Disaster displacement tied to unmet pediatric mental health needs

Children in US households displaced by natural disasters are more likely to have unmet mental health needs and less likely to receive adequate care, according to a cross-sectional analysis of nationally representative survey data published in JAMA Network Open.¹ The findings highlight displacement as an emerging social determinant of health with implications for pediatric mental health screening and service delivery.

Disaster-related displacement is increasing in the United States, with more than 11 million people displaced in 2024 alone.² Prior research has linked climate-related disasters to adverse mental health outcomes in children, including anxiety, depression, and disruptions in academic and social functioning.¹

“Disaster displacement is an understudied social determinant of health,” wrote investigators. “Displacement is a short-term stressor layered on long-term social risk, so these events exacerbate existing health needs.”

National survey links displacement to higher need, lower care access

Investigators analyzed data from the US Census Bureau Household Pulse Survey collected between June 2023 and September 2024, representing more than 35 million households with children nationwide. Among these, approximately 1.6% reported displacement because of a natural disaster within the prior year.

The study included 277,081 households with complete exposure data. Displaced households were more likely to be low income, experience material hardship, and include caregivers with symptoms of anxiety or depression. Hurricanes were the most commonly reported cause of displacement, followed by floods, tornadoes, and fires.

After adjustment for sociodemographic and household factors, displacement was associated with greater odds of reported pediatric mental health needs compared with nondisplaced households, with an odds ratio (OR) of 1.29. The adjusted probability of reported need was 26.8% among displaced households compared with 18.8% among nondisplaced households, indicating a substantial increase in perceived need following displacement.

Other factors increasing need

Additional factors were strongly associated with reported need. Households in which an adult reported symptoms of anxiety or depression had markedly greater odds of pediatric mental health need, with an OR of 1.86. Material hardship also contributed, with food insufficiency and energy insecurity both linked to increased likelihood of need.

Odds ratios for these factors were 1.17 and 1.17, respectively. Higher household income was associated with greater reporting of need, while Asian, Black, and Hispanic households were less likely to report need compared with White households.

Among the subset of 50,548 households reporting that at least 1 child needed mental health care, displacement remained a significant barrier to receiving treatment. Displaced households had nearly half the odds of receiving all needed mental health care compared with nondisplaced households, with an OR of 0.55.

Limited care and notable disparities

In absolute terms, only 51.0% of displaced households reported that children received all needed mental health care, compared with 75.6% of nondisplaced households. More than half of displaced households with identified need reported receiving only partial or no care.

Disparities in access persisted across multiple domains. Black households were significantly less likely to report complete treatment compared with White households with an OR of 0.42. Lower treatment receipt was also associated with food insufficiency, energy insecurity, and being behind on housing payments.

Odds ratios for these factors were 0.65, 0.73, and 0.78, respectively. In contrast, households with annual incomes greater than $150,000 were more likely to report complete receipt of care, with an OR of 1.53.

Sensitivity analyses using a broader definition of treatment receipt showed a weaker association between displacement and access to care that did not reach statistical significance based on an OR of 0.75, though the overall direction of effect remained consistent.

Clinical implications for pediatric care delivery

The current findings extend prior evidence by demonstrating both increased need and reduced access to care among displaced households. For pediatric clinicians, these data support proactive screening for disaster exposure and mental health symptoms, particularly in populations facing socioeconomic hardship.

“These findings suggest a gap in pediatric mental health care among disaster-displaced households, underscoring the need for equity-driven, child-centered responses in climate and disaster preparedness,” wrote investigators.

References

1. Ceasar JN, Cabrera KI, Mandell D. Pediatric mental health needs, unmet care, and disaster-related displacement. JAMA Netw Open. 2026;9(4):e264922. doi:10.1001/jamanetworkopen.2026.4922
2. 2025 Global report on internal displacement. Internal Displacement Monitoring Centre. May 13, 2025. Accessed April 23, 2026. https://www.internal-displacement.org/publications/2025-global-report-on-internal-displacement-grid/