After hurricane Maria caused massive destruction throughout Puerto Rico, many Puerto Ricans continue to face the challenge of whether to remain in their devastated community or move to the United States mainland, either temporarily or permanently. A number of studies on the psychological impacts of natural disasters suggest that the answer depends on the timeliness of reconstruction.

Of particular relevance is the result of a recently published study in "The Asian Journal of Psychiatry" of the long-term psychological effects of a powerful earthquake that struck Armenia in 1988 and claimed 25,000 lives. Researches were able to evaluate the psychological functioning 20 years after the event of a sample of Armenians who were living the country at the time. This is the first study that followed the victims of a natural disaster for such a long time.

One hundred thirty-four subjects participated in the study representing four different types of individuals: stayed, relocated but returned, left permanently, and a comparison group of Armenians who did not experience the earthquake at all. Individuals in the stayed group remained in the devastated city of Vanadzor; the relocated but returned group left the area for 6 to 18 months and then returned to Vanadzor; and the left group consisted of individuals who moved out of the area permanently. Psychologists administered clinical tests to all participants and collected extensive data about mental health and cognitive functioning. None of the participants had received any mental health services.

The study showed that those who remained in the city had the worst long-term psychological results. Almost a third of the population that stayed in the area were still, 20 years later, experiencing Post Traumatic Stress Disorder (PTSD) at four times the rate of those who had left the area permanently. They also displayed symptoms of depression and anxiety, and poorer functioning in several life situations than those who left.

Even those who had relocated but returned were experiencing PSTD at twice the rate of those who had left. Reconstruction of Vanadzor did not take place quickly; those who stayed or returned quickly experienced daily reminders of the destruction in the community, which resulted in poor clinical outcome.

By comparison, the study showed that permanent relocation provided by far the better psychological outcome. After 20 years, all of the subjects had a job and most of them reported greater contentment with life in their new communities.

In contrast to these findings, only 13 percent of the survivors of a serious Los Angeles earthquake met diagnostic criteria for PTSD three months after the disaster, in 1994. Major infrastructure was rebuilt ahead of schedule and the trauma victims were not exposed to the daily reminders of the disaster.

The motivation and aspirations of individuals can be significantly affected by a natural disaster, leading to serious psychological consequences. Another study showed massive flooding in Pakistan in 2010 washed away the aspirations and motivation of victims, along with their physical belongings. Many of these people lost faith in the future.

Psychological research consistently shows that constant and longer exposure to the results of a natural disaster, along with poor social support, is associated with the higher likelihood of PTSD. Interpreting the relevance of the Armenian study to the situation in Puerto Rico, Dr. Louis Najarian, the lead author of the study, said:

“Rapid reconstruction of hurricane-related destruction is necessary for better long term psychological outcomes.”

If the federal government does not accelerate the assistance to Puerto Rico and step up recovery efforts, the psychological future of the people who remain there may be more troubled.

Dr. Muhammad Majeed is a board-certified psychiatrist at Natchaug Hospital’s Joshua Center Thames Valley in Norwich.