Perceived Service Need after Hurricane Sandy in a Representative Sample of Survivors: The Roles of Community-Level Damage and Individual-Level Stressors

Objective We aimed to explore how individually experienced disaster-related stressors and collectively experienced community-level damage influenced perceived need for mental health services in the aftermath of Hurricane Sandy. Methods In a cross-sectional study we analyzed 418 adults who lived in the most affected areas of New York City at the time of the storm. Participants indicated whether they perceived a need for mental health services since the storm and reported on their exposure to disaster-related stressors (eg, displacement, property damage). We located participants in communities (n=293 census tracts) and gathered community-level demographic data through the US Census and data on the number of damaged buildings in each community from the Federal Emergency Management Agency Modeling Task Force. Results A total of 7.9% of participants reported mental health service need since the hurricane. Through multilevel binomial logistic regression analysis, we found a cross-level interaction (P=0.04) between individual-level exposure to disaster-related stressors and community-level building damage. Individual-level stressors were significantly predictive of individual service needs in communities with building damage (adjusted odds ratio: 2.56; 95% confidence interval: 1.58-4.16) and not in communities without damage. Conclusion Individuals who experienced individual stressors and who lived in more damaged communities were more likely to report need for services than were other persons after Hurricane Sandy.