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A new study published in JAMA looked at the association between repeated exposure to hurricanes and mental health in Florida residents.

“Our study sought to examine the relationship between exposure to catastrophic hurricanes on the Gulf Coast and both mental health and functional impairment (e.g., work and social functioning),” study author Dana Rose Garfin told us. “Importantly, we were able to assess people in advance of Hurricane Irma (which approached Florida as a Category 5 storm) and follow them after that hurricane as well as after Hurricane Michael, a Category 5 storm that hit Florida a year later.”

The research team also looked at different types of exposure - direct exposure [whether a person was in an evacuation zone or suffered losses (e.g., property)], indirect exposure (knowing someone directly exposed) and media-based exposure.

“We were interested in testing the relative contribution of each type of exposure on outcomes, and also whether elevated mental health symptoms would have measurable impacts on impairment,” Garfin told us. “Lots of people will experience some distress during an approaching disaster. Some of that can be good as it can motivate people to act (e.g., prepare, evacuate). But if that crosses the line into impairment, we can begin to see a potential for negative impacts of that distress.”

Rather than draw on a particular theory, the researchers drew on decades of research in disaster psychology to examine how all these disparate risk factors impacted outcomes using an improved methodology. One of the other main contributions of the study was the design - they used a large, representative sample of people both directly and indirectly exposed. Most studies are small and non-representative, which research shows can lead to biased results.

“Hurricanes are one of the few natural disasters that you have a bit of advance notice that you have a chance to get in the field before the disaster,” Garfin told us. “If you only study a disaster after the event, it's hard to assess how people were doing before an event. Thus a lot of research on natural disasters only assessed people after the event.”

That makes it hard to evaluate what people were like before the storm in terms of their prior exposure and pre-storm mental health. The implications of the study go beyond hurricanes and may apply to other disasters as well (e.g., tornadoes, earthquakes, heatwaves).

The researchers used a structural equation model to test mediation - that is the pathway by which an exposure can impact outcomes over time. They could look at how Wave 1 exposures and pre-storm factors impacted post-Irma psychological responses, how those in turn impacted psychological responses after Hurricane Michael, and finally, whether all that had a measurable impact on functional impairment.

They found that direct, indirect and media-based exposure had a cumulative/additive effect over time. These exposures were associated with more negative psychological responses to Hurricane Irma and in turn set folks up for more distress after Hurricane Michael.

“I was surprised at the lasting impact media exposure had, although this is consistent with what we have seen in our other studies after all types of collective traumas (including natural disasters and violent events),” Garfin told us. “Even though it's been such a robust finding across many studies my colleagues and I have conducted, it still always a bit of a surprise how much it can impact psychological distress, particularly when we are comparing it to direct and indirect exposure.”

As the climate crisis escalates, Garfin explains we are going to be seeing an increase in the severity and frequency of hurricanes and other natural disasters. A lot of scholars have been writing about the potential psychological impacts of the climate crisis and associated disasters.

“This study is unique in that is demonstrates the potential mental health crises that increasing natural disasters can have on our mental health using a methodologically rigorous, longitudinal design,” Garfin told us. “Clinicians and policy makers should be aware of this potential when tearing clients and allocating post-disaster services.”