8

Mental Health and Well-Being

8.1 Introduction

  • Daniel Dodgen
    U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response
  • Darrin Donato
    U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response
  • Nancy Kelly
    U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
  • Annette M. La Greca
    University of Miami
  • Joshua Morganstein
    Uniformed Services University of the Health Sciences
  • Joseph P. Reser
    Griffith University
  • Josef Ruzek
    U.S. Department of Veterans Affairs
  • Shulamit Schweitzer
    U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response
  • Mark M. Shimamoto
    U.S. Global Change Research Program, National Coordination Office
  • Kimberly Thigpen Tart
    National Institutes of Health
  • Robert J. Ursano
    Uniformed Services University of the Health Sciences

The effects of global climate change on mental health and well-being are integral parts of the overall climate-related human health impacts. Mental health consequences of climate change range from minimal stress and distress symptoms to clinical disorders, such as anxiety, depression, post-traumatic stress, and suicidal thoughts.1,2,3,4,5 Other consequences include effects on the everyday life, perceptions, and experiences of individuals and communities attempting to understand and respond appropriately to climate change and its implications.3,6,7

The social and mental health consequences of extreme weather events have been the focus of research for more than three decades.3,4,5,8,9,10 The mental health and well-being consequences of extreme events, particularly natural disasters, are common and form a significant part of the overall effects on health. These consequences of climate change related impacts rarely occur in isolation, but often interact with other social and environmental stressors.

Clothing drive

Residents and volunteers in Queens, New York City, filter through clothes and food supplies from donors following Superstorm Sandy on November 3, 2012. A majority of individuals psychologically affected by a traumatic event recover over time, and some experience a set of positive changes that known as post-traumatic growth as a result of coping with or experiencing a traumatic event.

The threat of climate change is a key psychological and emotional stressor. Individuals and communities are affected both by direct experience of local events attributed to climate change and by exposure to information regarding climate change and its effects.10,11,12,13,14,15 For example, public communication and media messages about climate change and its projected consequences can affect perceptions of physical and societal risks and consequently affect mental health and well-being. The interactive and cumulative nature of climate change effects on health, mental health, and well-being are critical factors in understanding the overall consequences of climate change on human health.16

People have inherent capabilities to adjust to new information and experiences and adopt new behaviors to cope with change. There is also an array of interventions and treatments that mental health practitioners use to address mental health conditions and stress reactions. These interventions occur within the context of health systems that have finite resources to deliver these services. These considerations are not discussed in detail, as this chapter focuses on the state of the science regarding the effects of climate change on mental health and well-being, rather than potential actions that could be taken in response to the impacts and risks associated with climate change.

 

Figure 8.1: Climate Change and Mental Health and Wellness

Figure 8.1: Climate Change and Mental Health and Wellness
This conceptual diagram illustrates the key pathways by which humans are exposed to health threats from climate drivers, and potential resulting mental health and well-being outcomes (center boxes). These exposure pathways exist within the context of other factors that positively or negatively influence health outcomes (gray side boxes). Key factors that influence health outcomes and vulnerability for individuals are shown in the right box, and include social determinants of health and behavioral choices. Key factors that influence health outcomes and vulnerability at larger community or societal scales, such as natural and built environments, governance and management, and institutions, are shown in the left box. All of these influencing factors may also be affected by climate change. See Chapter 1: Introduction for more information.

8.2 Effects of Climate Change on Mental Health and Well-being

The cumulative and interactive effects of climate change, as well as the threat and perception of climate change, adversely impact individual and societal health, mental health, and well-being. The following figure illustrates how climate change impacts create cascading and interrelated mental, physical, and community health effects. These impacts include exposures to higher temperatures and extreme weather events as well as vector-borne disease transmission, degraded air and water quality, and diminished food safety and security.

