Extreme Weather a Disaster for Mental Health

Megan Brooks

May 20, 2019

SAN FRANCISCO — The 2017 Atlantic hurricane season made clear that storm hazards are progressively worsening due to climate change and this amplifies the risk for severe mental health outcomes.

It was the "perfect storm season," said James Shultz, PhD, of the Center for Disaster and Extreme Event Preparedness (DEEP Center) at the University of Miami Miller School of Medicine in Florida.

"In a disaster, the size of the psychological footprint greatly exceeds the size of the medical footprint," said Shultz.

There is a compelling need to better anticipate and prepare for the psychological consequences of increasingly dangerous extreme weather events, he said.

Shultz and coauthor Zelde Espinel, MD, also at University of Miami, presented their research here at the American Psychiatric Association (APA) 2019 annual meeting.

Drs James Shultz and Zelde Espinel

They have studied and written extensively in the peer-reviewed literature about the 2017 Atlantic storm season and the many mental health and public health consequences.

The 2017 season showcased the role of "climate drivers," including warming oceans and rising sea levels, in magnifying hurricane hazards such as peak wind speeds and precipitation rates, Shultz explained.

Stronger, Longer, Wetter

"With climate change, storms are becoming stronger, they last longer, they are moving slower over populated areas, and they are wetter," he warned.

Take hurricane Maria, a category 5 storm that hit Puerto Rico in September 2017 with 175 mph winds. Maria killed more than 3000 island residents. It destroyed power grids and crippled infrastructure, rendering the population completely dependent on outside aid.

Millions of survivors were subjected to unrelenting, life-threatening tropical heat in the aftermath, as well as exposure to insect-borne infectious diseases. Staple crops were destroyed, leading to food insecurity. Water supplies were contaminated with wastes and, in some cases, hazardous materials.

The storm's aftermath led to "forced displacement" and mass migration with significant psychological impacts, Shultz said.  In one post-Maria study, 66% of residents of one hard-hit area reported significant symptoms of depression, generalized anxiety, and/or posttraumatic stress disorder (PTSD), he noted.

Hurricane Harvey, a category 4 storm with 130 mph winds, was another one for the record books. The 2017 storm rapidly intensified and then stalled over land, triggering catastrophic flooding in the Houston metropolitan area and southeast Texas. In a four-day period, many areas received more than 40 inches of rain.

It Takes a Village

"Extreme weather events really do seem to be happening more and more. We see it on the news and mental health providers need to be in on the planning for how to respond to these events," Rachel Yehuda, PhD, professor of psychiatry and neuroscience and director of the traumatic stress studies division at the Icahn School of Medicine at Mount Sinai in New York City, noted in an interview with Medscape Medical News.

She said it's important to realize that what a person may need in the first week may be very different than what he or she needs a year later.

"Getting wiped out by a hurricane or flood and losing all your possessions is devastating — and even more so if you didn't have a lot to begin with," said Yehuda. "That's ongoing stress. Add to that during the event you could have died, that can be associated with a unique set of outcomes that are more like classic posttraumatic stress disorder (PTSD).  You might have reminders and triggers that could be lasting."

What's the psychiatrist's role? Yehuda said clinicians have a choice to make. "When we see current events that create a mental health need, one of the conundrums that we have is: Do we wait for people to come to treatment, which is kind of the current model, or are we are more proactive in seeking people out and doing outreach?"

Extreme weather events can have psychological consequences, she added, "and beginning this conversation is long overdue. It's fantastic that the APA is inviting this kind of programming. There are so many opportunities to become vulnerable in this life and mental health providers can help people cope. But it's too much for one profession to handle. We need to build communities of support. It's going to take a village."

Improving access to mental health services is one key issue, incoming APA president Bruce Schwartz, MD, told Medscape Medical News.

"It's one of the biggest problems in this country. Even if you have insurance, it can be really hard to get an appointment with a mental health provider.  I believe we have an ethical and moral responsibility to improve access to mental health care," said Schwartz, deputy chairman and professor in the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.

The study had no funding. Shultz, Espinel, Yehuda, and Schwartz have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2019: Abstract 149. Presented May 19, 2019.

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