Depression and Anxiety Symptoms in Adults Displaced by Natural Disasters

Importance Mental health symptoms associated with disaster-induced displacement on a national scale are unknown. Knowledge of mental health outcomes can inform disaster management and recovery. Objective To investigate the association of depression and anxiety symptoms with disaster-induced displacement and the duration of displacement. Design, Setting, and Participants This cross-sectional study analyzed data from the US Census Bureau Household Pulse Survey, which was administered nationwide online between December 9, 2022, and October 30, 2023. One adult per selected US household with an email and/or mobile telephone number was eligible to participate. Exposures Natural disaster–induced displacement from home in the past 12 months and the duration of displacement. Main Outcomes and Measures Depression and anxiety symptoms were assessed using shortened (2-item) versions of the Patient Health Questionnaire and the Generalized Anxiety Disorder questionnaire. The composite questionnaire scores were used to determine the participants’ symptoms. Results The weighted sample included 183 730 553 US adults (mean [SD] age, 49.22 [16.65] years; 94 445 996 females at birth [51.4%]). In multivariable analyses, individuals who were displaced for more than a week had higher odds of depression (odds ratio [OR], 1.77; 95% CI, 1.40-2.25) and anxiety (OR, 1.54; 95% CI, 1.22-1.94) symptoms compared with those who were not displaced. The longer the duration of displacement, the higher the odds of reporting depression and anxiety symptoms; individuals who never returned home reported higher odds of depression (OR, 2.43; 95% CI, 1.70-3.49) and anxiety (OR, 3.04; 95% CI, 2.10-4.39) symptoms. Socially vulnerable populations, such as younger adults, sexual and gender minority groups, and people with lower educational level, lower annual income, and disabilities, had a higher prevalence of depression and anxiety symptoms. Conclusion and Relevance This study found that, in US adults, disaster-induced displacement from home was associated with increased odds of depression and anxiety symptoms, with the highest odds among those who never returned home. There is an urgent need to address mental health care for populations displaced by natural disasters, particularly socially vulnerable populations.