Context Global change is leading to more frequent and intense tree damage and mortality events. Drought-induced tree mortality is occurring worldwide leading to broad-scale events, but the spatial patterns of tree damage and mortality, their underlying drivers and their variation over time is largely unknown. Objectives We investigated the spatial patterns of tree damage and mortality across Mediterranean forests of the Iberian Peninsula, the underlying effects of stand structure and climate, and how the spatial patterns and relationships with underlying drivers changed over time. Methods We used the Spanish Forest Inventory to analyse the autocorrelation in tree damage and mortality across forest types, hurdle-gamma models to quantify the effect of stand structure and climate on tree damage and mortality, and cross-correlograms to assess their spatial dependence and its change over time. Results We observed a greater magnitude and a stronger autocorrelation in tree damage than mortality, with positive aggregation up to 20 kms. There was a spatial dependence between tree damage and mortality with their drivers, with spatial aggregation increasing with water availability, drought intensity and stand structure. The spatial dependence of tree damage and mortality with the underlying drivers increased over time, particularly for drought intensity. Conclusions Our results suggest that the combined effect of intense competition and drought could favour more extensive die-off and tree mortality events, providing key information for identifying vulnerable areas and the planning of adaptation measures.