The Impact of Wildfires on Mental Health

More than 60,000 wildfires were reported in the United States from January 1 to December 9, 2022, far exceeding the number reported for the same period in the preceding 10 years.¹ Researchers have documented numerous related effects on human health, with the bulk of the evidence highlighting the pulmonary and cardiovascular impacts of exposure to wildfire smoke among individuals who live in or near the affected areas.² However, an emerging body of research indicates various mental health consequences in these populations as well.

Results of a Scoping Review

In a 2021 scoping review published in Behavioral Sciences, To et al examined 63 studies pertaining to the mental health effects of exposure to wildfires and found that rates of post-traumatic stress disorder (PTSD) after wildfire exposure among adults were 24% to 60% at 3 months, 12.8% to 26% at 6 months, and 10.2% to 13.6% at 18 months. Rates of PTSD in children and adolescents ranged from 9% to 29.4% at 6 months and 27% to 37% at 12 months postwildfire.³

Trauma-related factors associated with an elevated risk for PTSD following wildfires included “personal witnessing of burning homes, having fear for one’s life or lives of loved ones, losing a loved one, significant property damage, or feeling a lack of support from family, friends, and/or the government,” according to study authors. Ongoing trauma and life stressors were cited as an additional contributing factor to PTSD risk.³

Numerous studies that To et al reviewed also demonstrated increased rates of depression following wildfires among adults in affected populations, ranging from 25.5% to 33% at 3 months, 10.4% to 17.1%% at 6 months, and 18.3% to 24.8% at 18 months. In pediatric populations, rates of depression were 4.7% to 20% at 6 months, and 17% at 18 months postwildfire.³

While there have been fewer studies investigating rates of anxiety disorders following wildfires, available evidence suggests rates of 27%, 19.8%, and up to 18.7% at 3, 6, and 18 months, respectively, among adults and 14.1% and 27% in children and adolescents at 6 and 18 months after the event, respectively.³

The risk factors noted for depression and anxiety after fire exposure were similar to those identified for PTSD.³

In addition to the psychiatric disorders and symptoms observed in populations affected by wildfires, there are “novel terms to describe emotional and mental health responses to natural disasters, such as solastalgia, eco-anxiety, and ecological grief, which will likely become more prominent as such tragedies continue to occur,” wrote To et al. Solastalgia refers to mourning changes in one’s environment, while eco-anxiety reflects worry about the negative impact of environmental change, and ecological grief describes emotional distress due to the loss of nature.³

Additional Findings

Study findings published in 2021 in Research in Developmental Disabilities examined the mental health effects of exposure to the Northern California Wildfires of 2017 among children and youth with developmental disabilities. The results showed that participants and their parents “exhibited stress, grief, and other emotional and behavioral reactions during evacuation, in the immediate aftermath, and 1 year postdisaster,” the authors stated. They cite the need for disaster-related mental health care approaches that are both trauma-informed and disability-informed to address the needs of this population following wildfires and other disasters.⁴

A 2022 study by Agyapong et al demonstrated the cumulative effects of multiple traumatic events among wildfire survivors in a Canadian city. Among those who experienced COVID-19 and either a flood or wildfire, the odds of general anxiety disorder symptoms were 11 times higher (odds ratio [OR], 11.39; 95% CI, 1.43-91.04), while odds of major depressive disorder (MDD) were 4 times higher (OR, 3.85; 95% CI, .995-14.90) and odds of PTSD were 10 times higher (OR, 10.47; 95% CI, 1.28-85.67) compared with participants who experienced COVID-only trauma.⁵

In a 2021 case study of 725 individuals affected by the deadliest California wildfire, researchers observed substantial increases in the risk for PTSD and MDD 6 months following the event.Additionally, they found that preexisting vulnerabilities including childhood adversities and sleep impairment negatively influenced mental health outcomes after the wildfire, while trait resilience was associated with a reduced impact of the event on participants’ mental health. Mindfulness was linked to lower rates of depression and anxiety symptoms, and physical exercise was associated with lower severity of depression symptoms.⁶

“Proactive climate adaptation requires a set of resilient personality traits and lifestyle factors that preserve mental health and facilitate a much-required cultural shift towards sustainability,” the authors concluded.⁶

Jyoti Mishra, PhD, MBA, is the Director of NEATLabs and Associate Professor of Psychiatry at the University of California San Diego, and a co-author of the 2021 case study⁶ described above. Laura M. Stough, PhD, is Professor Emerita at Texas A&M University, and co-author of the 2021 study on the effects of wildfire exposure on individuals with developmental disabilities.⁴

We spoke with Drs Mishra and Stough to further discuss their study findings and their clinical implications, as well as the ongoing needs in this area.

