Mental health and associated risk factors of Puerto Rico Post-Hurricane María

Abstract

Background: Mental health disorders have an increased prevalence in communities that experienced devastating natural disasters. Maria, a category 5 hurricane, struck Puerto Rico on September 20, 2017, weakening the island's power grid, destroying buildings and homes, and limiting access to water, food, and health care services. This study characterized sociodemographic and behavioral variables and their association with mental health outcomes in the aftermath of Hurricane Maria.

Methods: A sample of 998 Puerto Ricans affected by Hurricane Maria was surveyed between December 2017 and September 2018. Participants completed a 5-tool questionnaire: Post-Hurricane Distress Scale, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder (GAD) 7, and Post-Traumatic Stress Disorder checklist for DSM-V. The associations of sociodemographic variables and risk factors with mental health disorder risk outcomes were analyzed using logistic regression analysis.

Results: Most respondents reported experiencing hurricane-related stressors. Urban respondents reported a higher incidence of exposure to stressors when compared to rural respondents. Low income (OR = 3.66; 95% CI = 1.34-11.400; p < 0.05) and level of education (OR = 4.38; 95% CI = 1.20-15.800; p < 0.05) were associated with increased risk for severe mental illness (SMI), while being employed was correlated with lower risk for GAD (OR = 0.48; 95% CI = 0.275-0.811; p < 0.01) and lower risk for SIM (OR = 0.68; 95% CI = 0.483-0.952; p < 0.05). Abuse of prescribed narcotics was associated with an increased risk for depression (OR = 2.94; 95% CI = 1.101-7.721; p < 0.05), while illicit drug use was associated with increased risk for GAD (OR = 6.56; 95% CI = 1.414-39.54; p < 0.05).

Conclusion: Findings underline the necessity for implementing a post-natural disaster response plan to address mental health with community-based social interventions.

Keywords: General anxiety disorder; Hurricane; Mental health; PTSD; Puerto Rico; Severe mental illness.