As devastating wildfires continue to spread across southern California, thousands of structures have been destroyed or damaged and at least five people have been killed.

Residents and firefighters have suffered physical injuries, but doctors say the wildfires can also take a heavy mental health toll on civilians and first responders.

“I think when disaster like this is unfolding, it makes sense to prioritize people’s lives and mortality but, over time, we have to think about mental health consequences too,” Dr. Sarah Lowe, associate professor of social and behavioral sciences at Yale School of Public Health, told ABC News.

“We also know that mental and physical health are connected,” she continued. “While mental health symptoms might not necessarily be linked to the exposure itself, they could be linked to or exacerbated by physical health ailments.”

Increased risk of anxiety, depression, PTSD

Mental health experts say that most people are resilient and do not develop a mental health condition as a result of trauma from a natural disaster.

However, those with more exposure to the event — such as losing a home, losing a loved one or experiencing injury — are at higher risk, the experts said.

“It is common to experience emotional distress during these traumatic events, where people often lose a sense of control,” Dr. Jace Reed, director of emergency psychiatry for the Department of Psychiatry & behavioral neurosciences at Cedars-Sinai in Los Angeles, told ABC News. “The current wildfires have led to evacuations, the destruction of homes and property, the loss of beloved pets, physical injuries and even death, all of which can be profoundly distressing.

“Individuals may feel a range of emotions, including denial, anger, sadness, shock and hopelessness,” he added. “This emotional response can evolve into later stages, such as acceptance, further sadness, depression and bitterness.”

Research has shown wildfires can lead to increased rates of anxiety and depression and symptoms may become worse among people who already have these conditions.

Additionally, people can develop post-traumatic stress disorder (PTSD), which can include intrusive thoughts and nightmares.

Leaving PTSD untreated can result in the use of or dependence on drugs and alcohol, increased risk of chronic health conditions and increased risk of self-harm.

Dr. Ian Stanley, an assistant professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, told ABC News that untreated PTSD can put a strain on relationships including familial relationships, romantic relationships and friendships.

“It can really begin to eat away at, not just the person’s well-being, but also the social environment in which they live,” he said.

Wildfire smoke can also put you at risk

The experts said it’s not just people directly affected by the fire who are at risk of mental health impacts. People exposed to wildfire smoke are at risk as well.

Wildfire smoke can travel long distances, meaning cities hundreds of miles away may be experiencing unhealthy air quality.

A 2024 study from Emory University found that wildfire smoke was linked with emergency department visits for anxiety disorders with higher risks among girls, women and older adults.

“Even people who aren’t directly affected by fires, the smoke from them, coming into their neighborhoods and communities, even if it’s imperceptible, can have impacts on mental health,” Lowe said. “We’re seeing more and more, and that’s with a range of mental health conditions, including depression, anxiety.”

Firefighters, first responders also at risk

Firefighters battling the flames and first responders helping treat those who are injured or are in need are also at risk of experiencing mental health impacts.

Firefighters and other rescue personnel are at greater risk of developing PTSD compared to the general population. An August 2016 study found approximately 20% of firefighters and paramedics meet the criteria for PTSD at some point in their career compared to a 6.8% lifetime risk for the general population, according to the U.S. Fire Administration.

“They’re on the front lines, and first responders, firefighters, police, EMS have potentially pre-existing vulnerabilities to developing mental health problems at a higher rate than the civilian population,” Stanley said.

The duties of first responders — facing challenging situations, reaching out to survivors, providing support — can be strenuous and put them at an increased risk of trauma, according to a 2018 report from the Substance Abuse and Mental Health Services Administration.

“They’re trained to do this; this is their job, and yet it can still take a toll on them, especially the crews that are away from home, spending weeks away from home and maybe lacking the traditional support system that are used to,” Stanley said.

How to help those with mental health impacts

Lowe said it will be important for California to make sure it is providing enough licensed professionals to the areas where people may be in need.

This can be challenging in the face of a large-scale mental health crisis in the U.S. in which there is a shortage of mental health professionals.

“Having good coverage for mental health services, increasing access to services” is important, she said. “A lot of times, we can’t practice outside of our jurisdiction, but there’s declarations during disasters, folks can practice outside … so just ways to increase access.”

The experts also recommend limiting time reading news coverage and social media posts of the wildfires, much of which can be distressing.

“This can lead to increased anxiety, sleep difficulties and stress, causing many people to feel the urge to consume more information,” Reed said. This increased consumption is likely more anxiety-provoking than comforting. … I recommend that people consume this content in moderation and focus on activities that help reduce their stress levels.”

Family members and friends can help by providing a sense of support for their loved one and confidently checking in, the experts said.

“You can think of kind of the 3 Hs here: Do you want to be helped? Do you want to be hugged? Or do you want to be heard?” Stanley said. “Some people just want a shoulder to cry on. Some people want you to go into problem-solving mode and some people just want a listening ear.”