SYSTEMATIC REVIEW
published: 06 March 2020
doi: 10.3389/fpsyt.2020.00074
The Impact of Climate Change
on Mental Health: A Systematic
Descriptive Review
Paolo Cianconi 1*, Sophia Betrò 2 and Luigi Janiri 1,3
1 Department of Neurosciences, Institute of Psychiatry, Catholic University, Rome, Italy, 2 Institute of Psychopathology, Rome,
Italy, 3 Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
Edited by:
Konstantin Loganovsky,
National Academy of Medical Science
of Ukraine, Ukraine
Reviewed by:
Maria Teresa Avella,
University of Pisa, Italy
Batul Hanife,
Azienda Provinciale per i Servizi
Sanitari, Italy
*Correspondence:
Paolo Cianconi
pcianco@gmail.com
Specialty section:
This article was submitted to
Public Mental Health,
a section of the journal
Frontiers in Psychiatry
Received: 07 August 2019
Accepted: 28 January 2020
Published: 06 March 2020
Citation:
Cianconi P, Betrò S and Janiri L (2020)
The Impact of Climate Change on
Mental Health: A Systematic
Descriptive Review.
Front. Psychiatry 11:74.
doi: 10.3389/fpsyt.2020.00074
Background: Climate change is one of the great challenges of our time. The
consequences of climate change on exposed biological subjects, as well as on
vulnerable societies, are a concern for the entire scientific community. Rising
temperatures, heat waves, floods, tornadoes, hurricanes, droughts, fires, loss of forest,
and glaciers, along with disappearance of rivers and desertification, can directly and
indirectly cause human pathologies that are physical and mental. However, there is a clear
lack in psychiatric studies on mental disorders linked to climate change.
Methods: Literature available on PubMed, EMBASE, and Cochrane library until end of
June 2019 were reviewed. The total number of articles and association reports was 445.
From these, 163 were selected. We looked for the association between classical
psychiatric disorders such as anxiety schizophrenia, mood disorder and depression,
suicide, aggressive behaviors, despair for the loss of usual landscape, and phenomena
related to climate change and extreme weather. Review of literature was then divided into
specific areas: the course of change in mental health, temperature, water, air pollution,
drought, as well as the exposure of certain groups and critical psychological adaptations.
Results: Climate change has an impact on a large part of the population, in different
geographical areas and with different types of threats to public health. However, the delay
in studies on climate change and mental health consequences is an important aspect.
Lack of literature is perhaps due to the complexity and novelty of this issue. It has been
shown that climate change acts on mental health with different timing. The
phenomenology of the effects of climate change differs greatly—some mental disorders
are common and others more specific in relation to atypical climatic conditions. Moreover,
climate change also affects different population groups who are directly exposed and
more vulnerable in their geographical conditions, as well as a lack of access to resources,
information, and protection. Perhaps it is also worth underlining that in some papers the
connection between climatic events and mental disorders was described through the
introduction of new terms, coined only recently: ecoanxiety, ecoguilt, ecopsychology,
ecological grief, solastalgia, biospheric concern, etc.
Conclusions: The effects of climate change can be direct or indirect, short-term or long-
term. Acute events can act through mechanisms similar to that of traumatic stress, leading
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to well-understood psychopathological patterns. In addition, the consequences of
exposure to extreme or prolonged weather-related events can also be delayed,
encompassing disorders such as posttraumatic stress, or even transmitted to later
generations.
Keywords: climate change, mental health, resilience, migration, vulnerability, climatic and economic turmoil,
extreme events
INTRODUCTION
Since the 1970’s scientists have been trying to understand
processes related to environmental factors that lead to climate
change. Our climate is changing, with an unequivocal regional
effect such as heath waves, floods, and droughts. Human
activities have altered the atmospheric composition, producing
a greenhouse effect leading to global warming. These activities
produce a flux of complex variance with setbacks related also to
mental health (1). Scientists argue that they still have to
understand what kind of transformations can be expected
depending on the temperature, how pervasive theses
transformations will be in the various environments, when and
what points of no return can be identified, which short and long-
term consequences may be foreseen, and who are the most
exposed biological subjects and most vulnerable societies. A
part of climate change is due to the conditions of the planet
that are independent of human activities (solar irradiance,
autonomous activity of the planet such volcanic eruptions).
Most studies are focus on the chain of events occurring in the
biosphere primarily due to global warming. Global warming is in
part attributable to the anthropogenic activity through the use of
fossil fuels, deforestation, and pollution (1).
Global warming is likely to cause widespread emergencies in
the future (2). These emergencies are real phenomena when
extreme climatic events have an impact on local territories. These
events are: extreme heat (increased global mean surface
temperature, heat waves); climate change–related water
disasters (CCRWDs) (sea level (3)—flooding, hurricanes, and
coastal storms); droughts; wildfires; winter storms, extreme
snow, and severe CAPE (convective available potential energy)
thunderstorms (4) (supercells, derechos, and tornados).
When can we consider a climatic event as “extreme”? In
science, the term “extreme” is used in several contexts. By
definition, “extremes” are events that are rare or outside the
normal range. A definition of extreme has been already deeply
discussed in Seneviratne et al. report (5). Devastating natural
weather phenomena are not exclusively caused by climate
change. Some seasonal change or annual means temperature
may be “extreme”. Therefore, extremes are understood within
the context in which they take place. People and communities
judge events as “extreme” by comparing them with personal
experiences, when these events are unprecedented or divergent
from previous phenomena (6). In the area affected by sudden and
extreme climatic events, it is not rare to hear from the elderly that
“nothing like this has ever happened”. However, focusing on a
single climatic extreme and extraordinarily event does not allow
to understand the bigger picture. Nonetheless, recently extremes
are becoming more evident, even when a longer time arc
is considered.
All weather events are affected by climate change. Higher
global temperatures and differences in humidity compared to
previous eras have been registered in recent years (6). There is
some degree of uncertainty regarding climate change and the
scientific community has not yet been able to fully link climate
change to the increase of extreme weather events (7). However,
many authors strongly believe extreme climatic events have
important influence on ecosystems and societies. Shifts and
trends of mean temperatures and precipitation have been
directly correlated to the increases of hurricanes, droughts,
heat waves, and heavy precipitation (8). Scholars have
confidence that the anthropogenic influence has contributed to
the increase of extreme events with disastrous outcomes on
global scale (9).
