Puerto Rico Research Hub, University of Central Florida, Orlando, FL 32816, USA.
School of Medicine, University of Connecticut, Storrs, CT 06269, USA.
Int J Environ Res Public Health. 2024 Sep 25;21(10):1273. doi: 10.3390/ijerph21101273.
Mental health in Puerto Rico is a complex and multifaceted issue that has been shaped by the island's unique history, culture, and political status. Recent challenges, including disasters, economic hardships, and political turmoil, have significantly affected the mental well-being of the population, coupled with the limitations in the accessibility of mental health services. Thus, Puerto Rico has fewer mental health professionals per capita than any other state or territory in the United States.
This comprehensive review examines the impact of disasters on mental health and mental health services in Puerto Rico. Given the exodus of Puerto Ricans from the island, this review also provides an overview of mental health resources available on the island, as well as in the continental United States. This review identifies efforts to address mental health issues, with the intent of gaining a proper understanding of the available mental health services, key trends, as well as observable challenges and achievements within the mental health landscape of the Puerto Rican population.
A comprehensive search using the PRIMO database of the University of Central Florida (UCF) library database was conducted, focusing on key terms related to disasters and mental healthcare and services in Puerto Rico. The inclusion criteria encompassed studies on Puerto Rican individuals, both those who remained on the island and those who migrated post-disaster, addressing the mental health outcomes and services for adults and children. We included peer-reviewed articles published from 2005 onwards in English and/or Spanish, examining the impact of disasters on mental health, accessibility of services, and/or trauma-related consequences.
In this scoping review, we identified 39 studies addressing the mental health profile of Puerto Ricans, identifying significant gaps in service availability and accessibility and the impact of environmental disasters on mental health. The findings indicate a severe shortage of mental health services in Puerto Rico, exacerbated by disasters such as Hurricanes Irma and Maria, the earthquakes of late 2019 and early 2020 that followed, and the COVID-19 pandemic, resulting in substantial delays in accessing care, and limited insurance coverage, particularly in rural regions. Despite these challenges, efforts to improve mental health services have included substantial federal funding and community initiative aimed at enhancing care availability and infrastructure. Limitations include the use of a single database, language restrictions, and potential variability in data extraction and synthesis.
This scoping review highlights the significant impact of disasters on mental health in Puerto Rico and the challenges in accessing mental health services exacerbated by disasters. Despite efforts, significant gaps in mental healthcare and services persist, emphasizing the need for more rigorous research and improvements in infrastructure and workforce to enhance mental health outcomes for Puerto Ricans both on the island and in the continental United States.
波多黎各的心理健康是一个复杂且多方面的问题，受到该岛独特的历史、文化和政治地位的影响。最近的挑战，包括灾害、经济困难和政治动荡，极大地影响了民众的心理健康，再加上心理健康服务的可及性有限，波多黎各的每千人中拥有的心理健康专业人员比美国任何其他州或领土都要少。
本综合综述研究了灾害对波多黎各心理健康和心理健康服务的影响。鉴于波多黎各人离开该岛，本综述还概述了岛上以及美国大陆的可用心理健康资源。本综述确定了应对心理健康问题的努力，旨在深入了解现有的心理健康服务、关键趋势以及波多黎各人口的心理健康领域中可观察到的挑战和成就。
使用佛罗里达中中央大学 (UCF) 图书馆数据库的 PRIMO 数据库进行了全面搜索，重点是与波多黎各灾害和心理健康保健和服务相关的关键词。纳入标准包括针对波多黎各个人的研究，包括留在岛上和灾害后移民的个人，研究内容为成年人和儿童的心理健康结果和服务。我们纳入了自 2005 年以来以英文和/或西班牙文发表的同行评议文章，研究了灾害对心理健康、服务可及性和/或创伤后果的影响。
在本次范围综述中，我们确定了 39 项研究，这些研究探讨了波多黎各人的心理健康状况，确定了服务提供和可及性方面的显著差距以及环境灾害对心理健康的影响。研究结果表明，波多黎各的心理健康服务严重短缺，灾害如飓风“艾尔玛”和“玛丽亚”、2019 年底和 2020 年初的地震以及 COVID-19 大流行进一步加剧了这种情况，导致在获得护理方面出现了大量延误，并且保险覆盖范围有限，特别是在农村地区。尽管面临这些挑战，但改善心理健康服务的努力包括联邦政府提供的大量资金和旨在提高服务可用性和基础设施的社区倡议。存在的局限性包括使用单一数据库、语言限制以及数据提取和综合方面的潜在差异。
本范围综述强调了灾害对波多黎各心理健康的重大影响，以及灾害加剧了获取心理健康服务方面的挑战。尽管做出了努力，但心理健康保健和服务方面仍存在重大差距，这强调需要进行更严格的研究，并改善基础设施和劳动力，以提高波多黎各人民的心理健康结果，无论他们是在岛上还是在美国大陆。
