The Maria Generation

Little girl leaning against a wall.
Of the 96,000 third through 12th graders who took part in the survey, more than 80% saw houses damaged on the island, and 45% had damage to their home.

Hurricane Maria’s impact on Puerto Rican children’s mental health

by Helen Adams

Psychologists at MUSC measured the magnitude of Hurricane Maria’s impact on the mental health of children in Puerto Rico in one of the largest postdisaster screening projects in U.S. history.

Rosaura Orengo-Aguayo, Ph.D., an assistant professor in the Department of Psychiatry and Behavioral Sciences at MUSC, grew up in Puerto Rico and led the study. “More than 7% of youth, 6,900 of the children surveyed by the Puerto Rico Department of Education, reported clinically significant symptoms of PTSD,” she said.

Post-traumatic stress disorder can develop after a traumatic event, such as a natural disaster, and can affect the ability to cope with everyday life. PTSD can cause nightmares, flashbacks, the feeling of being always on guard, trouble sleeping and an inability to remember parts of the traumatic event.

Orengo-Aguayo said the survey also found that more than 6,000 children reported that a family member, friend or neighbor may have died as a result of the hurricane.

While more than 7% of the children surveyed had PTSD symptoms, that’s actually lower than anticipated. Regan Stewart, Ph.D., an assistant professor in MUSC’s Department of Psychiatry and Behavioral Sciences, is part of the research team. “I expected it to be higher, based on other studies that have been done in the mainland U.S. in which rates are somewhere between 13 and 30%.”

Stewart said one potential protective factor for Puerto Rican children may be a concept called “familismo” in Spanish. “It’s the importance of family and community. Puerto Ricans place a high value on these social connections. We know from the literature that social support may be a protective factor after a traumatic event.”

The PTSD rate might also have to do with the timing of when the Puerto Rico Department of Education conducted the survey, she said. “Most surveys have been done at the six- to 12-month mark. In this case, the department administered the surveys at five to nine months. Many of the students were still dealing with losses of basic necessities, such as food and electricity. Their focus could still be on getting these basic needs met, and mental health difficulties may have developed later, at the six- to 12-month mark, which was not captured in this survey.”

Soon after the storm hit, Orengo-Aguayo, and Stewart started working with another bilingual mental health expert, Michael de Arellano, Ph.D., a Psychiatry and Behavior Sciences professor at MUSC, and the Puerto Rico Department of Education to train teachers in how to take care of their own mental health while also caring for the kids who weathered the storm. This effort was funded using a grant they already had from the Substance Abuse and Mental Health Services Administration and the National Child Traumatic Stress Network.

The team emphasizes the importance of asking what people need instead of telling Puerto Ricans what to do during this project. They’ve also worked closely with Joy Lynn Suarez-Kindy, a clinical psychologist who lives there, to strategize and analyze what is needed.

“Puerto Rican youth experienced significant disaster exposure and reported trauma symptoms that warrant evidence-based services,” Orengo-Aguayo said. “Academics partnering with community stakeholders is the way to go to change the world one child at a time. That is our lab’s motto.”