{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:55:15Z","timestamp":1781805315740,"version":"3.54.5"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH119193"],"award-info":[{"award-number":["R01MH119193"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>Displacement following extreme weather events is a growing concern, yet evidence on its mental health impacts remains limited. In August 2017, Hurricane Harvey caused extensive flooding and damage in Houston, Texas, leading to substantial displacement. In this study, we take a counterfactual approach to examine how displacement scenarios affect post-traumatic stress disorder (PTSD) and depression symptoms among impacted residents. We conducted a cross-sectional survey of adult Houston residents who experienced Hurricane Harvey. Using Augmented Inverse Probability Weighting and Inverse Probability Weighted Regression Adjustment within a causal inference framework, we estimated the association between displacement and PTSD and depression symptom scores among residents affected by Hurricane Harvey. First, we estimated the Potential Outcome Means (POmeans) under counterfactual scenarios of displacement and non-displacement. We then computed the Average Treatment Effect (ATE) and the Average Treatment Effect on the Treated (ATT) for both PTSD and depression. Covariates included demographic factors, socioeconomic status, and self-reported physical health. POmeans indicated that displaced individuals had elevated PTSD and depression symptom levels compared with a counterfactual scenario in which they were not displaced. Displacement was associated with higher PTSD symptom scores (ATE: 5.88 points [95% CI, 3.37\u20138.39]; ATT: 5.43 [95% CI, 2.65\u20138.20]) and higher depression symptom scores (ATE: 1.93 [95% CI, 0.99\u20132.87]; ATT: 2.12 [95% CI, 1.04\u20133.20]). Using causal inference methods, our analysis suggests that displacement is associated with worsened PTSD and depression symptomatology. While our doubly robust approach strengthens inference, these estimates should be interpreted as associations given the potential for residual confounding from unmeasured variables. As climate-related disasters intensify, these results highlight the importance of proactive policies and mental health interventions that specifically address the psychological toll of displacement. Future studies using longitudinal designs could further elucidate the causal pathways linking disaster-related displacement to long-term mental health outcomes.<\/jats:p>","DOI":"10.1371\/journal.pmen.0000317","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:33:07Z","timestamp":1781803987000},"page":"e0000317","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the impact of natural disasters on post-traumatic stress disorder and depression symptoms: An examination of counterfactual displacement scenarios"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0395-4446","authenticated-orcid":true,"given":"Mohammed","family":"Abba-Aji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5474-4521","authenticated-orcid":true,"given":"Salma","family":"Abdalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruochen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1459-5327","authenticated-orcid":true,"given":"Jaimie","family":"Gradus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Galea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"pmen.0000317.ref001","first-page":"1513","article-title":"Weather and climate extreme events in a changing climate.","author":"SI Seneviratne","year":"2021","journal-title":"Climate Change 2021: The Physical Science Basis Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change"},{"key":"pmen.0000317.ref002"},{"key":"pmen.0000317.ref003","year":"2024"},{"key":"pmen.0000317.ref004","doi-asserted-by":"crossref","DOI":"10.55363\/IDMC.DAKY2849","volume-title":"2024 Global Report on Internal Displacement (GRID)","author":"Internal Displacement Monitoring Centre IDMC","year":"2024"},{"key":"pmen.0000317.ref005","volume-title":"2025 Global Report on Internal Displacement (GRID)","author":"Internal Displacement Monitoring Centre (IDMC)","year":"2025"},{"key":"pmen.0000317.ref006","doi-asserted-by":"crossref","DOI":"10.1596\/38431","volume-title":"Social Cohesion and Forced Displacement: A Synthesis of New Research","author":"World Bank","year":"2022"},{"key":"pmen.0000317.ref007","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1521\/psyc.65.3.207.20173","article-title":"60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001","volume":"65","author":"FH Norris","year":"2002","journal-title":"Psychiatry"},{"issue":"1","key":"pmen.0000317.ref008","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5055\/ajdm.2006.0008","article-title":"Social context and the health consequences of disasters","volume":"1","author":"S Galea","year":"2006","journal-title":"Am J Disaster Med"},{"issue":"1","key":"pmen.0000317.ref009","doi-asserted-by":"crossref","first-page":"17","DOI":"10.5055\/jem.2018.0350","article-title":"Displacement during Hurricane Sandy: The impact on mental health","volume":"16","author":"RM Schwartz","year":"2018","journal-title":"J Emerg Manag"},{"issue":"4","key":"pmen.0000317.ref010","doi-asserted-by":"crossref","DOI":"10.1016\/S2542-5196(17)30047-5","article-title":"Effect of evacuation and displacement on the association between flooding and mental health outcomes: a cross-sectional analysis of UK survey data","volume":"1","author":"A Munro","year":"2017","journal-title":"Lancet Planet Health"},{"issue":"2","key":"pmen.0000317.ref011","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/DMP.0b013e318173a8e7","article-title":"Prevalence and predictors of mental health distress post-Katrina: findings from the Gulf Coast Child and Family Health Study","volume":"2","author":"D Abramson","year":"2008","journal-title":"Disaster Med Public Health Prep"},{"issue":"5","key":"pmen.0000317.ref012","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.annemergmed.2006.12.004","article-title":"Health