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Sept. 21, 2017 -- When the evacuation order came as Hurricane Irma was bearing down on Florida, Maria Mendez followed steps she knew well.

"We got the house ready," says Mendez, a 68-year-old English professor from Cutler Bay, about 30 miles south of downtown Miami. The family put up the hurricane shutters, wrapped paintings and other valuables, and moved the patio furniture inside.

Suddenly, however, Maria ran out of the house.

"I opened the gate and started running," she says.

Her husband, Alfredo, and daughter Ana led her back to the house, calmed her down, and the family safely evacuated.

In hindsight, Maria knows what was behind her need to escape. Irma had triggered a reliving of Hurricane Andrew in 1992, when they lost their house, cars, and boat. During that storm, the family had holed up in the house, terrified as the bathroom ceiling collapsed and the roof blew away.

"We were sure we were going to die," she remembers. The psychologist who diagnosed her posttraumatic stress disorder (PTSD) after Hurricane Andrew had said to expect unusual reactions when disaster strikes.

With seemingly endless recent disasters -- hurricanes in Texas, Florida, and the Caribbean; wildfires out West; and now, major earthquakes in Mexico -- the immediate concern of the ones affected is survival: eating, drinking, and finding a place to sleep.

But soon after, the mental health fallout can start.

What's ‘Normal’ After Disaster?

Experts notice a pattern of mental health symptoms after disasters, says Yuval Neria, PhD, professor of medical psychology and director of the PTSD treatment and research program at Columbia University Medical Center. "Usually what we see first is the anxiety, fear, the difficulty in concentrating and functioning," he says.

If that's not addressed, substance abuse from self-medicating is a danger. PTSD is also a concern, he says.

"PTSD is a combination of anxiety and depressive symptoms," Neria says. It also includes hyperarousal, or feeling jittery, always alert, and on the lookout for danger, even when none is present.

It's also marked by nightmares, flashbacks, and avoiding situations or places that bring back the terror.

The anxiety can be fueled by the uncertainty of where you will go when disaster strikes, and even where you will sleep that night, as Daisy Gonzalez, a medical student at the University of Miami, knows.

She had to evacuate her apartment, about 15 minutes north of South Beach. When the hurricane looked imminent, she and her boyfriend, Peter Talesnik, both recent transplants from New York, were in a quandary. He couldn't drive, and she had just learned to drive. So they headed for the airport, hoping to catch a standby flight.

With no available flights after 7 hours, Daisy's dad called and said he would fly from New York to Miami and drive them back. They got out safely, but Daisy remembers the sinking feeling: "I honestly had no idea what we were going to do."

That fear of the unknown, along with the unusually long lead time before Irma struck, is difficult to deal with emotionally, says Arlene Wright, a family nurse practitioner in Fort Myers, FL, who worked to reassure patients before the storm that she would help them get medications.

Most callers just wanted reassurance. "It's an emotional roller coaster. There's so much hype before. You are sitting around, and it's like waiting for a death sentence."

When to Seek Help

People who have life-threatening exposure to a disaster, such as being in a building that shakes violently during an earthquake or being trapped in a flooded house during a hurricane, are more likely to develop PTSD, says James Shultz, PhD, director of the Center for Disaster and Extreme Event Preparedness at the University of Miami Miller School of Medicine.

Knowing when to get professional mental health help is key, Neria says. "If you can't sleep well, if you cannot concentrate, if you become angry and have emotional difficulty dealing with the daily routine, you must get help, and the sooner the better."

What Research Has Found

After Hurricane Katrina in 2005, researchers documented changes in mental and physical health among 392 low-income parents. They found that nearly half likely had PTSD. Their health effects continued for a year or more.

After Hurricane Sandy in 2012, Neria and Shultz reviewed published studies about disaster-related PTSD and found that PTSD risk is usually lower after natural disasters, compared with human-made and technological disasters, where human error or computer malfunction cause catastrophe.

If trauma-related symptoms such as PTSD persist, they say, you should get help that addresses the main issues. These symptoms may include:

  • Intrusive thoughts
  • Sleep problems
  • Nightmares
  • A heightened startle reaction (when something surprises or scares you)
  • Avoidant behaviors, or avoiding certain situation

Although symptoms usually start soon after the traumatic event, they can also happen months or years later.

Symptoms of trauma lasting more than 3 days could be acute stress disorder, or ASD. If they last more than 4 weeks, or are disruptive or distressing, PTSD is probable, experts say.

Cognitive behavioral therapy or CBT, also called talk therapy, can help survivors process the trauma, and medication could also be a treatment.

A counselor, such as a psychologist or other mental health professional trained in PTSD treatment, can also teach how to change the upsetting feelings and thoughts related to the trauma.

These three things are most important for the immediate mental health recovery of disaster survivors, according to the National Center:

  • Focus on positive ways of coping
  • Connect with social supports
  • Get needed services.

Moving On

Coping with loss is a major challenge after a disaster, Neria says. "It's really a marathon in which you are tested again and again to cope with loss -- loss of property, sometimes loss of lives, sometimes you lose your home base, or you lost your educational system."

Despite the obstacles, Neria says, most people will do well in the long term. People who have been through previous disasters and handled them well are likely to be more resilient, Neria says. He often finds younger people and the elderly struggle most.

Initially, rebuilding sounds romantic, full of energy and hope, Neria says. "But you need to overcome bureaucracy, change priorities, and sometimes you don't have the resources to do it."

Experts say getting back to a normal routine as quickly as possible is good for your mental health. Even if the routine is not quite back to normal, it can help, says Mendez, the Florida resident who fled Hurricane Irma.

Soon after the worst was over, her family, dripping from the high humidity, found a Denny's that was open. It isn't their favorite restaurant, she says. But they lingered as long as they could over that breakfast. And while the menu wasn't their favorite, the one hour they sat in air conditioning and ate breakfast felt great.

Show Sources

American Journal of Orthopsychiatry: "The Impact of Hurricane Katrina on the Mental and Physical Health of Low-Income Parents in New Orleans."

JAMA: "Mental Health Effects of Hurricane Sandy."

Maria Mendez, Cutler Bay, FL.

Yuval Neria, PhD, professor of medical psychology and director of the PTSD treatment and research program, Columbia University Medical Center.

James Shultz, PhD, director of the Center for Disaster and Extreme Event Preparedness, University of Miami Miller School of Medicine.

Daisy Gonzalez, medical student, University of Miami.

Arlene Wright, family nurse practitioner, Fort Myers, FL.

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