 

Figure 8.2: Impact of Climate Change on Physical, Mental, and Community Health

Figure 8.2: Impact of Climate Change on Physical, Mental, and Community Health
At the center of the diagram are human figures representing adults, children, older adults, and people with disabilities. The left circle depicts climate impacts including air quality, wildfire, sea level rise and storm surge, heat, storms, and drought. The right circle shows the three interconnected health domains that will be affected by climate impacts—Medical and Physical Health, Mental Health, and Community Health. (Figure source: adapted from Clayton et al. 2014).5

Extreme Weather Events

In the United States, the mental health impacts of extreme weather mainly have been studied in response to hurricanes and floods17,18,19,20,21,22,23,24 and, to a lesser extent, wildfires.25,26,27,28 Though many studies discuss the mental health impacts of specific historical events, they are demonstrative of the types of mental health issues that could arise as climate change leads to further increases in the frequency, severity, or duration of some types of extreme weather (see Ch. 1: Introduction and Ch. 4: Extreme Events). The mental health impacts of these events, such as hurricanes, floods, and drought, can be expected to increase as more people experience the stress—and often trauma—of these disasters.

Many people exposed to climate- or weather-related natural disasters experience stress reactions and serious mental health consequences, including symptoms of post-traumatic stress disorder (PTSD), depression, and general anxiety, which often occur simultaneously.29,30,31,32,33,34 Mental health effects include grief/bereavement, increased substance use or misuse, and suicidal thoughts.19,35,36,37,38 All of these reactions have the potential to interfere with the individual’s functioning and well-being, and are especially problematic for certain groups (see Section 8.3: “Populations of Concern”).

Photo 2

An elderly couple walk to the Superdome days after Hurricane Katrina made landfall. New Orleans, Louisiana, September 1, 2005

Exposure to life threatening events, like highly destructive hurricanes such as Hurricane Katrina in 2005, have been associated with acute stress, PTSD, and higher rates of depression and suicide in affected communities.18,20,23,30,39,40,41,42,43,44,45,46,47 These mental health consequences are of particular concern for people facing recurring disasters, posing a cumulative psychological toll. Following exposure to Hurricane Katrina, veterans with preexisting mental illness had a 6.8 times greater risk for developing any additional mental illness, compared to those veterans without a preexisting mental illness.48 Following hurricanes, increased levels of PTSD have been experienced by individuals who perceive members of their community as being less supportive or helpful to one another.49

Depression and general anxiety are also common consequences of extreme events (such as hurricanes and floods) that involve a loss of life, resources, or social support and social networks or events that involve extensive relocation and life disruption.20,21,23,29,30,31,33,37,41,46,50,51,52,53,54 For example, long-term anxiety and depression, PTSD, and increased aggression (in children) have been found to be associated with floods.55 First responders following a disaster also experience increased rates of anxiety and depression.37

Increases from pre-disaster rates have been observed in interpersonal and domestic violence, including intimate partner violence,5,56 particularly toward women, in the wake of climate- or weather-related disasters.37,57,58 High-risk coping behaviors, such as alcohol abuse, can also increase following extreme weather events.37,38,59,60,61,62 Individuals who use alcohol to cope with stress and those with preexisting alcohol use disorders are most vulnerable to increased alcohol use following extreme weather events.62

Persons directly affected by a climate- or weather-related disaster are at increased incidence of suicidal thoughts and behaviors. Increases in both suicidal thoughts (from 2.8% to 6.4%) and actual suicidal plans (from 1.0% to 2.5%) were observed in residents 18 months after Hurricane Katrina.19 Following Hurricanes Katrina and Rita, a study of internally displaced women living in temporary housing found reported rates of suicide attempt and completion to be 78.6 times and 14.7 times the regional average, respectively.63 In the six months following 1992’s Hurricane Andrew, the rate of homicide-suicides doubled to two per month in Miami-Dade County, where the hurricane hit, compared to an average of one per month during the prior five-year period that did not include hurricane activity of the same scale.64

Climate- or weather-related disasters can strain the resources available to provide adequate mental (or even immediate physical) health care, due to the increased number of individuals who experience severe stress and mental health reactions. Communities adversely affected by these events also have diminished interpersonal and social networks available to support mental health needs and recovery due to the destruction and disruption caused by the event.65

Drought

Many regions in the United States have experienced drought (see Ch. 1: Introduction and Ch. 4: Extreme Events).66 Long-term drought, unlike sudden extreme weather events, has a slow onset and long duration.66,67 Long-term drought interacts over time with multiple environmental and social stressors to disrupt lives and livelihoods and the functioning of individuals, households, and communities.68,69,70 Prolonged drought can have visible and long-term impacts on landscapes, on rural agricultural industries and communities, and on individual and community resilience.71,72,73

