Study participants who knew they had elevated water PFAS had greater worry and fear about health risks.

Study participants who had elevated water PFAS had higher PFAS-related anxiety and stigmatization.

Lack of a preexisting mental health diagnosis strengthened these associations.

Few studies have evaluated how awareness of PFAS contamination impacts psychosocial distress. We sought to quantify psychosocial distress associated with awareness of drinking water PFAS contamination in the Maine Biosolids Study (n=146), a rural cohort affected by agricultural biosolids spreading. Participants had residential well water PFAS concentrations measured by the Department of Environmental Protection and were notified about concentrations above or below the Maine Interim Drinking Water Standard [∑6 PFAS (PFOA, PFOS, PFNA, PFHxS, PFHpA, PFDA) ≥20 ng/L]. We utilized negative binomial mixed effects regression to study associations of awareness of water PFAS above the Standard with PFAS-related psychosocial outcomes and state-dependent anxiety. We explored effect modification by pre-existing mental health diagnoses and resilience coping style. Fifty-eight percent of participants had drinking water PFAS above the Standard, and 35% had pre-existing mental health diagnoses. Affected participants with drinking water PFAS above the Standard had greater PFAS-related anxiety, worry and fears about health risk, and perceived stigma [for example, IRRperceivedstigma (95% CI): 1.69 (1.32, 2.15)]. Knowledge of elevated water PFAS was associated with greater state-dependent anxiety, although confidence intervals included the null [IRR (95% CI): 1.21 (0.90, 1.61)]. Associations of awareness of water PFAS with worry about PFAS health risk and state-dependent anxiety were stronger among individuals without a prior mental health diagnosis [e.g., IRRworry (95% CI): 2.30 (1.49, 3.57) versus 1.27 (0.80, 2.02)]. We found no effect modification by resilience coping style. Individuals with knowledge of elevated drinking water PFAS had greater PFAS-related psychosocial distress. Mental health support and community education are public health needs in PFAS-affected communities.

PFAS contamination

Well water

Drinking water

Environmental worry

Stigma

Public risk perceptions

© 2025 The Authors. Published by Elsevier GmbH.