Las huellas de los huracanes: Uncovering hurricane Maria-related post-traumatic stress disorder symptom profiles and related correlates among youths of Puerto Rico
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Published
2025-12-30
Cynthia M. Navarro Flores
Alejandro L. Vázquez
Ines Cano-Gonzalez
Shari Linares
Jimena Mendoza Barrón
John Young
Rosaura Orengo-Aguayo
Regan W. Stewart
https://orcid.org/0000-0002-7787-8132
Abstract
This study identified PTSD symptom patterns among youths of Puerto Rico after Hurricane Maria and examined hurricane-related stressors. Latent profile analyses revealed three PTSD symptom profiles: (a) Predominantly Intrusion/Avoidance, (b) Predominantly Arousal/Reactivity and Negative Cognition/Mood, and (c) Low PTSD. The Predominantly Intrusion/Avoidance profile showed higher rates of clinically elevated PTSD scores and exposures to hurricane-related stressors. Through machine learning algorithms, we identified the most significant correlates for the Predominantly Intrusion/Avoidance (top classifier: thinking they could die) and Predominantly Arousal/Reactivity and Negative Cognition/Mood (top classifier: violence in the home or neighborhood) profiles. Our findings underscore the need for trauma-informed care and policy that address varied stress responses following natural disasters.
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Keywords
Post-traumatic stress, youths, natural disaster, latent profile analysis, machine learning
References
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https://doi.org/10.1176/appi.books.9780890425596
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Chandra, A., Marsh, T., Madrigano, J., Simmons, M., Abir, M., Chan, E., Ryan, J., Nanda, N., Ziegler, M., & Nelson, C. (2020). Health and social services in Puerto Rico before and after Hurricane Maria: Predisaster conditions, hurricane damage, and themes for recovery. RAND. https://doi.org/10.7249/RR2603
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Crimmins, A., Balbus, J., Gamble, J. L., Beard, C. B., Bell, J. E., Dodgen, D., Eisen, R. J., Fann, N., Hawkins, M. D., Herring, S. C., Jantarasami, L., Mills, D. M., Saha, S., Sarofim, M. C., Trtanj, J., & Ziska, L. (2016). The impacts of climate change on human health in the United States: A scientific assessment. USGCRP. https://doi.org/10.7930/J0R49NQX
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https://www.rand.org/pubs/research_reports/RR2595.html
Horn, S. R., Pietrzak, R. H., Schechter, C., Bromet, E. J., Katz, C. L., Reissman, D. B., Kotov, R., Crane, M., Harrison, D. J., Herbert, R., Luft, B. J., Moline, J. M., Stellman, J. M., Udasin, I. G., Landrigan, P. J., Zvolensky, M. J., Southwick, S. M., & Feder, A. (2016). Latent typologies of posttraumatic stress disorder in World Trade Center responders. Journal of Psychiatric Research, 83, 151–159.
