Date Published: January 27, 2017
Publisher: Public Library of Science
Author(s): Wil Lieberman-Cribbin, Bian Liu, Samantha Schneider, Rebecca Schwartz, Emanuela Taioli, Jeffrey Shaman.
Hurricane Sandy caused extensive physical and economic damage; the long-term mental health consequences are unknown. Flooding is a central component of hurricane exposure, influencing mental health through multiple pathways that unfold over months after flooding recedes. Here we assess the concordance in self-reported and Federal Emergency Management (FEMA) flood exposure after Hurricane Sandy and determine the associations between flooding and anxiety, depression, and post-traumatic stress disorder (PTSD). Self-reported flood data and mental health symptoms were obtained through validated questionnaires from New York City and Long Island residents (N = 1231) following Sandy. Self-reported flood data was compared to FEMA data obtained from the FEMA Modeling Task Force Hurricane Sandy Impact Analysis. Multivariable logistic regressions were performed to determine the relationship between flooding exposure and mental health outcomes. There were significant discrepancies between self-reported and FEMA flood exposure data. Self-reported dichotomous flooding was positively associated with anxiety (ORadj: 1.5 [95% CI: 1.1–1.9]), depression (ORadj: 1.7 [1.3–2.2]), and PTSD (ORadj: 2.5 [1.8–3.4]), while self-reported continuous flooding was associated with depression (ORadj: 1.1 [1.01–1.12]) and PTSD (ORadj: 1.2 [1.1–1.2]). Models with FEMA dichotomous flooding (ORadj: 2.1 [1.5–2.8]) or FEMA continuous flooding (ORadj: 1.1 [1.1–1.2]) were only significantly associated with PTSD. Associations between mental health and flooding vary according to type of flood exposure measure utilized. Future hurricane preparedness and recovery efforts must integrate micro and macro-level flood exposures in order to accurately determine flood exposure risk during storms and realize the long-term importance of flooding on these three mental health symptoms.
Hurricane Sandy made landfall on the Northeastern United States on October 29th 2012, resulting in 159 deaths and an estimated economic cost of $65 billion . The unusual combination of the Hurricane, a nor’easter in early November, and coincidence with the full moon produced winds up to 90 mph and a storm-tide as high as 14 feet . One of the main components of hurricane exposure is flooding. New York and New Jersey residents experienced extensive damage from inundation and high winds, as well as interruptions in basic water, electrical, and transportation services. Approximately 8.5 million customers lost power with outages lasting from weeks to months, and 50 deaths resulted from power outages in cold weather . Over 650,000 houses and businesses were damaged or destroyed by Sandy, including 350,000 housing units in New Jersey and 300,000 homes destroyed in New York State, hundreds of buildings flooded in New York City (NYC), and 100,000 homes severely damaged or destroyed on Long Island (LI) .
This study is the first of its kind to compare macro and micro Hurricane Sandy flood exposure assessments and to examine the associations between flooding and mental health outcomes (anxiety, depression, PTSD) according to the type of flood exposure measurement used. Results indicated that there are significant discrepancies between self-reported and FEMA flood exposure data and that the associations between flooding and mental health outcomes vary according to the type of flood exposure measure utilized in the model, with self-perception of exposure being a stronger predictor of mental health outcomes than FEMA objective measurements. This finding has important public health implications as it underlines the importance of perception of danger, rather than objective measures, in determining mental health symptoms.
This study emphasizes the strong effect of the type of exposure measure used in identifying the associations between flood exposure and mental health outcomes. The importance of perception was highlighted by the fact that self-reported dichotomous flooding resulted in significant associations with all mental health outcomes, while dichotomous FEMA flooding was only associated with PTSD symptoms. While macro-level FEMA flood data is a relatively less expensive and faster way to provide exposure estimates spanning larger geographic areas affected by Hurricane Sandy than micro-level estimates from cohort studies, macro-level exposure estimates may underestimate the full mental health impact of the hurricane. Future efforts to assess mental health needs in affected populations must therefore incorporate both micro and macro-level flood exposures and integrate them in order to produce the most accurate evaluations. Flooding is a unique aspect of natural disasters since it can be prepared for through flood-prevention measures, and thus hurricane preparedness and recovery efforts must accurately determine flood exposure risk during storms, as well as realize the long-term importance of flooding on mental health concerns.