The Katowice Climate Change Conference, held in Poland at
the end of 2018, was the last conference concerning global
change in an effort to commit each state to reduce emissions,
trying to keep the global temperature change below 1.5°C. An
increase of average global temperature over 1.5°C has been
linked to a global rise in the frequency and intensity of
extreme weather events (10, 11). Moreover, the greenhouse
effect has already altered global climate dynamics (12). A vast
amount of information supports that anthropogenic activity is
responsible for extreme events, such as the heat waves in Europe
and Russia (13), and the devastating floods in Pakistan (14, 15).
Understanding how climate change relates to extreme events is a
current scientific challenge. There are different explanatory
experimental models (16). Each method must be able to
explain the consequences of human activity and how they are
linked to natural climatic variations.
Models on how global climate has evolved throughout the
eras can be useful in order to give a context to current extreme
events (17, 18). Such studies have increased over the past
decades. Historical models and earth surface temperature
readouts suggest that there is a strong connection between
anthropogenic warming and the increased persistence of
extreme weather (14). These approaches allow us to quantify
the influence of historical global warming on the probability and
the severity of individual events (19). All extreme climatic events
are associated with large scale changes in the thermodynamic
environments (12). For example, increases of mean temperature
lead to heat waves (20); decreases in ground humidity and higher
evaporation trends lead to higher incidence and severity of
droughts (21) or changes in soil-moisture (22); high sea
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surface temperature and anomalies in humidity are linked to
storms and the melting of Arctic ice fields (23).
Statistical methods link extremes to an observed climatic trend.
This has proven to be challenging. The satellite era (1979–present)
coincides with a rapid increase of Arctic surface temperatures.
There is a high statistical confidence that links the anthropogenic
action to the current minimum extension reached by Arctic
glaciers, caused by the alteration of atmospheric circulation,
atmospheric humidity, and thermodynamic factors in general
(24). Authors strongly believe that some types of extreme event,
most notably heat waves and precipitation extremes, will increase as
an effect of the global warming (25). The frequency and the
intensity of extreme climate events are unprecedented in global
history (2). The debate is still open and, despite substantial
progresses, achieving an accurate analysis of local events,
evaluating all the involved thermodynamic processes, has proven
to be difficult (24). Some studies already suggest that a more
complex mechanisms may be involved in unprecedented
extremes climate events (25).
However, our climate does not act as a linear system (26), but
rather as a complex system (27), characterized by regime shifts,
oscillations, and chaotic fluctuations in all timescales (26), so that
predictions are impervious. Climate change will inevitably impose
alterations in our lifestyles and consequences in terms of human
losses and social readjustments. That said, it is not clear how many
people on the planet will be affected by extreme phenomena
caused by climate change, and to what extent and when these
phenomena will compromise the quality of their life. People could
be at risk for their survival, either directly (during, for example, an
extreme event) or indirectly (reduction of food, famine, water
scarcity, decrease in places to cultivate or hunt, displacement). In
order to advise societies on how to cope and adapt to these
phenomena, specialized international agencies have produced
reports on climate change and the extreme events suggesting
strategies and remedies (9, 28). Climatology, once a sub-field of
physical geography, has now grown in relevance throughout the
scientific community. Extreme events are the point of interaction
between climate change and the human world (29).
Moreover, our ecosystem will face plant and animal
extinction due to failure to adapt or migrate (30) leading to an
increased risk of an “extinction domino effect” (31). Climate
change can redistribute the strength of ecological interactions
between predator and prey (32). Moreover, effects of global
warming such as droughts and soil dry out (33) could have
amplified effect especially in rural areas (34) such as difficulties in
farming, starvation, forced migration (35); the consequent
overcrowding of coastal and delta areas could also lead to
physical illness by vector-borne disease. Global warming could
pose a risk to ecosystems with decreased biodiversity, modifying
fishing, and hunting activities (36). Famines can also be caused
by abnormal insects’ populations and consequent increased use
of pesticide or GMOs (37) with a change in biodiversity. Eighty
percent of global population is affected by water and food
insecurity due to climate change effects (38).
Environmental factors are becoming increasingly important
in psychiatry due to the fact that they can induce congenital
defects, impair neurodevelopment, even trigger endogenous
mental disorders as well arouse psychosomatic and
neurological disorders (39). Climate can produce strong
phenomena with a disastrous impact among human societies.
Disasters create a different kind of psychological and
psychopathological distress compared to normal seasonal
weather changes, as seen in tornados, floods, and droughts.
Furthermore, other climatic events, usually overlooked in
studies on mental health of exposed populations (e.g. ocean
acidification, acid rain, superfog (40), glacier melting, biomass
extinction), could also have a broader impact on mental health.
Psychiatry has only recently begun to deal with climate
change, albeit specific literature concerning the climate events
in relation to psychiatric disorders is still lacking and rather
undefined (41–43).
MATERIALS AND METHODS
All papers available on PubMed, EMBASE, and Cochrane
published from 1996 until June 2019 were reviewed. Searched
terms included “PTSD” or “anxiety” or “depression” or “mental
health” or “psychiatric disorder” or “psychosis” or
“schizophrenia” or “suicide” or “mood disorder” combined
with “climate change” or “extreme events” or “disaster events”
or “surface air temperature” or “heath waves” or “rise
temperature” or “floods” or “flooding” or “increased waters” or
“hurricanes” or “tornado” or “drought” or “wildfires” or “vector
borne disease” or “deglaciation” or “deforestation” or “river
disappearance” or “increased of desert” or “extinction” or
“solastalgia” or “ecoanxiety” or “ecomigration” or “resilience”
or “adaptation”. The search included all languages and we focus
on articles written in English or Italian. Studies related to both
human and animal conditions were selected, including data
available from government and non-governmental
organizations, reports, and books.
Screening was made on the basis of abstract and title.
Exclusion criteria are:
• Even in the event that direct effect on mental health was
proven, articles on urbanization (n = 3), air and water
pollution (n = 66), chemical pollution (n = 7), and ionizing
radiation (n = 22) were excluded, insofar as they were not
directly related to the focus of our study.
• Articles dealing exclusively with transmission of infectious
diseases (n = 3) or physical-medical pathologies were
excluded.
