There is broad recognition that our nation is facing a mental health crisis, but what is less widely recognized is the definitive role a changing climate is playing in creating and exacerbating this crisis. Recently, the southeastern United States has endured two catastrophic hurricanes. On September 26, Hurricane Helene, a Category 4 storm, struck the U.S., leaving hundreds dead and causing over $30 billion in damage. Just weeks later, Hurricane Milton followed as a Category 3, and despite being weaker, the devastation was massive; at least 17 people died.
Storms of this magnitude have not always been a regular occurrence. A 2022 Time article points out that between 1972 and 2022, only nine Category 4 or 5 hurricanes struck the U.S. mainland. However, six of those occurred between 2017 and 2022 -- a clear sign that these storms are becoming more frequent, fueled by rising ocean and atmospheric temperatures.
These increasing storms don't just leave physical destruction in their wake; they leave behind deep emotional and psychological scars. As a physician who has cared for thousands of patients with heart and lung disease, I have seen how acute and chronic illness and emotional stress impact not only the body but equally importantly the mind. From my experience, psychological resilience is as critical to well-being as physical health, and natural disasters with a changing climate push this resilience to its limits.
The changing climate is increasingly recognized not only as an environmental crisis but as a severe threat to human well-being -- and notably mental health. As global temperatures rise and weather patterns become more unpredictable, people across the world experience heightened psychological stress. Whether it's anxiety about an uncertain future or trauma from extreme weather events, the mental health impacts of climate change are profound and far-reaching, but rarely discussed.
The American Psychological Association (APA), in partnership with ecoAmerica, sought to further examine these impacts and shared in a 2017 report that, "Following disasters, damage to social or community infrastructural components, such as food systems and medical services, results in many acute consequences for psychological well-being. In contrast, gradual impacts of climate change, like changes in weather patterns and rising sea levels, will cause some of the most resounding chronic psychological consequences," including: post-traumatic stress disorder (PTSD), depression, anxiety, suicidality, and substance abuse.
Addressing these effects is crucial, as they touch on the overall health and well-being of individuals, and how those individuals together constitute the health of their communities. Poor mental health is also a key driver in healthcare costs and quality outcomes. In my cardiac patients over the years, I have seen firsthand how mental and emotional health contributes to the overall recovery of patients after an acute event, such as a heart transplant; climate change is creating similar challenges on a global scale.
Mental Health Disorders: Depression, Anxiety, and PTSD
As the APA noted, climate-related disasters such as hurricanes, wildfires, and floods take a massive toll on mental well-being, often leading to emotional trauma. Many people experience symptoms of anxiety and depression as a direct result of losing loved ones, homes, or financial stability. For others, the trauma of living through such catastrophic events leads to PTSD, a debilitating condition characterized by flashbacks, nightmares, and severe anxiety.
A study published in The Lancet Planetary Health found that individuals exposed to extreme weather events were more likely to develop depression and anxiety disorders, particularly in the months following a disaster. This is especially true for those who experience prolonged displacement, loss of livelihoods, or insufficient access to mental health services. Similarly, people who live through extreme weather events face a long road to mental recovery, as the trauma of the disaster often lingers long after the physical damage has been addressed.
Additionally, some of the physical ramifications of extreme weather events can also trigger mental health conditions. Wildfire smoke, for example, contains particulate matter, a mixture of solid particles and liquid droplets found in the air, which, if inhaled, can directly damage one's physical health. Research has shown that it can also have a negative impact on mental health.
The data from a series of studies suggest a connection between exposure to particulate matter and the development of a number of mental health and behavioral conditions in children. According to one study, "the strongest evidence" suggests that exposure to particulate matter 2.5 can lead children to develop "depression, anxiety, and conduct disorders," such as ADHD.
