Long-term negative mental health outcomes in mothers exposed to Hurricane Maria in Puerto Rico during the pre- and perinatal periods.

In September 2017, Category 4 Hurricane Maria devastated Puerto Rico (PR). This cross-sectional study evaluated the long-term mental health outcomes among women who were pregnant during or became pregnant shortly after (i.e., within 3 months) hurricane exposure. The HELiOS Study cohort recruited 187 mother-child dyads. Mothers reported prenatal hurricane-related experiences (threat, injury, property loss) and completed assessments of posttraumatic stress disorder (PTSD), perceived stress, and depressive symptoms. Maternal probable depression (19.5%), probable PTSD (21.4%), and moderate-to-severe stress (66.1%) were prevalent 12-54 months postpartum. Linear regression models showed that property damage/loss predicted depressive, B = 0.290, p = .007, and PTSD symptoms, B = 0.893, p = .001, and injury predicted higher depressive, B = 0.546, p = .039, and PTSD symptoms, B = 1.979, p = .003. Prehurricane depression also predicted higher depressive, B = 1.927, p = .035, and PTSD symptoms, B = 4.628, p = .046, whereas total trauma count was associated with PTSD symptoms, B = 1.905, p = .003, and perceived stress, B = 0.803, p = .007. Mothers interviewed closer to the hurricane were more likely to report PTSD symptoms, B = 5.001, p = .021. Married, B = -10.706, p = .038, and cohabitating women, B = -10.948, p = .035, reported lower perceived stress. Hurricane-related experiences during pregnancy can have negative long-term effects on maternal mental health. Single mothers and pregnant women with a history of trauma exposure and/or depression may have a heightened risk of adverse postdisaster mental health outcomes.