Table 2.

Included studies with exposed-only cohorts

Author Year Title	Study type Size Population	Data collection methods Time of collection post-fire	Mental health outcomes	Exposure measure	Outcome measure	Statistical methods	Confounding adjustment	Prevalence	Risk factors
Canadian Wildfires (2023)
Barrera et al. [108] 2025 Perceptions of and Responses to Wildfire Smoke Among New York State Residents: A Cross-Sectional Study	Cross-sectional 609 New York state residents in the summer of 2023	Online survey 4–5 months after the peak smoke wave (June 2023) from the Canadian wildfires	Anxiety	Responding “yes” to the question “During the summer of 2023, did you experience one or more days that were smokey, or days where you felt the air quality was poor due to wildfire smoke?”	Indicating “anxiety” to the question “Did you have any of the following symptoms during or a few days after one of the smoke events in Summer 2023?”	Descriptive statistics	Not Assessed	19.5% anxiety (not compared across exposure groups)	Not Assessed
Obuobi-Donkor et al. [109] 2024 Evaluating the 3-month Post-intervention Impact of a Supportive Text Message Program on Mental Health Outcomes During the 2023 Wildfires in Alberta and Nova Scotia, Canada	Cohort 150 Residents of Alberta and Nova Scotia during the wildfires who had subscribed to Text4Hope mental health support services	Online survey During the wildfires; baseline data were collected 2–3 months after their ignition, with follow-up data after receiving the Text4Hope mental health support services collected 5–9 months after their ignition.	GAD, MDD, resilience, PTSD, and mental well-being	All participants were considered exposed given their residence in Alberta or Nova Scotia during the wildfires.	GAD-7, PHQ-9, BRS, PCL-C, World Health Organization-5 Well-being Index (WHO-5)	Chi-square and paired sample t-tests	Not Assessed	Baseline: 42.1% likely GAD 55.7% likely MDD 42.0% likely PTSD 55.1% low resilience 71.6% poor mental well-being Follow-up: 33.3% likely GAD 47.8% likely MDD 38.4% likely PTSD 53.4% low resilience 48.3% poor mental well-being	Not Assessed
Black Summer Bushfires (2019–2020)
Halcomb et al. [110] 2023 Impacts of the 2019/20 Bushfires and COVID-19 Pandemic on the Physical and Mental Health of Older Australians: A Cross-sectional Survey	Cross-sectional survey 155 Community dwelling older people (aged 65 years and over) living in the South-eastern New South Wales, Australia during the disaster period	Online survey questionnaire (6 community groups received hard copies) 19–21 months	Self-report of mental health impacts	Median scores of bushfire impact were calculated based on responses to survey questions that assessed experiences with home evacuations, evacuation orders, home/property damage, personal safety threatened, and disruptions in everyday activities caused by the fire. However, in the assessment of mental health impact, participants were not aggregated by bushfire impact score, so all were considered exposed.	EuroQol-Visual Analogue Scale (EQ-VAS) for self-rated health, Connor-Davidson Resilience Scale (CD-RISC-2)	Mann–Whitney U test, Kruskal–Wallis H test, Wilcoxon signed-rank test and Spearman’s rank-order correlation coefficient	Not Assessed	86.2% anxious/worried Those who felt more impacted by the bushfires had lower resilience.Bushfires and bushfire smoke negatively impacted mental health more than the COVID-19 pandemic.	Not Assessed
Usher et al. [111] 2022 Coping Styles and Mental Health Outcomes of Community Members Affected by Black Summer 2019-20 Bushfires in Australia	Cross-sectional descriptive correlational design 405 Community members self-identified as being affected by the 2019–2020 Australian bushfires	Online survey questionnaire 0–12 months	Anxiety, coping styles, depression, stress	All participants were defined as exposed to the bushfires.	Coping Orientations to Problems Experienced (COPE) Inventory, DASS-21, IES-R	Bivariate correlations and independent samples t-tests	Not Assessed	Severe anxiety Moderate depression Moderate stress Approach and avoidance coping strategies Posttraumatic stress symptoms (i.e., intrusive thoughts and symptoms of avoidance and hyperarousal)	Not Assessed
Goseong Fire (2019)
