Displacement and mental health after natural disasters
Authors: Rebecca M Schwartz, Bian Liu, Wil Lieberman-Cribbin, Emanuela Taioli
Journal: The Lancet Planetary Health (2017)

We read with interest the Article by Alice Munro and colleagues,1Munro A Kovats RS Rubin GJ et al.Effect of evacuation and displacement on the association between flooding and mental health outcomes: a cross-sectional analysis of UK survey data.Lancet Planet Health. 2017; 1: e134-e141Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar and have observed similar results in a cohort of 1615 New York residents affected by Hurricane Sandy in 2012. Participants completed a questionnaire that measured mental health symptoms, Hurricane Sandy exposure, and displacement. The PHQ-4 depression scale was used to assess symptoms of generalised anxiety disorder and depression, the Post-Traumatic Stress Disorder Checklist-Specific was used to assess symptoms of probable post-traumatic stress disorder specific to Hurricane Sandy, and the Perceived Stress Scale was implemented as a general measure of perceived stress.2Schwartz RM Sison C Kerath SM et al.The impact of Hurricane Sandy on the mental health of New York area residents.Am J Disaster Med. 2015; 10: 339-346Crossref PubMed Scopus (49) Google Scholar The mean time since Hurricane Sandy was 14·47 months (SD 3·26, range 11·81–27·93). In this cohort, displaced participants (729 [45%]) were more likely to have symptoms of post-traumatic stress disorder (adjusted odds ratio [OR] 2·21, 95% CI 1·73–2·82), depression (1·37, 1·05–1·79), anxiety (1·30, 1·01–1·67), and increased perceived stress (β value 1·16, SE 0·38) compared with non-displaced participants, after adjusting for age, sex, race, Hispanic ethnicity, education, previous mental health conditions, and time since Hurricane Sandy.3Schwartz RM, Rasul R, Kerath S, et al. Displacement during Hurricane Sandy: the impact on mental health. J Emerg Manag (in press).Google Scholar We have since re-interviewed 130 participants from the original cohort in a follow-up study.4Schwartz RM Gillezeau CN Liu B Lieberman-Cribbin W Taioli E Longitudinal impact of Hurricane Sandy exposure on mental health symptoms.Int J Environ Res Public Health. 2017; 14: E957Crossref PubMed Scopus (60) Google Scholar The mean time since Hurricane Sandy was 33·27 months (SD 5·28, range 27·73–43·75). Experiencing personal and property damage during Hurricane Sandy continued to be positively associated with post-traumatic stress disorder symptoms at follow-up (adjusted OR 1·2, 95% CI 1·1–1·4). Of the 130 participants who were re-interviewed, 50 (38%) were displaced because of Hurricane Sandy. At baseline, displacement was statistically significantly associated with post-traumatic stress disorder symptoms (adjusted OR 3·72, 95% CI 1·47–9·42), but not with anxiety or depression. At follow-up, displacement was not statistically significantly associated with symptoms of anxiety (1·52, 0·65–3·59), depression (1·32, 0·52–3·34), or post-traumatic stress disorder (1·23, 0·46–3·32).4Schwartz RM Gillezeau CN Liu B Lieberman-Cribbin W Taioli E Longitudinal impact of Hurricane Sandy exposure on mental health symptoms.Int J Environ Res Public Health. 2017; 14: E957Crossref PubMed Scopus (60) Google Scholar The results suggest an attenuated mental health effect of displacement 2–3 years after Hurricane Sandy. Longitudinal studies with larger samples might be better powered to detect the effect of displacement on the mental health of those affected by hurricanes. We recognise the importance of understanding the impact of displacement and exposure on short-term and long-term mental health symptoms, and concur with Munro and colleagues1Munro A Kovats RS Rubin GJ et al.Effect of evacuation and displacement on the association between flooding and mental health outcomes: a cross-sectional analysis of UK survey data.Lancet Planet Health. 2017; 1: e134-e141Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar that mental health services should be strengthened for those who are displaced because of natural disasters, such as Hurricane Sandy in the USA or the extensive flooding in England. Additionally, there are many potential disaster preparedness policy implications that can be drawn from this research, including increasing funding for short-term crisis management services to those who are displaced. Research reported in this letter was supported by The Centers for Disease Control and Prevention under award number U01-TP000573-01, the Office of the Assistant Secretary for Preparedness and Response under HITEP 150029-01-00, the Association of State and Territorial Health Officials under ASTHO 64-45471, the Stony Brook-Mount Sinai Alliance Pilot Project, and a private gift given to Northwell Health. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. We declare no competing interests. Effect of evacuation and displacement on the association between flooding and mental health outcomes: a cross-sectional analysis of UK survey dataDisplacement after flooding was associated with higher reported symptoms of depression, anxiety, and post-traumatic stress disorder 1 year after flooding. The amount of warning received showed evidence of being protective against symptoms of the three mental illnesses studied, and the severity of flooding might be the reason for some, but not all, of the differences between the groups. Full-Text PDF Open Access