Impact of Hurricane Maria on Mental and Physical Health Among Puerto Ricans: A Matched Difference-in-Differences Analysis

Background and Purpose: Hurricane Maria's landfall on Puerto Rico on September 17, 2017, marked an unprecedented calamity, catapulting the island into a state of emergency due to massive infrastructural destruction and loss of life. This event, one of the most severe natural disasters in Puerto Rico's history, resulted in significant socio-economic and environmental upheaval, disrupting the lives of millions. Hurricane Maria's profound, enduring impact on individuals' mental and physical health underscores the critical need for an in-depth investigation. Such studies are vital for developing informed strategies to support recovery and implement effective interventions. This research aims to assess the sustained effects of Hurricane Maria on the health perceptions of Puerto Ricans, offering valuable insights into the broader implications of natural disasters on affected populations and the necessity for robust post-disaster health and welfare programs.

Methods: Employing a rigorous methodology, this study utilized the Behavioral Risk Factor Surveillance System (BRFSS) Surveys from 2016 to 2018 to explore the changes in self-reported poor mental and physical health days before and after Hurricane Maria's devastation. The research paired Puerto Rican respondents with a control group to ensure comparability and control for potential confounders through a differences-in-differences analytical approach complemented by propensity score matching. This methodological rigor was crucial in minimizing selection bias, enhancing the validity of the analysis, and enabling a precise assessment of the hurricane's nuanced impact on health outcomes.

Results: The study found statistically significant increases in self-reported poor mental (β=0.13, p<.05) and physical (β=0.17, p<.001) health days among Puerto Ricans post-Hurricane Maria. Detailed subgroup analysis revealed that the disaster disproportionately affected older women (aged 65+), with notable increases in poor mental health (β=0.37, p<.001) and physical health (β=0.35, p<.001). Those in the lowest income bracket (earning $15,000 or below) experienced significant deteriorations in both mental (β=0.28, p<.001) and physical health (β=0.20, p<.01), as did separated or widowed individuals (mental health β=0.19, p<.01; physical health β=0.23, p<.001). The most considerable decline in mental health was observed in the final quarter of 2017 (β=0.65, p<.001), while the most significant physical health decline occurred in the final quarter of 2018 (β=0.25, p<.001).

Conclusions and Implications: The sustained adverse effects of Hurricane Maria on the mental and physical health of Puerto Ricans highlight the urgent need for targeted interventions and policies focused on disaster recovery and resilience. The observed health deteriorations underscore the importance of a holistic healthcare approach in post-disaster settings, especially for the most vulnerable populations. Future research should endeavor to create, implement, and evaluate intervention strategies designed to address the long-term health effects of natural disasters. Engaging in such efforts will equip policymakers and healthcare providers to more effectively meet the complex health needs that emerge following catastrophic events, thereby improving the resilience and overall well-being of affected communities and paving the way for sustainable recovery and healing.