The following articles was eligible for analysis based on their
specific topic. Exclusions (n = 178) were made in order to avoid
redundancy of cited material (Figure 1).
• 100 articles on climate change in general—34 articles were
selected;
• 18 articles on heat waves and temperature increase—six
articles on heat waves and seven on temperature increase
were selected;
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FIGURE 1 | PRISMA flow diagram.
• 31 articles on flooding and sea-level increase—20 were
selected on flooding and 6 on sea-level increase;
• 20 articles on hurricanes—13 were included in this research;
• 10 articles on deforestation—seven were selected;
• 18 articles on drought—15 were selected;
• 25 articles on indigenous communities, vulnerability, and
migration—18 were selected;
• 23 articles on economic impact—two were selected;
• 16 articles on wildfires—10 articles were selected;
• 84 articles on psychiatric disorders connected with global
climate change—27 general articles were selected. Moreover,
28 association reports (WHO; IPCC; APA etc.) were studied
—15 reports were selected.
In each category, only pivotal studies included in the range of
the publication years were selected.
A total of 97 articles were analyzed, covering various extreme
weather events and their effects on psychiatric illness. We examined
7 reports and 28 reviews; among these, 3 were about communities, 1
about migrations; one studied event and consequences in 157
countries, one summarized the interviews performed on 105,549
patients. We analyzed 8 articles with regression time studies
(concerning 29 countries and data about surveys performed on
1,9 million citizens). Authors of 14 articles have given self-reported
questionnaires or surveys (range of scrutinized results went from 30
to 381,916 people in internet questionnaires). Nine articles reported
results from interviews, mainly about communities and children
studies, ranging from 14 to 342 people interviewed. One of the
selected articles is a population based retrospective study with 9
million data collected; one experimental study use statistic to
analyze 344,957 twitters, another analyzed 600 million social
media updates and reactions for a longitudinal and country scale
evidence study. Four of the selected articles were case-studies with
17 people interviewed and 1,526 questionnaires completed.
Excluding other minor selected categorized, other articles were
longitudinal or cross-sectional studies.
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RESULTS
Course of Mental Health Changes
Following Extreme Events
A vast body of works on mental health and climate change is now
emerging (43, 44). Impacts on mental health can occur after or
even before an extreme event (45). Mental health outcomes of
climate change range from minimal stress and distress symptoms
to clinical disorders, ranging from anxiety and sleep disturbances
(46) to depression, post-traumatic stress, and suicidal thoughts
(10, 47). Other consequences might include the effect on
individuals and communities in their everyday life, perceptions,
and experiences, having to cope, understand, and respond
appropriately to climate change and its implications (10). A large
number of people exposed to climate or weather-related natural
disasters experience stress and serious mental health consequences.
Some natural disasters are possibly going to be more frequent
because of climate change. Notoriously, reactions to extreme events
that involve life disruption, such as loss of life, resources, social
support and social networks, or extensive relocation, are post-
traumatic stress disorder (PTSD), depression, and general anxiety,
increased substance use or misuse, and suicidal thoughts (48).
Research has shown that peritraumatic experience is highly
related to acute stress during and immediately after a disaster,
which is expected to lead to the onset of PTSD (49). Later on, other
consequences come out for survivors, such as reduced daily life
activities and the loss of their “sense of place”. These conditions
could have an impact and exacerbate mental health risks. News
regarding climate change makes people uncertain and stressed, even
depressed and with a sense of powerlessness. The concrete impact of
those changes in life brings different types of psychopathological
reaction to these events. Briefly, acute impacts refer to all the
extreme events (e.g. floods, hurricanes, wildfires, etc.) that
immediately expose undefended and helpless people to mental
injuries. Subacute impacts involve intense emotions experienced
by people who indirectly witness the effects of climate change,
anxiety related to uncertainty about surviving of humans and other
species and, finally, sense of being blocked, disorientation, and
passivity. Long-term outcomes come in the form of large-scale social
and community effects outbreaking into forms of violence, struggle
over limited resources, displacement and forced migration (35, 50),
post-disaster adjustment, and chronic environmental stress (51). In
our study we considered the consequences for mental health for
each single extreme event. We also considered mental health
adaptation to environment changes.
Heat Waves
As a part of the Climate and Health Profile Report, both direct
and indirect impact on health with regard to extreme heat and
extreme precipitation were identified. Health risks caused by
these factors has significantly risen in recent years (52). Heat
weaves are spikes of high temperatures lasting some days that
range outside the normal temperature for a specific season (20).
This phenomenon is connected with climate change as they have
increased in frequency and intensity. Moreover, the frequency
and intensity of heat waves are considered extreme events linked
to climate change, with a regional effect.
Physical health, mental health, human well-being, and heat
waves appear to be specifically interconnected. Heat stress
directly caused by heat waves has been associated with mood
disorders, anxiety, and related consequences (53). People with
mental illness were three times more likely to run the risk of
death from a heat wave than those without mental illness (45).
During pregnancy, especially in the second and third trimester,
exposure to heat waves has been showed to be related to a lower
average birth weight and increase of incidence of preterm birth.
Effects during childhood and adulthood comprised reduced
schooling and economic activity, other than behavioral and
motor problems and reduced IQ (45). Some evidence seems to
hint a different vulnerability between genders. The percentage of
deaths were higher in women than men during the European
heat wave. Negative outcomes of heat waves are also related to
social factors. Women, young people, and people with low
socioeconomic status have shown to be more vulnerable to
anxiety and mood disorders related to disasters (54). Heat-
related illnesses and waterborne diseases are also connected
(52). It could also be noted that people are outside more
during the summer, and this could increase the opportunity
for conflicts. In hot temperatures, increase in discomfort leads to
increase feelings of hostility and aggressive thoughts and possibly
actions. Hotter cities were more violent than cooler cities. The
increase in heat-related violence are greater in hot summers and
showed increased rates in hotter years (55). Indeed, being
exposed to extreme heat can lead to physical and psychological
fatigue (53)—there is a clear association between warming
temperatures and rising suicide rates, especially in an early
summer ‘peak’ (56). Alcohol is likely to be involved in
increasing aggression. Higher temperatures than usual,
especially in June and July, were associated with an outbreak of
aggressive crimes. The co-occurrence of hot summer days and
weekends is therefore a perfect mix, resulting in a massive
increase in shootings (57). Preventive measures should be
taken against extreme temperatures to protect health, planning
targeted public health monitoring, expanding the availability of
air conditioning and providing countermeasures for what is
known as the “urban heat island” effect (52).
