When the floodwaters recede, or the wildfire embers burn out and the ash blows away, talk of “recovery” often begins.
But a recent study published in JAMA following more than 96,000 Puerto Rican young people in the wake of Hurricane Maria shines a light on how the end of natural disasters spark the beginning of mental health crises—and how climate change could continue to feed that fire.
“In any natural disaster, you have to realize that one disaster causes a cascade of secondary losses and stressors,” David Schonfeld, a developmental-behavioral pediatrician at the University of Southern California, told The Daily Beast in a phone call. Schonfeld often travels to the site of disasters, and stresses that the mental health burden, especially on children, can last well beyond what one might expect.
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This is certainly the case in Puerto Rico. To study Hurricane Maria’s effects on mental health, Rosaura Orengo-Aguayo, an assistant professor at the Medical University of South Carolina, and a team of researchers administered a survey to every public school student in Puerto Rico between five and nine months after the storm. Out of 226,808 students, they received completed surveys from 96,108 students, ranging from grade 3 up to grade 12.
Over 7%, or about 7,000 students, reported symptoms of post-traumatic stress disorder that would be considered clinically significant. For comparison, about 5% of all U.S. adolescents will show signs of PTSD at some point, according to the National Institute of Mental Health; for adults, 3.6% of the population has had PTSD within the previous year.
When one considers what they went through, this shouldn’t be too surprising. More than eight in ten of the participating students saw houses damaged, 32.3% experienced shortages of food or water, and more than 16,000 of them (16.7%) still didn’t have electricity restored half a year after the storm. Some students lost friends, family members, or pets, and more than half had a friend of family member leave the island as a result of Hurricane Maria. All these and more are considered stressors for developing PTSD.
“Hurricane Maria impacted the island over the course of 24 hours but the aftermath of the hurricane (13-plus months without electricity for some kids, lack of access to food or water, inability to return to school and a normal routine, social disruption) continued to impact the mental health of children long after the hurricane passed,” Orengo-Aguayo said in an email.
Interestingly, that rate of PTSD is actually a bit lower than that seen in other similar studies in the past, which Orengo-Aguayo said has ranged from 13 to 30 percent. This could suggest that Puerto Rican children have certain supports that make them resilient to the stressors of the hurricane, such as the cultural value of familismo, which emphasizes family connections. It is also likely skewed by all those people who did leave the island—the study could only assess those who stayed, and people who left may actually have been the most heavily impacted by the storm. In other words, the results are likely an underestimate of the overall mental health burden.
Other studies have laid bare some of those lasting effects. Almost 15 percent of adults in an area affected by Hurricane Katrina showed signs of PTSD between five and seven months after the storm hit; that actually rose to above 20 percent one year later. Suicidal ideation also jumped over that period. Six months after Hurricane Sandy devastated the Jersey Shore and parts of New York, 14.5 percent met the criteria for PTSD and six percent experienced depression.
It’s not just storms, and it’s not just the U.S. One study of people who experienced 2009’s Black Saturday bushfires in Victoria, Australia, found a similar rate of PTSD, at 15.6 percent in a “highly affected” community. That survey was done three to four years after the fires took place.
“I don’t think we are ready for the coming tsunami of climate mental health impacts,” said Elizabeth Haase, a psychiatrist and a member of the steering committee for a group called the Climate Psychiatry Alliance, in an email. “We need to help people understand how to weather change, how to take care of their stress systems during and long after these events to lessen the long term impact.”
The best ways to prepare for and respond to the lasting mental health effects of disasters represents a clear gap in research as climate change continues to produce stronger storms, more extensive flooding, lengthened and worsened wildfire seasons, and more.
“We need to pay more attention to mental health consequences” of climate change, said Susan Clayton, a professor and chair of the psychology department at Wooster College in Ohio who co-authored a 2017 report on mental health and the changing climate.
Paying more attention means simply being aware of the effects on mental health, but also thinking harder about how to manage those effects. “There are groups that rally to provide ‘psychological first aid’ after disasters, but the needs are longer lasting and there needs to be follow-up,” Clayton said in an email.
That time lag is at the root of the issue. “There is a tendency for us in the United States to prepare to respond, but not to prepare to recover,” said Schonfeld, who also directs the National Center for School Crisis and Bereavement and wrote an editorial accompanying the new study on Puerto Rico. “I think we need to be preparing any adults that work with kids… to have some of the basic schools to support children in distress.”
Orengo-Aguayo said that there is a clear need for evidence-based mental health response across multiple stages of a natural disaster. This could mean better preparation and ensuring availability of well trained personnel, strong protocols for dealing with the immediate aftermath of a storm or fire or other disaster, and an extended recovery program that doesn’t treat the end of the hurricane as the end of the problem.
Hurricane Maria was particularly devastating, but there will be another. “We need to be aware of the accumulating effect of hurricanes and other natural disasters on children's mental health and provide supports [in the] short and long term,” Orengo-Aguayo said.