Cascading and interacting economic, social, and daily life circumstances have accompanied prolonged drought in rural regions. Drought-related worry and psychological distress increased in drought-declared Australian regions, particularly for those experiencing loss of livelihood and industry.2,72,74,75,76 Long-term drought has been linked to increased incidence of suicide among male farmers in Australia.2,77

Extreme Heat

The majority (80.7%) of the U.S. population lives in cities and urban areas78 and urbanization is expected to increase in the future.79 People in cities may experience greater exposure to heat-related health effects during heat waves (see Ch. 2: Temperature-Related Death and Illness). The impact of extreme heat on mental health is associated with increased incidence of disease and death, aggressive behavior, violence, and suicide and increases in hospital and emergency room admissions for those with mental health or psychiatric conditions.80,81,82,83,84,85,86,87

Individuals with mental illness are especially vulnerable to extreme heat or heat waves. In six case-control studies involving 1,065 heat wave-related deaths, preexisting mental illness was found to triple the risk of death due to heat wave exposure.88 The risk of death also increases during hot weather for patients with psychosis, dementia, and substance misuse.84 Hospital admissions have been shown to increase for those with mental illness as a result of extreme heat, increasing ambient temperatures, and humidity.81,86,87 An increased death rate has also been observed in those with mental illness among cases admitted to the emergency department with a diagnosis of heat-related pathology.82

People who are isolated and have difficulty caring for themselves—often characteristics of the elderly or those with a mental illness—are also at higher risk for heat-related incidence of disease and death.86,88 Fewer opportunities for social interaction and increased isolation89,90,91 put people at elevated risk for not only heat-related illness and death but also decline in mental health and, in some cases, increases in aggression and violence.5 Hotter temperatures and poorer air quality limit people’s outdoor activities. For many, reductions in outdoor exercise and stress-reducing activities lead to diminished physical health, increased stress, and poor mental health.5

There may be a link between extreme heat (climate change related or otherwise) and increasing violence, aggressive motives, and/or aggressive behavior.80,92,93,94 The frequency of interpersonal violence and intergroup conflict may increase with more extreme precipitation and hotter temperatures.83 These impacts can include heightened aggression, which may result in increased interpersonal violence and violent crime, negatively impacting individual and societal mental health and well-being.85 Given projections of increasing temperatures (see Ch. 2: Temperature-Related Death and Illness), there is potential for increases in human conflict, but the causal linkages between climate change and conflict are complex and the evidence is still emerging.83,95,96

Threat of Climate Change as a Stressor

Remote control

People experience the threat of climate change through frequent media coverage.

Many people are routinely exposed to images, headlines, and risk messages about the threat of current and projected climate change. Forty percent of Americans report hearing about climate change in the media at least once a month.97

Noteworthy environmental changes associated with climate change constitute a powerful environmental stressor—an ongoing and stress-inducing condition or aspect of an individual’s everyday environment.69,98,99 Equally concerning are adverse impacts relating to people’s connections to place and identity, and consequent sense of loss and disconnection.11

About half of Americans reported being worried about climate change in a 2015 survey. However, these people tended to see climate change as a relatively distant threat: 36% said global warming would harm them personally, while more expected harm to come to people in other countries and to future generations.97 Public risk perceptions of the phenomenon and threat of climate change is associated with stigma, dread risk (such as a heightened fear of low-probability, high-consequence events), and uncertainty about the future.3,7,10,70,100,101,102,103,104,105,106,107

Many individuals experience a range of adverse psychological responses to the hybrid risk of climate change impacts. A hybrid risk is an ongoing threat or event, which is perceived or understood as reflecting both natural and human causes and processes. These responses include heightened risk perceptions, preoccupation, general anxiety, pessimism, helplessness, eroded sense of self and collective control, stress, distress, sadness, loss, and guilt.1,4,5,16,56,108,109,110,111,112

Media representations of serious environmental risks, such as climate change, are thought to elicit strong emotional responses,7,113 in part dependent on how climate change information is presented.114 People experience the threat of climate change through frequent media coverage describing events and future risks attributed to climate change. They also are directly exposed to increasingly visible changes in local environments and seasonal patterns, and in the frequency, magnitude, and intensity of extreme weather events.6,115 Furthermore, between 2012 and 2013, roughly a third of U.S. survey respondents report that they have personally experienced the effects of global warming.12,13 Exposure to climate change through the media could cause undue stress if the media coverage is scientifically inaccurate or discouraging. However, effective risk communication promotes adaptive and preventive individual or collective action.4,5,116,117,118,119

