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UNC-P study looks at ways people cope with lingering stress from Hurricane Florence

Ashley Batts Allen saw Lumberton and other parts of Robeson County endure a prolonged recovery following 2016’s Hurricane Matthew.

Then, two years later, Hurricane Florence brought flooding to many of the same areas. Allen, a professor at the University of North Carolina at Pembroke, is working with researchers from East Carolina University and the University of Colorado - Colorado Springs, to study what factors influence a person’s mental health and recovery following a disaster.

Researchers focused on Bladen, Columbus, Robeson and Scotland counties, where the Hope 4 NC Crisis Counseling Program has provided care to 38,393 people, representing nearly 30% of the total across the 28-county area it served following Florence.

In 261 responses to an initial survey from Allen’s team, 67% reported developing new or worsening mental health conditions and 26% said a child in their home had developed a new or worsening mental health condition.

The study

“Typically, we say in the first few months after a traumatic event that a lot of these symptoms like hyper-vigilance and increased anxiety and irritability are part of what we would call an acute stress response,” said Dr. Carrie Brown, the N.C. Department of Health and Human Services’ chief medical officer for behavioral health. “And if it continues on, it transforms into post-traumatic stress disorder, which typically is a more chronic illness.”

Allen’s research team found potential participants by going door-to-door in affected communities, as well as by setting up booths at health fairs and other gathering spaces. To participate, residents first had to tell researchers they were feeling lingering effects from the storm.

“We want to look at people’s emotional recovery, how that happens over time,” Allen said. “We’re anticipating there’s a lot of negative effects here in terms of coping methods and stress.”

Participation begins with a 25-30 minute survey that evaluates the person’s personality and coping methods. Then, those who took the initial survey can download an app and answer daily questions for six weeks about how they are continuing to cope and how the storm is affecting their daily lives.

In addition to the initial questionnaire, there is an additional survey at the three-month mark and then a concluding survey at the six-month mark. Those who took the first survey but did not download the app remain eligible for the milestone surveys.

While researchers were aiming for 300 participants, 261 have taken the initial survey thus far, with 164 of those downloading the app. Recruitment closed at the end of May.

The team is confident, Allen said, that they have enough participants to draw meaningful conclusions from the surveys and app answers.

“Because we’re doing so much with in-person data so you’re able to assess change in a person over time, the sample size you need is a lot lower. It’s definitely going to be good enough,” Allen said.

When the study is complete, the team intends to evaluate how survivors’ emotional recovery takes place over time after an event like a storm and look at the effectiveness of the coping methods people used.

“People who are kind and compassionate to themselves may be handling the stress better than other people,” Allen said.

Once the research is complete, Allen and the rest of the team plan to present their findings to health departments, as well as to organizations that helped recruit participants such as the Robeson Church & Community Center and local branches of the N.C. Farm Bureau.

Those presentations, Allen said, will include “whatever we learn from the study that could be helpful for them.”

Impact and recovery

Likely compounding problems on North Carolina’s southern border were lingering effects from Hurricane Matthew, whose rains caused catastrophic flooding in Fair Bluff, Lumberton and other nearby areas. Many residents suffered a nearly identical disaster after Florence’s floodwaters pushed the Lumber and other rivers to new heights.

Around Robeson County, Allen added, the severity of the two floods varies from neighborhood to neighborhood, with some experiencing a more significant disaster after Florence and others after Matthew.

Hope 4 NC, the DHHS-administered program providing free counseling and other mental health services to hurricane-impacted counties, has provided more services in Columbus County than any other in the state, with 16,294 people helped across three branches of the program. The program has a significant presence in other counties included in Allen’s study, as well, with 13,403 services provided in Robeson, while Bladen and Scotland were between 5,000 and 6,000, according to DHHS records.

“We don’t want people to suffer in silence. We want people to reach out and ask for help, and we, as a state, have a responsibility to ensure that when people do reach out for help, we can help them and connect them with care,” Brown said.

The Robeson County Disaster Recovery Committee is one of the nonprofits helping residents who are continuing to struggle, offering case management for those affected by the floods. In addition to referring people to Hope 4 NC , the organization also deals with needs such as food and housing.

“When you experience a disaster, a lot of times it’s not like your physical house is turned upside down, it’s like your whole life is turned upside down,” said Jay Leggette, a case manager with the organization.

Leggette said an unmet needs assessment is critical to helping him and other case managers develop long-term plans that can vary widely from person to person, allowing both the survivor and the case work to understand the entire situation and what resources may be available.

For instance, if a homeowner reports a leaking roof, Leggette will likely refer them to someone who can tarp the roof. But he would also make a referral to a mold remediation service to prevent spores from taking hold in the house.

“The value of a long-term recovery plan,” Leggette said, “is not to have a survivor focus on ‘Z,’ but to have a survivor focus on ‘A to Z.’”

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