Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis
Open accessAbstract
Background: Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health. Aims: Our aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters. Method: This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics. Results: Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27–0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43–2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies. Conclusions: Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects. Declaration of interest: None.
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Prior research on first responders to disasters and pandemics reports more anxiety, depression, acute stress, post-traumatic stress, and moral injury.
“Studies of first responders to previous disasters and pandemics (e.g., 9/11, SARS, MERS) suggest high rates of anxiety, depression, acute and post-traumatic stress reactions, and moral injury [[11], [12], [13], [14], [15], [16]].”
From Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response (2020) · cites this paper as [11]
The Discussion (page not provided) reports higher psychological distress and psychiatric disorder after natural disasters, including significant increases in PTSD and depression measures. But the review concerns disaster-exposed populations, not specifically first responders or pandemics; it does not support the moral-injury or acute-stress claims, and its increase in anxiety was not statistically significant. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSeveral systematic and scoping reviews have identified LMIC-specific evidence supporting negative mental health outcomes associated with climate change and climate-related disasters.
“Several systematic and scoping reviews have identified LMIC-specific evidence supporting the various negative mental health outcomes associated with climate change and climate-related disasters [6,14,15,16].”
From A Scoping Review of Climate Change, Climate-Related Disasters, and Mental Disorders among Children in Low- and Middle-Income Countries (2022) · cites this paper as [15]
Similar reviews have identified comparable trends.
“Notably, similar reviews have identified comparable trends.19 93”
From Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review (2021) · cites this paper as [93]
In a global meta-analysis, Beaglehole and colleagues reported a significant increase in postnatural disaster mental disorder outcomes (OR 1.84, 95% CI 1.43 to 2.38, p<0.001, n=6 studies).
“For example, in a global meta-analysis Beaglehole and colleagues93 reported a significant increase in postnatural disaster mental disorder outcomes (OR 1.84, 95% CI 1.43 to 2.38, p<0.001, n=6 studies).”
From Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review (2021) · cites this paper as [93]
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- Authors
- Beaglehole, B., Mulder, R. T., Frampton, C. M., Boden, J. M., Newton-Howes, G., & Bell, C. J.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- Beaglehole, Ben
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2018-10-10
- Volume
- 213
- Issue
- 6
- Pages
- 716-722
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2897769394
- Cited by
- 454
- References
- 42
- Citations by year
- 2026: 57 · 2025: 74 · 2024: 75 · 2023: 62 · 2022: 73 · 2021: 65 · 2020: 42 · 2019: 4 · 2018: 1
- FWCI
- 4.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Social Sciences › Sociology and Political Science › Disaster Management and Resilience
- Keywords
- natural disasters, psychological distress, mental illness, post-traumatic stress disorder, depression, anxiety, alcohol abuse, disaster mental health, disaster response
- MeSH terms
- Natural Disasters, Alcoholism, Anxiety Disorders, Depressive Disorder, Humans, Stress Disorders, Post-Traumatic
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