Resilience and Recovery

A majority of individuals psychologically affected by a traumatic event (such as a climate-related disaster) will recover over time.120 A set of positive changes that can occur in a person as a result of coping with or experiencing a traumatic event is called post-traumatic growth.121,122,123,124 An array of intervention approaches used by mental health practitioners also may reduce the adverse consequence of traumatic events. While most people who are exposed to a traumatic event can be expected to recover over time, a significant proportion (up to 20%) of individuals directly exposed develop chronic levels of psychological dysfunction, which may not get better or be resolved.21,35,47,53,125,126,127,128 Multiple risk factors contribute to these adverse psychological effects, including disaster-related factors such as physical injury, death, or loss of a loved one;18,23,51,129 loss of resources such as possessions or property;20,30,44,46,47 and displacement.32,130,131,132,133,134 Life events and stressors secondary to extreme events also affect mental health, including loss of jobs and social connections, financial worries, loss of social support, and family distress or dysfunction.18,20,46,47,129,135

Disaster-related stress reactions and accompanying psychological impacts occur in many individuals directly exposed to the event and can continue over extended time periods (up to a year or more). For example, three months after Hurricane Andrew, 38% of children (age 8 to 12 years) living in affected areas of south Florida reported symptom levels consistent with a “probable diagnosis” of PTSD. At 10 months post-disaster, this proportion declined to about 18%,21,44 representing a substantial decrease but still indicating a significant number of individuals with serious mental health issues resulting from the disaster event.

Emerging evidence shows that individuals who are actively involved in climate change adaptation or mitigation actions experience appreciable health and well-being benefit from such engagement.110,136 These multiple psychological and environmental benefits do not necessarily minimize distress. However, when people do have distress related to relevant media exposure or to thinking about or discussing climate change, taking action to address the issue can buffer against distress.110,136 Such engagement both addresses the threat and helps manage the emotional responses as people come to terms with—and adjust their understandings and lives in the context of—climate change.


8.3 Populations of Concern

Populations of concern will be at higher risk for poor mental health outcomes as the negative effects of climate change progress.10,137 In addition to the populations described below, farmers, those with limited mobility, immigrants, those living in coastal areas, those from Indigenous communities or tribes,138,139 and veterans are also expected to experience higher risk of poor mental health outcomes (see also Ch. 9: Populations of Concern).1,10,140,141,142,143,144,145

Children

Children looking through window

Children are at particular risk for distress, anxiety, and other adverse mental health effects in the aftermath of an extreme event.

Children are at particular risk for distress, anxiety, and other adverse mental health effects in the aftermath of an extreme event. As children are constantly developing, their reactions will vary by age and developmental level. Children have been shown to possess an innate resilience to adverse events,146,147,148,149 but despite this resilience, children can and do exhibit various stress symptoms when exposed to a traumatic event. These symptoms will depend on the developmental stage of the child, the level and type of exposure, the amount of destruction seen, and that particular child’s risk factors and protective factors.150

Children are dependent on others for care and a significant predictor of mental health and well-being in a child is the mental health status of the primary caregiver.5,151 If the primary caregiver’s mental health needs are being addressed, then a child will fare better after experiencing a disaster or other trauma.5,150,151,152,153

The potential exists for an array of difficult emotional and behavioral responses in children shortly after a disaster, such as depression, clinginess, aggressiveness, and social withdrawal, some of which are normal and expected and will resolve over time with proper support. However, children may be at a higher risk than adults of having symptoms persist in the long-term. Significantly more children than adults have shown continued PTSD symptoms more than two years post-disaster, and, in general, children are more likely to be impaired by a disaster.141 Chronic stress from the acute and ongoing impacts of climate change may alter biological stress response systems and make growing children more at risk for developing mental health conditions later in life, such as anxiety, depression, and other clinically diagnosable disorders.151

Women, Pregnant Women, and Post-partum Mothers

Post-disaster stress symptoms are often reported more frequently by women than men.154,155 Women have higher prevalence of PTSD and other mental health disorders after disasters than do men,156 and are prone to greater worry and feelings of vulnerability,157 anxiety disorders, and other adverse mental health outcomes.141,158 Increases in domestic violence towards women are also common after a disaster.5,56

