Objective:  The Hurricane Katrina disaster provides a model to study pregnant women affected by a chronic stressful life course. Over the past 6 years, women in this study lived through a catastrophic disaster, family and home disruption, relocation to temporary communities, followed by a move back to New Orleans to live. Women who became pregnant after the return to New Orleans also negotiated the stresses of living in the recovering communities with reduced access to health care and neighborhood instability. Immigrant women who moved into the city during the recovery period also faced a more stressful environment. Data is needed to describe what contribution the long-term effects disaster recovery experiences have on maternal stress and mental health risks.

Design:  Cross-sectional, descriptive study

Setting: Recruitment and data collection occurred at community prenatal care clinics, Healthy Start, and hospital prenatal classes in the Greater New Orleans area.

Patients/Participants: Prenatal women (n=222, 24-40 weeks gestation), currently enrolled in prenatal care and living in the Greater New Orleans area.

Methods: Measures analyzed included previous disaster exposure, perception of disaster recovery, depression (Edinburgh Depression Scale), post-traumatic stress disorder (Post-traumatic Checklist), and pregnancy-related distress (Lobel scale). Linear regression was used to model mental health outcomes, with adjustment for race, marital status, education, employment, age, and smoking.

Results:  Women were predominately African American (70%), single (72%) and with income <$15,000/year (58%).  Disaster exposure was moderately high: 29% walked through flood waters; 61% had some or enormous damage to their homes; and 10% saw someone die.  Mental health measures indicated 56% scored “at risk” for depression (EDS>8), while 11% were likely experiencing PTSD. Women who reported high exposure to Katrina scored significantly higher on the PTSD and pregnancy-related distress scales, and feeling that one’s life was still disrupted (36%) was strongly associated with depression and pregnancy-related distress (p<0.01), even after adjustment for experience of the hurricane. Life style practices such as smoking (14%) was associated with depression and higher perceived stress (p<0.01).  Higher social support, optimism about the future, and use of massage were associated with better mental health.

Conclusion/Implications for nursing practice: Both past exposure to hurricane disaster and current recovery status contribute to mental health problems. Pregnant women with a history of disaster exposure need ongoing mental health assessment and prenatal care that addresses this risk. Lifestyle choices such as smoking require further intervention to prevent perinatal risks.

Keywords: Disaster, PTSD, stress, perinatal depression