# Housing Displacement, Employment Disruption, and Mental Health After the 2023 Maui Wildfires

## TL;DR

The 2023 Maui wildfires led to increased depression and anxiety, with housing and income disruptions playing a major role in mental health impacts.

## Contribution

This study quantifies mental health effects of wildfires and identifies housing and income disruption as key indirect pathways.

## Key findings

- Wildfire-exposed individuals had 53% higher depression and 67% higher anxiety risk compared to unexposed individuals.
- Housing displacement and income loss explained over half of the mental health associations.
- Residents outside burn zones showed significantly higher risk of suicidal ideation.

## Abstract

What are the mental health consequences of wildfire exposure, housing displacement, and income disruption following the 2023 Maui wildfires?

In this cross-sectional study of 2453 adults, residents within wildfire burn zones had a 53% higher risk of depression and 67% higher risk of anxiety compared with unexposed individuals, with suicidal ideation not significantly higher within burn zones but elevated among residents outside burn zones. Housing displacement and income loss jointly accounted for more than half of the associations with depression and anxiety.

In this study, wildfire exposure and its socioeconomic aftermath were linked to widespread graded psychological harms, underscoring the need to incorporate mental health care, stable housing, and economic recovery into disaster response frameworks.

Climate-related disasters are escalating in frequency and severity, yet their population-level mental health impacts—especially in racially and ethnically diverse and geographically isolated settings—remain poorly characterized. The 2023 Maui wildfires, one of the deadliest US wildfires in more than a century, offer a critical opportunity to quantify these effects.

To examine associations between wildfire exposure and symptoms of depression, anxiety, and suicidal ideation and to assess indirect pathways of these associations through housing displacement and income disruption.

This multiarm, propensity-weighted cross-sectional study compared adults residing within burn zones and outside burn zones on Maui and unexposed residents from other Hawaiʻi counties. The analytic sample included wildfire-exposed and unexposed adults enrolled between January 2024 and February 2025 through the Maui Wildfire Exposure Study and the UHERO Rapid Health Survey. Residential addresses at the time of the fires were geocoded and linked to official burn zone perimeters to determine exposure status. Data were analyzed from May to September 2025.

The primary outcomes were self-reported depression (Center for Epidemiologic Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder scale), and suicidal ideation within the past 30 days, assessed using validated screening instruments.

The analytic sample included 2453 adults (1535 wildfire exposed and 918 unexposed), among whom mean (SD) age was 50.8 (16.3) years and 1502 participants (61.2%) were women. Wildfire exposure was associated with higher risk of depression (risk ratio [RR], 1.53; 95% CI, 1.20-1.94) and anxiety (RR, 1.67; 95% CI, 1.14-2.45) compared with unexposed individuals. Although suicidal ideation was more frequent among burn zone residents (RR, 2.15; 95% CI, 0.72-6.44), this association was not statistically significant. Residents outside burn zones showed significantly higher risk of suicidal ideation (RR, 2.65; 95% CI, 1.21-5.77). Mediation analyses indicated that housing displacement and income loss jointly accounted for more than half of the associations with depression and anxiety.

In this cross-sectional study, wildfire exposure and its socioeconomic consequences were associated with graded increases in psychological distress extending beyond the burn zone. These findings highlight the importance of integrating mental health care, housing stability, and economic recovery as central pillars of disaster response and climate resilience strategies.

This cross-sectional study conducted among Maui residents examines associations between wildfire exposure following the 2023 Maui wildfires and symptoms of depression, anxiety, and suicidal ideation.