Journal Article Annotations
2023, 3rd Quarter

Climate Change and Mental Health

Annotations by Mary G. Burke, MD
October, 2023

Ambient temperature and mental health: a systematic review and meta-analysis.
Heatwaves and wildfires suffocate our healthy start to life: time to assess impact and take action.

- The hidden health costs of climate change: Accounting for extreme heat harms to women in the global South.

PUBLICATION #1 — Climate Change and Mental Health

Ambient temperature and mental health: a systematic review and meta-analysis.

Rhiannon Thompson, PhD, Emma L Lawrance, DPhil, Lily F Roberts, MPH
Kate Grailey, PhD, Prof Hutan Ashrafian, PhD, Hendramoorthy Maheswaran, PhD et al.

Abstract: https//doi.org/10.1016/S2542-5196(23)00104-3.

Abstract: Interpretation
“Increased temperature and temperature variability could be associated with increased cases of suicide and suicidal behaviour, hospital attendance or admission for mental illness, and poor community health and wellbeing. Climate change is likely to increase temperature anomalies, variability, and heatwaves as well as average temperatures; as such, health system leaders and policy makers must be adequately prepared and should develop adaptation strategies. More high-quality, standardised research is required to improve our understanding of these effects.

In a qualitative narrative synthesis, we found that ambient outdoor temperature (including absolute temperatures, temperature variability, and heatwaves) was positively associated with attempted and completed suicides (86 studies), hospital attendance or admission for mental illness (43 studies), and worse outcomes for community mental health and wellbeing (19 studies), but much of the evidence was of low certainty with high heterogeneity.”

Annotation

The finding:
This systematic review (144 studies) and meta-analysis (19 suitable studies) used epidemiological and observational studies of the impacts of increased ambient heat on human health. The authors found that suicide risk increased by a statistically significant “1.5% for every 1 degree C increase in mean monthly temperature; a 1 degree C increase in mean daily temperature was associated with an increase in incidence of 1·7%; and a 1 degree C increase in mean monthly temperature was associated with a risk ratio of 1·01.”

In addition, hospital attendance or admission for mental illness during heatwaves vs non-heatwaves showed increase in incidence of 9·7%. This comprehensive scoping review is the second article on this topic by these authors. It may be the most comprehensive review yet of this topic.

Strengths and Weaknesses:
An increasing number of individual epidemiological studies show a relationship between prolonged excess heat and worsening mental health outcomes. This article brings together many of these original data, integrates their findings, and reviews their quality and usefulness. The authors note the heterogeneity of studies and the low certainty of the evidence. They only used articles in English, possibly missing research from the Global South that would add more dimension to the work.

Relevance:
There is growing awareness that increased heat increases the risk for suicidal ideation and completion as well as overall behavioral health impairment. All mental health practitioners should be ready to educate patients on what to expect and how to take care of themselves and family members during prolonged periods of heat. Handouts from the Climate Psychiatry Alliance—addressing heat, psychological distress, and wildfire smoke—can educate C-L psychiatrists, other providers, patients, and families:

https://www.climatepsychiatry.org/toolkits

https://www.climatepsychiatry.org/climate-distress-coping-toolkit

https://www.climatepsychiatry.org/wildfire-smoke-toolkit

https://www.climatepsychiatry.org/resources-to-mitigate-climate-distress

PUBLICATION #2 — Climate Change and Mental Health

Heatwaves and wildfires suffocate our healthy start to life: time to assess impact and take action.

Amita Bansal, PhD, Prof Nicolas Cherbuin, PhD, Prof Deborah L Davis, PhD, Prof Michael J Peek, FRANZCOG, Amanda Wingett, Prof Bruce K Christensen, PhD, et al.

Abstract: doi.org/10.1016/S2542-5196(23)00134-1.

Abstract:

Adverse environmental exposures in utero and early childhood are known to programme long-term health. Climate change, by contributing to severe heatwaves, wildfires, and other natural disasters, is plausibly associated with adverse pregnancy outcomes and an increase in the future burden of chronic diseases in both mothers and their babies. In this Personal View, we highlight the limitations of existing evidence, specifically on the effects of severe heatwave and wildfire events, and compounding syndemic events such as the COVID-19 pandemic, on the short-term and long-term physical and mental health of pregnant women and their babies, taking into account the interactions with individual and community vulnerabilities. We highlight a need for an international, interdisciplinary collaborative effort to systematically study the effects of severe climate-related environmental crises on maternal and child health. This will enable informed changes to public health policy and clinical practice necessary to safeguard the health and wellbeing of current and future generations.

Annotation

The finding:
This article provides a (non-systematic) review of the state of our scientific understanding of the impacts of wildfire smoke on pregnancy, maternal physical and mental health, and risks to fetal and child development. The review suggests mechanisms of action for the impact of smoke may be due to hormonal/metabolic changes, the effects of fine particulate matter (PM2.5), and psychological distress. The review also notes our current knowledge gaps in providing a blueprint for further investigation and public health mitigation.

Strengths and Weaknesses:
The article is well-referenced, with links to actions needed to improve our public health research and response. These include addressing inequities of impact and access to care. It also notes the need to include community members and clinicians in shaping research questions. It addresses the gaps on our knowledge base.

Relevance:
C-L clinicians working with pregnant, lactating, and postpartum mothers should be aware of the hormonal, metabolic and psychological impacts that may arise from exposure to wildfires, smoke, and related emergencies. Assessing these and providing targeted care can improve our ability to support our patients as climate-related emergencies increase. Researchers in maternal-child mental health can add questions about the impact of climate-related physical and mental adversity. The CDC hosts an excellent website that is of use for clinicians and patients alike.

PUBLICATION #3 — Climate Change and Mental Health

The hidden health costs of climate change: Accounting for extreme heat harms to women in the global South.

Vijay S. Limaye.

Abstract: https://doi.org/10.1371/journal.pclm.0000267.

None: The author reviews the multiple layers of health costs to women in the Global South, poorly documented in academic literature. “While climate change-fueled extreme heat is dangerous to all, it poses particular risks to women–but the gendered dimensions of heat-related health impacts are poorly captured in current understanding of harms and policy responses to address climate-sensitive health inequities. Researchers estimate that extreme heat caused about 47,000 premature deaths in India in 2019, but it is unclear the extent to which gender-specific health risks identified in other studies are considered in such national-level estimates. This limitation is a concern because finer scale data on heat-related health harms suggests that women are suffering disproportionately from heat.”

Annotation

This opinion piece reviews inequitable reporting of climate harms to women in the Global South. Reasons for this inequity include difficulties accessing data, women’s participation in the informal economy, and historical lack of gender-specific health analyses. The author recommends Heat Action Plans that explicitly recognize and address women’s health vulnerabilities to heat. Consult psychiatrists working with women in the Global South as well as from US areas with extreme heat should be aware of health risks. Clinical assessment of patients should include asking about outdoor activity, access to cooling—especially at night—and hydration, and access to fresh water. It is particularly important for pregnant women who have physiologically altered thermoregulation, are carrying extra weight, and have additional fluid needs.