FORT MYERS, United States (AP) — With her home gone and all her belongings trashed by Hurricane Ian, Alice Pujols wept as she picked through soggy clothes, toys and overturned furniture piled head-high outside a stranger’s house, looking to salvage something — anything — for her four children and herself.

“I’m trying to make it to the next day,” she said. “That’s all I can do. It’s really depressing. It really is.”

For those who lost everything to a natural disaster and even those spared, the anguish can be crushing to return home to find so much gone. Grief can run the gamut from frequent tears to utter despair. Two men in their 70s even took their own lives after viewing their losses, said the medical examiner in Lee County, where Ian first made landfall in south-western Florida.

The emotional toll in the days, weeks and months after a hurricane, flood or wildfire can be crippling. More pressing needs for food, shelter and clothing often take priority to seeking counselling, which is in short supply even in good times.

“When someone’s in a state of trauma that so many are in, they don’t know where to begin,” said Beth Hatch, CEO of the Collier County, Florida, branch of the National Alliance of Mental Illness. “They need that hand-holding and they need to know that there’s so many people here to help them.”

Hurricane Ian hammered Florida with such ferocity that it wiped out whole neighbourhoods, tossed boats onto highways, swept away beaches and swamped homes in roof-deep waters.

With sustained winds of 150 mph (240 kph), it was one of the strongest hurricanes to ever hit south-west Florida. It later cut a watery and wind-battered swath across the Florida peninsula before turning out to sea to regain strength and pummel South Carolina.

It killed more than 100 people, the majority of victims in Florida, making it the third-deadliest storm to hit the US mainland this century. Even a week after it passed through, officials warned that more victims could yet be found as they continued to inspect the damage. The storm knocked out power to 2.6 million and caused billions of dollars in damage.

Research has shown that between a third and half of those who survive a disaster develop some type of mental distress, said Jennifer Horney, an epidemiology professor at the University of Delaware who studies natural disaster impacts on public health.

Post-traumatic stress disorder, depression and anxiety rise along with substance abuse. Those with existing mental disorders are at greater risk of having those conditions exacerbated by the trauma.

A variety of help is available as additional resources are sent to the area.

The state of Florida was setting up support centres and the federal government has a 24-hour disaster distress helpline to provide counselling and crisis support. Hatch’s organisation was going to some homes in hard-hit areas to check on clients with mental illness.

The vast majority of people, though, were still assessing damage, trying to retrieve and dry out possessions worth keeping and drag what couldn’t be saved to growing trash heaps by the side of the road.

On Pine Island, just off the Florida mainland where Ian first struck, an emotional Alan Bickford said he was trying to take a longer view because what lay before him was bleak: the floors of his home were coated in stinky muck and his yard was littered with framed photos, furniture and other items he’d hauled outside.

“It’s like a death of a loved one. The pain just comes and goes,” he said. “There’s times when there are these little glimmers or slivers of hope. And then everything falls apart.”

Riding out a deadly storm amid screaming winds, pounding waves and rising waters, or escaping as danger closes in is terrifying and traumatic. Living out of a duffel bag or suitcase in an evacuation centre is disruptive, stressful and depressing. Returning to a flood-ravaged home that needs to be gutted to prevent mold from taking hold or, worse, reduced to splinters and scrap metal and scattered like confetti is heartbreaking.

Mao Lin walked an hour last Thursday to reach the plot of land where she had lived on Fort Myers Beach, which looked like a blast zone. She was distressed to find it gone.

“The whole street — nothing’s left,” she said. “We don’t have a home. We don’t have a car. We don’t have anything. We have nothing left.”

In recent days, the number of calls have doubled at Hatch’s organisation as people recognise they cannot rebuild their lives — and overcome trauma — alone.

“The needs are going to change over time,” Hatch said. “Some people have lost everything, maybe the walls of their home may be still standing, but they’re uninhabitable.”

Cleaning up the mess of a damaged home or finding a new one in the wake of a catastrophe gives way to the longer term challenges of navigating the maze of bureaucracy for financial assistance, securing permits for rebuilding or fighting insurance companies over reimbursements.

Horney studied suicide rates in counties that experienced a disaster between 2003-2015. She and her colleagues found suicides increased 23 per cent, when comparing the three-year period preceding a disaster to the three years after an event, according to the study published in The Journal of Crisis Intervention and Suicide Prevention.

She said the September 30 and October 1 suicides of men in their 70s was not typical so soon after a catastrophic event.

“It’s not usually an immediate, post-disaster thing,” Horney said. “It’s really these longer-term mental health problems that have either been exacerbated by or caused by the disaster that then over time tend to lead to more severe outcomes like suicide.”