“We learn from every natural disaster. Whether it’s a fire or a flood, we learn something from it so we can respond to the next one better”.
— Malcolm Turnbull
Climate change has increased the frequency and intensity of extreme weather events and natural disasters, including storms, flooding and wildfires. Research shows that survivors and first responders of natural disasters are at risk of developing a chronic stress response that impairs mental health and well-being in comparison to non-exposed individuals (Beaglehole et al, 2018). Indeed, studies show that over 20% of adult and youth survivors experience clinically significant symptoms of PTSD, depression and anxiety. First responders also report mental health complaints, albeit to a lesser extent (Heanoy and Brown, 2024).
Whilst treatments for mental disorders following natural hazards are known to be highly effective, less evidence exists around the success of preventative interventions, which aim to stop mental health disorders from occurring. Preventative interventions can be aimed at the general population, at-risk groups or those with early symptoms. They can lead to a better quality of life and reduce the cost of treatment and burden on individuals.
This study aimed to assess whether psychological or psychosocial interventions prevent mental health disorders like PTSD, depression and anxiety in survivors and first responders, following exposure to natural hazards.
We know that natural disasters lead to onset of mental health problems, but can these be prevented through psychological intervention?
Methods
Comprehensive searches were carried out in three databases (Web of Science, PsychINFO and Medline) for articles published up until February 2024 and using keywords and MeSH terms related to natural hazards and mental health. Eligible studies included ≥70% hazard exposed participants or first responders. Data were analysed using a random effects model (i.e. Metafor in RStudio) with effect sizes (Hedges’ g) calculated post intervention and at follow up. Heterogeneity was assessed using Higgins’ | ². The Cochrane RoB 2 tool evaluated bias and subgroup analyses examined outcome type, control group, intervention type, age and delivery mode.
Results
A total of 24,994 records were screened and 10 studies (RCTs) with 5,068 participants were included in the meta-analysis. Study quality was generally low due to missing data, reliance on self-report measures (in 6 studies) and incomplete reporting (only half of the studies were pre-registered).
There were 5,060 participants with a mean age of 21.8 years. Of these, 67.8% were female. Out of the 10 studies, 7 focussed on adults (≥18 years), the other 3 studied youth (<18 years). Four were conducted in America and the remainder in Canada, China, Nepal, New Zealand, Sri Lanka and Turkey. The majority were set in the aftermath of earthquakes (n=4) or hurricanes (n=3), whilst others followed a tsunami, tornado and wildfires. Almost ninety nine percent of participants were directly exposed to the disaster.
Most interventions were psychotherapeutic (n=8), often based on cognitive behaviour therapy (CBT), including psychoeducation, relaxation, mindfulness, symptom management and exposure. Two applied psychosocial support approaches such as teacher training and stress debriefing. Interventions varied in format i.e. group vs individual, setting and length, with an average of 5.3 sessions lasting on average 130.6 minutes.
Meta-analysis showed that preventative interventions did not significantly reduce PTSD or depression symptoms compared to passive or active controls at post intervention. At follow up, there were some improvements in PTSD and depression symptoms compared to passive controls, however these were based on a small number of studies. For anxiety, no significant effects were found post-intervention, although limited data suggests some benefit at follow up. In addition, subgroup analysis found no significant differences between online and face to face interventions. The only notable moderator effect was a small improvement in depression symptoms for adults. Overall, preventative interventions showed limited and inconsistent effectiveness.
This review found that preventative interventions did not significantly reduce PTSD, depression or anxiety symptoms in survivors of a natural disaster.
Conclusions
This study found no consistent evidence that psychological or psychosocial prevention programmes significantly reduce PTSD, depression or anxiety symptoms amongst survivors of natural hazards, and very limited benefits were observed in first responders.
The quality and quantity of available research was limited, hampering conclusions and generalisability.
Future research should focus on rigorous study design, early and context specific interventions, particularly digital health and potentially focus on broader mental health outcomes.
“This study found no consistent evidence that psychological or psychosocial prevention programmes significantly reduce PTSD, depression or anxiety symptoms amongst survivors of natural hazards, and very limited benefits were observed in first responders.”
Strengths and limitations
The meta-analysis represents an important step in synthesising evidence on preventative interventions for mental health following a natural hazard. The researchers utilised a comprehensive search strategy, screening almost 25,000 records, which minimises the risk of missing relevant studies thus enhancing the review’s transparency. In addition, the analysis included studies from a range of countries and disaster contexts, whilst also including survivors and first responders. This ensures the inclusion of diverse populations and therefore increases the relevance of findings. Finally, by focussing on RCTs (known as the gold standard in clinical trials), the analysis upholds a higher standard of evidence, whilst the use of subgroup analysis provides additional insights.
