4 National Centers for Environmental Information. BAMS State
of the Climate. NCEI, 2021 (https://www.ncei.noaa.gov/bams-
state-of-climate).
5 European Centre for Medium-Range Weather Forecasts.
Annual Report 2021. ECMWF, 2021 (https://www.ecmwf.int/en/
elibrary/20398-annual-report-2021).
6 Duffy KA, Schwalm CR, Arcus VL, Koch GW, Liang LL, Schipper
LA. 2021 How close are we to the temperature tipping point of
the terrestrial biosphere? Sci Adv 2021; 7(3): eaay1052.
7 Charlson F, Ali S, Benmarhnia T, Pearl M, Massazza A,
Augustinavicius J, et al Climate change and mental health – a
scoping review. Int J Environ Res Public Health 2021; 18: 1–38.
8 Morecroft MD, Speakman L. Biodiversity Climate Change
Impacts: Report Card 2015. Living with Environmental Change,
2015 (https://nerc.ukri.org/research/partnerships/ride/lwec/
report-cards/biodiversity/)
9 Cianconi P, Hirsch D, Chiappini S, Martinotti G, Janiri L. Climate
change, biodiversity loss and mental health – a global
perspective. BJPsych Int, 2022, in press.
10 Albrecht G, Sartore G, Connor L, Higginbotham N, Freeman S, Kelly
B, et al Solastalgia: the distress caused by environmental change.
Australas Psychiatry 2007, 15(special supplement): 95–8.
11 Atwoli L, Muhia J, Merali Z. Mental health and climate change
in Africa. BJPsych Int [Epub ahead of print] 17 Jun 2022.
Available from: https://doi.org/10.1192/bji.2022.14.
12 World Health Organization. WHO Global Code of Practice on
the International Recruitment of Health Personnel (WHA63.16).
WHO, 2010 (http://apps.who.int/gb/ebwha/pdf_files/WHA63/
A63_R16-en.pdf).
13 Socha-Dietrich K, Dumont J. International Migration and Movement
of Doctors to and within OECD Countries – 2000 to 2018:
Developments in Countries of Destination and Impact on Country of
Origin (OECD Health Working Papers no. 126). OECD Publishing, 2021.
14 OECD. Contribution of Migrant Doctors and Nurses to Tackling
COVID-19 Crisis in OECD countries (OECD Policy Responses to
Coronavirus (COVID-19)). OECD Publishing, 2020.
15 Pye A, Bash K, Joiner A, Beenstock J. Good for the planet and
good for our health: the evidence for whole-food plant-based
diets. BJPsych Int [Epub ahead of print] 14 Mar 2022. Available
from: https://doi.org/10.1192/bji.2022.7.
16 Krzanowski J. The need for biodiversity champions in psychiatry:
the entwined crisis of climate change and ecological collapse.
BJPsych Bull 2021; 45: 238–43.
THEMATIC Climate change, biodiversity loss and
PAPER mental health: a global perspective
Paolo Cianconi,1 Daniele Hirsch,2 Stefania Chiappini,3
Giovanni Martinotti4 and Luigi Janiri5
1Professor, Institute of Psychiatry
and Psychology, Department of
Geriatrics, Neuroscience and
Orthopedics, Fondazione
Policlinico Universitario A. Gemelli
IRCCS, Università Cattolica del
Sacro Cuore, Rome, Italy.
Email pcianco@gmail.com
2Resident, Institute of Psychiatry
and Psychology, Department of
Geriatrics, Neuroscience and
Orthopedics, Fondazione
Policlinico Universitario A. Gemelli
IRCCS, Università Cattolica del
Sacro Cuore, Rome, Italy
3PhD student, Department of
Neuroscience, Imaging and
Clinical Sciences, G. D’Annunzio
University, Chieti, Italy
4Professor, Department of
Neuroscience, Imaging and
Clinical Sciences, G. D’Annunzio
University, Chieti, Italy
5Professor, Institute of Psychiatry
and Psychology, Department of
Geriatrics, Neuroscience and
Orthopedics, Fondazione
Policlinico Universitario A. Gemelli
IRCCS, Università Cattolica del
Sacro Cuore, Rome, Italy
Keywords. Climate change; men-
tal health; biodiversity loss;
nature experience;
ecopsychology.
First received 5 Nov 2021
Final revision 24 Apr 2022
Accepted 25 May 2022
Climate change can have various
psychopathological manifestations which
have been more actively addressed by
scientific research only in recent years. Indeed,
extreme weather events and environmental
changes have been shown to be associated
with a range of mental health problems.
