Objective: To examine the mental health effects of Hurricane Ike, the third costliest hurricane in US history, which devastated the upper Texas coast in September 2008. Method: Structured telephone interviews assessing immediate effects of Hurricane Ike (damage, loss, displacement) and mental health diagnoses were administered via random digit-dial methods to a household probability sample of 255 Hurricane Ike-affected adults in Galveston and Chambers counties. Results: Three-fourths of respondents evacuated the area because of Hurricane Ike and nearly 40% were displaced for at least one week. Postdisaster mental health prevalence estimates were 5.9% for posttraumatic stress disorder, 4.5% for major depressive episode, and 9.3% for generalized anxiety disorder. Bivariate analyses suggested that peritraumatic indicators of hurricane exposure severity-such as lack of adequate clean clothing, electricity, food, money, transportation, or water for at least one week-were most consistently associated with mental health problems. Conclusions: The significant contribution of factors such as loss of housing, financial means, clothing, food, and water to the development and/or maintenance of negative mental health consequences highlights the importance of systemic postdisaster intervention resources targeted to meet basic needs in the postdisaster period. (Disaster Med Public Health Preparedness. 2012;6:26-32)