Thousands of North Carolina residents are still displaced in shelters after Hurricane Florence, and research suggests those evacuees may be more likely to develop PTSD symptoms than people who stay with family or friends.<\/b>
\nWhen Hurricane Florence made landfall in coastal North Carolina on Friday morning, some 20,000 residents had evacuated from their home and were taking refuge in 157 shelters, according to Governor Roy Cooper. \u201cWe\u2019ve spent the last week telling people to evacuate. Now we\u2019re working very hard to save lives,\u201d Cooper said Friday in an interview with NPR. In the days since, some of those evacuees have returned to their home, but the total number of people in the state still in shelters was estimated on Tuesday to be around 10,000.
For families who end up displaced from their home due to mandatory evacuation, fear of unsafe conditions, or actual unsafe conditions, the immediate inconvenience of being away from their bed and belongings is just the beginning of the ordeal. Several studies published in the past 20 years have shown a link between exposure to a hurricane and increased symptoms of PTSD and depression. Other research has linked displacement specifically to higher levels of PTSD and depression. Newer research, though, clarifies that some kinds of displacement can lead to better mental-health outcomes than others.
A study published earlier this year in the Journal of Emergency Management found that among New York City\u2013area residents displaced by Hurricane Sandy in 2012, \u201cparticipants who were able to stay with friends or family had 48 percent decreased odds of experiencing PTSD symptoms as compared to those who were displaced and stayed in a shelter.\u201d The study goes on to note that any displacement from a natural disaster has a negative impact on mental health\u2014but displacement to the home of a loved one or a familiar person can lessen the traumatic effects associated with having to leave or abandon one\u2019s own home. (As the lead researcher, Rebecca Schwartz, an associate professor at the Zucker School of Medicine at Hofstra University, clarified in an email, \u201cdisplaced\u201d in this study meant spending at least one night away from one\u2019s home.)
Photos: The aftermath of Hurricane Florence
The study suggests there\u2019s a two-pronged phenomenon at work here. First, there\u2019s a \u201cprotective effect\u201d associated with spending what\u2019s already a scary, anxious time with an established support network. \u201cIt is likely that the presence of continued social support and the preservation of social cohesion and family networks plays a large role, as the disruption of these elements have been shown to increase the likelihood of developing PTSD, depression, and other mental health difficulties,\u201d the authors write. As Daniel P. Aldrich noted in The Atlantic recently, people in tight-knit, trusting communities have been found to be more likely both to survive disasters and to bounce back from them psychologically.
And second, if the presence of family and\/or friends has an especially good effect, perhaps being in a temporary shelter could be said to have an especially bad effect. Though there\u2019s not much other research on the \u201cspecific negative correlates of displacement to shelters in the wake of natural disasters,\u201d the study says, \u201cit is likely that, particularly within temporary shelter settings, there are several nonsocial elements that interact to compound the negative effect on those displaced.\u201d Those include unsafe conditions, limited access to needed health-care services or health items (such as glucose meters or glasses), and the prevalence of illness inside the shelters. Other studies, the authors write, have found that shelter residents are more likely to experience \u201cdisruptions\u201d to their immune-system function and sleep cycles, both of which have been shown to negatively impact physical health as well as mental health.
\u201cShelter settings\u2014even the best-run shelters, with the most well-intentioned people, with the best leadership\u2014can be highly stressful,\u201d says Lori Peek, the director of the Natural Hazards Center at the University of Colorado at Boulder and an author of the book Children of Katrina. \u201cShelters involve a bringing together of people who are unfamiliar with one another, or strangers. They often involve open-air settings where lots of people are sleeping on cots in very tight settings. People are scared. There\u2019s very little privacy. So there are lots of things about the shelter itself that can be stress inducing.\u201d Plus, Peek says, many populations she\u2019s studied express added anxiety about discrimination inside of shelters. When Peek and some other researchers interviewed Muslim American families in Florida about whether and how they would evacuate in a hurricane, they found that one chief concern was discrimination inside the shelter. Another was a shortage or lack of halal food.
\u201cIt is hard to accommodate different dietary needs, cultural needs, religious needs, and gender-based needs,\u201d Peek acknowledges. \u201cBut we do recognize how important these different [accommodations] are to assist with launching people into their recovery process.\u201d
Of course, the study does note that taking refuge in shelters, as opposed to motels or other people\u2019s homes, is more common evacuation behavior for some populations than others \u2014 and some of the same conditions that might make someone more likely to end up in a shelter, as opposed to a family member or friend\u2019s home or a motel, are also likely predictors of poor mental-health outcomes. \u201cThe proportion of participants staying at a shelter was significantly higher among blacks and other nonwhites compared to whites\u2026 and among those who did not complete high school compared to those who did,\u201d the authors specify. And as Peek notes, \u201cWe know that the vast majority of the population does not choose, if they have the opportunity to choose, to go into a shelter. Who is in a shelter in the first place? Often, persons who may not have had an opportunity to go stay with family, to go stay with friends, to rent a hotel, etcetera.\u201d So it\u2019s possible, she says, that \u201cthe people who are in those shelters may have already been living more stressful, more difficult lives before the disaster, which is in part why they ended up in the shelter in the first place.\u201d Plus, Peek adds, being able to evacuate to a friend or family member\u2019s home requires one to have not only the resources to travel but also friends or family located within accessible distance but still outside the storm-affected area.
In the hierarchy of evacuation behaviors, evacuating to a shelter may not be as sound an option as evacuating to a loved one\u2019s home, but it\u2019s better than not evacuating at all. Research has shown that among children, for example, being exposed firsthand to a life-threatening situation is strongly associated with negative mental-health outcomes and trauma, not to mention an increased level of physical danger. The best-case scenario in a hurricane, Peek says, is removing oneself from danger and finding safety wherever it\u2019s available. \u201cOne hundred percent,\u201d Peek says. \u201cWhat we would hope is that no individual would be left behind.\u201d<\/p>\n

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