SAN JUAN — The violent winds and screeching rains of Hurricane Maria assaulted Puerto Rico for 72 hours. Now there are warning signs of a full-fledged mental health crisis on the island, health officials say, with much of the population showing symptoms of post-traumatic stress.

Puerto Rico was already struggling with an increase in mental illness amid a 10-year recession that brought soaring unemployment, poverty, and family separation caused by emigration. Health officials and caregivers say that Maria has exacerbated the problem.

Many Puerto Ricans are reporting intense feelings of anxiety and depression. Some are paranoid that a disaster will strike again. And people who had mental illnesses before the storm,have seen their conditions deteriorate.

“When it starts raining, they have episodes of anxiety because they think their house is going to flood again,’’ said Dr. Carlos del Toro Ortiz, a psychologist. “They have heart palpitations, sweating, catastrophic thoughts. They think ‘I’m going to drown,’ ‘I’m going to die,’ ‘I’m going to lose everything.’’’

With hurricane nearly two months in the past, the island is still in shock. Its residents are haunted by dozens of deaths caused by the storm, and many more life-threatening near misses.

Returning to a routine is the most important step toward overcoming trauma, according to physicians and public health officials. But for most Puerto Ricans, logistical barriers like scarce water and electricity and closed schools and businesses are making that impossible.

NEW YORK TIMES