status among internally displaced persons in Louisiana and Mississippi travel trailer parks","volume":"49","author":"R Larrance","year":"2007","journal-title":"Ann Emerg Med"},{"issue":"4","key":"pmen.0000317.ref013","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1017\/S0033291707001353","article-title":"Post-traumatic stress disorder following disasters: a systematic review","volume":"38","author":"Y Neria","year":"2008","journal-title":"Psychol Med"},{"key":"pmen.0000317.ref014","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.socscimed.2014.05.025","article-title":"The impact of housing displacement on the mental health of low-income parents after Hurricane Katrina","volume":"113","author":"E Fussell","year":"2014","journal-title":"Soc Sci Med"},{"key":"pmen.0000317.ref015","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780190459376.001.0001","volume-title":"Population Health Science","author":"KM Keyes","year":"2016"},{"issue":"4","key":"pmen.0000317.ref016","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s11524-023-00767-2","article-title":"Depression and PTSD among Houston Residents who Experienced Hurricane Harvey and COVID-19: Implications for Urban Areas Affected by Multiple Disasters","volume":"100","author":"GH Cohen","year":"2023","journal-title":"J Urban Health"},{"issue":"9596","key":"pmen.0000317.ref017","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"key":"pmen.0000317.ref018","unstructured":"Super Neighborhoods. https:\/\/www.houstontx.gov\/superneighborhoods\/"},{"key":"pmen.0000317.ref019","volume-title":"American Community Survey Information Guide","author":"U.S. Census Bureau","year":"2017"},{"key":"pmen.0000317.ref020","unstructured":"Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). 2013. https:\/\/www.ptsd.va.gov\/professional\/assessment\/adult-sr\/ptsd-checklist.asp"},{"issue":"9","key":"pmen.0000317.ref021","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"4","key":"pmen.0000317.ref022","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/jts.20355","article-title":"Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first two years after Hurricane Katrina","volume":"21","author":"S Galea","year":"2008","journal-title":"J Trauma Stress"},{"issue":"1","key":"pmen.0000317.ref023","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/pan\/mpp036","article-title":"An Introduction to the Augmented Inverse Propensity Weighted Estimator","volume":"18","author":"AN Glynn","year":"2010","journal-title":"Polit anal"},{"key":"pmen.0000317.ref024","doi-asserted-by":"crossref","DOI":"10.1201\/9780429246593","author":"B Efron","year":"1994","journal-title":"An Introduction to the Bootstrap"},{"issue":"5","key":"pmen.0000317.ref025","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1037\/h0037350","article-title":"Estimating causal effects of treatments in randomized and nonrandomized studies","volume":"66","author":"DB Rubin","year":"1974","journal-title":"Journal of Educational Psychology"},{"key":"pmen.0000317.ref026","volume-title":"Causal Inference: What If","author":"M Hern\u00e1n","year":"2020"},{"issue":"4","key":"pmen.0000317.ref027","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1111\/j.1541-0420.2005.00377.x","article-title":"Doubly robust estimation in missing data and causal inference models","volume":"61","author":"H Bang","year":"2005","journal-title":"Biometrics"},{"key":"pmen.0000317.ref028","unstructured":"Statistical software for data science. 2025. https:\/\/www.stata.com\/"},{"issue":"1","key":"pmen.0000317.ref029","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/atm.2018.12.10","article-title":"Balance diagnostics after propensity score matching","volume":"7","author":"written on behalf of AME Big-Data Clinical Trial Collaborative Group","year":"2019","journal-title":"Ann Transl Med"},{"issue":"25","key":"pmen.0000317.ref030","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"PC Austin","year":"2009","journal-title":"Stat Med"},{"issue":"4","key":"pmen.0000317.ref031","doi-asserted-by":"crossref","first-page":"437","DOI":"10.3102\/0162373713493129","article-title":"What Would It Take to Change an Inference? Using Rubin\u2019s Causal Model to Interpret the Robustness of Causal Inferences","volume":"35","author":"KA Frank","year":"2013","journal-title":"Educational Evaluation and Policy Analysis"},{"issue":"3","key":"pmen.0000317.ref032","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1177\/1536867X19874223","article-title":"konfound: Command to quantify robustness of causal inferences","volume":"19","author":"R Xu","year":"2019","journal-title":"The Stata Journal: Promoting communications on statistics and Stata"},{"issue":"12","key":"pmen.0000317.ref033","article-title":"Association of Postdisaster Depression and Posttraumatic Stress Disorder With Mortality Among Older Disaster Survivors of the 2011 Great East Japan Earthquake and Tsunami","volume":"2","author":"X Li","year":"2019","journal-title":"JAMA Netw Open"},{"key":"pmen.0000317.ref034","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1176\/appi.ajp.2016.15111403","article-title":"Mental health and social networks after disaster","volume":"174","author":"RA Bryant","year":"2017","journal-title":"Am J Psychiatry"},{"key":"pmen.0000317.ref035","volume-title":"2021-2022 NSDUH: Guide to State Tables and Summary of Small Area Estimation Methodology","author":"N S D U H","year":"2024"},{"key":"pmen.0000317.ref036","first-page":"98","article-title":"Confounding","volume-title":"Causal Inference: What If","author":"M Hern\u00e1n","year":"2020"}],"container-title":["PLOS Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:33:16Z","timestamp":1781803996000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000317"}},"subtitle":[],"editor":[{"given":"Paolo","family":"Raile","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmen.0000317","relation":{},"ISSN":["2837-8156"],"issn-type":[{"value":"2837-8156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]}}}