Further, extreme heat worsens air quality - increasing the likelihood of fires and resulting smoke, and droughts that increase dust particles in the air. It creates the conditions that increase ozone gases in the air when pollutants (for example, from burning fossil fuels) react with heat and sunlight. When we breathe in polluted air, fine particles enter the bloodstream. And once in our bloodstream, they can travel to the brain - which may cause inflammatory responses within the brain itself. This inflammation of the brain is closely linked to depression. Today's most widely used anti-depressants, the SSRIs and SNRIs, possess significant anti-inflammatory actions.
Managing the mental and psychological toll of these conditions is just as important as treating the physical symptoms. Based on my clinical experience as a surgeon frequently treating trauma, I know we simply don't do as well diagnosing and treating mental conditions as we do with purely physical disease. And people continue to suffer.
In my career as a physician, I've joined teams of first responders providing care in the days after catastrophic events around the world. The anguish in the eyes and faces of those I met and treated left no doubt in my mind that their mental health was severely compromised by the trauma they and their loved ones had just lived through. But beyond my lived experience, the data bear this out. From New Orleans to Sudan, to Bangladesh and the Indian Ocean, the destruction of natural disasters, intensified by a changing climate, are creating a generation changed by the experience, mentally as well as physically.
In the immediate aftermath of Hurricane Katrina, which struck on August 29, 2005, I led an emergency medical relief team to New Orleans. Within two days of the hurricane's landfall, we arrived to deliver supplies and provide urgent medical care to evacuees. Upon our arrival at the airport, we were quickly put to work -- there was an acute shortage of first responders. Hundreds of survivors had been evacuated with individuals transported for safety and treatment to both the convention center and to the airport. I vividly recall inside the airport terminal - which was packed with displaced people, many lying on the floor - the wailing call for help from a patient on a stretcher. It was a plea for someone to find his insulin and his blood pressure medicines. He had been without them for 36 hours and his doctor had previously told him he would die if he didn't take them. I remember his face, the agony, the fear. All had washed away in the flooding, and he had no hope of finding them.
Several hours later at the New Orleans Convention Center, where hundreds of people were lying on cots, the psychological trauma was palpable. Many had been separated from their families, unsure of their loved ones' safety. Their world had been turned upside down, and the emotional weight of that reality pressed heavily on me as I moved through the makeshift wards.
As a doctor, I understand how life-altering health crises can be. My patients had to adjust mentally and emotionally to the reality that their cardiac disease left them no choice but to have their heart removed and replaced. Much like my former patients, disaster survivors face an overwhelming emotional adjustment as they try to rebuild their lives after such massive loss. The mental toll was so significant that many Katrina survivors experienced what became known as "Katrina Brain," a syndrome with symptoms of short-term memory loss and cognitive impairment. And even 12 years after the storm, a study of survivors reported elevated levels of psychological distress and post-traumatic stress symptoms compared to the general population.
In the early 2000s, during a medical mission trip to the southern region of Sudan, I witnessed the devastating effects of the severe droughts from 2001 through 2002. These droughts, worsened by ongoing conflict and displacement, led to widespread food shortages and humanitarian crises. Entire communities were uprooted, and the extreme mental health toll was evident. The combination of physical exhaustion, hunger, and uncertainty about the future created a deep sense of hopelessness that medical care alone couldn't address. For many, the psychological toll of losing their homes, livelihoods, and support networks was profound. All hope had been extinguished.
A United Nations report from March 2001 described the ongoing situation. As of the time of the report, it was estimated that more than 600,000 people had suffered as a consequence of the drought. Furthermore, somewhere around 2.4 million people required aid due to the civil war taking place at the time, the effects of which were undoubtedly exacerbated by the drought. Environmental problems have continued to persist in Sudan since the early 2000s. A December 2019 release from the UN World Food Programme offered details about the ongoing situation. According to the release, an estimated 5.5 million South Sudanese were likely to require food on account of recent extreme weather conditions, such as a drought that had occurred in October of that year. This need is compounded by the ongoing, years-long civil war.
