By Lindy Washburn

The lingering effects of Superstorm Sandy _ slow rebuilding of homes and businesses, long insurance battles and mold that refuses to die _ have taken a toll on the mental health of New Jersey residents in its path, a major study released Wednesday found.

Nearly three years after storm waters surged through Moonachie and Little Ferry and swept houses off their foundations at the Jersey Shore, the study found that more than one in four residents whose homes were damaged still experienced emotional distress. More than one in eight reported signs of post-traumatic stress disorder.

The effect was like being thrust into deep poverty, with its constant, stressful drumbeat of uncertainty, said David Abramson, an associate professor of public health at New York University and the principal investigator of the study, which was funded by the New Jersey Department of Health.

"The similarities between Hurricanes Katrina and Sandy are quite disturbing," said Abramson, who conducted similar research in Louisiana after that 2005 disaster and is an expert in the growing field of resiliency research. "Many adults and children are still experiencing emotional and psychological effects so long after the storm passed."

For many of those still recovering, "housing damage is at the heart of the problem," he said.

More than a million people _ about one-eighth of the state's population _ resided in the storm's path from Cape May to Bergen counties, and 100,000 suffered through significant structural damage to their homes, the researchers said. Of the 117 people who died as a result of the storm on the East Coast, 75 were in New Jersey.

"We're still in recovery," said Health Commissioner Mary O'Dowd, whose department allocated $1.1 million in federal aid for the study, conceived shortly after the storm's 2012 devastation. "We wanted to take the opportunity to learn from our experience in Sandy."

Early data helped guide decisions about state spending on social services and health. That included, for example, mental health screening of everyone who sought care at an emergency room or a community health center in the storm areas _ an initiative that has reached 50,000 people so far and has been extended for another year.

A key finding from the research is that children whose homes were damaged were particularly at risk. Those living in homes with minor damage were more than five times as likely to feel sad or depressed as those living in homes with no damage, and more than eight times as likely to have trouble sleeping.

Surprisingly, the kids in homes with minor damage _ defined as uninhabitable for only a short period of time _ were reported to suffer more psychologically than those living in homes with major damage. That may be because households that sustained major damage were completely focused on repairs and rebuilding, whereas those with minor damage may have taken longer to address the problem.

Their damaged surroundings may be "a persistent reminder to the children of what had happened and the fact that chaos is still in their lives," Abramson said. Housing assistance programs might do well to accelerate repairs to homes with young children, the report said in its conclusions. The presence of mold, too, can be an enduring reminder of the storm's assault.

Mold had a double-barreled effect: Adults exposed to it were 2 { times more likely to be diagnosed with asthma than those who weren't exposed, and twice as likely to report mental distress, the study said.

This validated the state's focus on helping get rid of the mold that grew in homes that had been flooded, O'Dowd said. The state distributed more than 10,000 copies of a mold brochure in a dozen languages to homeowners, municipal offices and disaster relief groups, and it trained more than 200 public health professionals and housing officials at Rutgers.

Data for the Sandy Child and Family Health Study were gathered by more than 30 researchers fielded by Rutgers University, who conducted hourlong, face-to-face interviews with 1,000 adults in the storm's footprint. A random sampling of addresses within 20 miles of the water's edge in nine counties was chosen for the first set of interviews, conducted from August through April. A second round, with the same people, is underway.

"We never really knew what we would find when we went out," said Donna Van Alst of the Rutgers Graduate School of Social Work, a co-investigator on the study. Some of the homes had sustained little damage and simply lost power for a day, while at other addresses, the home had been destroyed. Many of the people interviewed cried during the interview, she said.

The research revealed the layered impact of such a large-scale natural disaster. "At the very beginning, there's basic needs," such as making sure the family has food and shelter. "Then there's a lot of rebuilding," she said. "People put aside dealing with the emotional impact and the effect on family relationships. It's not surprising that you see these mental health effects" three years after the storm.

(c)2015 The Record