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

Importance: 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. Objective: 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. Design, Setting, and Participants: This multiarm, propensity-weighted cross-sectional study compared adults residing within burn zones and outside burn zones on Maui and unexposed residents from other Hawai'i 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.