https://doi.org/10.1016/j.jpsychires.2016.08.018
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https://doi.org/10.1007/s10826-014-9934-3
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Orengo-Aguayo, R., Stewart, R. W., de Arellano, M. A., Suárez-Kindy, J. L., & Young, J. (2019). Disaster exposure and mental health among Puerto Rican youths after Hurricane Maria. JAMA Network Open, 2(4), e192619. https://doi.org/10.1001/jamanetworkopen.2019.2619
Pietrzak, R. H., el-Gabalawy, R., Tsai, J., Sareen, J., Neumeister, A., & Southwick, S. M. (2014). Typologies of posttraumatic stress disorder in the U.S. adult population. Journal of Affective Disorders, 162, 102–106. https://doi.org/10.1016/j.jad.2014.03.024
Riley, R. D., Ensor, J., Snell, K. I. E., Harrell, F. E., Martin, G. P., Reitsma, J. B., Moons, K. G. M., Collins, G., & van Smeden, M. (2020). Calculating the sample size required for developing a clinical prediction model. BMJ, m441. https://doi.org/10.1136/bmj.m441
Rolon-Arroyo, B., Oosterhoff, B., Layne, C. M., Steinberg, A. M., Pynoos, R. S., & Kaplow, J. B. (2020). The UCLA PTSD Reaction Index for DSM-5 Brief Form: A screening tool for trauma-exposed youths. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 434–443. https://doi.org/10.1016/j.jaac.2019.06.015
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Self-Brown, S., Lai, B. S., Thompson, J. E., McGill, T., & Kelley, M. L. (2013). Posttraumatic stress disorder symptom trajectories in Hurricane Katrina affected youth. Journal of Affective Disorders, 147(1-3), 198–204. https://doi.org/10.1016/j.jad.2012.11.002
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Tang, F., & Ishwaran, H. (2017). Random forest missing data algorithms. Statistical analysis and data mining: Statistical Analysis and Data Mining: The ASA Data Science Journal, 10(6), 363-377. https://doi.org/10.1002/sam.11348
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Vázquez, A. L., Flores, C. M. N., Feinberg, D. K., Gonzalez, J. C., Young, J., Stewart, R. W., & Orengo‐Aguayo, R. E. (2024). A network analysis of Hurricane Maria–related traumatic stress and substance use among Puerto Rican youth. Journal of Traumatic Stress, 37(2), 267-279. https://doi.org/10.1002/jts.23008
Vernberg, E. M., La Greca, A. M., Silverman, W. K., & Prinstein, M. J. (1996). Prediction of posttraumatic stress symptoms in children after Hurricane Andrew. Journal of Abnormal Psychology, 105(2), 237–248. https://doi.org/10.1037/0021-843X.105.2.237
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32–35. https://doi.org/10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3
https://www.germanwatch.org/sites/default/files/2025-02/Climate%20Risk%20Index%202025.pdf
Alto, M. E., Nicasio, A. V., Stewart, R., Rodríguez-Sanfiorenzo, T. D., González-Elías, G., & Orengo-Aguayo, R. (2021). Provision of mental health services immediately following a natural disaster: Experiences after Hurricane Maria in Puerto Rico. Journal of Emergency Management, 19(8), 167–175.
https://doi.org/10.5055/jem.0634
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596
Campbell, S. B., Trachik, B., Goldberg, S., & Simpson, T. L. (2020). Identifying PTSD symptom typologies: A latent class analysis. Psychiatry Research, 285, 112779. https://doi.org/10.1016/j.psychres.2020.112779
Cao, X., Wang, L., Cao, C., Zhang, J., & Elhai, J. D. (2019). PTSD Latent classes and class transitions predicted by distress and fear disorders in disaster-exposed adolescents. Journal of Clinical Child and Adolescent Psychology, 48(2), 332–342. https://doi.org/10.1080/15374416.2017.1410825
Chandra, A., Marsh, T., Madrigano, J., Simmons, M., Abir, M., Chan, E., Ryan, J., Nanda, N., Ziegler, M., & Nelson, C. (2020). Health and social services in Puerto Rico before and after Hurricane Maria: Predisaster conditions, hurricane damage, and themes for recovery. RAND. https://doi.org/10.7249/RR2603
Chorpita, B. F., Weisz, J. R. (2009). Modular approach to therapy for children with anxiety, depression, trauma, or conduct problems (MATCH-ADTC).PracticeWise.
Crimmins, A., Balbus, J., Gamble, J. L., Beard, C. B., Bell, J. E., Dodgen, D., Eisen, R. J., Fann, N., Hawkins, M. D., Herring, S. C., Jantarasami, L., Mills, D. M., Saha, S., Sarofim, M. C., Trtanj, J., & Ziska, L. (2016). The impacts of climate change on human health in the United States: A scientific assessment. USGCRP. https://doi.org/10.7930/J0R49NQX
Dogan-Ates, A. (2010). Developmental differences in children's and adolescents' post-disaster reactions. Issues in Mental Health Nursing, 31(7), 470–476.
https://doi.org/10.3109/01612840903582528
Enders, C. K. (2022). Applied missing data analysis (2nd ed.) The Guilford Press.