Following the destruction of ecosystems,
biodiversity loss can cause mental distress and
emotional responses, including so-called
‘psychoterratic’ syndromes arising from
negatively felt and perceived environmental
change. Studies investigating relationships
between biodiversity and mental health reveal
a complex landscape of scientific evidence,
calling for a better understanding of this
challenging issue.
The World Health Organization (WHO) has
described climate change as one of the greatest
health threats of the 21st century.1 It identifies cli-
mate change as one of several factors behind the
loss of biodiversity, along with habitat change,
environmental overexploitation and pollution.2
Biodiversity is a multifaceted concept belong-
ing to ecology and it has been defined as the ‘vari-
ability among living organisms from all sources,
including terrestrial, marine and other aquatic
ecosystems, and the ecological complexes of
which they are part’.3 An ecosystem is a complex
dynamic group of various living organisms acting
as a whole functioning unity. The diverse groups
of ecosystems, the species living within those eco-
systems and the genetic variations within each
population, in addition to the processes involving
their functioning, constitutes what is called bio-
diversity.4 With regard to mental health, the rela-
tionship between biodiversity and psychology can
be summarised in three types of relationship: bio-
diversity and well-being, biodiversity and mental
health, and biodiversity loss and mental disor-
ders. The objective of this perspective paper is
to point out what the evidence shows about
those relationships and to highlight further fields
of investigation.
Biodiversity and well-being
Holistic and biophilic theories see nature as a
source of health due to humans’ innate emotional
affinity for other living organisms. The conserva-
tion of natural resources, including biodiversity,
has been identified as necessary for the promotion
of good health.5 From Lovell et al’s pioneering
study, it is clear how difficult it is to identify benefits
of nature on mental health. Indeed, their review
suggests some caution in making a definitive correl-
ation between biodiversity richness and health, as
BJPSYCH INTERNATIONAL VOLUME 19 NUMBER 4 NOVEMBER 2022
83
https://doi.org/10.1192/bji.2022.20 Published online by Cambridge University Press
doi:10.1192/bji.2022.20
© The Author(s), 2022. Published
by Cambridge University Press on
behalf of the Royal College of
Psychiatrists. This is an Open
Access article, distributed under
the terms of the Creative
Commons Attribution licence
(http://creativecommons.org/
licenses/by/4.0/), which permits
unrestricted re-use, distribution
and reproduction, provided the
original article is properly cited.
not all studies reported this association, which
appears to depend on the pattern of interaction
and type of exposure to nature.6 Currently,
researchers are attempting to identify cues and
clues from natural environments leading to better
health and a sense of well-being, but these have
not yet been clarified.
The way in which people perceive nature
depends on cultural factors (e.g. cultural beliefs,
religious beliefs, holism), personal factors (e.g.
having lived in rural or urban areas, previous
experiences), the type of community considered
(e.g. current rural or urban dwellers, tourists),
the type of contact (direct/indirect) and the pre-
conceived idea that people have about the con-
cept of intact nature. For example, in Western
societies, urbanisation often prevents people
from open and permanent contact with natural
environments, so the contact with an urban park
is identified as a nature experience; however,
this type of contact has little to do with the con-
cept of biodiversity, suggesting that it may be
the perceived biodiversity, rather than the actual
biodiversity of places that gives rise to a person’s
experience of nature.7 Regarding the relationship
between biodiversity and well-being, the effects of
exposure to green areas with greater plant diver-
sity have been grouped in: (a) harm reduction,
such as reducing stress; and (b) restoring/building
capacities, including improving cognitive function
(such as memory and attention), increasing posi-
tive social interactions and social cohesion,
improving mood, self-esteem, relaxation and sub-
jective well-being, and increasing academic per-
formance, imagination and creativity of children.8
Biodiversity and mental health
‘Nature experience’ refers to an individual’s per-
ceptions and/or interactions with the natural
world (from plants and private gardens to more
expansive public green space and wilderness,
the weather and movements of the sun) through
all sensory modalities, including sight, hearing,
taste, touch and smell. These can be real, or
occur through representations (e.g. landscape
photographs) or simulations (e.g. virtual reality).9
Mental health benefits from nature experience
may occur through multiple psychological causal
mechanisms and pathways.9 The literature
reports an association with a reduction in risk fac-
tors for psychiatric disorders, such as improved
sleep and reduced chronic stress, and a decreased
incidence of certain disorders, such as anxiety,
depression, substance use disorders and
attention-deficit hyperactivity disorder (ADHD).9
One study reported that people in urban areas
exposed to more visible and identifiable natural
features (plant cover, abundance of afternoon
birds) showed a lower prevalence of depression,
anxiety and stress; for example, residents of
urban areas moving to neighbourhoods with
vegetation reported a reduction in depressive
symptoms by up to 11%, and the number of anx-
iety and stress cases fell by up to 25% and 17%
respectively.10 Another study showed that the
presence of sufficiently large green spaces close
to a community can reduce the risk of schizophre-
nia.11 Nonetheless, although a recent review by
Marselle and colleagues12 found some evidence
to suggest that biodiversity promotes better men-
tal health and well-being, more studies reported a
non-significant association. A possible interpret-
ation of these data could be that if a certain
threshold is not exceeded, the loss of biodiversity
would not have direct negative effects on mental
health or well-being.13 Moreover, no studies
determined the level of biodiversity that is
required for an environment to have mental
health benefits. Also, a limitation emerging from
