‘Even the Best-Run Hurricane Shelters Can Be Highly Stressful’

Thousands of North Carolina residents are still displaced after Hurricane Florence, but research suggests evacuees who stay with family or friends are less likely to develop PTSD symptoms.

Five people load up duffel bags and a dog onto a truck bed in a flooded street.
Thomas B. Shea / AFP / Getty

When Hurricane Florence made landfall in coastal North Carolina on Friday morning, some 20,000 residents had evacuated from their home and were taking refuge in 157 shelters, according to Governor Roy Cooper. “We’ve spent the last week telling people to evacuate. Now we’re working very hard to save lives,” Cooper said Friday in an interview with NPR. In the days since, some of those evacuees have returned to their home, but the total number of people in the state still in shelters was estimated on Tuesday to be around 10,000.

For families who end up displaced from their home due to mandatory evacuation, fear of unsafe conditions, or actual unsafe conditions, the immediate inconvenience of being away from their bed and belongings is just the beginning of the ordeal. Several studies published in the past 20 years have shown a link between exposure to a hurricane and increased symptoms of PTSD and depression. Other research has linked displacement specifically to higher levels of PTSD and depression. Newer research, though, clarifies that some kinds of displacement can lead to better mental-health outcomes than others.

A study published earlier this year in the Journal of Emergency Management found that among New York City–area residents displaced by Hurricane Sandy in 2012, “participants who were able to stay with friends or family had 48 percent decreased odds of experiencing PTSD symptoms as compared to those who were displaced and stayed in a shelter.” The study goes on to note that any displacement from a natural disaster has a negative impact on mental health—but displacement to the home of a loved one or a familiar person can lessen the traumatic effects associated with having to leave or abandon one’s own home. (As the lead researcher, Rebecca Schwartz, an associate professor at the Zucker School of Medicine at Hofstra University, clarified in an email, “displaced” in this study meant spending at least one night away from one’s home.)

The study suggests there’s a two-pronged phenomenon at work here. First, there’s a “protective effect” associated with spending what’s already a scary, anxious time with an established support network. “It is likely that the presence of continued social support and the preservation of social cohesion and family networks plays a large role, as the disruption of these elements have been shown to increase the likelihood of developing PTSD, depression, and other mental health difficulties,” the authors write. As Daniel P. Aldrich noted in The Atlantic recently, people in tight-knit, trusting communities have been found to be more likely both to survive disasters and to bounce back from them psychologically.

And second, if the presence of family and/or friends has an especially good effect, perhaps being in a temporary shelter could be said to have an especially bad effect. Though there’s not much other research on the “specific negative correlates of displacement to shelters in the wake of natural disasters,” the study says, “it is likely that, particularly within temporary shelter settings, there are several nonsocial elements that interact to compound the negative effect on those displaced.” Those include unsafe conditions, limited access to needed health-care services or health items (such as glucose meters or glasses), and the prevalence of illness inside the shelters. Other studies, the authors write, have found that shelter residents are more likely to experience “disruptions” to their immune-system function and sleep cycles, both of which have been shown to negatively impact physical health as well as mental health.

“Shelter settings—even the best-run shelters, with the most well-intentioned people, with the best leadership—can be highly stressful,” says Lori Peek, the director of the Natural Hazards Center at the University of Colorado at Boulder and an author of the book Children of Katrina. “Shelters involve a bringing together of people who are unfamiliar with one another, or strangers. They often involve open-air settings where lots of people are sleeping on cots in very tight settings. People are scared. There’s very little privacy. So there are lots of things about the shelter itself that can be stress inducing.” Plus, Peek says, many populations she’s studied express added anxiety about discrimination inside of shelters. When Peek and some other researchers interviewed Muslim American families in Florida about whether and how they would evacuate in a hurricane, they found that one chief concern was discrimination inside the shelter. Another was a shortage or lack of halal food.

“It is hard to accommodate different dietary needs, cultural needs, religious needs, and gender-based needs,” Peek acknowledges. “But we do recognize how important these different [accommodations] are to assist with launching people into their recovery process.”

Of course, the study does note that taking refuge in shelters, as opposed to motels or other people’s homes, is more common evacuation behavior for some populations than others — and some of the same conditions that might make someone more likely to end up in a shelter, as opposed to a family member or friend’s home or a motel, are also likely predictors of poor mental-health outcomes. “The proportion of participants staying at a shelter was significantly higher among blacks and other nonwhites compared to whites … and among those who did not complete high school compared to those who did,” the authors specify. And as Peek notes, “We know that the vast majority of the population does not choose, if they have the opportunity to choose, to go into a shelter. Who is in a shelter in the first place? Often, persons who may not have had an opportunity to go stay with family, to go stay with friends, to rent a hotel, etcetera.” So it’s possible, she says, that “the people who are in those shelters may have already been living more stressful, more difficult lives before the disaster, which is in part why they ended up in the shelter in the first place.” Plus, Peek adds, being able to evacuate to a friend or family member’s home requires one to have not only the resources to travel but also friends or family located within accessible distance but still outside the storm-affected area.

In the hierarchy of evacuation behaviors, evacuating to a shelter may not be as sound an option as evacuating to a loved one’s home, but it’s better than not evacuating at all. Research has shown that among children, for example, being exposed firsthand to a life-threatening situation is strongly associated with negative mental-health outcomes and trauma, not to mention an increased level of physical danger. The best-case scenario in a hurricane, Peek says, is removing oneself from danger and finding safety wherever it’s available. “One hundred percent,” Peek says. “What we would hope is that no individual would be left behind.”