Even as firefighters are starting to gain ground on the devastating wildfires in Los Angeles, residents there are just beginning to grapple with the emotional trauma of the disaster.

The fires have, so far, left more than two dozen people dead and destroyed over 10,000 structures and homes, with those numbers expected to rise. People returning to their charred homes or awaiting permission to reenter their neighborhoods to see the extent of the damage face tremendous uncertainty around what the future holds. Helping survivors address their short- and long-term mental health needs following a disaster of this magnitude presents a formidable challenge, experts say.

Connecting survivors with mental health experts is key. But so, too, is addressing other needs not often considered as part of mental health care. Economic losses brought on by stressors like job loss or ongoing home repairs in the months and years following a disaster strongly link to ongoing psychological distress, says Alexis Merdjanoff, a public health sociologist at New York University. “We tend to only address the mental health needs directly related to immediate exposure. It’s really these longer-term needs that get overlooked.”

And those needs are not evenly distributed across the population. For instance, a quarter of people displaced by the fires, or 74,000 individuals, identified as Latino, according to a report released January 10 by the Latin Policy and Politics Institute at UCLA.

Latino individuals are also more likely to suffer job loss and economic instability following the disaster, according to second institute report released January 15. For instance, in the Palisades fire zone, Latinos comprise just 7 percent of residents but hold 34 percent of jobs. And across Los Angeles, 85 percent of household workers identify as Latino.

Silvia R. González, an urban planning expert at the institute, worries especially about how the fires will impact the largely female Latina housekeepers, home health aides and nannies working in wealthier communities leveled by the fires. Those women have lost their jobs, their connections to the families they serve and, for those residing with those families, their homes.

Science News spoke to several social scientists studying disasters to understand how to identify survivors most at risk of developing mental health problems and how to best support them during their recovery process.

What recovery support should state and federal leaders put in place immediately?

Helping survivors, including firefighters and first responders, access mental health services is crucial, experts say. Untreated post-traumatic stress disorder, for instance, correlates with substance abuse, chronic health conditions and self-harm. That cascade can also strain relationships with loved ones.

Minimizing other stressors can also alleviate immediate psychological distress, research suggests. Oral interviews with survivors of Australia’s 2003 wildfires in Canberra, for instance, showed the immense value people placed on visiting charred homes and neighborhoods in the disaster’s aftermath. That brief moment in time enabled neighbors to come together and share their grief, says Christine Eriksen, a disaster geographer at the University of Bern in Switzerland. Yet officials often prioritize clearing the rubble as quickly as possible. “Removing rubble before people have a chance to connect with their home is traumatizing,” says Eriksen, whose findings appear in June 2021 in Social and Cultural Geography.

In an ideal world, federal and state agencies would also extend aid beyond just a few months, the common length, to allow people to begin to rebuild mentally, emotionally and physically, Merdjanoff says.

For instance, she notes, people tend to ignore their mental health to address more pressing concerns in a disaster’s immediate aftermath. Extending mental health services beyond a few months could rope in a lot more people in need, Merdjanoff says. “A lot of people will push off their mental health needs until … mental health programming has expired.”

What are the mental health risks associate with direct exposure to the fires?

Direct exposure to the disaster, such as having to evacuate, amplifies the likelihood of receiving a formal mental health diagnosis, particularly for post-traumatic stress disorder, depression or anxiety, research shows.

For instance, researchers have gauged people’s psychological distress in the months and years after floods devastated Alberta, Canada, in 2013. The team administered the Transitional Impact Scale to 200 survivors of the floods weeks after the event. Six years later, 65 of those initial respondents retook the survey. That 12-item scale asks respondents to rate the material and psychological changes to their lives following a major life event on a scale from 0 for completely disagree to 5 for completely agree. For instance, a statement on the material subscale reads, “I spend my time in different places NOW than I did BEFORE the disaster event,” while a statement on the psychological subscale reads, “My current attitudes now are different than the attitudes I held BEFORE the disaster event.”

Scoring above a 3 on both subscales correlated with higher levels of PTSD six years after the floods, the team reported in Sustainability in August 2023. The findings suggest that LA officials should closely monitor evacuees, says study coauthor Eamin Zahan Heanoy, a mental health researcher at the University of Alberta in Canada.

What about those with more indirect exposure to the fires?

