Depression caused by the devastating May 22 tornado has been linked by medical experts to three suicides and a significant increase in mental health issues in this Missouri city.
Officials at the Freeman Hospital's mental health center said calls to its crisis hot line have quadrupled since the storm, many involving post-traumatic stress disorder or PTSD.
They said three suicides have been tied directly to the tornado and that 40 other people treated for depression have acknowledged suicidal thoughts.
Judy Lauck, a behavioral health nurse, said seven weeks after the tornado that killed 158 the shock has worn off but agitation, anxiety and stress are affecting the survivors.
"They don't have a home," Lauck said. "They don't have a job. They have lost their place of business. They're dealing with a lot of uncertainty."
Patricia McGregor, a private practice psychologist, said even those residents who lived in that part of Joplin not struck by the tornado are experiencing problems.
"I am seeing people who consider themselves not impacted by it, but they are having post-trauma experiences and they feel guilty about it," said McGregor.
"They did not lose their house, but their neighbor did. They did not lose their job, but someone they know did. That's survivor guilt."
McGregor said people who had mental health issues before the tornado are finding them magnified by the post-storm depression — issues such as domestic violence, marital strife and family dysfunction.
"We should expect to see an increase in those kinds of things," she said. "We've moving out of the shock and denial phase into the, 'Oh, my God. This is going to last forever' phase."
Freeman Hospital's mental health center is reaching out to residents in need under a crisis intervention program titled, "Healing for Joplin." The program is funded by the Federal Emergency Management Agency.
The state has also provided $2million to estalbish the Joplin Child Trauma Treatment Center for children and families affected by the tornado.
Dr. Charles Graves, a psychiatrist at Freeman Hospital, said he is especially concerned with the community's children.
"Some may refuse to return to school," he said. "Some may have persistent fears related to the catastrophe, including sleep disturbances, nightmares, bed wetting, changes in the way they concentrate, and irritability. Some will be easily startled or spooked. Some will have behavioral problems where none were before."
Graves said these are normal reactions in children "but when it persists for a month or longer, when the symptoms impair function, what's when you call things a disorder. That's when you need therapeutic intervention."
Both children and adults can suffer from post-traumatic stress disorder after a tornado as ravaging as the one that wiped out one-third of Joplin, said Graves.
"PTSD is not a diagnosis that is only associated with war," he said. "It very readily can occur after an event of this magnitude. (Victims) have flashbacks, intrusive memories of nightmares. They may feel like it's happening to them again."