February 23, 2026 — After a disaster, population mental health generally improves, but an increase in mental health problems often follows, potentially peaking years later , according to a systematic review and meta-analysis published in the March/April issue of Harvard Review of Psychiatry , part of the Lippincott portfolio from Wolters Kluwer .
Michel L.A. Dückers, PhD, of ARQ National Psychotrauma Center and the Faculty of Behavioral and Social Sciences at the University of Groningen in the Netherlands, and colleagues say, "perhaps the most profound practical implication is that, by relying on gradual post-disaster mental health improvement, we may have underestimated the long-term effects."
A multilevel meta-analytic review with stringent inclusion criteria
Dr. Dückers and his colleagues are the first to assess the long-term effects of disaster exposure across different time periods while controlling for multiple characteristics that potentially affect mental health risks. They searched scientific databases for English-language longitudinal studies with at least two post-disaster assessments of at least 30 participants directly or indirectly affected by disaster. The last measurement had to be at least 12 months post-event. Assessments of professionals, responders, and victims of armed conflict were excluded.
The final analyses included 71 studies with a total of 137,004 participants. The studies were published between 1990 and 2024 and addressed disasters in 23 countries. Nearly all studies investigated populations in high-income and upper-middle-income countries, and 34 focused on China and the United States. The longest follow-up was 25 years.
The 71 studies included 76 cohorts exposed to multiple disaster categories: earthquakes (29), storms (9), terrorist attacks (9), tsunamis (8), accidents (6), floods (4), mass shootings (4), explosions (3), volcanic eruptions (2), fires (1), and a landslide (1).
In their meta-analyses, the research team controlled for disaster type (natural vs. human-made), disaster category (e.g., earthquake, storm, etc.), population type (children and adolescents vs. adults), disaster year, country income level, and study quality.
Mental health burdens post-disaster may be more universal than previously believed
The team’s key findings were:
The overall prevalence of current or recent mental health problems was 22.1%, with considerable variation both across and within studies.
Depression was the most commonly reported mental health problem (prevalence of 30.17%); other very common issues were distress (27.76%) and sleep problems (26.67%).
Controlling for other factors, the prevalence of mental health problems did not differ between natural and human-made disasters, different age groups, or country income groups.
There were no significant distinctions in effects according to disaster category, such as earthquakes, mass violence, and industrial disasters.
Across countries, the prevalence of mental health problems decreased during the first few years after a disaster, then increased with peaks 9 to 18 years later, followed by a rather steep decrease.
"A cascading interplay of risk factors, reflected, for instance, in accumulated unmet health care needs, unresolved and new problems, life events, lack of support, and secondary stressors in the aftermath, may account for the increased mental health burden," Dr. Dückers and his co-authors note. "In the years following a disaster, social relationships can deteriorate, and those affected may experience diminished recognition within their personal, professional, and community environments."
"These potentially broad and enduring influences underscore the need for early, proactive, participation-driven recovery approaches," the reviewers continue. "With support from long-term monitoring programs to guide shared decision-making, we can target at-risk communities to help alleviate the mental health burdens of disasters."
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Harvard Review of Psychiatry
The Long-Term Mental Health Impact of Disasters: A Systematic Review and Multilevel Meta-Analysis of Longitudinal Epidemiological Studies
23-Feb-2026