Hong et al. [112] 2022 Mental Health Effects of the Gangwon Wildfires	Panel study with 1, 3 and 6 month follow-ups 206 Adult fire survivors who completed an initial psychological support services assessment and agreed to be contacted for follow-up counseling	The outreach team conducted initial in-person baseline interviews and subsequent interviews were over the phone. 0–1 months (initial assessment)	Anxiety, depression, grief, insomnia	All survivors who received psychological support services from the “Integrated Mental Health Service Team for Wildfires” were considered exposed.	Post-disaster Psychological Responses-Checklist	Linear mixed models with repeated measures	Not Assessed	Baseline assessment: 50.0% anxiety 32.5% depression 33.0% grief 59.2% insomnia Mental health improved over time.	Experience of flashbacks
Fort McMurray Wildfire (2016)
Belleville et al. [113] 2023 Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial	Randomized Control Trial 136 Residents of Fort McMurray who reported either (a) moderate or mild symptoms of PTSD or (b) mild symptoms of PTSD with moderate symptoms of depression or subthreshold insomnia	Participants used a therapist-guided, online self-help treatment. Data on the outcomes of interest were collected via phone interview. 24–32 months	Anxiety, depression, disability, insomnia, PTSD	All participants were considered exposed given their Fort McMurray residence. Level of exposure to the fire was assessed by a previously developed survey [59].	GAD-7, ISI, PHQ-9, PCL-5, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)	Intent-to-treat mixed models ANOVAs	Not Assessed	Pretreatment Mean Scores Across All Treatment Groups: PCL-5: 26.2 PHQ-9: 9.7 ISI: 16.1 GAD-7: 8.2 WHODAS: 68.2	Not Assessed
Binet et al. [114] 2021 A Portrait of Mental Health Services Utilization and Perceived Barriers to Care in Men and Women Evacuated During the 2016 Fort McMurray Wildfires	Cross-sectional survey 1,510 Evacuees from the Fort McMurray wildfire who were at least 18 years old and spoke sufficient English	Telephone survey 12–14 months	Depression, insomnia, PTSD	All participants were considered exposed; defined by having to evacuate from the fire. Participants were asked exposure-related questions, but these data were not used in the analyses to predict the mental health outcomes.	ISI, PCL-5, PHQ-9	Chi-square tests and multiple logistic regression	Not Assessed	PTSD 17.7% probable diagnosis 21.5% subclinical symptoms Depression 7.8% probable diagnosis 5.2% subclinical symptoms Insomnia 13.5% probable diagnosis 23.3% subclinical symptoms	Sex
Brown et al. [115] 2021 Mental Health Symptoms Unexpectedly Increased in Students Aged 11–19 Years During the 3.5 Years After the 2016 Fort McMurray Wildfire: Findings from 9,376 Survey Responses.	Panel study 9,376 (sample size, not unique number of participants) Grade 7–12 students enrolled in either junior or senior high schools in both Public and Catholic School Districts in Fort McMurray in 2017	An initial intake survey, with mental health surveys were administered in-person, during class time for 3 consecutive years. 18, 30, and 42 months	Anxiety, depression, PTSD, quality of life, resilience, self-esteem, substance use, suicidal thinking	The Impact of Fire Questionnaire (IOF)a was administered. However, students were not classified by their level of impact; thus, all participants were considered exposed.	CYRM-12, CRAFFT Questionnaire, CPSS, HADS, Kidscreen-10, PHQ-A, Rosenberg Self-Esteem Scale	Permutation testing on the slope parameter from a fitted linear model	Not Assessed	2019 prevalence (direction of change relative to 2017 prevalence): 41.0% probable PTSD (↑) 35.0% probable depression (↑) 20.0% probable moderately severe depression (↑) 18.0% suicidal thinking (↑) 31.0% probable anxiety (↑) 16.0% probable alcohol/ substance use disorder (↑) 12.0% tobacco use (↓) Self-esteem and quality of life scores decreased. Resilience scores did not change significantly.	Age and gender identity
Belleville et al. [116] 2019 Post-Traumatic Stress Among Evacuees from the 2016 Fort McMurray Wildfires: Exploration of Psychological and Sleep Symptoms Three Months After the Evacuation	Cross-sectional survey 379 (of which 55 participated in a clinical interview) Evacuees from the Fort McMurray wildfire who were at least 18 years old and spoke sufficient English	Online questionnaire survey and optional follow-up clinical interview 2–4 months	Depression, insomnia, PTSD	Exposure was not explicitly measured - participants were evacuees from the wildfire.	Online Survey: ISI, PCL-5, PHQ, PHQ-9, Pittsburgh Sleep Quality Index and its Addendum for PTSD (PSQI; PSQI-A), the Post-Traumatic Cognitions Inventory (PTCI) Clinical Interview: Clinician- Administered PTSD Scale (CAPS), Mini International Neuropsychiatric Interview (MINI)	Pearson’s correlations, hierarchical multiple regression	Not Assessed	Prevalence from questionnaire: 62.5% PTSD Confirmed by interview: 29.1% PTSD, 25.5% depression, and 43.6% insomnia	Age
