The associations between financial impact of Hurricane María and the 2020 sequence of tremors and psychological distress among young adults in Puerto Rico Open Access

Abstract

Background: Puerto Rico has recently experienced some of its worst natural disasters in recent history, with Hurricane María (HM) in 2017 followed by the sequence of tremors (ST) in 2020. Studies have independently documented the negative psychological and financial toll of HM on the island; however, the association between the financial impact of HM and psychological distress has not been examined. Similarly, data are scarce on the financial and psychological toll of the ST 2020 as well as the association between the two. The present study seeks to evaluate the association between the financial impact of HM and the ST 2020, and psychological distress among young adults in Puerto Rico; and will explore the moderating role of social support in these associations.

Methods: This cross-sectional analysis used baseline data from the PR-OUTLOOK study. Participants (n=1,484) were ages 18-29 years, recruited between September 2020 and September 2022. The following psychological outcomes were assessed: symptoms of depression (CESD-10), anxiety (STAI-10), post-traumatic stress disorder (Civilian Abbreviated Scale PTSD checklist), ataque de nervios, and perceived stress (PSS-4). All outcomes were dichotomized according to clinical or population-based cutoffs. The financial impact of HM and the ST was assessed through two items with responses dichotomized as no/little (low impact) vs. some/a great deal (high impact). Adjusted prevalence ratios (PR) and their respective 95% confidence intervals (95% CI) were estimated using log binomial regression. The moderating effect of social support was assessed using multiplicative interaction terms with each of the exposures.

Results: Of the sample, 44% reported high financial impact from HM and 10% from the ST 2020. In fully adjusted models, individuals reporting some/high financial impact from HM (vs. none/low) had elevated symptoms of depression (PR=1.15; 95% CI=1.06-1.25), perceived stress (PR=1.14; 95% CI=1.06-1.23), and anxiety (PR=1.41; 95% CI=1.17-1.69). Individuals reporting high financial impact from the ST 2020 (vs. none/low) had higher prevalence of elevated symptoms of depression (PR= 1.41, 95% CI=1.17, 1.69), and perceived stress (PR= 1.10, 95% CI=1.01, 1.19). No moderating effect by social support was found.

Conclusion: Experiencing a moderate/high financial impact from HM and the ST 2020 was associated with higher prevalence of psychological distress among young adults in Puerto Rico. Future studies of the financial impact of natural disasters on psychological distress among young adults are needed to inform potential interventions that build resilience, especially among vulnerable populations.

Table of Contents

TABLE OF CONTENTS

 

LITERATURE REVIEW (BACKGROUND)…………………………………………………………...1

Climate Change and Natural Disasters…………………………………………………………….1

Psychological Effects of Natural Disasters………………………………………………………...2

Puerto Rico: Vulnerability to Natural Disasters…………………………………………………...3

Puerto Rico: The Financial and Psychological Toll of Natural Disasters…………………………4

Social Support……………………………………………………………………………………...7

INTRODUCTION…………………………………………………………………………………………9

METHODS……………………………………………………………………………………………….11

Study Sample……………………………………………………………………………………..11

Variables and Measures…………………………………………………………………………..12

Statistical Analysis………………………………………………………………………………..14

RESULTS………………………………………………………………………………………………...15

DISCUSSION…………………………………………………………………………………………….17

Limitations, Strengths, and Future Directions……………………………………………………19

Public Health Implication………………………………………………………………………...20

REFERENCES…………………………………………………………………………………………...22

TABLES…………………………………………………………………………………………………..29

FIGURES…………………………………………………………………………………………………33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Mental Health
Keyword	mental health natural disaster global vulnerable population latinx
Committee Chair / Thesis Advisor	Andrea Lopez-Cepero, Emory University

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