Fausset, R. (2017, October 2). In Puerto Rico, equal parts fear and fellowship after storm. The New York Times.
https://www.nytimes.com/2017/10/02/us/puerto-rico-hurricane-crime.html
Fischbach, J. R., May, L. W., Whipkey, K., Shelton, S. R., Vaughan, C. A., Tierney, D., Leuschner, K. J., Meredith, L. S., & Peterson, H. J. (2020). After Hurricane Maria: Predisaster conditions, hurricane damage, and recovery needs in Puerto Rico. RAND.
https://www.rand.org/pubs/research_reports/RR2595.html
Horn, S. R., Pietrzak, R. H., Schechter, C., Bromet, E. J., Katz, C. L., Reissman, D. B., Kotov, R., Crane, M., Harrison, D. J., Herbert, R., Luft, B. J., Moline, J. M., Stellman, J. M., Udasin, I. G., Landrigan, P. J., Zvolensky, M. J., Southwick, S. M., & Feder, A. (2016). Latent typologies of posttraumatic stress disorder in World Trade Center responders. Journal of Psychiatric Research, 83, 151–159.
https://doi.org/10.1016/j.jpsychires.2016.08.018
Hosmer, D.W., & Lemeshow, S. (2000). Applied logistic regression (2nd edition). Wiley.
Joseph, S. R., Voyles, C., Williams, K. D., Smith, E., & Chilton, M. (2020). Colonial neglect and the right to health in Puerto Rico after Hurricane Maria. American Journal of Public Health, 110(10), 1512-1518. https://doi.org/10.2105/AJPH.2020.305814
Kronenberg, M. E., Hansel, T. C., Brennan, A. M., Osofsky, H. J., Osofsky, J. D., & Lawrason, B. (2010). Children of Katrina: Lessons learned about postdisaster symptoms and recovery patterns. Child Development, 81(4), 1241–1259.
https://doi.org/10.1111/j.1467-8624.2010.01465.x
Kuhn, M., & Johnson, K. (2013). Applied predictive modeling (Vol. 26). Springer.
Lai, B. S., Kelley, M. L., Harrison, K. M., Thompson, J. E., & Self-Brown, S. (2015). Posttraumatic stress, anxiety, and depression symptoms among children after hurricane Katrina: A latent profile analysis. Journal of Child and Family Studies, 24(5), 1262–1270.
https://doi.org/10.1007/s10826-014-9934-3
Moleti, C. A., Contreras Sollazzo, L., Minick, M., & Esposito, C. L. (2020). Aftermath of Maria: An ethnographic review of rescue, recovery, climate, and social justice in Puerto Rico. Journal of the New York State Nurses Association, 47(1), 45–56.
Morgan, G. B., Hodge, K. J., & Baggett, A. R. (2016). Latent profile analysis with nonnormal mixtures: A Monte Carlo examination of model selection using fit indices. Computational Statistics & Data Analysis, 93, 146-161.
https://doi.org/10.1016/j.csda.2015.02.019
Navarro Flores, C. M., Vázquez, A. L., Young, J., Orengo-Aguayo, R., & Stewart, R. W. (2025). After the storm, the calm never came: Hurricane Maria-related stressors and PTSD symptoms among Puerto Rican youth. Psychological Trauma: Theory, Research, Practice, and Policy, 17(1), 48–56. https://doi.org/10.1037/tra0001837
Norrholm, S. D., & Jovanovic, T. (2010). Tailoring therapeutic strategies for treating posttraumatic stress disorder symptom clusters. Neuropsychiatric Disease and Treatment, 6, 517–532. https://doi.org/10.2147/NDT.S10951
Orengo-Aguayo, R., Stewart, R. W., de Arellano, M. A., Suárez-Kindy, J. L., & Young, J. (2019). Disaster exposure and mental health among Puerto Rican youths after Hurricane Maria. JAMA Network Open, 2(4), e192619. https://doi.org/10.1001/jamanetworkopen.2019.2619
Pietrzak, R. H., el-Gabalawy, R., Tsai, J., Sareen, J., Neumeister, A., & Southwick, S. M. (2014). Typologies of posttraumatic stress disorder in the U.S. adult population. Journal of Affective Disorders, 162, 102–106. https://doi.org/10.1016/j.jad.2014.03.024