Water
Global warming will lead to CCRWDs such as an increase in
both intensity and global number of tropical cyclones (58, 59),
frequency and severity of hurricanes, and flooding (60).
Floods
Floods are an overflow of water, usually from the ocean, submerging
land areas. Flooding is one of the most frequent types of major
disaster, leading to 53,000 deaths in the past decade (61). CCRWDs
generate flooding in urban areas on the coasts, like those in Asian
deltas rivers (62, 63). These events could potentially have a negative
effect on the health of vulnerable populations. Moreover, CCRWDs
have a devastating impact on communities and the health of
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residents, for example by exposing people to toxins, precipitating
population susceptibility, and creating crises for healthcare
infrastructures (60). There are direct impacts in terms of
morbidity and mortality related to water (such as drowning,
electrocution, cardiovascular events, nonfatal injuries, and
exacerbation of chronic illness); waterborne diseases (due to
contamination of drinking water); infectious diseases (64); and
psychiatric and mental health disorders. The principal effect after
flooding seems to be located in the mental health area, leading
especially to PTSD. A direct correlation between the intensity of the
disaster and the severity of the mental health effects was noted (65).
After the acute emergency phase, a number of members of the
affected populations are subjected to some level of psychological
distress and mental health problems (61). As studied all around the
world (i.e. India and Bangladesh (61); Dakota USA (66); Italy (67);
Venezuela (68) etc.) floods bring mourning, displacement, and
psychosocial stress due to loss of lives and belongings, as a direct
outcome of the disaster or of its consequences. All these are risk
factors for PTSD, depression, and anxiety (69). With specific
reference to flood victims, 20% had been diagnosed with
depression, 28.3% with anxiety and 36% with PTSD (70).
Consequences are still present well after the flood is over, due to
the presence of mourning, economic problems, and behavioral
problems in children (71, 72). Moreover, some cases show an
increase in substance abuse, domestic violence, as the calamity
exacerbates and precipitates previous existing people’s mental health
problems (70, 73–75). Contradictory evidence was obtained
regarding suicide following a flooding. In addiction there are
aspects of vulnerability such as poverty (60, 76), living in
makeshift housing solutions, and the lack of access to healthcare.
Flooding disrupts infrastructure, causing problems for the standard
systems of care, including mental health care that could assist and
mitigate the psychological outcome for victims. Other susceptibility
factors for mental illness related to these events include: women, the
young or elderly age, having a disability, being part of an ethnic or
linguistic minority, living in a household with a female head and
having lower level of schooling. Among residents and relief workers,
having limited resources or living in lower income countries are
additional risk factors (77). The disaster can only exacerbate any
existing barriers in the access of mental health care in the population
(78). The focus of many articles is on PTSD occurring immediately
after the disaster, when vulnerable people are more at risk and
fragile (61). This part of the population can develop mental health
problems and mental disorders in the short-, medium- or long-term
(78). In addition, even families not residing nearby the affected area
shown high levels of post-traumatic stress, due to the fact that they
still bear the charge of the disruption of community cohesion (76).
People who are affected by flooding could show remarkable
resilience, however they still need organizations to support them,
in order to recognize and cope with the distress, while also
providing assistance to avoid any possible additional mental
health problem or disorder arising from the situation.
Psychosocial resilience, due to its personal and collective
components, makes it fundamental to mitigate the distress of
flooding together with the social and health risks caused by the
event. Restoring social cohesion of communities and families
immediately after calamities is crucial in order to reduce suffering
and promote effective recovery (73). Community resilience also has
a preventive effect, as it prepares the population for future events
while also helping them to cope with the current situation (76).
Air
Tornadoes, hurricanes, and storms have all increased in
intensity, frequency, and duration over recent decades. Data on
tornadoes and mental health issues came from the latest kind of
this disasters, such as hurricane Katrina in Florida and Louisiana
in 2005 and Sandy in 2012 in Cuba, Jamaica, and Haiti (79–81).
There is still uncertainty regarding how much humanity is at
fault for this increase (82). Based on information provided by the
United Nations Development Program, nations like the United
States, Japan, Australia, and New Zealand and other twenty-nine
developing nations have been greatly exposed to hurricanes,
cyclones, and typhoons (83). The damage suffered by health
care infrastructure and the interruption of public health service
due to hurricanes leads to an increase in serious illness, injuries,
disability, and death (84). As in extreme events, there are health
issues that emerged or worsened after hurricanes due to
psychological stress: increase in rates of cardiovascular diseases
(85), prenatal maternal stress and depression, infants more likely
to experience anxiety, fear and sadness, and less responsive to
pleasant stimuli (86), lack of insurance possibly increasing
chronic illnesses with no access to medical care during a
disaster (87, 88), population exposures to contaminated
floodwaters (88). Many people experienced PTSD, stress,
depression, anxiety (87), and suicide (79). Consequences of
material damages lead to substance abuse (45, 89). The
incidence of PTSD, that has been studied most extensively, was
consistently associated with several factors. Severity of exposure
and previous mental health problems has shown to be stable
predictors of development of distress (84). Other vulnerability
factors are represented by: age, women, low education level, low
socioeconomic status, being unemployed or disabled before
hurricane disaster, and being single (54). People living in an
affected area showed high levels of suicide and suicidal ideation,
one in six people developed PTSD, and half of them developed an
anxiety or mood disorder, including depression (45). Additional
consequences are the loss of social support, job insecurity, and
loss of belongings, as well as disruption of medical health system,
displacement, and relocation are related to the onset of
psychological distress. Mental health disorders are often seen
even one year after the disaster or event (90). A strategy for
coping immediately after a hurricane is a successful evacuation of
vulnerable areas by reducing the number of victims.
Displacement to shelters often results in separation from social
support networks and creates a disruption in normal
psychological processes, particularly familiarity, attachment
and identity, and decrease in perceived social support in the
months following the hurricane, which in turn has been shown
to be associated with increased symptoms of general
psychological distress. Being moved from one shelter to
another is traumatic, compounded by the limited amount of
healthcare services (91).
