The surveys were administered at nine public sites – including libraries, a laundromat, a café and a bus station – in an effort to capture the racial and socioeconomic diversity across the low-income, predominantly Black city. The researchers conducted surveys in late 2019 as part of the Flint Community Engagement Project, a longitudinal study started in 2017 for which Ezell, a native of the Flint area, serves as principal investigator. Even several years after the city switched back to its original water source in 2016, the researchers said, federal, state and local government guidance, and guidance from healthcare practitioners in the city, about tap water safety remained ambiguous and often contradictory. Ezell and Chase found that more than half the respondents were never screened for elevated blood lead levels, but that Black residents were nearly twice as likely to seek screening as whites – possibly an indication that they perceived a higher threat level, Ezell said, similar to the gap in threat perception seen across race in relation to COVID-19’s severity.
“If you don’t trust your water and you actively avoid it over persistent concerns on its safety, that’s a stark form of psychological trauma in and of itself,” said Jerel Ezell, assistant professor in the Africana Studies and Research Center in the College of Arts and Sciences. Nearly half the survey respondents reported experiencing skin rashes and more than 40% experienced hair loss, among physical symptoms associated with elevated levels of bacteria and heavy metals in water. More than a quarter of respondents reported symptoms of depression or anxiety, and nearly a third had PTSD symptoms specifically related to the water crisis.
Ezell and Elizabeth Chase, a doctoral student at the University of Michigan School of Public Health, are co-authors of “A Population-Based Assessment of Physical Symptoms and Mental Health Outcomes Among Adults Following the Flint Water Crisis,” published March 31 in the Journal of Urban Health. In a survey of more than 300 residents, 10% reported having been diagnosed by a clinician with elevated blood lead levels – well above national averages – after a state-appointed city manager, as part of a cost-saving measure, switched the city’s water source to one that became contaminated with lead and harmful bacteria on April 25, 2014.
The authors acknowledged limitations to the study, including that the survey sample was not randomly selected and that symptoms were self-reported and could have been affected by recall bias. Factors other than water contamination, they cautioned, could have contributed to elevated blood lead levels and other reported symptoms. The data nonetheless suggests, Ezell said, that Flint’s adult residents experienced significantly more adverse health symptoms during and in the years after the water crisis’ initiation than would be expected from the city’s population. The results – 26.3% of residents exhibited depressive or anxious symptoms, and 29% met criteria for trauma – revealed “a steep and broad mental health toll,” the researchers said.
The study used validated surveys to measure feelings of depression or anxiety and of post-traumatic stress disorder, as was observed in New Orleans after Hurricane Katrina and more recently in Puerto Rico after Hurricane Maria. They asked, for example, if respondents had persistent and ongoing thoughts about the quality of their tap water, or if they blamed themselves or someone else for the city’s water crisis. Nearly 60% of Black respondents reported skin rashes beyond what they considered normal before the crisis, compared with 33.9% of whites. Black residents also reported significantly higher percentages of hair loss, nausea and emotional agitation. The more physical symptoms one reported, the study determined, the more likely they were to report psychological symptoms.
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