Riley, R. D., Ensor, J., Snell, K. I. E., Harrell, F. E., Martin, G. P., Reitsma, J. B., Moons, K. G. M., Collins, G., & van Smeden, M. (2020). Calculating the sample size required for developing a clinical prediction model. BMJ, m441. https://doi.org/10.1136/bmj.m441
Rolon-Arroyo, B., Oosterhoff, B., Layne, C. M., Steinberg, A. M., Pynoos, R. S., & Kaplow, J. B. (2020). The UCLA PTSD Reaction Index for DSM-5 Brief Form: A screening tool for trauma-exposed youths. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 434–443. https://doi.org/10.1016/j.jaac.2019.06.015
Saunders, R., Buckman, J. E. J., & Pilling, S. (2020). Latent variable mixture modelling and individual treatment prediction. Behaviour Research and Therapy, 124, 103505. https://doi.org/10.1016/j.brat.2019.103505
Self-Brown, S., Lai, B. S., Thompson, J. E., McGill, T., & Kelley, M. L. (2013). Posttraumatic stress disorder symptom trajectories in Hurricane Katrina affected youth. Journal of Affective Disorders, 147(1-3), 198–204. https://doi.org/10.1016/j.jad.2012.11.002
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2018). Disaster Technical Assistance Center Supplemental Research Bulletin: Behavioral health conditions in children and youth exposed to natural disasters. SAMHSA. https://www.samhsa.gov/sites/default/files/srb-childrenyouth-8-22-18.pdf
Tang, F., & Ishwaran, H. (2017). Random forest missing data algorithms. Statistical analysis and data mining: Statistical Analysis and Data Mining: The ASA Data Science Journal, 10(6), 363-377. https://doi.org/10.1002/sam.11348
U.S. Department of State. (n.d.). The climate crisis: Working together for future generations. https://2021-2025.state.gov/climate-crisis/?safe=1
Vázquez, A. L., Flores, C. M. N., Feinberg, D. K., Gonzalez, J. C., Young, J., Stewart, R. W., & Orengo‐Aguayo, R. E. (2024). A network analysis of Hurricane Maria–related traumatic stress and substance use among Puerto Rican youth. Journal of Traumatic Stress, 37(2), 267-279. https://doi.org/10.1002/jts.23008
Vernberg, E. M., La Greca, A. M., Silverman, W. K., & Prinstein, M. J. (1996). Prediction of posttraumatic stress symptoms in children after Hurricane Andrew. Journal of Abnormal Psychology, 105(2), 237–248. https://doi.org/10.1037/0021-843X.105.2.237
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32–35. https://doi.org/10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3
How to Cite
Las huellas de los huracanes: Uncovering hurricane Maria-related post-traumatic stress disorder symptom profiles and related correlates among youths of Puerto Rico. (2025). Puerto Rican Journal of Psychology, 36(2), 150-166. https://doi.org/10.55611/reps.3602.03
Section
Artículo de investigación
Si se acepta un trabajo para su publicación, los derechos de impresión y de reproducción por cualquier forma y medio son de la Asociación de Psicología de Puerto Rico (APPR), que no rechazará cualquier petición razonable por parte de los autores para obtener el permiso de reproducción de sus contribuciones. Debe adjuntarse una carta tipo de cesión de derechos. Se entiende que las opiniones expresadas en los artículos son de responsabilidad exclusiva de los autores y no comprometen la opinión y política científica de la Revista ni de la APPR. Igualmente, las actividades descritas en los trabajos publicados estarán de acuerdo con los criterios de ética, tanto por lo que se refiere a los trabajos con humanos como a la experimentación animal, así como en todo lo relativo a la ética profesional.
How to Cite
Las huellas de los huracanes: Uncovering hurricane Maria-related post-traumatic stress disorder symptom profiles and related correlates among youths of Puerto Rico. (2025). Puerto Rican Journal of Psychology, 36(2), 150-166. https://doi.org/10.55611/reps.3602.03