What does the available evidence suggest about the impact of wildfires on mental health, and what did your findings add to our understanding of this topic? 

Dr Mishra:The literature has documented that in the immediate aftermath of a natural disaster such as wildfires, floods, and earthquakes, mental health impacts are observed, especially PTSD. Yet, in California we are observing wildfires at a very high frequency, such that now there is an annual wildfire season in several counties. These frequent wildfires have been linked to climate change.

Before our study, evidence of the mental health impact in the context of the recent California wildfires had only been anecdotal. We quantified the chronic mental health sequalae of the wildfires, demonstrating rates of PTSD that were 3 times greater in individuals who were directly exposed to California’s deadliest wildfire to date, the Camp Fire, relative to the general control population.

Individuals who were indirectly exposed (ie, witnessed the fires but were not directly impacted) had a prevalence of PTSD that was 2 times greater than that of controls. The prevalence of depression and anxiety was also 1.5 to 2 times greater in individuals exposed to fire. Moreover, we observed these effects to be chronic, lasting beyond 6 months after the wildfire event.

What are recommendations for clinicians who may encounter affected patients in clinical practice?

Dr Mishra:Clinicians need to be aware of how climate change-accelerated extreme events such as wildfires are aggravating mental health, such that individuals show symptoms of PTSD, depression, and anxiety. Awareness and acknowledgment that these mental health impacts are real for patients is the first step to recovery. Plans for recovery and building resiliency as well as the practical logistics of planning in case the individual is in danger of facing wildfires in the future should be discussed.

Dr Stough: When people are impacted by wildfires, they may have lost their homes, neighborhoods, or even loved ones. Feelings of sadness, depression, and grief are normal under such circumstances. However, only a small percentage of individuals affected by disaster will develop PTSD. That number is substantially decreased when patients have received appropriate clinical intervention.

What other measures are needed to address these issues?

Dr Mishra:Greater mental health support services need to be mobilized in the community. We find that these can make a difference in protecting well-being in such environments.

Dr Stough: Feelings of sadness and grief associated with loss from disasters should be normalized, not pathologized. For many wildfire survivors, once they can return to their homes and work and school routines, these feelings will diminish. However, wildfires can substantially change the environmental surroundings for survivors and be constant reminders of the disaster. In some cases, wildfire survivors will decide to relocate as their neighborhood and community is no longer perceived as a desirable location. Others will relocate as they wish to avoid future wildfire risk.

The economic loss for wildfire survivors is highly pertinent. Some survivors do not have sufficient insurance, others lose items — photos, family heirlooms — that cannot be replaced. Other survivors lose their jobs if their employer also was affected by the disaster. Taking shelter or living temporarily in another location can be costly. In areas that lost power, have downed trees, or are subjected to fire retardants or water, houses and their contents can be damaged. Substantial time off from work is needed to deal with insurance agencies, Federal Emergency Management Agency (FEMA), and repairs. All these pragmatic factors are stressful and often contribute to depressed mood.

What should be the focus of future research in this area?

Dr Mishra:Future research needs to continue to explore the mental health impacts in greater detail. For instance, are any effects of cognition and brain function observed? Also, is the climate trauma that we are observing in our communities really equivalent to PTSD, which was contextualized in war settings, or is it different?

There is a need for active research in efficacious, resiliency-building interventions embedded within our communities. Many of our impacted communities are in regions that already have low rates of health care provision and a paucity of health care professionals. In this context, community health workers, social workers, and others need to be educated on imparting resiliency solutions so that the burden for care is not just on clinicians.

Dr Stough: Psychological health is affected by situational factors. In the case of disasters, the instrumental supports available to survivors are critical not only to increase physical well-being but psychological well-being. Research that examines changes in mental health as external stressors decrease and barriers to recovery are eliminated will better highlight these interconnections.

What additional points would you like to emphasize to clinicians regarding this topic?

Dr Stough: Research clearly shows that people with disabilities and other marginalized populations received less disaster recovery support, including less psychological support. In addition, no clinical interventions exist that have been modified to address the psychological needs of individuals with cognitive disabilities, such as intellectual disabilities, traumatic brain injury, autism spectrum disorder, and senility who experience disaster. Clinicians should deliberately reach out to disabled and marginalized populations to address such discrepancies in psychological services postdisaster.