Cascading disasters and mental health: The February 2021 winter storm and power crisis in Texas, USA.

In February 2021, the state of Texas and large parts of the US were affected by a severe cold air outbreak and winter weather event. This event resulted in large-scale power outages and cascading impacts, including limited access to potable water, multiple days without electricity, and large-scale infrastructure damage. Little is known about the mental health implications of these events, as most research has predominantly focused on the mental health effects of exposure to hurricanes, wildfires, or other natural disasters that are more commonly found in the summer months. This study aimed to analyze the crisis responses from the 2021 winter weather event in Texas using Crisis Text Line, a text-based messaging service that provides confidential crisis counseling nationwide. To date, Crisis Text Line is the largest national crisis text service, with over 8 million crisis conversations since its inception in 2013. We employed multiple quasi-experimental analytic techniques, including segmented regression, interrupted time series, autoregressive integrated moving average (ARIMA), and difference-in-difference (DID), to investigate numerous time periods of exposure for all crisis conversations. ARIMA and DID were further utilized to examine specific crisis outcomes, including depression, stress/anxiety, and thoughts of suicide. Results found increases in total crisis conversations and for thoughts of suicide; however, crisis outcomes varied in time. Thoughts of suicide in high-impact regions were higher across multiple time periods (4-weeks, 3-months, 6-months, 9-months and 11-months) and were elevated compared to pre-event time periods for 6-months and 11-months from the initial event. Total crisis volume also reamined elevated for high-impact regions compared to low-impact regions up to 11-months after the beginning of the winter event. Our work highlights that cascading winter weather events, like the Texas 2021 Winter storm, negatively impacted mental health. Future research is needed across different disaster types (e.g., cascading, concurrent) and for specific crisis outcomes (e.g., depression, suicidal ideation) to understand the optimal timing of crisis intervention post-disaster.