Mental health impacts of climate change and extreme weather events on mothers

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

The impact of extreme high temperatures on ADRD hospitalization in Guangdong, China, 2017-2019

Alzheimer's disease and related dementias (ADRD) have emerged as a major global health challenge due to the aging population. This study is among the first to investigate the impact of extreme high temperatures on ADRD hospitalization in a developing country, leveraging individual-level inpatient medical records. We found that both transient and cumulative exposure to heat waves significantly increased total hospitalization expenses and the length of hospital stay for ADRD patients. Specifically, an additional day with a daily mean temperature exceeding 30 °C in the preceding 7 days, compared to a moderate day with a temperature between 14-18 °C, was associated with a 1.5 % (200.2 yuan) increase in total hospitalization expenses and a 1.8 % (0.2 days) increase in the length of hospital stay. These effects were largely driven by out-of-pocket expenditures on nursing care and were particularly pronounced among male patients and those aged over 75.

Global call to understand intersectionality between heat exposure and perinatal mental health

Increasing heat events, due to human induced climate change have shown to affect vulnerable populations such as pregnant and postpartum women and their mental health. Moreover, consequences of heat events can be unevenly distributed, affecting communities with existing structural discrimination and socially and economically disadvantaged populations. The risk of perinatal depression might be higher in pregnant and postpartum women. In this commentary, we argue, based on the review of literature, that there is a quintessential need for scientific research to investigate the interlinkage between heat events and perinatal depression.

The connection between climate change and perinatal mental health

Climate change and extreme weather events are particularly concerning for pregnant and postpartum women and have been related to negative birth outcomes. However, the impact of climate change on perinatal mental health outcomes is not well studied. Mood and anxiety disorders are among the leading comorbidities during pregnancy and the postpartum period, and they are associated with significant familial and societal burdens. It is crucial to include environmental factors in the risk profile of perinatal mental illness to optimize prevention and early intervention strategies. In the clinical experience of one of the authors, new mothers can feel particularly concerned about their baby's physical health when faced with extreme heat or may present as agitated due to heat-related sleep deprivation. This is in line with qualitative research showing maternal worrying about a baby's thermal dysregulation as one of the emerging themes. With extreme weather events becoming more frequent, clinicians have a role in advocating for climate adaptation in healthcare settings. Climate inequalities need to be addressed alongside health and social inequalities.

Climate change and gendered vulnerability: A systematic review of women's health

BACKGROUND

Climate change is an urgent global threat, with women in low- and middle-income countries (LMICs) disproportionately facing adverse health outcomes. Gendered roles, combined with socioeconomic, cultural, and environmental factors, exacerbate women's vulnerabilities, increasing the burden of mental health issues, water insecurity, sanitation challenges, and caregiving responsibilities.

OBJECTIVES

This review seeks to systematically examine the intersection between climate change and gendered health vulnerabilities, with a particular focus on women. It explores how climate change intensifies gender-specific risks and identifies pathways for integrating gender-responsive policies to mitigate both short- and long-term health impacts.

DESIGN

Following Arksey and O'Malley's methodological framework, this systematic review mapped key concepts and evidence from studies conducted between January 2011 and January 2024. The review focuses on identifying the multifaceted health impacts of climate change on women, particularly in LMICs and marginalized communities.

DATA SOURCES AND METHODS

A systematic search was conducted in Web of Science and Scopus databases using key terms and Medical Subject Headings related to climate change, women's health, gender inequality, mental health, water security, sanitation, and caregiving burdens. Studies were screened and selected based on relevance to the predefined criteria, with data extracted on study design, key findings, and limitations.

RESULTS

From 2163 citations screened, 61 studies were included in the final analysis. The review highlights that climate change disproportionately affects women, exacerbating pre-existing gender inequalities. Specific impacts include heightened mental health challenges, adverse maternal and newborn health outcomes, increased water insecurity, and an intensified caregiving burden. Women in LMICs are particularly vulnerable due to reduced access to resources, healthcare, and decision-making platforms, further limiting their adaptive capacities.

CONCLUSION

The findings underscore the critical need for gender-responsive climate policies that address both immediate health impacts and the broader socioeconomic and environmental determinants affecting women. Effective climate adaptation strategies must integrate gender perspectives, ensuring that women's specific vulnerabilities are accounted for in policy frameworks. This review advocates for the empowerment of women through increased access to resources and decision-making, thus enhancing their resilience and adaptive capacity in the face of climate change.