the cited studies is that most of them focused on
urban environments in high-income countries,
leaving out low- and middle-income countries.14
In fact, a further aspect contributing to the com-
plexity of the relationship between biodiversity
and mental health is that the effects vary accord-
ing to socioeconomic factors, preferences, place
of residence, occupation, culture, gender and
age.15 It would appear that exposure to biodiver-
sity may be positive for mental health if indivi-
duals are in built environments with favourable
social conditions (e.g. in northern European and
North American countries), whereas greater
biodiversity might not show the same benefit for
the mental health of those living in poorer social
conditions.16
Biodiversity loss and mental disorders
The Global Assessment Report describes a bio-
sphere transformed and degraded by human
activity: 75% of the Earth’s surface has been sig-
nificantly altered and over 85.5% of the wetland
area has been lost.2 In this regard, ecosystem ser-
vices refer to the varied benefits to humans pro-
vided by the natural environment and healthy
ecosystems; they include (a) regulating services,
for example carbon sequestration and climate
regulation; (b) provisioning services, including
food and raw materials; (c) cultural services,
including use of natural systems as motifs in
books, films and paintings, or for school excur-
sions and scientific discovery; and (d) supporting
services such as nutrient cycling, primary produc-
tion and soil formation.17 Ecological integrity
refers to the ability of environmental life-support
systems to sustain themselves in the face of
human-induced impacts. Ecological integrity is
rapidly declining to the point where adaptation
strategies will not be optional but necessary for
survival.13
Biodiversity loss and its consequences in terms
of psychopathology for individuals and communi-
ties is becoming an area of great interest for men-
tal health. Psychological symptoms, including
anxiety, frustration and depression that cannot
be attributed solely to intrapsychological or family
issues may arise from a ‘disconnection’ from the
natural world. One study found that people resid-
ing in the lowest amount of green space had 24%
84
https://doi.org/10.1192/bji.2022.20 Published online by Cambridge University Press
BJPSYCH INTERNATIONAL VOLUME 19 NUMBER 4 NOVEMBER 2022
higher risk of developing schizophrenia.18
Biodiversity loss can also have an impact on indi-
viduals and communities through emotional and
affective responses that result not directly from a
traumatic event, but rather from the simple obser-
vation and ascertainment of climate change
effects worldwide, for example territories known
to specific populations for generations can be dra-
matically modified by climate change. In fact, cli-
mate change and the speed of the disruption have
direct and indirect effects leading to societal vul-
nerability. We are only beginning to understand
the functional adaptation (biological, phenotyp-
ical, behavioural and technological) that our spe-
cies can generate in the face of a radical change
such as the massive loss of biodiversity: maladjust-
ments range from the psychopathology of indivi-
duals and groups to processes of collapse of
complex societies in general.19
Besides biodiversity loss, worsening habitat
conditions may push people towards migration,
which is itself a risk factor for major psychiatric
disorders. It can be hypothesised that our slow
reactive adaptation to the rapid loss of biodiver-
sity might reduce our resilience to major stressors
and traumatic experiences. As early as 2007,
Albrecht and colleagues20 noted the existence of
a form of emotional distress arising from the
awareness that humankind faces problems due
to climate change, suggesting how this awareness
contributes to what they termed ‘psychoterratic
syndromes’, which include phenomena such as
ecoanxiety, ecoguilt, ecoparalysis, ecological grief
and solastalgia. These concerns about the health
of the biosphere (for example watching the slow
and seemingly irrevocable impact of ecological
imbalance, feeling frustration due to an inability
to cope with climate change, and anxiety concern-
ing the future of later generations) are now
experienced more keenly as people are globally
immersed in information and communication
about it.21
It will certainly take time and further studies to
identify these new diseases and disorders. There
are no specific references to mental disorders
related to climate change in the DSM-5 or
ICD-11. However, in response to the growing
mental health effects of long-lasting
climate-related events, psychotherapists are pio-
neering a new field of treatment, termed ‘ecopsy-
chology’, dedicated to the study of the connection
between environmental changes caused by
human activity and the psychological difficulties
resulting from our increasing experience of
these changes. Ecopsychology is comprised of
multiple subdisciplines, which include subcat-
egories such as nature, spirituality, transpersonal
psychology, environmental activism, experiential
environmental education, human ecology,
ecotherapy and nature connection.22 The thera-
peutic focus of ecopsychology is also a central
component of this field, looking for the roots of
environmental problems in human psychology
and society and the roots of some personal and
social problems in our dysfunctional relationship
with the natural world. Adaptation to climate
change requires from humans a frequent switch
between different levels of perspective, ranging
from macro- (e.g. resources), to meso- (e.g. col-
lectivity, ethnic realities, mass phenomena and
psychosocial phenomena) and micro- (e.g. psy-
chological adaptation, family and individual)
levels. Coping strategies are needed to manage
the feelings and thoughts that these changes
may provoke, so that people can come to terms
with them; also, a reduced psychological distance
is associated with a higher level of concern and
more pro-environmental intentions that lead to
better adaptation.6 Finally, psychiatry and psych-
ology, dealing with biodiversity, are refining their
tools of study and proposing further targeted
studies, for example aimed at investigating the
complex interaction with social determinants, nat-
ural disasters (hurricanes, floods, fires and heat
waves of short duration) and industrial/techno-
logical emergencies (technological disasters trig-
gered by natural hazards, or ‘natech’ disasters).