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Drought
Historically, a natural drought lasts about a decade. Due to
climate change, there will be droughts lasting around three
decades, also known as “megadroughts”. From a current
historical frequency of 12%, these events may increase up to
60% (92) due to possible changes in future anthropogenic
greenhouse gas emissions and atmospheric concentrations
measured in CO2-equivalents (93). A combination of high
temperatures and low precipitation increases the frequency of
drought over the world (94). A temperature fluctuation is
correlated with agricultural loss by affecting crop productivity
and yields. This loss is linked to a decrease on economic growth
leading to a long-term economic disadvantage and promoting
political instability and conflicts (95). Farmers all over the world
are more vulnerable to environment-induced mental health risks
carried by drought. Long-term droughts and erratic rain fall have
been associated with deterioration of economic conditions,
reduced social functioning, and psychological distance to
perception of negative climatic conditions (96). The regulation
and adjustment of emotion is disrupted by depression,
demoralization, fatalism, passively resigning to fate, especially
in women and adolescents or people with lower socioeconomic
status, showing feelings of distress and helplessness (52, 53).
Drought has been often connected to suicide (97–101), especially
in older people (102). In semi-arid and peri-urban areas,
adaptive capacity is necessary to cope with an increased
temperature and a reduced rainfall. In this case, vulnerability is
seen as the degree to which people are susceptible by events that
disrupt their lives—events that are beyond their control. Resilient
systems cope with extreme events in order to create a response
that maintains essential function, identity, and structure, and the
capacity for adaptation. Consequently, local communities
strongly perceive the impact of climate change. Negative events
stimulate feelings of alertness, constant monitoring of current
and future events, mental distress, anxiety, depression, and
suicide (103), as well as prolonged emotional stress, inevitably
provoking high job insecurity (51) and other psychological
issues (104).
Drought and migration are related through an assessment of
crop yields (105). The landscape changes with periodical drought
impact for example on the Turkana’s ability to gain access food,
water, health, and security. These indigenous people are farmers
that have grown dramatically in number in the last decades with
a majority living below the poverty line. Prolonged and more
frequent droughts and unpredictable rainy seasons have
exacerbated the difficult access to potable water or food.
Consequently, changes in water availability, temperature or
other environmental variables can have a truly devastating
impact on their daily life. Many extreme weather events and
famine lead to displacement of entire communities and forced
migration, within and outside national borders, with onset on
conflicts over natural resources (106). In northern Ghana’s
savanna (an arid zone with severe droughts), climate change
exposes farmers to adverse climatic conditions that include low
rainfall, forest fires, soil erosion, loss of soil fertility, poor harvest,
and destruction of property and livestock. In this region, farmers
with small plots are at a higher risk of suffering acute, sub-acute,
and long-term problems caused by extreme climate change (51).
Wildfires
The term “wildfire” refers to large-scale fires, generally occurring
in forests and jungles. These phenomena have involved Siberia,
Central Africa, and the Amazon in the present times. The areas
affected by the wildfire may be sparsely populated or nearby the
city boundaries. The greatest concerns are those related to the
climate. The effects on the ecosystem are devastating, as a forest’s
carbon dioxide storage capacity is forever lost (107). Once burnt,
forest tend to become savannah, scarcely covered by deciduous
trees or cultivation. Vast decline of forests will have
reverberations for the world’s climate, as anticipated by many
government administrations and institutions all over the world.
A “business as usual” scenario will lead to a rise in temperature of
about 4 degrees Celsius by 2100 and plants will have to find new
strategies to survive.
In the past, a more local phenomenon has been described as
bush-fire. These involved urban areas in proximity with
bushlands or forests and could affect residential
neighborhoods, suburbs or slums in different ways, albeit
devastating for farmers and people in the area. Firestorms
generated by bush-fires led to destruction and evacuation of
residents. Wildfires have a heterogeneous impact on property
damage, physical injuries, and mental health (108). During the
years following the disaster, an increase of mental health issues
was observed, such as general mental health problems, post
traumatic disorders (109), psychosomatic illness, and alcohol
abuse (110). Effects can be delayed in onset and can persist over
at least several years. Proximal populations, not directly affected
by the bush-fires, can also be involved (111). Studies performed
in areas hit by Australian bush-fires observed that a year after the
events 42% of the population exposed was classified as potential
psychiatric cases (109). Californian wildfires also offer a rather
dramatic picture, with 33% showing symptoms of major
depression and 24% showing symptoms of PTSD. A similar
effect was observed in Greek wildfires (112), with an increased
somatization symptoms, depression, anxiety, hostility, and
paranoia (113). Post-disaster mental health issues observed
were PTSD, physiological hyperarousal, chronic dissociation,
sadness and depression, detachment (114) disorganized
thinking and behavior, numbing or avoidance, poor
concentration, and behavioral problems. In the youth
population, connections have been found between the young
age and the experience of personal life threat (115). Children
were also affected by bush-fires, showing posttraumatic
phenomena such as anxiety disorders and panic attacks,
problems sleeping, acute stress disorder, compulsively
repetitive play, flashbacks, and psychotic disorders (116).
Wildfires could become quite frequent with climate change.
Addressing such phenomena on a global scale will prove
challenging. It is also difficult to predict how populations will
react once the anthropogenic role of this type of event takes hold.
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Long-Term Environment Changes
and Critical Psychological Adaptations
Climate change leads to extreme events that bring an immediate
and direct impact on the population in terms of mental health.
However, changes also occur slowly, as in the case of temperature
increase. Climate change will also modify the representation of
territories as historically and traditionally known and lived by the
populations. This loss of spatial and cultural parameters is not
favorable to the people’s life in terms of changes of lifestyle that they
might undergo. People may also become less familiar with places
and usual products (resources) of the environment. Landscape
changes are brought about by deforestation, deglaciation, river
disappearance, desertification, water shortage, increase of
infectious diseases, and biomass extinction. On its own,
desertification (117) may cause resource-based conflicts (106).
Increase of Average Land Surface Air Temperature
The earth could become very hot due to the anthropogenic effect
of greenhouse gases that alters the dynamics of CO2. Moreover,
recent studies have highlighted how climate change and global
warming are nonlinear trends (118).