A 2022 study published in the Annals of Medicine and Surgery, titled "Sudan's unmet mental health needs: A call for action," sounded the alarm on the nation's behavioral health burden. It noted that displaced people - of which Sudan has many - had a greater prevalence of mental diseases (53%) than non-displaced people, including major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%), and PTSD (14.2%).
In 2007, as part of a "Save the Children" medical mission to Bangladesh, I saw the devastating effects of flooding on maternal and child health. I met mothers who were in anguish over whether they could reach a birthing facility in time to deliver their child safely. The floodwaters had separated many from essential prenatal care, and the fear of complications during childbirth was overwhelming. The psychological distress caused by the inability to access medical care with rising waters was profound, and it underscored how environmental disasters can ripple through every aspect of life, especially for the most vulnerable.
Stress during pregnancy can have enormous psychological effects on the unborn child. Higher levels of cortisol (a hormone associated with stress) in the expecting mother can affect the brain development of the unborn child. The consequences of this altered brain development can be lifelong. Research shows that the children of mother's who experienced extreme stress during pregnancy have a higher risk of developing mental health disorders, such as anxiety, depression, and mood disorders. Also, evidence suggests that they are more likely to experience psychopathic thoughts and behaviors. The mental health consequences of natural disasters are not short term. Rather, they reach far into the future, impacting multiple generations.
In December 2004, I traveled to Sri Lanka to assess those regions devastated by the Indian Ocean tsunami just days after the disaster. It was one of the deadliest natural disasters in history, with over 230,000 people killed across 14 countries. Not a product of climate change, the tsunami was caused by an earthquake which occurred on December 26 after the fault between the subducting Indian Plate and the Burma Plate ruptured.
What I observed was the devastating impact of flooding, especially on mental health -- in many ways similar to the recent flooding with Hurricane Helene in North Carolina and Tennessee. In addition to the huge loss of life, the flooding led to other physical diseases such as outbreaks of cholera and malaria. Access to healthcare facilities was interrupted. The tsunami had destroyed water supplies and contaminated wells, leaving survivors without access to clean water.
The psychological toll on the communities was immense. Families were struggling not only with the immediate loss of loved ones and homes but also with the sheer terror of not having water to drink. The emotional weight of not being able to provide for one's family in such a basic way was heartbreaking. Survivors experienced severe psychological trauma, leading to increased rates of PTSD, anxiety, and depression.
The data reaffirm this. A 2004 study in Sri Lanka found that 56% of individuals "displaced by the tsunami" were suffering from PTSD. A similar study conducted in India found that a significant percentage of individuals over the age of 18 were suffering from PTSD; certain groups were more affected than others, including "individuals with no household income, females, and those injured during the tsunami." Four and a half years after the event, a survey was conducted to understand the long-term mental health effects. Anxiety symptoms were found in 23.1% of individuals, depression in 33.6%, and PTSD in 70.9%. A shocking 44.7% of individuals showed symptoms of two or more of these conditions.
Climate Change and Mental Health: A Call for Action
The mental health ramifications of a changing climate are undeniable. Both the American Psychiatric Association and the American Psychological Association agree the effects are real and are actively worsening our nation's mental health crisis.
With approximately 10% of the U.S. population projected to experience one or more natural disasters in their lifetime - a percentage that's likely to grow - the health effects of a changing climate will only intensify in the coming decades. Rising temperatures, sea levels, and an increase in extreme weather events are all but inevitable. Even regions not currently facing immediate impacts will eventually feel the ripple effects -- whether through economic losses, environmental degradation, or displacement. Children are especially vulnerable, as their developing bodies and minds make them more susceptible to both the physical and emotional tolls of their surrounding environment.
It is crucial that we continue to study and discuss the full scope of changing weather patterns and climate's impact on mental health. These conversations are not just about addressing today's challenges -- they are about securing a better world for future generations. By taking the issue seriously and looking to understand its far-reaching consequences, we can work toward solutions that will help not only us but also those who will inherit the planet.