Post-Traumatic Stress Disorder, Major Depressive Disorder, and Wildfires: A Fifth-Year Postdisaster Evaluation among Residents of Fort McMurray

Abstract

Background: Over 90,000 residents had to be evacuated from Fort McMurray (FMM), Alberta, Canada due to the wildfire that engulfed the city in May 2016. Overall, about 2400 homes or 10% of the housing stock in Fort McMurray were destroyed. The fire consumed about 200,000 hectors of forest, reaching into Saskatchewan. During major disasters, communities’ infrastructure is disrupted, and psychological, economic, and environmental effects are felt for years afterwards. Objective: Five years after the wildfire disaster, this study assessed the prevalence rate of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) in Fort McMurray residents and determined the demographic, clinical, and other risk factors of probable MDD and PTSD. Methodology: A quantitative cross-sectional survey was conducted to collect data through an online questionnaire administered via REDCap between 24 April and 2 June 2021. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of MDD symptoms in respondents. The PTSD Checklist for DSM-5 (PCL-C) was used to assess likely PTSD in respondents. Descriptive, univariate, and multivariate regression analyses were employed. Results: 186 out of 249 individuals who accessed the survey link completed it (74.7% response rate). The median age of the subscribers was 42. The sample included a majority of 159 (85.5%) females; 98 (52.7%) > 40 years of age; 175 (94.1%) employed; and 132 (71%) in a relationship. The overall prevalence of MDD symptoms in our study sample was 45.0% (76). Four variables independently predicted MDD symptoms in the multivariate logistic regression model, including: unemployed (OR = 12.39; 95% CI: 1.21–126.37), have received a mental diagnosis of MDD (OR = 4.50; 95% CI: 1.57−12.92), taking sedative-hypnotics (OR = 5.27; 95% CI: 1.01−27.39), and willingness to receive mental health counseling (OR = 4.90; 95% CI: 1.95–12.31). The prevalence of likely PTSD among our respondents was 39.6% (65). Three independent variables: received a mental health depression diagnosis from a health professional (OR = 4.49; 95% CI: 1.40–14.44), would like to receive mental health counseling (OR = 4.36, 95% CI: 1.54–12.34), and have only limited or no support from family (OR = 11.01, 95% CI: 1.92–63.20) contributed significantly to the model for predicting likely PTSD among respondents while controlling the other factors in the regression model. Conclusions: According to this study, unemployment, taking sleeping pills, having a prior depression diagnosis, and the willingness to receive mental health counseling significantly increase the odds of having MDD and PTSD following wildfires. Family support may protect against the development of these conditions.

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“…A score ≥ 44 denotes likely PTSD, while ≤44 shows unlikely PTSD. The PCL-C demonstrates high internal consistency (Cronbach's = 0.94) and acceptable reliability and convergent validity [48].…”

Psychotropic Medication Prescriptions and Large California Wildfires

“…In this cohort study of large California wildfires from 2001 to 2018, the analysis demonstrated a significant association between psychotropic medication fills and wildfires consistent with previous literature describing mental health risk associated with wildfires, but on a broader spatial and timescale using administrative prescription data. 3,4,[7][8][9]13,28 These findings warrant further examination of mental health effects related to wildfires, including exploration of exposure pathways and mechanisms for mental health effects, incident diagnoses compared with exacerbation of preexisting mental health conditions, and identification of mental health needs in communities and populations disproportionately affected by wildfires. Further investigation on mental health prescription medications is needed, particularly focusing on populations with limited or no access to mental health services, so that appropriate public health measures can be implemented with an emphasis on addressing medication needs of affected populations.…”

“…11,12 Furthermore, published studies have identified associations between wildfire and impaired mental health including anxiety, depression, and PTSD, but these studies have relied primarily on qualitative methods or focused on a particular wildfire or season; and, to our knowledge, none have used prescriptions of psychotropic medications as a proxy for mental health burden nor evaluated across wildfire seasons. 3,4,[7][8][9]13 We hypothesized that the presence of large wildfires in California, especially near population centers, would be associated with exacerbations of underlying mental health conditions. Toward this end, our objective for this study was to analyze associations between large wildfires in California and prescription rates of various psychotropic medication categories as a proxy indicator of public mental health burden.…”

“…The public health burden due to wildfires can be substantial with negative health consequences resulting from direct fire-related damage, air pollution, and severe disruptions to ecosystems. While the physical health effects of wildfires have been extensively studied, their effect on mental health is poorly understood despite a vast burden expected . Prior studies assessing mental health outcomes associated with disasters have identified increases in diagnoses and medication prescriptions for anxiety, depression, posttraumatic stress disorder (PTSD), and sleep disturbances associated with earthquakes, hurricanes, and floods .…”

“…Few studies have explored the implications of wildfires on mental health, which remain challenging to study due to a range of factors including stigma, underdiagnosis, and difficulty in measuring mental health burden . Furthermore, published studies have identified associations between wildfire and impaired mental health including anxiety, depression, and PTSD, but these studies have relied primarily on qualitative methods or focused on a particular wildfire or season; and, to our knowledge, none have used prescriptions of psychotropic medications as a proxy for mental health burden nor evaluated across wildfire seasons …”