The Human Toll of Disasters: Examining Stress, Mental Health, and Service Referral Across Crisis Counselors and Affected Civilians

Abstract

Natural disasters increasingly threaten the mental health of both civilian populations and crisis responders. While research has extensively documented trauma among survivors, less is known about how pre- and post-disaster stressors influence both service recipients and providers, or how mental health symptoms like PTSD and suicide risk mediate the relationship between disaster exposure and recovery service engagement. This dissertation includes three interrelated studies that examine the psychological and behavioral impacts of disaster-related stress on civilians and crisis counselors.

Article 1 focuses on 211 crisis counselors deployed through the Federal Emergency Management Agency’s (FEMA) Crisis Counseling Assistance and Training Program (CCP), exploring how pre-disaster life stress and post-disaster adversity predict emotional reactions. Results revealed that both stressors were associated with increased emotional reactivity, with additive effects on counselor well-being. However, individual variability and protective factors may mitigate these effects.

Article 2 analyzes over 21,000 household-level civilian encounters across 11 disasters to assess how disaster-related risks influence emotional well-being and service referrals. Findings showed that individuals with greater exposure to risks (e.g., injury, displacement, bereavement) were more likely to show severe reactions and receive referrals. However, disparities in referral patterns were evident across regions, disaster types, and demographic groups.

Article 3 uses structural equation modeling on 123 high-risk civilians to test a sequential mediation model linking disaster exposure to service referral and acceptance through PTSD symptoms and suicide risk. Results confirmed that PTSD symptoms—but not suicide risk—were the strongest mediators of both referral and acceptance outcomes. While risk exposure predicted higher PTSD symptoms, PTSD was the most consistent predictor of both referral and follow-through with services.

Together, these studies provide a multidimensional view of disaster recovery, revealing that psychological symptoms—not disaster exposure alone—drive service engagement. The findings underscore the need for trauma-informed outreach, better screening for PTSD, and more equitable disaster response systems. For crisis counselors, results point to the importance of addressing personal stressors to reduce emotional exhaustion and burnout. This work informs public health strategies aimed at strengthening mental health infrastructure, reducing service disparities, and improving recovery outcomes for both survivors and responders in disaster-affected communities.