Bastrop County Complex Fire (2011)
Kirsch et al. [117] 2016 Longitudinal Community Assessment for Public Health Emergency Response to Wildfire, Bastrop County, Texas	Cross-sectional household-level survey repeated at two time points First survey: 135 households Follow-up survey: 185 households 35 randomly selected census blocks within, overlapping, or touching the Bastrop County Complex Wildfire perimeter. Seven households within each census block were intended to be interviewed, for a total of 245 target surveys.	In-person survey at participants’ homes First survey: 20–21 days post-ignition Follow-up: 3.5 years	Depressed mood/hopelessness, sleeping problems, stress	Households were considered exposed if their residence fell within, overlapped, or touched the fire perimeter.	Mental health questions were derived from the Center for Disease Control and Prevention’s (CDC’s) Behavioral Risk Factor Surveillance System (BRFSS) (e.g., “Over the past 2 weeks, how often have you felt down, depressed, or hopeless?”).	Descriptive statistics, risk differences	Not Assessed	First survey: 54.8% of adults experienced a depressed mood/hopelessness in the previous 2 weeks 54.8% of adults experienced sleeping problems in the previous 2 weeks 30.8% of children experienced sleeping disturbances in the previous 2 weeks Follow up (2015): Comparing those that sustained damage to their homes to those who did not, 11.5% of households reported sleep disturbances as a long-term mental health impact of the wildfire on their children. Respondents exposed to the 2011 wildfire were at greater risk of depressive symptoms (risk difference = 5.6%). Those exposed to the 2011 wildfire reported significantly higher stress in 2015 than in 2011, compared to those unexposed to the wildfire (27.3% versus 8.1%).	Residing in homes that sustained wildfire damage
Mount Carmel Forest Fire (2010)
Hashoul-Andary et al. [118] 2016 A Longitudinal Study of Emotional Distress Intolerance and Psychopathology Following Exposure to a Potentially Traumatic Event in a Community Sample	Cohort 151 Adults who had to evacuate their homes due to the fire and who met the DSM-IV criterion A of PTSD (i.e., felt intense fear, horror or helplessness in response to the fire)	Online or hard copy survey Time point 1: within 30 days Time point 2: 3 months Time point 3: 6 months	Anxiety, anxiety sensitivity, depression, distress, post-traumatic stress, suicidality	All participants were considered exposed given they evacuated from the fire. The Carmel Trauma Questionnaire was developed to measure participants’ proximity to the fire, injury to the participant or their relatives, and property damage.	Anxiety Sensitivity Index-3 (AS-I-3), Distress Tolerance Scale (DTS), Inventory of Depression and Anxiety Symptoms (IDAS), Posttraumatic Diagnostic Scale (PDS)	Structural equation modeling	Not Assessed	Mean scores on scales from time point 1 to time point 3: AS-I-3 decreased DTS decreased PDS decreased IDAS Depression decreased (but increased from time point 2 to time point 3) IDAS Suicidality increased	Not Assessed
Zeller et al. [119] 2015 Self-Compassion in Recovery Following Potentially Traumatic Stress: Longitudinal Study of At-Risk Youth	Cohort 64 High school students living in an educational residential youth village in northern Israel and who had proximal exposure to the fire in the 30 days prior to initial survey administration	Online survey Time point 1: within 4 weeks Time point 2: 3 months Time point 3: 6 months	Depression, panic, post-traumatic stress, suicidality, well-being	All participants were considered exposed given they evacuated from the fire. The Carmel Trauma Questionnaire was developed to measure participants’ proximity to the fire, injury to the participant or their relatives, and property damage. As the hypothesized mediator, self-compassion was measured with the Self Compassion Scale.	IDAS	Multilevel modelling of mediation	Not Assessed	Comparing symptoms at time point 1 to time point 3: Panic increased Post-traumatic stress increased Depression did not change Suicidality did not change Well-being did not change Self-compassion mediated symptoms of posttraumatic stress, panic, depression, and suicidality.	Not Assessed
Black Saturday Bushfires (2009)
