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: 10991759
• 负责人: GLORISA J CANINO
• 金额: $ 16.13万
• 依托单位: UNIVERSITY OF HAWAII AT MANOA
• 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 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10991759
• 关键词: Psychiatric; substance; use; disorders; Puerto

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.

项目摘要/摘要 2017年9月，玛丽亚飓风袭击了波多黎各岛，在整个岛上造成了严重破坏， 使其成为记录历史上最具破坏性的风暴。该岛的居民仍在从 飓风艾尔玛（Irma），两周前袭击。玛丽亚之后的几个月，许多社区缺乏必不可少的 服务和资源，例如获得电力，饮用水，安全道路和桥梁，健康食品， 和医疗保健。确实，八个月后，仍然缺乏这些服务和资源的社区。 损害的程度，无论地理或贫困状况如何，都影响了所有居民， 波多黎各经济的脆弱状态导致了机构恢复的反应，这是前所未有的 缓慢而不足。这些因素的融合给精神病和 药物使用问题，尤其是在具有精神病理史的人们中。很少有研究 检查了精神病和物质使用障碍的纵向发展和加剧 在自然灾害使用相同的代表性样本之后。我们有独特的机会， 基于由八个分层的岛屿范围代表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个波多黎各人（18-64岁）组成，是 2014年5月至2016年6月，在玛丽亚袭击该岛的一年之前进行了调查。所有一生和12个月 使用世界心理健康评估了该队列中的精神病和药物使用障碍 - 综合国际诊断访谈（WMH-CIDI版本21）。我们提出了第二波 评估侧重于焦虑，与创伤有关，抑郁和药物使用障碍的评估，以及 自杀性。使用国家少数民族健康与健康差异研究所研究框架和 艾布拉姆森及其同事的弹性激活框架，我们将解决四个特定目标：（1） 估计精神病和物质使用障碍的患病率的变化， 了解导致心理病理学增加的机制，包括机构反应和 恢复工作和污点后压力源，（3）确定个人，家庭和邻里因素 在玛丽亚后没有精神病理学的人和（4）的人中，没有心理病理学的韧性 了解机构反应和恢复工作对八种心理病理学的影响 地理和飓风影响水平各不相同的卫生区域。该项目在提供 对心理病理学前后的纵向发展和加剧的独特估计 飓风，并检查独特的调解人，尤其是机构的反应和恢复失败。这是 还专注于不同级别（即个人，家庭，社区）的因素的创新性，这些因素导致 面对经济挣扎的领土上的主要自然灾难的个人韧性。

项目成果

The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico.

医疗补助资金结构对纽约、佛罗里达和波多黎各拉丁裔医疗保健获取不平等的影响。

• DOI: 10.1111/1475-6773.14036
• 发表时间: 2022
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Rivera-González,AlexandraC;Roby,DylanH;Stimpson,JimP;Bustamante,ArturoVargas;Purtle,Jonathan;Bellamy,ScarlettL;Ortega,AlexanderN
• 通讯作者: Ortega,AlexanderN