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Abstract
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In a study in JAMA Network Open, Orengo-Aguayo and associates report on a population-based survey completed by 42.4% of students (N = 96 108) attending grades 3 to 12 in Puerto Rico public schools that was conducted 5 to 9 months after Hurricane Maria. As would be expected, the children had experienced widespread, substantial disaster exposure (eg, nearly 30% perceived their lives to be at risk) and loss (6.6% experienced the death of a family member, friend, or neighbor and 57.8% had friends or family who permanently moved away from the island). Based on screening questions, the research team estimated that 7.2% of children had symptoms suggesting a likely diagnosis of posttraumatic stress disorder (PTSD).
In a similar study involving students in grades 4 to 12 in public schools in New York, New York, that was conducted 6 months after the September 11, 2001, terrorist attack on the World Trade Center, 1 or more of 6 probable anxiety or depressive disorders were identified in 28.6% of the students. The prevalence of probable PTSD in that study was 10.6%, which is not that dissimilar from the 7.2% reported by Orengo-Aguayo et al. Given that avoidance of talking or thinking about a traumatic event is a major characteristic of PTSD, it is likely that some of the most affected students in the Puerto Rico study may be among the majority of students who elected not to participate in the survey (approximately 90% of students present on the day of the survey after the September 11, 2001, terrorist attack participated in the survey, which is more than twice the 42.4% participation rate in Puerto Rico1). Similarly, those who were most directly affected in the study after Hurricane Maria may be among the many people who permanently relocated prior to when the study was conducted there.
As the authors pointed out, it is also likely that the somewhat narrow focus on screening for PTSD and depression in the Puerto Rico study may have underestimated the effect of the hurricane.1 The most prevalent probable diagnoses in the study after the September 11, 2001, terrorist attack were agoraphobia (14.8%) and separation anxiety (12.3%), which were not assessed in the survey designed by Orengo-Aguayo et al, in part because the authors were conducting the survey to guide where to deploy trauma treatment services in Puerto Rico and understandably focused on PTSD.
Hurricane Maria caused massive damage on the island of Puerto Rico, estimated at $90 billion. In the study ...
Language: en |