Florida team to examine the recovery of Gulf Coast residents after the spill.
Lost income, increased distress
The consortium projects are ongoing, but Grattan's group has published findings that support her point. She and her colleagues compared mental health outcomes in two fishing communities: Baldwin County, Alabama, which was directly exposed to spilled oil, and Franklin County, Florida, which was indirectly affected though it never saw oil on its shores.
Both communities had sharply elevated levels of anxiety and depression after the tragedy, Grattan's team found. During the spill, between one-third and half of the population met the criteria for clinical depression — notably higher than the 10 percent to 11 percent base rate expected in those communities, she says (Environmental Health Perspectives, 2011).
That high rate of depression persisted a year after the spill. Two years post-spill, about 20 percent of the population was still depressed. It wasn't until three years after the spill that depression levels dropped back to near baseline, she says.
Loss of income was the biggest driver of mental health problems, Grattan and her colleagues found (Transactions of the American Clinical and Climatological Associationopens in new window, 2013). Among people with spill-related income loss, more than 83 percent experienced clinically significant depression one year after the spill, and more than 89 percent experienced clinically significant anxiety.
It wasn't only fisheries and tourism companies that suffered financially in the aftermath of the spill, says Grattan. "There was a snowball effect where local restaurants, stores, transportation and other areas of income were also disrupted," she says.
Higher levels of bitterness and anger were also associated with worse mental health outcomes, Grattan found. That's an important finding because oil spills and other human-made disasters tend to be associated with more bitterness and anger than natural disasters, she says. "Anger is a really strong driver of distress."
Past studies have also suggested that technological disasters may be harder to recover from than natural disasters, says Grattan's colleague Brian Mayer, PhD, a sociologist now at the University of Arizona. He is studying the same populations that Grattan is investigating, but focusing on community-level, rather than individual, resilience. Mayer has found signs of "community corrosion" in the wake of the spill, in the form of reduced emotional support and reduced sharing of information and resources. Similar outcomes were seen after other human-made calamities such as the 1989 Exxon Valdez oil spill in Alaska, he adds.
The decay in community bonds may be caused in part by the differing amounts of damage settlements BP was paying. As of last February, the company had paid out more than $11 billion to individuals and businesses. "One thing we observed very quickly was a growing distrust among people about whether or not someone got more than they deserved," Mayer says. That distrust contributed to a breakdown of the social support that's particularly crucial after a disaster.
Elsewhere in the Gulf, researchers have identified similar suspicions. At the University of Texas Medical Branch, epidemiologist Sharon Croisant, PhD, is collecting data about the physical and mental health, stress and resilience of Louisiana residents affected by the spill. Anecdotally, she's noticed a lot of distrust in institutionalized information, whether that's from the government, media reports or university researchers. "The [residents] believe their community has been damaged," she adds, "and a lot of them believe the Gulf will never be the same."
Multiple hits
Hardships in the Gulf of Mexico aren't exclusive to the oil spill, of course. When it comes to dealing with natural disasters in the region, Croisant says, "it's when, not if." In the last decade alone, the long-suffering Gulf Coast has seen major storms such as Hurricanes Katrina and Rita, declining fish stocks, coastal erosion and flooding in addition to the 2010 oil spill. "It's a cumulative mental health risk," she says.
And those multiple stressors are taking a toll. In her study populations in Florida and Alabama, Grattan found that people who had direct experiences with Hurricane Katrina had worse mental health outcomes following the spill.
At Tulane University, researchers are studying how repeated stressors, including the oil spill, affect the health and reproductive outcomes of pregnant women. As part of its consortium research, Tulane is focusing specifically on pregnant women and women of reproductive age, says Maureen Lichtveld, MD, MPH, principal investigator of the Tulane Consortium. That emphasis grew out of conversations with community members who were very concerned about what would happen to their babies, she says.
To that end, Lichtveld is reaching out to low-income, first-time pregnant mothers, hoping to improve their reproductive outcomes. The project combines two important components: community health workers and mobile health technology. The health workers are armed with tablet computers that allow them to collect survey data and access clinical information during visits with the women at multiple stages of pregnancy and up to six months after delivery. The participating moms also receive regular communications (such as reminders to take vitamins and make clinic appointments, and how to prepare for hurricane season) through their phones.
Part of that project will explore the role of culture in the women's health. New Orleans, for instance, is home to large African-American and Vietnamese populations as well as Cajuns, among other groups. The extent to which people feel they do or do not "belong" within their community's culture has previously been linked to chronic stress, Lichtveld says. She hopes to understand how cultural factors affect both individual and community resilience following a disaster like the oil spill.
It's a question that intrigues other researchers as well. "We talk about community as if we know what that means," says Croisant. "In reality there are thousands of communities embedded in every community."
Reaching out
Fortunately, the researchers have help in understanding those diverse populations. They work closely with numerous community partners, including mental health agencies, social service agencies, nonprofit organizations and churches. Those partnerships have allowed researchers to develop projects that address the communities' most pressing concerns. Just as important, the connections allow the investigators to share information that can directly improve residents' well-being.
"Our observation is that very few people have adequate access to health care and in most cases virtually no access to mental health care," Croisant says. "It's important that when we leave, community groups can use that information to advocate for better access to those services."
For instance, in the course of their research, Grattan and her colleagues identified a community with high rates of intimate partner violence and another with a spike in suicidal thoughts and attempts among high school students. Community partners are now using those data to apply for funding to target those specific issues, Grattan says.
The oil spill research will also help communities better prepare for the health impacts of future disasters. By contributing to that evidence base, Lichtveld says, "we can do what public health is all about — prevention."
NIEHS funding for the project will continue through 2016, and much of the research data are still being analyzed. Still, it's not too early to draw one big conclusion, says Lichtveld. "The health of the ecosystem is inextricably linked to the health of the community. You can't separate the two."
Kirsten Weir is a journalist in Minneapolis.
