<p>Hundreds of victims of Hurricane Katrina were suffering acutely from psychological stress — including post-traumatic stress disorder — more than four years after the flood waters receded. Recognizing the persistence of stress could help improve Hurricane Sandy recovery efforts and lead to more effective preparations for the inevitable next superstorm. This op-ed, written by Brown President Christina H. Paxson and research colleagues Jean E. Rhodes and Mary C. Waters, first appeared in the <a href="http://www.huffingtonpost.com/christina-h-paxson/those-for-whom-sandys-tra_b_2150875.html">Huffington Post</a>.</p>

All the lights will come back on, the waterlogged cars will be replaced, and the flooded, crushed and burned houses will be rebuilt, but even then, Sandy’s damage may still be with us. What research has told us about Hurricane Katrina is that among a significant subset of victims, the psychological trauma has lasted for years. Our society’s obligation after this monstrous storm — and the inevitable next one — will be to prevent what we have seen in the past.

Sandy brought some degree of suffering to millions of people of all walks of life. While the death toll was thankfully nowhere near that of Katrina, the storm’s effects were still terrible and widespread. There is more to a disaster than the visceral horror involved in confronting the destruction of entire neighborhoods. When whole swaths of a neighborhood are destroyed or emptied — as they were in New Jersey and New York — the connections people have to their property, their security, and their community are frayed at the least, and severed at the worst. People who have suffered damage to their homes and their community networks may need psychological and social support for years, even if they seem to be OK right now.

After Katrina we were able to follow up with hundreds of low-income parents — mostly black single mothers — whom we had been studying before the storm to assess the educational and psychological benefits of scholarships to community colleges in New Orleans. From our initial interviews we knew a great deal about their pre-storm mental state. We interviewed them about a year after Katrina and then more than four years later. What we found is that for a third of these parents, even at the later date, measurable indicators of psychological distress and post-traumatic stress disorder were still at higher levels than before the storm.

The lesson of our research is that the effects of trauma from disasters at the scale of Hurricane Katrina, and perhaps Sandy, do not recede nearly as quickly as the floodwaters do. Although the majority of individuals were resilient, a substantial minority experienced prolonged psychiatric distress. Data from studies like ours can help us learn who is at greatest risk and what we can do to mitigate that risk.

The biggest risk factors fell into two categories: traumatic events that were experienced during or immediately after the hurricane and ongoing problems associated with rebuilding lives and communities. The immediate traumas produced by Hurricane Katrina were considerable. People who lost family members, friends and pets; who didn’t know the status of loved ones including children during the storm; or who struggled to get access to needed medicines, food and water in the storm’s aftermath were more likely than others to experience mental health problems more than four years after the hurricane. But the wear and tear associated with rebuilding homes in destroyed neighborhoods or rebuilding new lives in strange places also took a toll. Those who experienced significant home and property damage were substantially more likely than others to have chronic long-term signs of psychological distress and post-traumatic stress disorder. This was true for people who went back to New Orleans as well as people who put down roots in new locations.

The long-term stressors associated with home damage continued long after the hurricane. Individuals lost their ties to friends and neighbors during the displacement from their homes, and often experienced multiple moves in short periods of time. Their children’s schooling and friendships were disrupted. And the more often the family had to move after Katrina, the more symptoms of distress the children showed over time. Those who decided to return to their old neighborhoods had to deal with the daily hassles of managing and paying for rebuilding; those who did not return had to establish lives in new places. Often those who returned still mourned the loss of community they experienced when their relatives and neighbors did not return. The people we studied were all poor, and we do not know if these stresses played out the same way for those with greater means. But, for more vulnerable low-income people, there was insufficient help in place after Hurricane Katrina to address these longer-term factors.

We can do better for the most vulnerable victims of Sandy who have now lost their homes and perhaps their community ties. The disaster relief efforts have been appropriately focused on the immediate essentials: food, water, shelter, power, and medical care. But when the emergency responders depart, there will be a continued and long-term role for mental health screening and care for people who have experienced trauma and loss. Community mental health centers and local health services will have to pick up the baton from the emergency responders, and continue to be alert to psychological distress for some time to come.

We are still early in the process of addressing Sandy’s psychological impact. We are also in the calm before the next “superstorm.” Our hope is that if we can properly support Sandy’s at-risk victims for the long term, then when people check in with them four years from now they will find that there has been healing among even the most at-risk people.

Christina H. Paxson is president of Brown University and a professor of economics.
Jean E. Rhodes is National Mentoring Partnership Professor of Psychology at the University of Massachusetts–Boston.
Mary C. Waters is the M.E. Zukerman Professor of Sociology at Harvard University.