Pregnant and postpartum women can be quite resilient, but their resilience diminishes when social supports are reduced and when they have experienced injury, illness, or danger due to the disaster, and when they have lived through multiple disaster experiences.39,57,159 Estimates indicated that there were 56,100 pregnant women and 74,900 infants directly affected by Hurricane Katrina160 and that pregnant women with high hurricane exposure and severe hurricane experiences were at a significantly increased risk for PTSD and depression.156 The increases in PTSD and depression found in pregnant women exposed to Hurricane Katrina was likely due to the severity of the event and the intensity of the disaster experience rather than a general exposure to the event.42,156

The many consequences of natural disasters, such as destruction of homes, and of gradual climate change impacts, such as rising temperatures, incidence of vector-borne illness, waterborne illness, and even compromised food,160 can all contribute to the emotional stress that women have while pregnant, nursing, or responsible for young children. Nutrition is essential to women’s health and well-being, especially if pregnant or nursing. Access to clean water and food is critical, and the lack of either may affect women’s ability to cope with the impacts of climate change. Poor nutrition can lead to difficult pregnancies, delivery problems, low birth weight, and even death of a newborn, all of which can be immensely stressful to the mother.161

Elderly

In the United States, the number of individuals 65 years of age and older is expected to climb from 47.8 million by the end of 2015 to 98 million in 2060, an increase from 14.9% of the population to 23.6%.162 The aging population may have difficulty responding to the challenges of climate change, as they tend to have higher rates of untreated depression and physical ailments that contribute to their overall vulnerability, such as increased susceptibility to heat and accompanying physical and mental health and well-being impacts.

Physical health problems are associated with the development of mental health problems,163,164 particularly among older adults.137,165 Long-term exposure to air pollution is linked with poorer cognitive function and an increased rate of cognitive decline among the elderly.166,167,168,169,170 Greater flood exposure, lack of social support, higher stoicism, and the use of maladaptive coping are all associated with greater deterioration in mental health after floods for seniors.17 The mental health consequences experienced by the elderly in response to a disaster may ultimately be due to challenges they face with physical health, mobility, and difficulty managing trauma in response to the disaster.142

Economically Disadvantaged

People living in poverty and with fewer socioeconomic resources have less capacity to adapt to the challenges brought by climate change. They are less able to evacuate should there be a natural disaster, and are more exposed to harmful conditions created by heat waves and poor air quality. Low-income people disproportionately experience the most negative impacts and weather-related mental distress due to more fragile overall health, reduced mobility, reduced access to health care, and economic limitations that reduce the ability to buy goods and services that could provide basic comfort and mitigate the effects of disasters.140,143

Many low-income people in the United States are employed in climate-dependent sectors, such as agriculture and fishing, or live in weather- and temperature-vulnerable areas, such as cities, flood zones, and drought-prone areas (see Ch. 9: Populations of Concern). As observed internationally, such individuals also have higher levels of distress and are more vulnerable to experiencing poor mental health due to extreme weather events or other climate change impacts.137,171 Farming or rural communities may be particularly vulnerable to the negative mental health outcomes associated with drought. For example, older farmers in Australia reported experiencing an overwhelming sense of loss as a result of chronic drought and its economic consequences.172

Emergency Workers and First Responders

Man in smoke

Hugh Campbell reacts after firefighters arrive to take over the protection of his home and two of his neighbors' homes in Rim Forest, California, October 3, 2003.

Emergency workers and first responders, including healthcare workers and public safety workers, are exposed to deaths, injuries, diseases, and mental stress caused by climate and weather-related disasters. As some extreme weather events increase in frequency and severity (see Ch. 4: Extreme Events), there will be an increased need for emergency response workers involved in rescue and cleanup.173 Firefighters, emergency medical service providers, healthcare workers, those recovering human remains, and non-traditional first responders who may be involved with supporting the community after a natural disaster are all at increased risk for mental health consequences, including substance use, both in the short term and long term.174,175

The very nature of the work, which involves being exposed to a traumatic event and helping others in crisis, frequently working long hours in difficult environments and away from loved ones, increases the susceptibility of first responders and emergency workers to experiencing negative mental health consequences. The level of stress and distress in responders increases when the injured are children or people they know.176 Vicarious trauma or identifying with the victim’s suffering, and being overwhelmed by the number and scope of injuries, can also adversely impact the general mental health and well-being of all responders.176,177

