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

项目摘要/摘要 2017年9月，飓风玛丽亚袭击波多黎各，在全岛造成严重破坏， 使其成为有记录以来最具破坏性的风暴。岛上的居民仍在恢复中 两周前袭击的飓风伊尔玛。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、 和医疗护理。事实上，八个月后，仍然有一些社区缺乏这些服务和资源。 破坏的程度，影响到所有居民，无论地理位置或贫困状况，以及 波多黎各经济的脆弱状态导致了前所未有的机构复苏反应 缓慢而又不充分。这些因素的汇合造成了大量的精神疾病和 物质使用问题，特别是那些有精神病病史的人。很少有研究发现 检查精神和物质使用障碍的纵向发展和恶化之前 并在自然灾害后使用相同的代表性样本。我们有独一无二的机会 基于按八个国家分层的全岛代表性样本的预先组装队列的优势 波多黎各的卫生区。这一队列由3,062名波多黎各人组成，年龄在18岁到之间， 调查从2014年5月到2016年6月，也就是玛丽亚袭击该岛的一年前。终身和12个月 精神障碍和物质使用障碍在这一队列中使用世界精神卫生- 综合国际诊断访谈(WMH-CIDI版本21)。我们提出了第二波 评估的重点是焦虑、创伤相关、抑郁和物质使用障碍，以及 自杀。利用国家少数民族健康和健康差距研究所的框架和 艾布拉姆森及其同事的弹性激活框架，我们将解决四个具体目标：(1) 估计飓风前后精神和物质使用障碍患病率的变化，(2) 了解导致精神病理学增加的机制，包括机构反应和 恢复努力和灾后压力源，(3)确定个人、家庭和邻里因素 导致那些在飓风玛丽亚之后没有精神病理学的人具有韧性，以及(4) 了解机构应对和康复努力对八国精神病理学的影响 地理位置和飓风影响程度不同的卫生地区。该项目在提供 对精神病理学前后纵向发展和恶化的独特估计 在审查独特的调解人，特别是机构应对和恢复失败方面。它是 在关注不同层面的因素(即个人、家庭、邻居)方面也具有创新性 在一个经济困难的领土上，面对重大自然灾害时的个人韧性。

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.