Wasiak et al. [120] 2013 12-month Generic Health Status and Psychological Distress Outcomes Following an Australian Natural Disaster Experience: 2009 Black Saturday Wildfires	Case study 15 Patients admitted to Victorian Adult Burns Unit with burn injuries as a result of the Black Saturday Wildfires	Baseline in-clinic interview within 21 days of admission with follow-up phone interviews at 3, 6, and 12 months	Alcohol use, psychological distress	All patients were considered exposed.	AUDIT, K-10, 36-item Short Form Health Survey (SF-36)	Generalized linear models	Not Assessed	At 3 and 6 months: 33.0% high to very high psychological distress At 12 months: 27.0% high psychological distress Across study period: No changes in AUDIT scores	Not Assessed
Greek Forest Fires (2007)
Psarros et al. [121] 2017 Insomnia and PTSD One Month After Wildfires: Evidence for an Independent Role of the “Fear of Imminent Death”	Cross-sectional survey 92 Randomly selected victims of wildfires who were permanent residents in the Greek province of Ilia in 2007	In-person interviews and questionnaires 1 month	Insomnia, PTSD	All victims were considered exposed.	Athens Insomnia Scale (AIS), ICD-10 diagnostic criteria of PTSD	Univariate and multiple logistic regression	Not Assessed	63.0% insomnia 46.7% PTSD	Age, sex, fear of death, PTSD
Canberra Bushfires (2003)
Camilleri et al. [122] 2010 Recovery from Bushfires: The Experience of the 2003 Canberra Bushfires Three Years After	Cross-sectional 500 Canberra households that had been registered with the Bushfire Recovery Centre	Paper survey 3.25 years	Psychological distress	Participants reported their experiences of threats and losses as a result of the bushfire, but these were not analyzed in association with psychological distress.	K-10	Descriptive statistics	Not Assessed	19.5% high to very high distress over the past four weeks 11.5% high levels of psychological distress 8.0% very high levels of psychological distress	Not Assessed
Multiple/Unspecified
Isaac et al. [123] 2025 Digital Cognitive Behavioral Therapy–Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial	Randomized control trial 30 Wildfire survivors from Australia, Canada, and the US recruited from May - December 2023 who had met at least one of the criteria: a score of ≥ 8 on the ISI, a score of ≥ 3 on the Nightmare Disorder Index, or a score of ≥ 31 on the PCL-5	Online surveys and treatment modules Variable; mental health assessments performed at baseline, posttreatment, and at a 3 month follow-up	Anxiety, depression, insomnia, PTSD	All participants were considered exposed given their indication of being wildfire survivors.	GAD-7, ISI, PHQ-9, PCL-5	Intent-to-treat analysis (primary) and per-protocol analysis (secondary) with mixed-effects models	Not Assessed	Intent-to-Treat Pretreatment Mean Scores Across All Treatment Groups: GAD-7: 1.9 ISI: 3.4 PCL-5: 48.4 PHQ-9: 12.5	Not Assessed
Isaac et al. [124] 2023 Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America	Cross-sectional 126 Wildfire survivors from Australia, Canada, and the US	Online survey Unspecified	Anxiety, depression, insomnia, and PTSD symptoms	Participants indicated if they had experienced the wildfire event more or less than 12 months from when they completed the survey.	GAD-7, ISI, PHQ-9, PCL-5	ANCOVA	Not Assessed	Australia: 35.1% moderate to severe anxiety 44.2% moderate to severe depression 34.1% moderate to severe insomnia 48.6% above clinical PTSD threshold Canada: 37.0% moderate to severe anxiety 55.6% moderate to severe depression 59.2% moderate to severe insomnia 75% above clinical PTSD threshold US: 63.0% moderate to severe anxiety 57.4% moderate to severe depression 56.4% moderate to severe insomnia 88.9% above clinical PTSD threshold	Gender, education level, employment, income, and recency of fires
Hooper et al. [125] 2018 Life After Bushfire: Post-traumatic Stress, Coping and Post-traumatic Growth	Cross-sectional 65 Adults aged 19–65 who indicated they had experienced one or more Australian bushfire events	Online survey Variable – exact bushfire event not specified	Post-traumatic stress, post-traumatic growth	Survey questions included the number of bushfire events experienced, time since most recent bushfire experience, having lived in a house or property directly impacted by bushfire, and bushfire evacuation of self, family, or friends.	IES-R, Post-Traumatic Growth Inventory (PTGI)	Generalized linear regression	Age, time since fire	Prevalence not assessed. Longer time since the most recent bushfire experience was associated with decreased post-traumatic stress and growth.	Not Assessed

^aIOF = a custom questionnaire to assess the impact of the 2016 wildfire, with exposure-related questions of whether the participant was present in Fort McMurray during the fire, whether they were evacuated, whether they personally saw the fire, and whether their home was destroyed