Rates of PTSD among first responders have ranged from 13% to 18% up to four years following large-scale response events.174 Among Australian firefighters with PTSD, a large proportion (77%) also presented with simultaneously occurring mental health conditions, such as depression, panic disorder, or phobic disorders.174 In a study of Coast Guard responders to Hurricanes Katrina and Rita, local responders were three times more likely to report depression than those who were not local.178

Extreme weather events and natural disasters can cause damage to infrastructure (such as power grids, roads, and transportation) and buildings and put response workers at increased risk of traumatic injury and death (see Ch. 4: Extreme Events).179 The impacts of more frequent and intense weather events result in increased stress for responders and threaten their overall mental health and well-being.37,177,180

People Who Are Homeless

About 30% of people who are chronically homeless suffer from some form of mental illness.181 The majority of homeless populations live in urban and suburban areas, where they are more vulnerable to health risks from exposure to heat waves due to the urban heat island effect.182 The combination of risk factors, including high rates of mental illness and the geographical location of the homeless, make the homeless very vulnerable to the effects of extreme heat.

Some extreme weather events are projected to become more frequent and severe, and those who become homeless due to these disasters are at increased risk for post-traumatic stress symptoms. People experiencing homelessness are also vulnerable to acquiring a vector-borne illness. Increases in human–mosquito exposure have been observed after hurricanes, such as after Hurricane Katrina.183 For the homeless population, Lyme disease and West Nile virus have the potential to compound already high rates of mental illness with additional cognitive, neurological, and mental health complications that can result from these vector-borne illnesses.184,185

Individuals with Prior or Preexisting Mental Illness

As of 2013, there were an estimated 43.8 million adults aged 18 or older in the United States who had any mental illness in the past year, representing 18.5% of all adults in the United States.186 An estimated 2.6 million youth age 12–17 had a major depressive episode during the past year.186 People with mental illness and those using medications to treat a variety of mental health disorders such as depression, anxiety, and other mood disorders are particularly vulnerable to extreme weather events and extreme heat.137 Between 2005 and 2010, approximately 6% of the U.S. adolescents aged 12–19 reported using medications to treat a mental illness.187 As the U.S. population and average age increases, the total number of U.S. adults with depressive disorders is projected to increase from 33.9 million to 45.8 million from 2005 to 2050—a 35% increase, with those over 65 years old having the largest increase (117%) in depressive disorders.188 As the number of people with mental health disorders increases, so will the number taking medications for these disorders, giving rise to a larger population vulnerable to the effects of extreme heat and extreme weather events.

Extreme weather events carry threats of psychological trauma and disruption to behavioral health services systems. Individuals with mental health and stress-related disorders, such as PTSD, depression, anxiety, sleep difficulties, and sometimes those who abuse drugs or alcohol, can experience an exacerbation of symptoms following a traumatic event. When infrastructure is damaged and communication lines are weakened, mental health services and personal support networks are also disrupted, leaving those with a mental illness vulnerable to experiencing additional negative mental health consequences (see Ch. 4: Extreme Events).

Woman with medication

Many medications used to treat a variety of mental health disorders interfere with temperature regulation and heat elimination and may directly induce hyperthermia.

Many medications used to treat a variety of mental health disorders interfere with temperature regulation and heat elimination and may directly induce hyperthermia. Being dehydrated can also influence the way some medications such as lithium (used to stabilize mood)82,189 or anti-epileptics work in the body.190 One of the major underlying risks for death due to extreme heat is the use of medications that affect the body’s ability to regulate heat or have neurological effects, increasing susceptibility to the effect of heat.191

After the 2012 heat wave in Wisconsin, nearly 52% of the heat-related deaths studied occurred among people with at least one mental illness, and half of those were taking a medication that treats mental illness and sensitizes people to heat.192 Certain drugs prescribed for depression, sleep disorders, psychosis, and anxiety-related disorders were found to be independent risk factors for heat-related hospitalization cases at an emergency department studied after the 2003 heat wave in France.82 Many studies have found increased susceptibility to heat for people taking certain classes of medication typically used to treat mental health disorders and other conditions, as well as for alcohol- and drug-dependent people.81,89,189,193,194,195,196,197

Several other factors, besides the effects or side effects of medication use, might explain why people with mental illness are vulnerable to heat-related death.196,198 Isolation and deficits in care, common to those with severe mental illness, are critical characteristics of those with the highest rates of heat-related illness and death, as these factors lower the likelihood of utilizing preventive strategies such as showers and cooling shelters during times of extreme heat.192 Those with mental illness often experience poorer overall health and have fewer social supports. Persons with a combination of mental and physical disorders and who are taking more than one kind of medication are also at greater risk of heat-related death.