The increase in environmental temperature can notoriously
compromise the functioning of the central nervous system,
similar to insolation and heat stroke. The correct temperature
for proper functioning is around 22°C (119). Outside
temperature can affect the risk of onset or continuous mental
disorders in different ways. For example, temperature stress can
influence psycho-physiological functions by directly affecting
bio-chemicals levels, (e.g. altering the production of serotonin
and dopamine) (120) or by disrupting the homeostasis of
thermoregulation (121, 122). Additionally, direct heat could
result in sleep disturbance, exhaustion, and heat stress
associated with suicide (56, 123). Moreover, the correlation
between mental illness and increase of temperature depends on
latitude and factors that go beyond geography, such as cultural,
political, and socio-behavioral factors (120). In the tropics,
temperature fluctuations show a clear connection to negative
agricultural, economic, and political situations. This is clearly
seen in poor countries, which are more vulnerable to weather
and climate fluctuation than wealthier countries (95). As
described above, a single disaster, like a hurricane or flooding,
has profound effects on mental health, in direct and acute
manners. Furthermore, heat waves and extremely high
temperatures expose the population to the possible onset of
mental disorders. Sensitivity of mental disorders to temperature
should not be underestimated when compared to other heat-
related physical diseases that are commonly studied. Naturally,
the levels of exposure to high temperatures can vary, affecting
populations in different geographical areas, thus leading to
greater challenges in the study of risks (120). Studies show higher
risks of mental-disorder correlated to warmer temperatures,
specifically mania in the elderly, as well as a positive association
with transient mental disorders and episodic mood disorders and an
increase in hospital admissions for mental illness within a few days
after warmer temperatures. When temperature rose over a
threshold of about 20°C, there is an increase in drug-related
mental disorders. Furthermore, there is also a correlation with
increased mortality and morbidity risks among people with
mental and behavioral disorders (120). Increases in hospital
emergency room visits are also shown for many of mental
illnesses such as mood disorders (124), substance abuse, behavior
disorders, neurotic disorders, and schizophrenia and schizotypal
disorders. People are more affected by high temperature especially if
they have schizophrenia, schizotypal disorders, and mood disorders
(121). During the increase of temperature, there is a risk of mental
states of aggression resulting in violence and self-harm, inflicted
injury/homicide, and self-injury/suicide (122). Many studies found
no significant associations with cold temperatures (51, 120).
Increase in Sea Level
Global sea level is projected to rise between 30 to 121 centimeters
by 2100, due to the influx of water from melting glaciers and the
expansion of seawater as it warms (125). There are many factors
that contribute to the increase of water (melting glaciers
specifically in Greenland and Antarctic as well as worldwide),
as well as changes in rainfall patterns and increasing frequency of
severe weather such as flooding (126–129). Countries with low-
lying areas, small islands like those in the Indian or Pacific
Oceans, are concerned that their land areas might decrease due
to flooding and coastal erosion. Consequently, many people
could be forced to migrate to other countries leading a
persistent worry and thoughts of relocation (128). Specific fears
of encirclement or siege by the sea would replace the population’s
normal relationship with the sea or ocean (130).
Deforestation
Deforestation occurs due to the loss of plant biomass caused by
climatic events and the direct action of mankind, driven by
agriculture, animal grazing, and mining (131). There has been an
enormous loss of forests due to human activity. News regarding
such events have a stressogenic impact on western populations,
due to the increased ecological awareness. People believe that an
important world heritage has been damaged and lost. This
feeling is now known as a biospheric concern. On the other
hand, for indigenous populations, deforestation has a deeper
impact, leading to profound maladaptive disorders and
depression. In general, people believe that forests are a source
of health and protection from various types of stress (132).
Urban green areas help maintain low temperatures in the city
during the summer months, improve air quality, and reduce
people’s stress level (133). An ever-increasing number of studies
shown that living in green urban spaces leads to health benefits,
including better physical and mental health and a longer life
expectancy (134). Studies suggest that the positive influence of
nature on health can be observe especially between vulnerable
groups such as the elderly, those in rehabilitation for mental
disorders, and individuals in crisis rehabilitation (135). In the
older population, contact with parks and green areas has been
linked with slower cognitive decline. Moreover, children benefit
from living in greener urban areas, such as better spatial working
memory, improved attentional control and capacity, and higher
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academic achievement, particularly in mathematics (136), as well
as improved behavior and emotional development, and positive
structural changes in the brain (134). Moreover, green areas and
parks in childhood have a preventive effect on the risk of
developing various mental disorders later in life. More
greenery in urban areas creates higher social cohesion and
increases people’s physical activity level, therefore improving
children’s cognitive development (137). In general, subjects
living more urban green areas have a better quality of life.
Unfortunately, those people who could get more benefits from
a change of exposure often do not have sufficient resources or
capacity to move to more healthy environments (138).
Landscape modification: landscape modification can induce
individuals to develop a profound sense of loss of connection and
detachment from the environment they know. Solastalgia is a
term that describes this type of loss, especially when a person
finds it difficult to adapt to environmental changes, possibly
creating risks for mental health (53). Solastalgia describes a
complex phenomenon that can have an impact on
psychological levels, similar to that experienced by people who
are forced to migrate (139). Biospheric concern refers to a type of
stress that people feel when they see vulnerable nature such as
plants or animals and the environment (140). Daily life can
undergo variation due to climate change and when people lose
their autonomy and control, they could experience a deep
psychological change. For example, the loss of employment
related to environmental changes can lead to a loss of
individual identity. Immediately after a disaster, damages on
social or community sources, or lack on food and medical
services, could results in many acute consequences for the
psychological well-being (139). In contrast, slow change of the
environment due to climate change, like changes in usual
weather or rising sea levels, will cause acute and chronic
psychopathologic trauma and shock, PTSD, depression,
anxiety, suicide, substance or alcohol abuse, aggressiveness and
violence, difficulties in social and interpersonal relationships, loss
of personally important places, alteration of social ties, loss of
autonomy, and control, as well as personal and professional
identity, leading to the emergence of feelings of helplessness and
fear, solastalgia, and eco-anxiety (45).
Economic Impact
After ecological and environmental changes in a country,
economic crises can occur and lead to an increase in suicide
rates and other mental and behavioral disturbances especially
working men (141). This type of stress, when associated with low
socioeconomic status, paired with limited access to resources and
reduced health, can lead to a diminished ability to cope.
