Prevalence and predictors of posttraurnatic stress disorder among hemodialysis patients following Hurricane Katrina

Background: Patients with end-stage renal disease reliant on maintenance hemodialysis therapy. may be particularly susceptible to developing post-traumatic stress disorder (PTSD) after natural disasters. Study Design: Cross-sectional study. Setting & Participants: Patients who received treatment at 9 New Orleans, LA, metropolitan area hemodialysis units before Hurricane Katrina made landfall on August 29, 2005, were recruited for the study. Overall, 391 patients completed the interview between April and October 2006 (participation rate, 85.6%). Predictors: Demographic, dialysis-related, and evacuation characteristics. Outcomes & Measurements: PTSD was assessed by using the 17-item PTSD Checklist and defined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Results: Overall, 23.8% of hemodialysis patients reported symptoms consistent with PTSD. After adjustment for age and sex, black patients were 1.92 (95% confidence interval, 1.31 to 2.83) times more likely than whites to have PTSD. After age, race, and sex adjustment, PTSD was more common in hemodialysis patients who were in their first 2 years of treatment, were evacuated fewer than 2 days before the hurricane made landfall, were evacuated initially to a shelter, and missed 3 or more dialysis treatments because of Hurricane Katrina and its aftermath. Additionally, patients who remained displaced for 3 or more months were more likely to have PTSD. Limitations: Data were not available to distinguish between the presence of acute, chronic, or delayed-onset PTSD. Conclusions: A substantial proportion of hemodialysis patients had PTSD symptoms approximately 1 year after Hurricane Katrina. Emergency planning for hemodialysis patients should include the identification and treatment of PTSD after future disasters.