8.4 Emerging Issues

Multiple issues warrant further attention regarding the impact of climate change on individuals’ and communities’ mental health and well-being. Broadly, these include: 1) the impacts of mass evacuation and relocation before, during, and after extreme weather events; 2) the influence of individuals’ understandings and attitudes toward climate change and associated risk perceptions on their disaster-related psychological reactions; and 3) the cumulative effects of media presentations of extreme events on mental health and well-being.

A more specific emerging issue is the effect of extreme temperatures on mental health, in particular suicide. Some studies report a connection between higher temperature and suicide;199 with some indicating increased risk of suicide.200,201,202 The association between hotter temperatures and suicide appears to be stronger for violent suicide methods than for non-violent suicide methods,203 and there is emergent evidence that deaths by suicide may increase above certain temperatures, suggesting hot weather may trigger impulsive and aggressive behaviors.201,204 More studies are needed to better understand the relationship, as negative correlations have been found,205,206 as well as no correlation at all.207,208,209

Children who use methylphenidate (for example, to treat attention deficit disorder) and are engaging in physical activity in hot and humid environments may also be at heightened risk for heat-related illness.210 More studies are needed to assess what the impact will be on children who use behavior modification medications during extreme heat. In addition, more frequent and prolonged heat waves may increase the amount of time spent indoors, which could have an effect on mental health, particularly for children and those who use the outdoors for exercise and stress management.

As more is learned about the relationship between climate change and vector-borne illnesses, it will be important to further understand the scope of mental health consequences for those who become infected. Chapter 5 (Vector-Borne Diseases) addresses the complex relationship between climate change and vector-borne illnesses, focusing primarily on West Nile virus and Lyme disease. Individuals infected with either WNV or Lyme disease may experience a range of mental health consequences following infection that can include reduced cognitive function as well depression associated with other symptoms, such as fatigue, pain, and muscle and joint aches.184,185 These mental health symptoms can last for months but usually resolve over time.

Clinical depression has been observed in patients who are infected with WNV.211,212 In a long-term observational study, 35% of participants were found to have new-onset depression. Those with the more severe neuroinvasive forms of WNV are at greater risk for depression between 13 to 18 months post-infection.212 People who are left with limited mobility as a result of WNV infection can experience long-term mental health impacts.212 Patient experiences, such as undergoing an extended treatment process or experiencing stress in family or work life due to a lingering illness, can result in mental health consequences.

Poor air quality may have an effect on depression and suicide.213,214,215 While the current literature is not robust enough to imply causation, studies have found significant associations between short-term exposure to air pollution (sulfur dioxide [SO2], particulate matter smaller than 2.5 microns [PM2.5], nitrogen dioxide [NO2], and carbon monoxide [CO]) and emergency department admissions for depressive episodes in Canada.213,214 Recent studies conducted outside of the United States also found associations between air pollution, including aeroallergens, and risk of suicide and emergency department admissions for suicide attempts.215,216,217 These emerging issues may prove to be a significant impact if air quality conditions worsen in the United States.

The severity of risks to mental health and well-being for Indigenous populations that have a close connection to the environment, and in some cases lower economic resources, is also a concern.144,145,218,219 All of these areas will require further study.

With regard to the impact of climate change related food safety risks, increased CO2 levels could decrease the nutritional value of some foods (see Ch. 7: Food Safety). Malnutrition (specifically, iron deficiencies) can cause fatigue and depression in children and adolescents.220 More needs to be learned regarding the mental health and well-being impacts that will result from changes to food composition, quality, and safety due to climate change.