Even living in areas shrouded in heavy smoke, can increase the prevalence of psychological distress months or years after the event, research shows. Alberta flood survivors who scored above a 3 on the psychological subscale but low on the material subscale — indicating that their homes and livelihoods remained relatively intact — had higher levels of anxiety and depression than those with lower scores six years after the floods, Heaney’s team found.

Merdjanoff’s research similarly highlights the importance of paying attention to less impacted individuals and communities. For instance, from summer 2014 to spring 2015 her team surveyed 1,000 households in New Jersey. All respondents had at least one household member who had lived through Hurricane Sandy, which caused widespread flooding and property damage when it hit the state in 2012.

Respondents filled out two mental health surveys, one assessing PTSD using a standard trauma questionnaire and another assessing quality of life. Questions on the quality of life form asked people about their everyday lives, such as limitations to their physical and social activities and levels of pain and fatigue. Merdjanoff’s team also asked people about their exposure to the floods at both the individual and community level. For example, to gauge indirect community exposure, the team measured housing damage at the block level. That allowed them to evaluate the mental health of respondents whose homes remained intact while those around them flooded.

About 16 percent of respondents were still experiencing psychological distress two years after the storm, compared with 6 percent of respondents’ struggling with symptoms characteristic of PTSD, the team reported in December 2022 in the Clinical Social Work Journal. Strikingly, residents who reported losing income were five times more likely to report high levels of distress than those who did not experience income loss. Mental distress lasts longer and affects more people than PTSD, Merdjanoff says. That’s because survivors, even those who didn’t bear direct witness to the event, can experience secondary stressors, such as job loss and costly home repairs.

Particularly at-risk are those families in limbo, she says. Her work with survivors of hurricanes Katrina and Sandy shows that families whose houses were destroyed and families with no structural damage to their homes tended to report higher levels of well-being than families whose homes were damaged but still standing. When a home floods beyond repair or burns to the ground, families are forced to decide if they should stay or go, she says. But families tasked with fixing damaged homes wind up in a gray zone, often eating into their savings to continue with repairs.

“After Sandy, so many people were tapping into their credit and their kids’ college savings accounts. When their kids were getting ready to go to college, they didn’t have that nest egg to give them,” Merdjanoff says.

Is there a link between socioeconomic status and mental health vulnerabilities post-disaster?

Lower-income individuals face more stressors, such as difficulty finding temporary housing, lack of homeowners insurance and more precarious jobs, than higher income individuals, research shows. And those stressors can increase psychological distress. In her study of Hurricane Sandy survivors, for instance, Merdjanoff found that households earning between $50,000 to $100,000 were over three times more likely to report high levels of psychological distress than households earning over $100,000.

“Lower income may be associated with poorer housing quality and less access to resources. That can lead to worse mental health resources in the long run,” says Kate Burrows, an environmental health expert at the University of Chicago who was not involved with that research.

Wildfires do not burn dwellings indiscriminately, concurs sociologist Kathryn McConnell of the University of British Columbia in Vancouver. Her analysis of the roughly 17,500 residential structures that burned during the 2018 Camp Fire in northern California, showed that the fire destroyed roughly 78 percent of single family dwellings compared with 87 percent of mobile homes. Rental homes were also more likely to burn than owner-occupied homes.

That disparity probably arises from a variety of factors, says McConnell, whose findings appear in July 2024 in Landscape and Urban and Planning. For instance, larger homes tend to have larger yards and more space between structures. That makes it harder for the radiant heat around one building to ignite the neighboring building.

Such disparities also persist due to post-disaster gentrification, McConnell’s findings show. Most of the 600 or so residences rebuilt 20 months after the fire were owner-occupied and higher in value than they were before the fire. Absent housing support for renters and lower-income individuals, a similar gentrification process could play out in Los Angeles, experts caution.

Getting people into more permanent housing, ideally within a few months of the disaster, is the single greatest way to support people’s well-being, research by Merdjanoff and others shows. “Finding stable housing, we’ve heard from interviews we’ve done, is the most critical piece to …. self-reported recovery,” she says.

The fires have displaced entire communities. Is there a way to maintain social cohesion?

In times of disaster, people lean on their communities, Merdjanoff says. A person’s network provides both emotional support and access to information. The fracturing of communities can lead to long-term isolation.

Yet Merdjanoff says she has seen people come up with creative solutions to reach those displaced by disaster. After the official recovery ended following Hurricane Sandy, for instance, local community members set up offices where people could get help with everything from filling out insurance claims to finding contractors. Creating those sorts of one-stop shops could go a long way toward helping people recover, Merdjanoff says.