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People gather at the St. Agnes Catholic church in Lac-Mégantic, Que, for a candlelight vigil in memory of train-derailment victims on July 12, 2013.MOE DOIRON/The Globe and Mail

About one-third of the people most severely harmed by the Lac-Mégantic train crash have sought help for mental illness in the past year, according to a public health study that examined the ongoing impact of the disaster.

The survey, conducted by public health officials for Quebec's Eastern Townships, evaluated the direct impact and mental health fallout of the crash of the runaway oil train on July 6, 2013. The report found few people in the region emerged unscathed from the disaster that killed 47 people.

An overwhelming 64 per cent of people in the region lost a loved one in the crash, while a quarter suffered material loss, such as a work interruption or a damaged home, the study of 800 subjects found. The study found about half the people in the region described themselves as suffering from heightened stress, lost sleep or a negative outlook on the future as a result of the crash.

Nearly one-in-five Lac-Mégantic residents suffered a death of a loved one, in combination with material loss and stress, creating a category of victim the study describes as "intensely exposed." Few people suffered more intense exposure than René Simard, a high school teacher who ran for his life chased by a flow of burning oil on the night of the disaster. Several of his friends died; he couldn't work for more than a year and was diagnosed with post-traumatic stress disorder.

"It's really touched everyone," said Mr. Simard, who is under the care of a psychologist and still suffers nightmares and jumps at loud noises. "That's part of what's difficult in Lac-Mégantic. It's one thing to be stressed and in mourning. It's another when the entire community is dealing with it."

The mental-health impact on those intensely exposed such as Mr. Simard was steepest: Half say they suffer from depression and 23 per cent from anxiety – both nearly double the rate for the untouched local population.

The study found people in the intense category were four times as likely to binge drink at least once a week and twice as likely to take medication. One-third of them sought help from a mental-health professional, nearly four times the rate for unaffected people.

"I think what was a revelation was how at all levels, depression, anxiety, alcohol consumption, there was a major impact," said Mélissa Généreux, head of the regional public health authority. "The findings are clear: Whether you look at human or material loss … the population of the area has suffered and is still suffering."

Dr. Généreux said Lac-Mégantic has benefited from two important health factors. Even before the accident, people had better-than-usual access to family doctors. Since the accident, the province has sent in teams of social workers and psychologists to help.

The teams have held 982 group-counselling sessions and 3,300 individual sessions for the 8,000 people in the area.

Dr. Généreux and Lac-Mégantic Mayor Colette Roy-Laroche urged the provincial government to continue with the effort despite Quebec's recent austerity push which has seen a host of services cut. "We need ongoing monitoring of the community's mental-health status," Ms. Roy-Laroche said. "This is going to take years."

The survey may have only scratched the surface, according to Mr. Simard. He says a lot of his friends and acquaintances still have a "taboo" about getting help for mental-health issues and have not yet sought help. "I honestly think this will take 10 years," he said.

In the months following the crash, Mr. Simard had terrible nightmares. He slept on his sofa fully clothed. His intense anxiety was eased by the idea he could flee at a moment's notice. "I'm still fragile, still jumpy, I still leap up to look out the window when the snow plow passes," he said.

But Mr. Simard has improved. He is under psychological care and takes prescribed medication. In September, he began a gradual return to work. He still sleeps on the couch, but is comfortable enough to take off his shoes and a few clothes. "And when visitors come, I'll sleep in my bed upstairs," he said. "It's a work in progress."