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Katrina continues to take a toll on the mental and physical health of storm survivors and others, including volunteers and rebuilders. How big that toll is, one year later, is uncertain. No one agency has begun the long-term overview studies, although some are expected this autumn.

The one certainty is that health issues will continue, likely to a lesser degree, although the jury is still out on depression and post-traumatic distress. The one-year anniversary is considered a trigger for enhanced or newly surfaced psychological problems.

On the physical front, broken bones, falls and head injuries from house repairs; gastrointestinal problems; neglected annual check-ups; depression from loss and change; substance abuse; neglected exercise; and poor eating habits are among post-Katrina issues physicians and mental-health experts talk about.

But there’s this encouraging news from the Mississippi Department of Health, reported by state epidemiologist Dr. Mills McNeil:

“The disease-surveillance program put into place in the aftermath of Hurricane Katrina confirmed that no major outbreaks of communicable diseases or clusters of preventable major injuries occurred as a result of the hurricane. In addition, the number of reportable diseases and conditions reported to the Mississippi Department of Health remains essentially unchanged from levels seen prior to Hurricane Katrina.”

It’s the other health picture, the one that excludes reportable diseases such as cholera feared in Katrina’s wake, that Coast doctors now concentrate on.

The youngest are of particular concern.

“No one knows for sure the long-term effect on children, but physically kids seem to be doing OK,” said Bay St. Louis, Miss., pediatrician Dr. Scott Needle. “Mentally, I think we’ll see more problems. Children are resilient and they’ll follow the lead of adults. Even with that, we’re going to have some kids, by the nature of what they’ve been through, have flashbacks.”

For adults, the stress of juggling so many decisions and change continues taking its toll, causing psychologists to quote an observation of concentration-camp survivor Viktor Frankl: “An abnormal reaction to an abnormal situation is normal behavior.”

“We certainly see some ongoing chronic stress, in terms of new cases of depression and anxiety problems in people who had no stress-related problems before the storm,” said Steve Barrileaux, director of the adult outpatient program at Gulf Coast Mental Health Center. “It’s new to them so they’re not sure what’s going on.

“People’s sense of safety and security were shattered. We’re supposed to be able to process what happened and move on with our lives but people are still in FEMA trailers, and dealing with insurance and finding places to live. I don’t mean to paint a bleak picture. The fact is that most of the mental-health symptoms people are experiencing are normal, predicted and time-limited.”

Medications, psychologists such as Barrileaux believe, can be appropriate for ongoing disaster recovery. He suspects one Harrison County, Miss., pharmacy is indicative across the Gulf Coast. That store compared the first three months of 2005 with 2006, which showed the sale of three popular drugs: the anti-depressant was up 26 percent; the sleeping pill, up 12.5 percent, and the anti-anxiety drug, up 10.5 percent.

Although they are needed shelter, the small FEMA trailers cause their own problems.

“The closeness and proximity inside can be wearing on people along with everything else they are putting up with,” said Raymond M. Scurfield, University of Southern Mississippi-Gulf Coast associate professor of social work.

Scurfield is recognized nationally for trauma studies and has written articles on Katrina’s myths, such as “my trauma was not as bad as what others suffered,” to triggers, such as the opening of hurricane season, to coping in the post-Katrina world. He and other psychologists talk about the fives stages of disaster recovery: heroic; tunnel vision; honeymoon; disillusionment; and reconstruction.

“I hear a lot of people who are now in the disillusionment stage of post-disaster recovery,” said Scurfield, whose university is applying for grants to research post-Katrina health implications. “They thought there was a light at the end of the tunnel and things keep dragging on.

“To explain how people respond, I draw a parallel with Mardi Gras. Some said we had to celebrate, to get back traditions and get rid of the doom and gloom, but some didn’t want to go to a parade.

“I think we will have a similar dichotomy on the one-year anniversary. You will have those who focus on how far we’ve come and others will see it as a benchmark of how far we have to go, and then there will be those who see both sides. There is room to argue that all these arguments have validity.”

Attempted suicides are another issue difficult to track, although health professionals suspect they are on the rise.

“When the (current) hurricane season began I had several suicide-attempt patients at the same time in ICU, and I was not the only doctor to comment on this,” said Dr. Scott Russell, medical director of Coastal Family Health, a group of 23 South Mississippi clinics for the uninsured and underinsured.

Nonspecific illnesses, sometimes dubbed by survivors as Katrina cough or crud, seem to have abated, although Coastal Family Health is still seeing rashes from people returning to Katrinaed property, as well as upper respiratory problems.

Post-Katrina links are difficult to prove.

“I can’t say there is a particular physical problem now that can be positively related to Katrina,” said Dr. George Ward, emergency-department director at Memorial Hospital at Gulfport. “I don’t know that we’re seeing anything that we normally wouldn’t see this time of year.

“People probably aren’t taking care of themselves as much as they used to. They are skipping check-ups and follow-up appointments because they are dealing a lot with finances and time-consuming things.”

Many have not fully returned to sensible pre-Katrina diets and exercise, observes gastroenterologist Dr. John D. McKee of Ocean Springs, Miss. He said bowel and gastroenterology problems linger for some survivors who were in water a long time.

“I also think the storm changed the way people eat — whatever they can easily grab — and there are problems associated with nutrition that we’ve seen,” McKee said. “But I think people are doing a lot better now and they are getting back on their routines.”

Katrina revisited

• Katrina: The Long Road Back, tonight at 7 p.m. on NBC. Brian Williams reflects on his experiences covering the storm, revisits Superdome refugees a year later, and reports on the community’s continued efforts to recover from the destruction.

• Katrina: 7 Days in September, Tuesday at 7 p.m. on History Channel. The story of the storm’s wrath from the viewpoint of the National Guard.

• When the Levees Broke: A Requiem in Four Parts, Tuesday at 7 p.m. on HBO. Director Spike Lee details the post-storm devastation.