Climate change and rising CO2 levels may increase the incidence of food allergies.221 Such an increase in food allergies would have an impact on mental health status, where those with food allergies have higher rates of stress and anxiety.222 Food allergy in children and adolescents has been connected to psychological distress, including anxiety and depression. Parents of children with food allergies have been found to have higher rates of stress and anxiety than parents of children without food allergies.223 Those with food allergies have higher rates of major depression, bipolar disorder, panic disorder, and social phobia than those with no food allergy. 224


8.5 Research Needs

In addition to the emerging issues identified above, the authors highlight the following potential areas for additional scientific and research activity on mental health and well-being, based on their review of the literature. Studies of the broad range of health effects of climate change should incorporate mental health effects and consequences, since many mental health impacts are secondary to other health problems. In addition, the U.S does not currently have sustained psychological and social impact assessments or monitoring programs and measures necessary to identify important changes in mental health and well-being associated with climate change. National psychosocial impact assessment and monitoring programs could enhance the development of standardized methodologies and measures of psychological and social pathways needed to better predict mental health and well-being outcomes.

Future assessments can benefit from research activities that:

  • better understand how other health risks from gradual climate change affect mental health, including exposures to extreme heat, poor air quality, diminished food safety and security, and increased vector-borne risks;
  • explore the associations between extreme temperatures and violent behavior, including violent suicide;
  • develop efficient questionnaires and other methods of collecting data on mental health, psychological, and social impacts for use in epidemiological studies of other health impacts of climate change;
  • identify predictors or risk factors for adverse psychological outcomes following weather-related or climate-related disasters;
  • further improve evidence-based practices to facilitate recovery and post-traumatic growth following extreme events;
  • identify the best practices for adaptation and prevention strategies to reduce the impacts of extreme heat on people with mental illness, including patients taking medications that increase their vulnerability to heat stress;
  • improve understanding of the effects of secondary exposure, including cumulative media representations of climate change, as well as how an individual’s understanding of the threat of climate change affects their psychological well-being and resilience; and
  • enhance understanding of the mental health and psychosocial impacts of long-term displacement, relocation, or loss of culturally significant geographic features, particularly for Indigenous populations.

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Likelihood

Very Likely
≥9 in 10
Likely
≥2 in 3
As Likely as Not
≈ 1 in 2
Unlikely
≤ 1 in 3
Very Unikely
≤1 in 10

Confidence Level

Very High Strong evidence (established theory, multiple sources, consistent results, well documented and accepted methods, etc.), high consensus
High Moderate evidence (several sources, some consistency, methods vary and/or documentation limited, etc.), medium consensus
Medium Suggestive evidence (a few sources, limited consistency, models incomplete, methods emerging, etc.), competing schools of thought
Low Inconclusive evidence (limited sources, extrapolations, inconsistent findings, poor documentation and/or methods not tested, etc.), disagreement or lack of opinions among experts
 

Documenting Uncertainty: This assessment relies on two metrics to communicate the degree of certainty in Key Findings. See Appendix 4: Documenting Uncertainty for more on assessments of likelihood and confidence.

Key Finding 1: Exposure to Disasters Results in Mental Health Consequences

Many people exposed to climate related or weather-related disasters experience stress and serious mental health consequences. Depending on the type of the disaster, these consequences include post-traumatic stress disorder (PTSD), depression, and general anxiety, which often occur at the same time [Very High Confidence]. The majority of affected people recover over time, although a significant proportion of exposed individuals develop chronic psychological dysfunction [High Confidence].

Key Finding 2: Specific Groups of People Are at Higher Risk

Specific groups of people are at higher risk for distress and other adverse mental health consequences from exposure to climate-related or weather-related disasters. These groups include children, the elderly, women (especially pregnant and post-partum women), people with preexisting mental illness, the economically disadvantaged, the homeless, and first responders [High Confidence]. Communities that rely on the natural environment for sustenance and livelihood, as well as populations living in areas most susceptible to specific climate change events, are at increased risk for adverse mental health outcomes [High Confidence].

Key Finding 3: Climate Change Threats Result in Mental Health Consequences and Social Impacts

Many people will experience adverse mental health outcomes and social impacts from the threat of climate change, the perceived direct experience of climate change, and changes to one’s local environment [High Confidence]. Media and popular culture representations of climate change influence stress responses and mental health and well-being [Medium Confidence].

Key Finding 4: Extreme Heat Increases Risks for People with Mental Illness

People with mental illness are at higher risk for poor physical and mental health due to extreme heat [High Confidence]. Increases in extreme heat will increase the risk of disease and death for people with mental illness, including elderly populations and those taking prescription medications that impair the body’s ability to regulate temperature [High Confidence].