The Impact of Hurricane Trauma and Cultural Stress on Posttraumatic Stress Among Hurricane Maria Survivors Relocated to the U.S. Mainland

Background and Purpose: Following Hurricane Maria, many Puerto Rican “Maria migrants” fled the island with tens of thousands permanently resettling on the U.S. mainland. Emerging evidence suggests that many Maria migrants are exposed to migration-related cultural stressors, including discrimination, negative context of reception, and language stress. Although scholars have long recognized that contextual factors beyond the traumatic event itself impact both the development and course of trauma disorders in migrants fleeing dangerous circumstances, in the case of Maria migrants, a number of pressing questions remain, including: (1) Is post-migration exposure to cultural stressors associated with posttraumatic stress and, importantly, does cultural stress independently predict posttraumatic stress when accounting for hurricane trauma exposure? (2) Do hurricane trauma and cultural stress conjointly predict posttraumatic stress? The present study aimed to address these questions.

Method: Participants were 319 adult (age 18+, 71% female) Puerto Rican Hurricane Maria survivors on the U.S. mainland. Data were collected virtually between August 2020 and October 2021. Participants completed Spanish-language measures of hurricane-related trauma, post-migration cultural stress exposure, and PTSD symptoms and positive screens via the PTSD Checklist, Civilian Version (PCL-C). Using ordinary least squares regression (OLS) regression, we examined hurricane trauma (model 1) and cultural stress (model 2) as independent predictors of PTSD, while controlling for demographic factors only. Then, we examined hurricane trauma and cultural stress as predictors of PTSD in the same multivariate model. Finally, using multiplicative terms, we examined the interactions between hurricane trauma and cultural stress in relation to PTSD.

Results: One in five (20.5%) Maria migrants reported PCL-C scores in the range indicating a likely PTSD diagnosis. Both hurricane trauma and migration-related cultural stressors independently predicted posttraumatic stress and positive PTSD screens. Additionally, controlling for the effect of hurricane trauma, discrimination and language stress were strongly linked with PTSD. Further, hurricane trauma and cultural stressors interact such that cultural stress predicts PTSD symptoms/positive screens at low-to-moderate levels of hurricane trauma exposure but not at high-to-very-high levels.

Conclusions and Implications: The present study offers fresh insights regarding the experiences of Maria migrants. First, we see that an important subset of this population—roughly one in five—likely meets criteria for PTSD 3-4 years after the hurricane. This rate is similar to that observed in studies conducted with Maria migrants shortly after the hurricane, suggesting that, for many, trauma-related distress may be best conceptualized as a longer-term challenge. Second, we see that both hurricane trauma and migration-related cultural stressors represent important predictors of PTSD symptom severity/diagnosis. Third, the magnitude of the impact of cultural stress on PTSD appears to be, in part, a function of the severity of hurricane trauma exposure. Specifically, among those exposed to high levels of hurricane trauma, cultural stress exposure does not “add” to the effects of hurricane trauma vis-à-vis predicting risk of developing a trauma disorder (i.e., we observe a ceiling effect). Taken together, these findings underscore the importance of considering both pre-migration trauma and post-migration experiences in terms of the mental health of crisis migrant populations.