Emergency Department Burden of Mental Health and Substance Misuse After Hurricane Helene: Insights From Rural Appalachia.

Objectives. To quantify temporal changes in mental health and substance use emergency department utilization following Hurricane Helene (September 2024) in Western North Carolina and identify disparities across vulnerable populations. Methods. We conducted a cross-sectional analysis using emergency department surveillance data from Western North Carolina counties. We calculated incidence rate ratios (IRRs) with 95% confidence intervals (CIs) by comparing 3 recovery periods (immediate, early, short-term) with their corresponding calendar dates in 2023. Results. Alcohol-related visits increased across all periods (immediate: IRR = 1.35; 95% CI = 1.14, 1.60; early: IRR = 1.47; 95% CI = 1.31, 1.65; short-term: IRR = 1.36; 95% CI = 1.21, 1.52). Anxiety disorders increased across all periods, mood disorders increased during early recovery, schizophrenia visits increased during short-term recovery (IRR = 1.19; 95% CI = 1.02, 1.40), and opioid-related visits showed marginally significant increases during short-term recovery (IRR = 1.21; 95% CI = 1.00, 1.45). Counties with higher elderly populations showed amplified alcohol and anxiety effects; counties with higher uninsured or covered by Medicaid rates showed lower utilization. Conclusions. Hurricane Helene was associated with sustained increases in alcohol- and anxiety-related emergency department visits. Disparities across age and insurance status highlight differential vulnerability and access patterns requiring targeted interventions. (Am J Public Health. Published online ahead of print April 16, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308456).