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

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.

Background: 遭受重大自然灾害的社区，其精神障碍患病率显著升高。2017年9月20日，五级飓风玛丽亚（Hurricane Maria）袭击波多黎各，导致当地电网瘫痪、建筑与住宅大面积损毁，同时限制了水、食品与医疗服务的可及性。本研究旨在刻画飓风玛丽亚灾后的社会人口学与行为变量的特征，并分析上述变量与精神健康结局的关联。

Methods: 本研究于2017年12月至2018年9月间，对998名受飓风玛丽亚影响的波多黎各居民开展问卷调查。参与者需完成一套包含5个量表的问卷：飓风后痛苦量表（Post Hurricane Distress Scale）、柯斯勒K6量表（Kessler K6）、患者健康问卷9项版（Patient Health Questionnaire 9, PHQ-9）、广泛性焦虑障碍7项量表（Generalized Anxiety Disorder 7, GAD-7），以及《精神障碍诊断与统计手册（第五版）》（DSM-V）创伤后应激障碍检查表。本研究采用逻辑回归分析，探究社会人口学变量与风险因素和精神障碍风险结局之间的关联。

Results: 多数受访者报告曾遭遇与飓风相关的应激事件。与农村受访者相比，城市受访者报告的应激暴露发生率更高。低收入（比值比OR=3.66；95%置信区间CI=1.34~11.40；P<0.05）与受教育程度（OR=4.38；95%CI=1.20~15.80；P<0.05）与重型精神疾病（severe mental illness, SMI）的发病风险升高相关；而就业则与广泛性焦虑障碍（GAD）发病风险降低（OR=0.48；95%CI=0.275~0.811；P<0.01）及重型精神疾病（SMI）发病风险降低（OR=0.68；95%CI=0.483~0.952；P<0.05）相关。处方阿片类药物滥用与抑郁症发病风险升高相关（OR=2.94；95%CI=1.101~7.721；P<0.05）；而非法药物使用则与GAD发病风险升高相关（OR=6.56；95%CI=1.414~39.54；P<0.05）。

Conclusion: 本研究结果凸显了制定灾后心理健康应对方案、并依托社区开展社会干预的必要性。