Abstract
Mental health effects are frequently reported following natural disasters. However, little is known about effects of living in a hazard-prone region on mental health. We analyzed data from 9312 Gulf Long-term Follow-up Study participants who completed standardized mental health questionnaires including the Patient Health Questionnaire-9 (depression = score ≥10), Generalized Anxiety Disorder Questionnaire-7 (anxiety = score ≥10), and Primary Care PTSD Screen (PTSD = score ≥3). Geocoded residential addresses were linked to census-tract level natural hazard risk scores estimated using the National Risk Index (NRI). We considered an overall risk score representing 18 natural hazards, and individual scores for hurricanes, heatwaves, coastal flooding, and riverine flooding. Log binomial regression estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations between risk scores (quartiles) and mental health outcomes. Increasing hurricane and coastal flooding scores were associated with all mental health outcomes in a suggestive exposure-response manner. Associations were strongest for PTSD, with PRs for the highest vs lowest quartile of hurricane and coastal flooding risks of 2.29 (95% CI, 1.74-3.01) and 1.59 (95% CI, 1.23-2.05), respectively. High heatwave risk was associated with anxiety (PR = 1.25; 95% CI, 1.12-1.38) and depression (PR = 1.19; 95% CI, 1.04-1.36) and suggestively with PTSD (PR = 1.20; 95% CI, 0.94-1.52). Results suggest that living in areas prone to natural disasters is one factor associated with poor mental health status. This article is part of a Special Collection on Environmental Epidemiology.