Economic difficulties that last over time or in conjunction with
other factors, lead to a physical, cognitive, psychological, and
social malfunction with a decrease in well-being and health
(142). Both economic and climatic variables are strongly
correlated with suicide, with 62.4% of male and 41.7% of
female suicide rate variability across the continent (141).
Exposure Groups
Certain people are indeed more vulnerable to the potential
impacts of climate change on mental health. There are
communities that are more vulnerable to such events. This
impact implies psychological effects (45) especially in
vulnerable groups like children, the elderly, the chronically ill,
people with mobility impairments, pregnant and postpartum
women, people with mental illness, and those with lower
socioeconomic status. Consequently, climate change has
worsened global economic inequality (143). The more
temperature shifts from optimum levels, the more there will be
groups that cannot cope. A striking example is the traditional
native populations. Different studies have considered the effect of
climate change on native communities (such as first nations and
aborigines), highlighting aspects of vulnerability and resilience
(144, 145). Among these populations, the elderly is a clear
example of difficulty in re-adaptation. These minorities and at-
risk groups, such as the Inuit communities, first nations, and
aborigines (146), are experiencing rapid change in climatic
conditions (132, 147, 148). In the Canadian arctic, the Inuit
refer to having a protective factor for their mental health and
well-being in “being on the land”. Melting ice and change in
weather conditions are strongly linked to the impairment of
these protective factors due to a decrease in access to land with
some of the highest rates of youth suicide that have been
documented among Inuit youth (149).
Climate change is a social determinant for mental health
(150). Strong impact has been noted on refugees and migrants
(151), ethnic minorities, the homeless or vulnerable populations
such as the poor in countries like India, China, and Brazil (152).
Women, those with low socioeconomic status, living in poverty,
with scarce economic and social resources, reduction of social
support, and mental health problems existing before the events,
along with traumatic experiences (death or life risk, serious
injury or sexual assault) and stressors, represent vulnerable
groups that tend to develop new mental disorders or see their
previous problems worsen (49). After climate disasters, children
typically show more severe disturbances than adults, with more
severity and prevalence with regard to the onset of PTSD and
depression. (71).
Residential populations in changing territories are subjected to
new environmental conditions. For these people, this violation of
the usual context is experienced with passivity and a sense of
powerlessness. Many studies show that when people experience
feelings of loss, helplessness, and frustration caused by their inability
to cope with climate change, a term today coined as ecoanxiety (45,
153). People may also experience feelings of uncertainty and
anticipation of the unknown regarding climate change. This leads
to a psychological distance, a perception of distance, when a climatic
event occurs as near or far, at a temporal, spatial, and s ocial level
(51). In response to growing ecoanxiety and various type of
biospheric concern, psychotherapists are pioneering a new field of
treatment, termed “ecopsychology”. It is important for doctors to
teach patients to accept their own powerlessness. For example, when
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it starts raining, some patients have episodes of anxiety because they
think of the past flooding with fear of losing the house again due to
the flood. “Ecological grief” is a recorded grief and anxiety spread
among the native Inuit to describe what they have seen (154).
These new words are emerging from recent observations on
the impact and power that climate change has on mental health.
It will certainly take time and further studies in order to identify
these new diseases and disorders. The DSM-5 and ICD-10 offer
no specific references to mental disorders related to climate
change. The chapter “Other conditions that may be a focus of
clinical attention” in the DSM-5 contains the section “Economic
Problems” where the following conditions are listed: lack of
adequate food or safe drinking water, extreme poverty, low
income, insufficient social insurance, or welfare support. In the
section “Problems Related to other Psychosocial, Personal and
Environmental Circumstances” the following conditions are
listed: exposure to disaster, war, or other hostilities (155).
Certain groups and communities are now beginning to
experience disruptions with regard to social, economic, and
environmental determinants. When exposed to climate change,
a population experiences constant uncertainty, anxiety, loss,
disruption, displacement, and fear even before a disaster has
even occurred. Climate change negatively impact on mental
health and wellbeing with unequal distribution within and
among communities (156). After a natural disaster has
occurred, damage and efforts to repair it have increased the
disparity of wealth between races (this has been shown in United
States). There has been a clear-cut increase with regard to
inequality in countries that are frequently hit by extreme
events. When certain areas receive more redevelopment aid,
racial inequality is going to be amplified (157). When farmers
in various parts of the world perceive the psychological pressure
of climate change, they are motivated to engage in different
strategies in order to adapt to climate change (51).
DISCUSSION
Summary of Main Findings
There is a strong link between natural disasters and mental
disorders. In the future, climate change will bring about an
increasing frequency of extreme weather. We know that
weather changes may induce psychopathological phenomena
such as seasonal affective disorders to weather sensitivity and
meteoropathic conditions. Specific symptom patterns, below the
pathological threshold, may be devised in reaction to various
atmospheric changes and perturbations: temperature, humidity,
rain, barometric pressure, brightness, rate of air flow, air
ionization, thunderstorms, and sudden shifts of some of these
factors (158). What is also seen as a temperamental trait has been
called “meteorosensitivity”. Living organisms may be biologically
more prone to suffer the effect of atmospheric events on mind
and body. On the other hand, meteoropathic subjects are those
individuals who develop a specific illness or the worsening of an
existing disease as a consequence of climatic changes. Psycho-
physical symptoms include: mood disturbances, irritability,
anxiety, mental and physical weakness, hypertension,
headache, hyperalgesia and pains, and autonomic symptoms
(159). Moreover, air pollution can induce neural instability
(158). Scarce rain and low average temperature have been
found to lead to psychiatric visits in emergency departments
(160). Hippocrates himself wrote: “Whoever wishes to
investigate medicine properly, should proceed a so: in the first
place to consider the seasons of the year … then the winds, the
hot and the old … we must also consider the qualities of the
water …” (161). Weather can impact everyday activity and
changes in the behavior result from physical characteristics of
the environment. With global climate change, these
psychopathological phenomena due to sensitivity to normal
weather conditions can today be studied within a
wider dimension.