However, there are a few methodological weaknesses that limit the reliability of the conclusions. For instance, study quality was low with many trials relying on self-reported outcomes; these are susceptible to observer bias that may lead to over or under-estimating clinical effects. In addition, blinding procedures were not consistently reported, which raises concerns about observer and performance bias, particularly where studies use objective outcome measures.
Participants were generally recruited from populations with access to formal care or education, therefore likely excluding those most impacted or marginalised, meaning that there is a concern about selection bias. Moreover, one study excluded the most severely affected individuals, which limits generalisability and possibly undermines intervention effects (Kip et al, 2025).
There was substantial heterogeneity in intervention types, delivery and timing, which further complicates the interpretation of pooled effects. Many interventions were delivered months after the disaster, potentially masking the benefits of early intervention. In addition, there were high attrition rates and incomplete reporting on missing data, which raises concerns about attrition bias.
This meta-analysis offers the first rigorous overview of preventive psychological interventions after natural hazards, with impressive breadth and transparency, but is weakened by the quality of the included studies themselves.
Implications for practice
These findings challenge many assumptions about the effectiveness of psychological and psychosocial preventative interventions in the aftermath of natural hazards. This study shows that existing preventative strategies offer little benefit in reducing symptomology with regards to PTSD, anxiety and depression, immediately following such an event.
In addition, the findings suggest that widespread implementation of generic prevention programs might not be the optimal solution post-natural disaster. Instead, resources may be better focussed on early identification systems and person-centred support. However, it is important to note that some benefits were seen at follow up, therefore interventions may still have long-term potential, by refining timing, delivery and content. This review also suggests the importance of tailoring interventions to specific populations i.e. first responders who appeared to benefit more consistently.
In terms of policy, funding should be directed towards high quality research to determine what works, when and for whom with the inclusion of people who have lived or living experience in this area (both first responders and survivors). In addition, I would advocate for developing and testing digital preventative tools, which have the potential to offer many benefits, such as; timely access to support, scalability (serving thousands of people at a time), accessible (overcoming geographic barriers), reducing stigma, enabling data collection (therefore ongoing improvement), personalisation and flexibility and cost effectiveness.
My own experience has shown me the incredible benefits of utilising digital health during the pandemic, whereby I was supporting people within my Social Care Role whilst also undertaking a MSc in Digital Health Interventions. At that time, I was providing emotional support to people online (people with pre-existing and no previous mental ill health). I was able to offer online support and reassurance, therefore providing a space to contain someone’s distress. In addition, I was also able to recommend a variety of other digital tools for managing stress, helping with sleep issues, or just providing information on different mental health tools. Feedback at that time was incredibly positive and I was able to meet the needs of individuals rather than offering a one size fits all approach to distress.
Rethinking prevention: why post-disaster mental health needs person-centred, digitally-enabled, and evidence-based support.
Statement of interests
I have no conflicting interests to express.
Links
Primary paper
Kip, A., Weigand, L., Valencia, S., Deady, M., Cuijpers, P., & Sander, L. (2025). Prevention of mental disorders after exposure to natural hazards: A meta‑analysis. BMJ Mental Health, 28*(1)*, e301357. https://doi.org/10.1136/bmjment-2024-301357
Other references
Beaglehole, B., Mulder, R. T., Frampton, C. M., Boden, J. M., Newton-Howes, G., & Bell, C. J. (2018). Psychological distress and psychiatric disorder after natural disasters: Systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 716–722. https://doi.org/10.1192/bjp.2018.210
Heanoy, E. Z., & Brown, N. R. (2024). Impact of natural disasters on mental health: Evidence and implications. Healthcare (Basel), 12(18), Article 1812. https://doi.org/10.3390/healthcare12181812
Kip, A., Weigand, L., Valencia, S., Deady, M., Cuijpers, P., & Sander, L. B. (2025). Prevention of mental disorders after exposure to natural hazards: A meta-analysis. BMJ Mental Health, 28(1), 1–9. https://doi.org/10.1136/bmjment-2024-301357
Lotzin, A., Franc de Pommereau, A., & Laskowsky, I. (2023). Promoting recovery from disasters, pandemics, and trauma: A systematic review of brief psychological interventions to reduce distress in adults, children, and adolescents. International Journal of Environmental Research and Public Health, 20(7), 5339. https://doi.org/10.3390/ijerph20075339
Sherwood, J. B. (2002). Planning for disaster: Concepts and future trends for emergency management. Emergencies in Public Health, 1(2), 83–98. PMC11430943.
Quotlr. (n.d.). Quotes about natural disaster. Quotlr. Retrieved July 23, 2025, from https://quotlr.com/quotes-about-natural-disaster/
