The Hurricane Choir: Remote Mental Health Monitoring of Participants in a Community-based Intervention in the post-Katrina Period

Introduction

Natural disasters such as the hurricanes that struck the coast of southern Louisiana, Mississippi, and Texas in 2005 are synonymous with the destruction of the physical environment and the depletion of material assets of individuals and whole communities. They are unique in that the widespread destruction they cause often results in collective trauma in which whole communities find themselves engulfed in severe shock.¹ In the case of the 2005 hurricane season, the rapid succession of a number of large and destructive hurricanes is likely to have intensified the psychological impact of the disasters, as infrastructure that survived previous storms was destroyed, rebuilding efforts were restricted, and stressors on survivors were exacerbated and drawn out over a long period.

Typically, post-disaster stress symptoms include (among others) recurrent nightmares, intrusive memories, hypervigilant arousal, impaired concentration, depression, emotional detachment from others, and disengagement from parts of life that were previously rewarding.^1,2 With exposure to such severe psychological distress, post-traumatic stress disorder (PTSD) can develop, having a severe impact on healthy functioning and making emergence from the effects of a disaster much more difficult.³ For example, David and colleagues⁴ demonstrated that 51% of survivors who were exposed to Hurricane Andrew developed a new-onset psychiatric disorder. Of these, PTSD was the most common (at 36%), followed by major depression (30%) and generalized anxiety disorder (11%). Moreover these researchers found significant co-morbidity, with 68% of PTSD sufferers also satisfying the clinical criteria for major depression.

In the case of the hurricane disaster of 2005, it is possible that the prevalence rates of psychological trauma are likely to be associated with the presence or absence of community risk factors. Prior to Hurricane Katrina, data from the U.S. Census (2000) highlighted the fact that New Orleans had an 18% poverty rate and was one of the poorest metropolitan centers in the country.⁵ Nationally, New Orleans was ranked in the bottom 20% for the educational qualifications of its residents. Class and race divisions were prevalent, with two thirds of the Black population living in the inner city of New Orleans in contrast to a predominantly White suburban population. In short, the region of New Orleans was growing slowly, struggling with issues such as segregation, concentrations of chronic poverty in Black communities, and underemployment.⁶ Given these disadvantages, it is probable that the region was particularly ill-equipped to tackle the devastating impact of Hurricane Katrina.

The Hurricane Choir

Being a member of a functional community can have broad benefits to mental health.^7–11 As suggested by Norris and colleagues, it is necessary to develop ongoing assistance and interventions that provide mental health care to disaster victims in a way that is "culturally appropriate and feasible."^12,p.291 Given the musical heritage of South Louisiana, a culturally appropriate community initiative in the post-hurricane period was a choir, organized by Australian choral leader Martin Meader in Baton Rouge, Louisiana. The choir (called the Hurricane Choir) comprised hurricane disaster evacuees and survivors who rehearsed and performed to live audiences. The choir commenced six months after the hurricane disasters and had a 12-week intensive rehearsal period that culminated in three public performances in the American Spring of 2006. Rehearsals were held three times a week in local churches, community centers, and evacuee villages.

The organizers of the Hurricane Choir were keen for the mental health outcomes of choir participants to be monitored during rehearsals. Subsequently, researchers from Sentiens, an Australian health care company, and the University of Western Australia were invited by the choir organizers to collaborate in the project and develop a strategy to track the mental health outcomes of choir participants.

Ours was a naturalistic research project and we did not attempt to influence the planning and processes involved with the formation of the choir. A web-based monitoring system...