Beyond the burn zone: Maui wildfires create widespread mental health issues

The deadly wildfires that devastated Maui in August 2023 created an island-wide mental health crisis, according to new research from the Economic Research Organization of the University of Hawaii and the Maui Wildfire Study.

The study, published Wednesday in JAMA Psychiatry, found that the fires were associated with significantly higher levels of depression and anxiety among residents — even those who did not live near the burn zones in Lahaina and Kola. More than half of the disaster’s impact on mental health can be traced to increased housing and job insecurity, according to the study, although the long-term burden of the fires is still evident.

“This shows that housing displacement and loss of income were not side issues – they were central drivers of psychological harm,” said Ruben Juarez, UHERO professor and lead author of the study. “Recovery policy must treat stable housing, employment and mental health care as inseparable.”

According to the study, people living in fire-exposed areas had a 53% higher risk of depression and a 67% higher risk of anxiety than unexposed residents. However, other Mayo residents also experienced significantly higher mental health risks, including more than twice the risk of suicidal thoughts, the researchers said.

While exposure to trauma negatively affected the mental health of many survivors, researchers found that increased stress and anxiety were primarily caused by social and economic instability.

For wildfire survivors, housing and job insecurity explained nearly 62% of disaster-induced depressive symptoms and 77% of anxiety symptoms, according to the study. For other people on Maui, these factors were behind nearly 55% of reported symptoms of depression and 96% of anxiety.

“While disaster research often focuses on post-traumatic stress disorder, our results suggest that depression, anxiety, and suicidality associated with socioeconomic disruption are widespread, immediate, and changeable and should be treated as core components of disaster recovery,” the study authors wrote. Lead authors included Juarez, Ben Lee and Christopher Knightsbridge.

The researchers were surprised by the evidence showing that the fires led to a decline in mental health across the state, according to study co-author and John A. Burns School of Medicine professor Alika Monakia.

“Climate disasters affect biological, social and economic systems simultaneously,” Manakia said. “If we only rebuild structures and don’t stabilize housing, employment and mental health services, we leave communities vulnerable after the smoke clears.”

Knightsbridge, who leads the mental health research team for the MauiWES study, said the study’s findings are consistent with his experience working directly with Maui firefighters. Many people who have lost loved ones, their homes or their livelihoods to fires cannot begin to process the trauma they have endured because they are too busy dealing with the secondary effects of the disaster, he said.

“We can’t treat this trauma until the patient’s basic survival needs are met, and since the fire, everyone is in survival mode,” Knightsbridge said. “Where do I live? Why is the insurance company afraid of me? Why aren’t the contractors doing what they said they were going to do?”

He added that the disaster had a ripple effect on housing, the local economy and other broader issues, so everyone on the island felt the consequences.

Knightsbridge, who lives on Oahu, didn’t think people living on other islands fully understood the extent of the ongoing mental health crisis on Maui.

“I guarantee they don’t,” he said. “It’s – just based on my observations – it’s a different kind of stress on Maui and especially in Lahaina. It’s a real crisis level of suicidality, stress, trauma and always feeling on edge.”

Study participants who were employed were significantly less likely to report symptoms of clinical depression, anxiety and suicidal ideation, while those living in temporary housing were more likely to develop anxiety than those in stable housing, according to the researchers.

“This article gives Mayo a warning and a road map,” Juarez said. “True recovery requires investing in the social and psychological well-being of the entire community, not just the burned areas.”

The researchers examined 2,453 adults between January 2024 and February 2025, including 1,535 Maui residents affected by the wildfires and 918 unexposed people living in other Hawaiian states.

The study’s findings expand on previous studies by MauiWES and UHERO that found wildfire survivors who lived or worked in the burn area were more likely to exhibit long-term exposure to harmful heavy metals and were more likely to report symptoms of heart, lung and mental health issues than non-survivors.

The Lahaina Wildfire destroyed thousands of buildings and killed at least 102 people, making it the deadliest wildfire in modern American history. It has affected a racially diverse and geographically segregated community that has long suffered from socioeconomic and public health disparities. Still, the researchers took a first look at the population-wide impact of wildfires on the mind, the researchers said, and it could inform climate adaptation policy, trauma-informed disaster recovery, and equitable mental health response systems around the world as climate-related disasters increase.

This story was originally published by Honolulu Soul Beat and is distributed in partnership with The Associated Press.