Psychiatric and substance use disorders in Puerto Rico before and after Hurricane Maria

飓风玛丽亚前后波多黎各的精神和物质使用障碍

• 批准号: 10548137
• 负责人: GLORISA J CANINO
• 金额: $ 68.17万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-02 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10548137
• 关键词: Acute; Address; Affect; Age; Anxiety; Caring; Categories; Cessation of life; Communication; Communities; Development; Diagnostic; Disasters; Disease; Electricity; Emergency Care; Environment; Event; Exposure to; Failure; Family; Feeling suicidal; Food; Generalized Anxiety Disorder; Geography; Health; Health Disparities Research; Health Food; Healthcare Systems; Humidity; Hurricane; Income; Individual; Infrastructure; Institution; International; Interview; Island; Literature; Major Depressive Disorder; Mediator; Medical; Mental Depression; Mental Health; Mental disorders; Methodology; Minority; Minority Groups; Molds; National Institute on Minority Health and Health Disparities; Natural Disasters; Neighborhoods; Outcome; Perception; Pharmacy facility; Population; Post-Traumatic Stress Disorders; Poverty; Prevalence; Psyche structure; Psychological Stress; Psychopathology; Public Health; Puerto Rican; Puerto Rico; Recording of previous events; Recovery; Reporting; Resources; Risk; Risk Factors; Sampling; Services; Socioeconomic Status; Stress; Substance Use Disorder; Suicide prevention; Surveys; Symptoms; Testing; Trauma; Water; addiction; behavioral health; cohort; depressive symptoms; experience; high risk; innovation; landfill; low socioeconomic status; minority health; minority health disparity; physical conditioning; population health; psychiatric symptom; resilience; resilience factor; response; social; stressor; substance use; suicidal; suicide rate

PROJECT SUMMARY/ABSTRACT In September 2017, Hurricane Maria hit the island of Puerto Rico and wreaked havoc throughout the island, making it the most destructive storm in recorded history. The island's residents were still recovering from Hurricane Irma, which hit two weeks prior. For months after Maria, many communities lacked essential services and resources, such as access to electricity, potable water, safe roads and bridges, healthy foods, and medical care. Indeed, eight months later there are still communities lacking these services and resources. The extent of the damage, which impacted all residents regardless of geography or poverty status, and the fragile state of the Puerto Rican economy led to an institutional recovery response that was unprecedentedly slow and insufficient. The confluence of these factors created substantial population risk for psychiatric and substance use problems, particularly among those with a history of psychopathology. Few studies have examined the longitudinal development and exacerbation of psychiatric and substance use disorders before and after a natural disaster using the same representative sample. We have the unique opportunity and advantage of a preassembled cohort based on an island-wide representative sample stratified by the eight health regions of Puerto Rico. The cohort, which consists of 3,062 Puerto Ricans, ages 18-64 years, was surveyed from May 2014 to June 2016, one year before Maria hit the island. All lifetime and 12-month psychiatric and substance use disorders were assessed in this cohort using the World Mental Health- Composite International Diagnostic Interview (WMH-CIDI Version 21). We propose a second wave of assessments with a focus on anxiety, trauma-related, depressive, and substance use disorders, and suicidality. Using the National Institute of Minority Health and Health Disparities Research Framework and the Resilience Activation Framework of Abramson and colleagues, we will address four specific aims: (1) estimating the change in prevalence of psychiatric and substance use disorders from pre- to post-hurricane, (2) understanding the mechanisms that lead to increased psychopathology, including institutional response and recovery efforts and post-disaster stressors, (3) identifying the personal, family and neighborhood factors that lead to resilience among those who did not have psychopathology post-Hurricane Maria, and (4) understanding the effects of institutional response and recovery efforts on psychopathology across the eight health regions that vary in geography and levels of hurricane impact. The project is innovative in providing unique estimation of the longitudinal development and exacerbation of psychopathology pre- and post- hurricane, and, in examining unique mediators, particularly institutional response and recovery failures. It is also innovative in focusing on different levels (i.e.,personal, family, neighborhood) of factors that lead to individual resilience in the face of a major natural catastrophe in an economically struggling territory.

项目总结/摘要 2017年9月，飓风玛丽亚袭击了波多黎各岛，并在整个岛屿造成严重破坏， 使其成为有史以来最具破坏性的风暴岛上的居民仍在从 两周前袭击的飓风厄玛。在玛丽亚之后的几个月里，许多社区缺乏必要的 服务和资源，如获得电力、饮用水、安全的道路和桥梁、健康食品， 和医疗保健。事实上，八个月后，仍然有社区缺乏这些服务和资源。 损害的程度影响到所有居民，无论其地理位置或贫困状况如何， 波多黎各经济的脆弱状态导致了前所未有的机构恢复反应， 缓慢和不足。这些因素的共同作用造成了大量的精神病和 物质使用问题，特别是那些有精神病理学史的人。很少有研究 研究了精神和物质使用障碍的纵向发展和恶化， 以及在自然灾害后使用相同的代表性样本。我们有独特的机会， 基于全岛代表性样本的预组装队列的优势， 波多黎各的卫生区。该队列由3，062名年龄在18-64岁之间的波多黎各人组成， 从2014年5月到2016年6月，也就是玛丽亚撞上该岛的前一年，进行了调查。所有寿命和12个月 精神和物质使用障碍在这个队列中进行了评估，使用世界精神卫生组织- 复合国际诊断访谈（WMH-CIDI第21版）。我们建议第二波 评估重点是焦虑、创伤相关、抑郁和物质使用障碍，以及 自杀倾向利用国家少数民族健康和健康差异研究框架研究所和 Abramson及其同事的弹性激活框架，我们将解决四个具体目标：（1） 估计飓风前后精神病和药物使用障碍流行率的变化，（2） 了解导致精神病理学增加的机制，包括机构反应， 恢复工作和灾后压力源，（3）确定个人，家庭和邻里因素， 导致那些在飓风玛丽亚后没有精神病理学的人恢复能力，以及（4） 了解机构反应和恢复工作对八个国家精神病理学的影响， 健康地区的地理位置和飓风影响程度各不相同。该项目是创新的， 独特的估计纵向发展和恶化的精神病理学的前和后， 在审查独特的调解人，特别是机构的反应和恢复失败。是 在关注不同层面上也是创新的（即，个人、家庭、邻里）的因素，导致 在一个经济困难的地区，面对重大自然灾害，个人的复原力。