The Association between Emotional Responses to Climate Change, Antenatal Anxiety and Maternal-Fetal Attachment in Primigravida Women

AIM

To investigate the association between emotional responses to climate change, antenatal anxiety, and maternal-fetal attachment in primigravida women.

DESIGN

A multi-site cross-sectional research design study.

METHODS

This study was conducted at four primary health care (PHC) facilities in Damanhur district, El-Behera, from February 2024 to April 2024. Two hundred eighty-five women completed a comprehensive questionnaire that included a Woman's Social and Reproductive Form, The inventory of climate emotions (ICE) scale, The Stirling Antenatal Anxiety Scale (SAAS) and the Maternal-Fetal Attachment Scale (MFAS-HU-20).

RESULTS

The study revealed that emotional responses to climate change show strong positive correlations with each other, ranging from 0.689 to 0.840, all significant at p < 0.001 level. Additionally, antenatal anxiety demonstrates substantial positive correlations with emotional responses to climate change, albeit with associations ranging from 0.239 to 0.287, all significant at p < 0.001 level. Moreover, maternal-fetal attachment displays substantial negative correlations with emotional responses to climate change, indicating that as emotional responses to climate change increase, maternal-fetal attachment tends to decrease. The correlations range from -0.263 to -0.426, all significant at p < 0.001.

CONCLUSIONS

The emotional impact of climate change can adversely affect the bonding process between mother and fetus.

IMPLICATIONS FOR THE PROFESSION

Healthcare professionals, including obstetricians, midwives, and mental health counsellors, should integrate climate-related emotional distress into their assessments and interventions. Providing targeted psychological support for expectant mothers.

IMPACT

The study's findings highlight the need for nursing to integrate climate-related emotional distress screening into prenatal care and for research to explore long-term effects and intervention effectiveness. In practice, healthcare providers should adopt holistic approaches that combine environmental and psychological support, developing comprehensive guidelines and community-based programs to support pregnant women.

REPORTING METHOD

The research adhered to that is STROBE.

PATIENT OR PUBLIC CONTRIBUTION

Public contributions by women in community health centers.

Impact of air pollution exposure on the severity of major depressive disorder: Results from the DeprAir study

BACKGROUND

Major depressive disorder (MDD) is one of the most prevalent medical conditions worldwide. Different factors were found to play a role in its etiology, including environmental ones (e.g., air pollution). The aim of this study was to evaluate the association between air pollution exposure and MDD severity.

METHODS

Four hundred sixteen MDD subjects were recruited. Severity of MDD and functioning were evaluated through five rating scales: Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HAMD), Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), and Sheehan Disability Scale (SDS). Daily mean estimates of particulate matter with diameter ≤10 (PM10) and 2.5 μm (PM2.5), nitrogen dioxide (NO2), and apparent temperature (AT) were estimated based on subjects' residential addresses. Daily estimates of the 2 weeks preceding recruitment were averaged to obtain cumulative exposure. Multivariate linear and ordinal regression models were applied to assess the associations between air pollutants and MDD severity, overall and stratifying by hypersusceptibility and AT.

RESULTS

Two-thirds of subjects were women and one-third had a family history of depression. Most women had depression with symptoms of anxiety, while men had predominantly melancholic depression. NO2 exposure was associated with worsening of MDD severity (HAMD: β = 1.94, 95% confidence interval [CI], [0.41-3.47]; GAF: β = -1.93, 95% CI [-3.89 to 0.02]), especially when temperatures were low or among hypersusceptible subjects. PM exposure showed an association with MDD severity only in these subgroups.

CONCLUSIONS

Exposure to air pollution worsens MDD severity, with hypersusceptibility and lower temperatures being exacerbating factors.

Taking a trauma and adversity perspective to climate change mental health

The European Journal of Psychotraumatology has had a long interest in advancing the science around climate change and traumatic stress. In this special issue, we include papers that responded to a special call in this area. Six major themes emerge from these papers and together they contribute to trauma and adversity model of the mental health impacts of climate change. We argue that, in addition to individual vulnerability factors, we must consider the (i) cumulative trauma burden that is associated with exposure to ongoing climate change-related impacts; (ii) impact of both direct and indirect stressors; (iii) individual and community protective factors. These factors can then guide intervention models of recovery and ongoing resilience.