In September 2017, Hurricane Maria struck the island of Puerto Rico with Category 4 force winds, knocking off an entire power grid and killing nearly 3,000 people in its wake.

After the storm, more than 150,000 Puerto Ricans fled the island to resettle in Central and South Florida. They were faced with finding a new home and job. Children had to re-enroll in new schools. Many had to learn a new language.

Researchers from the University of Miami Miller School of Medicine found that survivors who moved to Florida experienced higher rates of depression, anxiety and post-traumatic stress disorder than those who stayed on the island. Of those interviewed, 65.7% of Puerto Ricans in South and Central Florida had experienced unwanted and upsetting memories of the storm compared to 32.7% of those who stayed.

“Those who left the island lost everything, no house, no job, nothing there,” said Seth Schwartz, professor of public health and coauthor of the study. “Having to make a move that they were not expecting had to be unsettling.”

Carolina Scaramutti, a graduate research assistant who coauthored the study, said those who stayed on the island were still affected, but internalized their trauma.

“So you have two different things happening at once,” she said. “You have those who left trying to start a new life and those who have stayed and are continuing to live in that trauma.”

To conduct the study, the authors interviewed and conducted focus groups with 213 survivors in South Florida, Orlando and Puerto Rico.

Interviews revealed that while the Federal Emergency Management Agency provided temporary hotel rooms to the displaced, the buildings were often in isolated areas without access to public transportation, adding another hurdle to landing a job. While federal officials assumed the survivors’ move to Florida was temporary, 95 percent of the study participants still remain in Florida.

“Everyone forgot about them,” said Seth Schwartz,  “There was no follow up. We know from research after Hurricanes Andrew and Katrina that the mental health affects of those storms last for years.”

Schwartz emphasized that these results are not specific to Hurricane Maria and can inform and improve future disaster plans.

“This was not just about Hurricane Maria,” he said. “This could be Hurricane Michael, which also resulted in a lot of displaced people. FEMA is focused on rebuilding roads and buildings and beaches. But we want to focus on rebuilding people. ”

Schwartz and Scaramutti are now developing a toolkit to guide more organized disaster migration responses in the future. Their hope is that mental health is not left as an afterthought.

“The earlier we can get to these families, the better the outcome,” Scaramutti said. “We can’t wait six to ten months to provide them mental health services. These should be one of the first services provided when they receive first aid so they can see how many people have been experiencing trauma or shock.”

Schwartz said he hopes his findings show the need for a more holistic approach to disaster aid, especially at the federal level.

“Our mission with this research is to bring attention to the human side of crisis migration, in this case resulting from a major hurricane,” Schwartz said.

Managing traumatic stress after a hurricane

The American Psychological Association provides steps you can take to gain a sense of control after a natural disaster.

  1. Recognize that this is a challenging time but one that you can work to manage.
  2. Allow yourself to mourn the losses you have experienced.
  3. Take a break from the news and images of the storm.
  4. Ask for support.
  5. When ready, find ways to express yourself.
  6. Eat well, get rest and avoid drugs and alcohol.
  7. Establish or reestablish routines.

Header photo: Homes lay in ruin as seen from a U.S. Customs and Border Protection, Air and Marine Operations, Black Hawk during a flyover of Puerto Rico after Hurricane Maria September 23, 2017. U.S. Customs and Border Protection photo by Kris Grogan