Data availability
Data availability is not applicable to this article as no new data
were created or analysed in this study.
Acknowledgements
We are grateful to BJPsych International for covering in their
journal such an important and topical issue as climate change
and mental health, and for giving us the opportunity to share
our knowledge on the topic, which has been the subject of our
research over the past few years.
Author contributions
P.C. conceived the paper and organised it with L.J. and G.M.; P.C.
carried out literature searches which D.H. and S.C. used to write
the first draft of the paper; D.H. and S.C. edited the drafts of
the paper according to corrections provided by P.C., L.J. and G.M.
Funding
This research received no specific grant from any funding agency,
commercial or not-for-profit sectors.
Declaration of interest
None.
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THEMATIC
PAPER
Mental health and climate change in
Africa
Lukoye Atwoli,1 Joy Muhia2 and Zul Merali3
1Associate Director, Brain and
Mind Institute, Aga Khan
University, Nairobi, Kenya. Email:
lukoye.atwoli@aku.edu
2Technical Advisor, Division of
Mental Health, Ministry of Health,
Nairobi, Kenya
3Director, Brain and Mind
Institute, Aga Khan University,
Nairobi, Kenya
Keywords. Low- and middle-
income countries; Africa; mental
health impacts; mental disorders;
climate change.
First received 4 Oct 2021
Final revision 14 Apr 2022
Accepted 17 Apr 2022
doi:10.1192/bji.2022.14
© The Author(s), 2022. Published
by Cambridge University Press on
behalf of the Royal College of
Psychiatrists. This is an Open
Access article, distributed under the
terms of the Creative Commons
Attribution licence (https://creative-
commons.org/licenses/by/4.0/),
which permits unrestricted re-use,
distribution, and reproduction in
It is now widely acknowledged that low- and
middle-income countries in Africa are among
global hotspots for high vulnerability to
climate change, despite making comparatively
low contributions to this phenomenon.
Climate change has been shown to affect
mental health as a result of disruption of
social and economic structures that
populations depend on for good health,
including mental health. After decades of
neglect, recent efforts by governments such as
in Kenya to address the twin issues of climate
change and mental health demonstrate the
growing importance of these issues. Here we
briefly review the evidence of climate change
impacts on mental health in Africa and
demonstrate that there is need for more
contextual awareness and research in this
area in Africa to mitigate or forestall potential
mental health crises in the near future. We
recommend systematic efforts to support
funding for research and interventions at the
nexus between climate change and mental
health in Africa, and urge institutions and
governments in Africa to begin paying
attention to this emerging threat to the
health of African populations.
On 1 June 2019, the President of Kenya declared
mental ill health a national priority, and later
formed a National Taskforce on Mental Health
in Kenya. This was a first in Africa, and the result-
ant taskforce report1 identified many issues as
being associated with the mental health crisis,
including social and environmental factors that
could be linked to climate change. The mental
health impact of the COVID-19 pandemic further
exposed weaknesses in the health system and the
potential role climate change plays in the emer-
gence of new diseases and exacerbation of existing
ones.
This Kenyan experience foregrounds the twin
emergence, in African discourse, of issues related
to mental health and climate change on the one
hand and the intersection between the two on
the other. It is widely acknowledged that despite
little contribution to climate change compared
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BJPSYCH INTERNATIONAL VOLUME 19 NUMBER 4 NOVEMBER 2022