The Growing Storm: Increased Tropical Storms in Puerto Rico Carry Mental Health Cost

Over the past few decades, the Puerto Rico and Florida region has witnessed a disturbing trend: a significant increase in the frequency and intensity of tropical storms. As climate change continues to alter weather patterns, this region is increasingly vulnerable to the destructive forces of nature, which includes serious mental health consequences. Its impact on mental health is a point of unperceived emphasis. This article will focus on highlighting the mental health crisis among the population in this area, as well as the disparities within it.

Since 2016, Puerto Rico and Florida have had 15 tropical storms and hurricanes, including one major event from which Puerto Rico still has not recovered—Hurricane Maria and its precursor, Hurricane Irma. On September 6, 2017, Hurricane Irma left over 1 million people with no power in Puerto Rico, and, just 14 days later, Hurricane Maria made landfall on Puerto Rico as a category 4 hurricane. According to a research project by the University of Florida in 2018, in the 10 weeks immediately following the hurricane, 3% to 6% of Puerto Rico’s population migrated to Florida due to lack of power and potable water and the declaration by the Federal Emergency Management Agency that their homes were unlivable.

An early postcatastrophe study in Disaster Medicine and Public Health Preparedness by Carolina Scaramutti, L.M.H.C., M.Ph., and colleagues found that one-third of the study participants who emigrated to Florida met the criteria for depression. Half met the criteria for posttraumatic stress disorder (PTSD), with more severe symptoms than Puerto Ricans who remained on the island. Within that half, rural and suburban Puerto Ricans were even more likely to meet the criteria for PTSD than their metropolitan counterparts. Many schools lost essential services such as power and water, disrupting the lives of approximately 350,000 students and teachers—a study of 8,167 teachers in the Journal of Traumatic Stress by Enoch Sackey, Ph.D., and colleagues demonstrated how PTSD symptoms were exacerbated with relative consistency in this population of students and teachers, similar to the increase after Hurricane Ike in 2008.

The increased frequency of these storms exacerbates the already prevalent mental health disparities on the island, with marginalized communities often bearing the brunt of the physical impacts. Residents of lower-income neighborhoods, which are more likely to be situated in vulnerable areas such as flood plains, face more significant challenges in preparing for and recovering from storms. As a result, the residents are not only more exposed to the immediate dangers but also more likely to experience long-term mental health issues.

A factor impacting these communities is the inequitable distribution of disaster appropriation funding, which can prolong the effects of the physical catastrophe on the island. This is exemplified by Puerto Rico’s prolonged wait of over four months compared with that of Texas and Florida, which secured a similar sum of funds in just half the time after the hurricane’s landfall. The consequences of this delay varied in severity but severely affected rural and geographically vulnerable areas. Hospitals and clinics located in flood plains or the rural Cordillera Central were damaged or destroyed, and medical supplies were scarce. The lack of health care services was particularly acute in rural areas, increasing the risk of untreated medical conditions and complicating recovery efforts for injured and chronically ill patients.

The increase in the frequency of tropical storms in Puerto Rico is having a multifaceted effect on the mental health of citizens of this region. As the government grapples with the physical consequences of climate change, it’s imperative to recognize and address the mental health disparities in these geographically vulnerable communities. A multipronged approach is essential to address this growing mental health crisis. Moreover, disaster preparedness and response plans must incorporate mental health considerations. Evacuation centers should have mental health professionals on hand, and outreach programs should be established to connect with displaced individuals and provide ongoing support. ■

Luis Figueroa Vélez, M.D., is a second-year psychiatry resident at the University of Connecticut.