Hurricane Maria had a significant impact on the mental health of Puerto Rican children, according to a new study.
The hurricane hit the island on Sept. 20, 2017, and researchers surveyed public school students on how it impacted them between Feb. 1 and June 29, 2018. The study, conducted by the Puerto Rico Department of Education, the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool and the Medical University of South Carolina (MUSC), found that more than 7% of youths reported symptoms attributable to post-traumatic stress disorder after the storm.
As a result of the natural disaster, 83.9% of youths saw houses damaged, 57.8% had a friend or family member leave the island, 45.7% reported damage to their own homes, 32.3% experienced food shortages, 29.9% believed their lives were at risk and 16.7% still had no electricity five to nine months after the hurricane.
The study’s author, Rosaura Orengo-Aguayo, M.D., assistant professor in MUSC's department of psychiatry and behavioral sciences, and her colleague Regan Stewart, M.D., assistant professor in the department, said they were surprised by the magnitude of disaster exposure that the children of Puerto Rico experienced.
“We know from prior literature that these are all significant risk factors for developing mental health concerns long-term. Additionally, the fact that all children endorsed significant disaster exposure, regardless of where they were on the island, speaks to how Maria severely impacted the entire island,” Orengo-Aguayo told FierceHealthcare.
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In general, up to one-third of children within one year of a natural disaster will develop chronic symptoms such as PTSD, depression, anxiety, substance abuse, suicidal ideation and aggressive behaviors, and the aftermath in Puerto Rico was no different, according to the study.
However, unlike most disasters, the effects on mental health appear to be equal regardless of children’s geographical location or socioeconomic status in Puerto Rico. Plus, the implications were compounded by the mass exodus of people leaving the island.
Hurricane Georges hit Puerto Rico on September 21, 1998, with the potential for similar hurricane-related stressors, but reportedly only 0.8% of the population experienced PTSD, according to the study. This current study hypothesizes that the differences could be attributed to the fact that Hurricane Georges was a category 3, not 4, hurricane or that the data were collected further in the aftermath, 18 months after the storm.
Comparison with studies conducted after other mainland U.S. disasters, with findings ranging between 13% and 30%, indicates the rates of likely PTSD after Hurricane Maria were on the lower end.
“This suggests that Puerto Rican children may have experienced protective factors that we did not include in this survey. Future studies should examine protective factors such as long-term social support, cultural values such as ‘familismo’ which places a strong value on family, among others,” Orengo-Aguayo said.
“The results of this needs assessment are helping inform targeted and sustainable evidence-based practices aimed at improving mental health outcomes for Puerto Rico’s youths after Hurricane Maria,” the study concluded.
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So what can be done to mitigate the psychological aftermath of a disaster?
In an accompanying editorial, David Schonfield, M.D., a member of the USC National Center for School Crisis and Bereavement and the department of pediatrics at Children’s Hospital Los Angeles, writes that the results of the Puerto Rico study were compared to a similar one conducted six months after September 11, 2001, in New York City public schools. The prevalence of PTSD at the time was 10.6%, a bit higher.
But Schonfield notes that given the natural tendency for people to avoid thinking about a traumatic event, it is likely some affected Puerto Rico students elected not to participate in the study. As many as 90% of students participated in the Sept. 11 survey, more than twice the 42.4% that participated in Puerto Rico.
Plus, Schonfield notes that a natural disaster is not a single, isolated event and that it generally causes second stressors in people later on.
“The findings should prompt all pediatricians and other child health care professionals to become prepared to provide psychosocial support to children and families after a disaster—which can occur in any community,” he stated.
“Hopefully, they will be able to continue to obtain data to track the recovery of these students and be able to demonstrate not only the significant morbidity attributable to the mental health effect of this disaster, but also some evidence that the United States stepped up to ensure that effective interventions and support were consistently provided to mitigate these effects,” Schonfield added.
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Orengo-Aguayo agrees that the results of this survey show the need for evidence-based, trauma-focused treatments for youth post-disaster. Plus, it demonstrates that a one-size-fits-all approach won’t work, she said.
“The literature tells us that we need to have a ‘multi-tiered’ approach in which children with low, moderate and severe symptoms can receive adequate services,” Orengo-Aguayo said. “Our team is continuing its collaboration with the Puerto Rico Department of Education over the next three years, offering trainings on evidence-based trauma-focused treatment to help meet the mental health needs of children in Puerto Rico post-Maria.”