Hurricane Helene was associated with sustained increases in alcohol- and anxiety-related emergency department visits, with disparities across age and insurance status highlighting differential vulnerability and access patterns requiring targeted interventions.
Key Findings
Results
Alcohol-related emergency department visits increased significantly across all three post-Hurricane Helene recovery periods compared to the same calendar dates in 2023.
Alcohol-related visits showed the most consistent increases across all recovery periods of any condition studied
Study used cross-sectional analysis with emergency department surveillance data from Western North Carolina counties
Results
Anxiety disorder-related emergency department visits increased across all recovery periods following Hurricane Helene.
Increases were observed during the immediate, early, and short-term recovery periods
Specific IRR values for anxiety disorders were not reported in the abstract but described as increasing across all periods
Counties with higher elderly populations showed amplified anxiety effects
Anxiety was one of two conditions (along with alcohol) showing sustained increases across all recovery periods
Results
Mood disorder-related emergency department visits increased during the early recovery period following Hurricane Helene.
Mood disorder increases were specific to the early recovery period
Mood disorders did not show increases during the immediate or short-term recovery periods
Specific IRR values for mood disorders were not reported in the abstract
This suggests a delayed but transient effect on mood disorder presentations
Results
Schizophrenia-related emergency department visits increased significantly during the short-term recovery period.
Short-term recovery period IRR = 1.19 (95% CI = 1.02, 1.40)
Schizophrenia visits did not show significant increases during the immediate or early recovery periods
This suggests a delayed effect on psychotic disorder presentations following the hurricane
The finding indicates that severely mentally ill populations may face worsening conditions as recovery extends
Results
Opioid-related emergency department visits showed marginally significant increases during the short-term recovery period.
Short-term recovery period IRR = 1.21 (95% CI = 1.00, 1.45)
The authors described this increase as 'marginally significant'
Opioid-related increases were only observed during the short-term recovery period, not in immediate or early periods
This delayed pattern suggests opioid misuse may emerge as a coping mechanism in the weeks following disaster
Results
Counties with higher elderly populations showed amplified alcohol and anxiety effects following Hurricane Helene.
Higher elderly population proportions at the county level were associated with greater increases in both alcohol- and anxiety-related ED visits
This finding highlights older adults as a particularly vulnerable population in post-disaster mental health outcomes
The analysis was conducted at the county level using Western North Carolina emergency department surveillance data
The study was conducted in rural Appalachia, a region with known health disparities
Results
Counties with higher rates of uninsured residents or residents covered by Medicaid showed lower emergency department utilization for mental health and substance use conditions after Hurricane Helene.
Higher uninsured rates at the county level were associated with lower observed ED utilization
Higher Medicaid coverage rates were also associated with lower ED utilization
The authors interpret this as reflecting differential access patterns rather than lower need
This finding suggests underutilization of emergency services among economically vulnerable populations, potentially masking true burden
The authors note this highlights 'differential vulnerability and access patterns requiring targeted interventions'
Methods
The study used a cross-sectional design comparing three defined post-disaster recovery periods to corresponding calendar dates in 2023 as a baseline.
Three recovery periods were defined: immediate, early, and short-term recovery
Comparisons were made to equivalent calendar dates in 2023 to control for seasonal variation
Incidence rate ratios (IRRs) with 95% confidence intervals were the primary statistical measure
Emergency department surveillance data from Western North Carolina counties affected by Hurricane Helene (September 2024) were used
The study focused on rural Appalachian communities
What This Means
This research suggests that Hurricane Helene, which struck Western North Carolina in September 2024, led to significant and lasting increases in people seeking emergency department care for mental health and substance use problems. Compared to the same time periods in 2023, alcohol-related ER visits rose by 35–47% across all phases of recovery, and anxiety-related visits also stayed elevated throughout. Other conditions emerged on different timelines: mood disorders increased in the weeks immediately after the storm, while schizophrenia and opioid-related visits rose in the longer-term recovery phase — suggesting that the mental health toll of the disaster continued to grow over time rather than fading quickly.
The study also found important differences across communities. Areas with more elderly residents saw even larger spikes in alcohol and anxiety-related ER visits, suggesting older adults were especially hard-hit. Counterintuitively, counties with more uninsured residents or those relying on Medicaid actually showed lower ER utilization — not because they needed less help, but likely because financial and systemic barriers prevented people from seeking care. This gap between need and access is a critical concern in a region already facing significant healthcare challenges.
This research matters because it documents that the mental health and substance use consequences of a major hurricane are not short-lived — they persist and even worsen over months of recovery, particularly in rural, economically vulnerable communities like those in Appalachia. The findings point to a need for proactive mental health and substance use services to be deployed both immediately after disasters and sustained throughout the recovery period, with special attention to elderly residents and those with limited insurance coverage.
Sugg M, Ryan S, Preaux A, Quattro C, Alexander-Eitzman B, Thompson M, et al.. (2026). Emergency Department Burden of Mental Health and Substance Misuse After Hurricane Helene: Insights From Rural Appalachia.. American journal of public health. https://doi.org/10.2105/AJPH.2026.308456