Climate change can lead to extreme weather, which include
large storms, flooding, droughts, and heat waves, and it has
effects not only on physical health (e.g. degraded air quality)
through the spread of diseases and the reemergence of existing
diseases, but also on mental health. Mental health consequences
of natural disasters cover a wide range of disorders.
The connection between climate change and its consequences
on mental health is far from reaching a clear conclusion. The
complexity of current studies highlights this challenge. This
difficulty is largely due to the heterogeneity in what to measure
and how to measure the impact of climate change. Attempts to
discover the underlying mechanisms of adaptation, as well as the
definition of deviations from normality in extreme climate
events, and finally attempts to define direct cause-effect
relationships are all challenging tasks. Socio-behavioral factors,
culture, information, and preparedness all play a relevant role in
peri-traumatic experience, determining collective resilience or
psychological disruption and exhaustion. Studies that empirically
established connections between climate change and mental
health consequences are now coming forth in literature.
Impact of climate change on mental health can occur either
directly with immediate effect (heat waves), or indirectly in the
short term during extreme events (floods, tornadoes, hurricanes),
or indirectly in the long term (changes in the territory such as
prolonged droughts, increase in the sea levels, deforestation,
forced migration). All these events affect the mental health of a
population, with the appearance of psychiatric conditions such
as PTSD, mood disorders such as depression, anxiety, increased
suicide rate and substance use, as well as increased aggressive
behavior. Climate change will also exert the greatest impact on
groups of vulnerable populations that therefore have an
increased probability of developing psychopathologies: women,
the elderly, children, people with previous psychiatric illnesses
who can consequently worsen their mental condition, and people
with low income or poor social network, as well as indigenous
and native communities. Extreme weather events seem to have
the power to also destroy social ties (162). Vulnerable
communities are those located in exposed regions (e.g. coastal
regions, where windstorm or extreme heat can occur).
Climate change will produce profound changes in the
environment and alter lifestyles, while also generating
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environmentally-motivated migration (random asylum seekers
and climatic refugees). These groups of people, forced to migrate,
already have their own psychological vulnerabilities (162). They
may find it difficult even to identify the appropriate emotional
control for specific climate changes. Moreover, extreme events
produce different types of psychopathological reactions over
time, as there are acute, sub-acute, and long-term impacts on
mental health. Mental adaptation and certain behavioral patterns
will develop following the chronology of events: in the pre-alert
phase, during the disaster and after the event (163). Long-term
consequences are difficult to define. Consequences of climate
change, such as economic and social difficulty, contribute not
only to the increase in the incidence of mental illnesses in the
affected population, but also in the subsequent generations.
Literature analyzes single types of climatic events, since certain
consequent disorders are specific while others generally occur in
different extreme events (162). Being able to understand what
this change entails makes it possible to program early
interventions and actions for a population’s mental health.
Limitations
Studies on the consequences that climate change has on mental
health are still at their very beginning. In the future, it would be
useful to further investigate the correlation between psychiatric
diseases and extreme events. We did not find any study on how
people react to the changes in landscape such as deglaciation,
disappearance of rivers, desertification, fires, and water
shortages. A greater understanding of the characteristics of
acute, sub-acute, and long-term consequences is an also
desirable goal. Furthermore, we believe that future research in
climate change and mental health will include multi-disciplinary
studies. Scholars should focus on how different vulnerable
groups can be affected by natural disasters and climate change,
as well as how to make use of the available protective measure
and healthcare resources. A limitation of the present descriptive
review is the lack of a meta-analysis as a methodological
completion of the systematic review. This could be useful in
the upcoming research in order to establish specific causal
associations between climate change and mental health
consequences (symptoms and disorders).
Conclusions
Based on the studies and literature reviewed in this paper, there
appears to be strong evidence of the influence that the climate
change exerts on mental health.
This study examined the effects of global climate change on the
general population, as well as at-risk groups and vulnerable
communities. We chose to focus on extreme events, such as
those produced by temperature increase, heat waves, floods,
drought, tornadoes, hurricanes, and wildfire. Consequences have
been described in terms of distress symptoms, suicide rates, and
clinical disorders (depression, anxiety, sleep disturbances, PTSD,
etc.). Even though some of these events may occur in a slower and
less acute manner (e.g. temperature increase or droughts), most of
these events are rapid in their onset and manifest themselves in the
form of disasters, the reactions to which often see PTSD as a
prototypical model. On the other hand, we could support that
people who are more sensitive to weather and atmospheric
phenomena may be more affected by gradually occurring global
climate changes and their consequences, such as global warming,
rising sea levels, landscape changes, and loss of familiar
environmental landmarks.
Moreover, the disappearance of animal and plant species may
bring about feelings of hopelessness and depression. When a
person’s feelings about their environment are considered, it
should be clear that we are moving toward a cultural and
contextual dimension. The wound inflicted to this symbolic
domain causes more complex psychopathological
consequences, such as identity disorders (164) or long-term
personality changes (119), as seen in trauma related to extreme
weather events and loss of familiar landscape, or dissociative
syndromes (165) as seen in trauma related to extreme events or
in migratory syndromes. Lastly, we also need to learn how
meteoropathy and weather sensitivity, paired with
environmental and climate changes, deeply influence the
psychosomatic sphere of mankind, activating mechanisms of
somatization and conversion, and inducing somatic disorders
and physical illnesses or worsening previously existing distress at
the body level. These psychiatric disorders, in quality and
quantity, are linked to the type of evolution of post-modern
societies. In short, all of these issues need to be more extensively
studied and clinical experience should be gained in order to
support our provisional conclusions. The challenge of climate
change will be protracted in the upcoming years. Therefore, this
branch of “ecopsychiatry” will surely be supported by new data
sets and further studies.
AUTHOR CONTRIBUTIONS
PC, SB, and LJ all contributed to the brainstorming, writing, and
critical review of this manuscript. LJ edited the manuscript.
FUNDING
Funding for this study was provided by Fondazione Policlinico
Gemelli - Institute of Psychiatry, Catholic University, Rome, Italy.
The funders had no role in this study design, data collection and
analysis, decision to publish, or preparation of the manuscript.
ACKNOWLEDGMENTS
We would like to thank the World Psychiatric Association,
Section on Ecology Psychiatry & Mental Health for the
scientific support.
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Conflict of Interest: The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be construed as a
potential conflict of interest.
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March 2020 | Volume 11 | Article 74