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Introduction To date, increased attention has focused on how early psychological support after trauma may reduce suffering and limit the chronicity of psychological problems such as posttraumatic stress disorder (PTSD). However, few studies have assessed the reach or effectiveness of post-disaster interventions. The population of Iceland is frequently exposed to natural disasters and since 1995 extensive psychosocial support has been provided to disaster survivors in the country. The aim of this study is to assess the implementation, utilization, and perception of psychosocial support offered in the wake of three natural disasters in Iceland and to assess the association between utilization of support and PTSD symptoms. Method Three population-based studies on inhabitants affected by avalanches in 1995 (n = 399), an earthquake in 2008 (n = 1301) and a volcanic eruption in 2010 (n = 1615) were utilized. Follow-up time varied from 2 months post-disaster (earthquake) to 16 years post-disaster (avalanches). Questionnaire data was used in all three cohorts to assess utilization of psychosocial support and psychological morbidity. Response rate in the studies ranged from 71% to 82%. PTSD symptoms were assessed with validated measurement tools in all studies. Pearson's chi-square tests were used to compare utilization and perception of psychosocial support with regard to PTSD symptoms. Results Utilization of psychosocial support varied between disaster cohorts (16% after the 2008 earthquake; 26% after the 2010 eruption and 37% after 1995 avalanches). Satisfaction with support increased over the years, with 53% of respondents reporting being satisfied or very satisfied with the support after the 1995 avalanches; 68% after the 2008 earthquake and 82% after the 2010 eruption. Only in the disaster cohort with the shortest follow-up time (2 months) were PTSD symptoms negatively associated with utilization of psychosocial support (earthquake cohort; p Conclusions The Icelandic national plan for psychosocial support has developed considerably since services were first formally offered in 1995. Results indicate that satisfaction with received psychosocial support has increased among disaster-affected populations from 1995, when services were first offered, to the year 2010, after the psychosocial plan had undergone substantial improvements. Furthermore, utilization of psychological support appears to be contingent on the severity of the disaster. Further studies are needed to assess the effectiveness of coordinated empirically informed assistance.