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.

项目概要/摘要 2017年9月，飓风玛丽亚袭击波多黎各岛，给全岛造成严重破坏， 使其成为历史上最具破坏性的风暴。岛上居民仍在恢复中 两周前袭击的飓风艾尔玛。玛丽亚去世后的几个月里，许多社区缺乏必需品 服务和资源，例如获得电力、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，以及 波多黎各经济的脆弱状况导致了前所未有的机构复苏反应 缓慢且不足。这些因素的综合作用造成了巨大的人群精神和疾病风险。 物质使用问题，尤其是那些有精神病理学史的人。很少有研究表明 之前检查了精神和物质使用障碍的纵向发展和恶化 以及在自然灾害之后使用相同的代表性样本。我们拥有独特的机会和 基于全岛代表性样本的预组装队列的优势，该样本由八个分层 波多黎各卫生区。该队列由 3,062 名年龄在 18 岁至 64 岁之间的波多黎各人组成， 调查时间为 2014 年 5 月至 2016 年 6 月，即玛丽亚登岛前一年。终身和 12 个月 使用世界心理健康- 综合国际诊断访谈（WMH-CIDI 版本 21）。我们提议第二波 重点关注焦虑、创伤相关、抑郁和药物滥用障碍的评估，以及 自杀倾向。使用国家少数民族健康和健康差异研究框架和 艾布拉姆森及其同事的复原力激活框架，我们将解决四个具体目标：（1） 估计飓风前后精神和药物滥用疾病患病率的变化，(2) 了解导致精神病理学增加的机制，包括机构反应和 恢复工作和灾后压力源，(3) 确定个人、家庭和邻里因素 为那些在飓风玛丽亚后没有精神病理学的人带来恢复力，以及（4） 了解机构应对和恢复工作对八个国家的精神病理学的影响 地理和飓风影响程度各不相同的卫生区域。该项目的创新之处在于提供 对心理病理学前后的纵向发展和恶化的独特估计 飓风，并检查独特的调解因素，特别是机构反应和恢复失败。这是 还创新地关注导致不同层面（即个人、家庭、邻里）的因素 在经济困难的地区面对重大自然灾害时的个人复原力。

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。

• 发表时间: 2022-12
• 影响因子: 3.4
• 作者: Rivera;Roby, Dylan H;Stimpson, Jim P;Bustamante, Arturo Vargas;Purtle, Jonathan;Bellamy, Scarlett L;Ortega, Alexander N
• 通讯作者: Ortega, Alexander N