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I am writing this as Hurricane Florence approaches the southeast coast of the United States. News reports of affected residents’ fears, worries, and anxieties, brought to mind the concerns that I and many of my colleagues faced following 9/11, regarding the mental well being aspects of affective populations, and particularly of children. That thought reminded me once again that some aspects of the aftermath of a disaster are often unrelated to whether the disaster was “natural” or the result of human activity.

Disaster can strike at any time, and few are truly prepared for the aftermath. Mere minutes is all it takes for nature’s wrath to swallow homes, resources, and human lives. Extensive loss with no easy solution can strike deep at the psyche of those affected, and leave wounds that linger long after the danger subsides. The relationship of disaster and mental health has now been examined by many; an example of such effort is that of the University of Missouri’s Disaster and Community Crisis Center, which has researched the mental health effects of major natural disasters, and how survivors cope with the devastation left in wake.

Most people are prone to feeling extreme anxiety, despair and shock immediately following a disaster. But if these emotions persist for weeks or months, it can be symptomatic of mental illness, according to the Missouri research. Perhaps the most common problem faced by survivors is post-traumatic stress disorder (PTSD), a disease triggered by severe trauma, such as deadly situations, destroyed property, or loss of life–all of which occurs during a catastrophic event.

The National Institutes of Health (NIH) explains this well.  Symptoms of PTSD from a natural disaster may include flashbacks and physical reactions (sweaty palms, rapid heartbeat, etc.), anxious thoughts, nightmares and insomnia, startling easily, mood swings to anger, gaps in memory of the event, avoidance of areas, people or objects that trigger painful memories, a pessimistic worldview, unwillingness to participate in pleasurable activities, and self-blame or survivors’ guilt. Generally, a diagnosis of PTSD isn’t given unless multiple symptoms are present for over one month.

Another common mental disorder among disaster survivors is depression. The scope of devastation may lead to difficulties replacing lost employment or property. Dealing with the loss of valuable or meaningful possessions, as well as financial issues can be jarring, and survivors may feel hopelessness and despair as they struggle to cope. In addition, a study of Hurricane Katrina refugees living in Houston, Texas found that about one third reported using more addictive substances post-disaster. The possibility of domestic violence may be higher for survivors as well; another study revealed a spike in domestic violence rates among Mississippi women who lost their homes to Hurricane Katrina. The study suggests that some survivors may turn to domestic violence as a way of compensating for the fact that they no longer feel in control.

Prolonged exposure to the stress of catastrophic disaster may also contribute to suicidal thoughts and tendencies. Data from Puerto Rico’s health department reveals a one third increase in suicides since the island was hit by Hurricane Maria in October 2017. In addition, upon visiting Puerto Rico post-Maria, Oxiris Barbot–First Deputy Commissioner of the New York City Department of Health and Mental Hygiene–interviewed survivors, and found that every person she spoke with knew someone in their “immediate circle” or “one-degree removed” who had either contemplated or committed suicide.

While everyone affected by disaster feels the sting of loss and fear, such stress can be hard to quell for some. Initial recovery efforts are often largely directed towards physical recovery, however mental health resources, like crisis counseling and cognitive behavioral therapy, are essential as well.  Communities also have a responsibility to encourage reconnection–via public events and activities–as maintaining a strong social support net among survivors is perhaps the most effective method of fending off mental illnesses brought on by disaster.