Climate Change a Major Mental Health Threat, Experts Warn voxreport

Climate Change a Major Mental Health Threat, Experts Warn

voxreport

Climate change is a major threat to mental health, the American Psychiatric Association (APA), warns. The association has joined the growing ranks of physician groups that are sounding the alarm about the multifactorial effects that rising seas, temperature extremes, and changing environments are having on individuals' physical and mental health.

In a new position statement, the APA focuses on the profound impact of climate change on mental health, which may include the development or exacerbation of mental illnesses such as anxiety, depression, posttraumatic stress disorder (PTSD), or substance abuse.

"Those with mental health disorders are disproportionately impacted by the consequences of climate change. APA recognizes and commits to support and collaborate with patients, communities, and other healthcare organizations engaged in efforts to mitigate the adverse health and mental health effects of climate change," the APA statement said.

Climate change and its weather-related consequences are occurring more frequently, becoming more destructive, are are occurring in places where they were not as common before, Joshua C. Morganstein, MD, the lead author of the position statement, told Medscape Medical News.

The APA began working on its climate change response in 2015. After review by various committees, the association's assembly approved the statement in November 2016 and submitted it to the board, which gave its backing in March of this year.

The statement is supported by a growing body of scientific evidence on the damaging effects of climate change, said Dr Morganstein. "There's a relatively robust body of literature about the adverse psychological and behavioral health effects of weather-related disasters," he said.

Dr Morganstein and coauthor Robert Ursano, MD, who are both members of the APA's Psychiatric Dimensions of Disaster Committee and are practicing psychiatrists in Bethesda, Maryland, also contributed to the chapter on mental health in a recent key federal report on climate change, The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. The report was issued by the US Global Change Research Program in April 2016.

Among the report's main findings for mental health: 

• Exposure to disasters results in mental health consequences, some chronic.

• Children, the elderly, people with preexisting mental illness, the economically disadvantaged, and first responders are at higher risk for distress and other adverse mental health consequences from climate- or weather-related disasters. Communities that rely on the natural environment for sustenance and livelihood, as well as populations living in areas most susceptible to specific climate change events, are at increased risk for adverse mental health outcomes.

• Just the threat of climate change can cause some people to experience adverse mental health outcomes, and media and popular representations of climate change can influence stress responses and mental well-being.

• Extreme heat can put people with mental illness at higher risk for poor physical and mental health.

Dialing Down the Stress

The report helped solidify the idea that mental health is just as important as physical health, especially when it comes to weather-associated disasters caused by climate change, said Dr Morganstein. "For some disasters, the mental health effects can vastly exceed the economic costs or other health effects," he said.

Often, the mental impact of a natural disaster is lost in the shuffle, he said. Having an understanding of the potential short- and long-term fallout on mental well-being is key to preventing worse outcomes, said Dr Morganstein.

Individuals with existing anxiety or depression or PTSD could see a worsening of symptoms. Individuals may develop these disorders as a result of the stress of the event. Distress reactions may also occur in the form of risky behaviors, such as increased alcohol or drug use, he added.

Many individuals will show up in the emergency department or primary care physician's office first — that's why it's important for psychiatrists to collaborate with other specialties to help prepare for these disasters, he said.

For many individuals, just the thought of climate change is enough to produce severe anxiety and/or depression, and perhaps a sense of hopelessness. For others, it gives rise to a strong denial reaction.

Dr Morganstein said psychiatrists can help dial down stress in patients —especially those who are more vulnerable because of existing mental disorders — by giving them pragmatic steps, such as asking them to determine and understand their child's school emergency plan or their own workplace emergency plan.

"Feeling like you can help yourself and feeling like you can help others is a really important piece of how people can respond to disasters," said Dr Morganstein.

Another recommendation, especially for people already prone to anxiety, is to limit exposure to media, he said. For some, repeated ingestion of climate change news can increase stress and negative reactions. "We encourage people to be very cautious about this," said Dr Morganstein.

A sense of preparedness can help ease stress, at least on a population level, he said. "We can't control when disasters will occur," he said. But physicians can help patients "control how well prepared they feel" for a disaster, said Dr Morganstein.

"Climate Change Is a Fact"

Some of the Trump administration's appointments and policies — such as pledging to renegotiate the landmark 2015 Paris agreement to fight climate change that was backed by the United States and some 200 countries — have caused concern that the public's health will be put at risk during the next 4 years.

But the APA's statement was not issued as a rebuke to the new administration, said Dr Morganstein, noting that it had been in the works for several years.

The American College of Physicians issued a position statement on climate change in May 2016.

"The issue of climate change is not political," Nitin Damle, MD, MACP, immediate past president of the ACP, told Medscape Medical News. "Climate change is a fact," he said. "It's occurring now, and it's affecting our patients' health from an individual and a public health standpoint."

Dr Damle cites increases in respiratory illness, asthma, and allergies from increased pollution and longer pollen seasons, heat waves that put people at risk for heat-related illnesses, and an increase in vector-borne diseases such as Lyme disease, dengue, West Nile virus, and chikungunya. Forced migration due to environmental changes such as drought or flooding are leading to a strain of social relationships, depression, and PTSD, he said.

The time to take action is now, said Dr Damle.

The ACP is part of the Medical Society Consortium on Climate and Health, which released a report in March, Medical Alert! Climate Change Is Harming Our Health.

The consortium includes the American Academy of Family Physicians, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, and the Society of General Internal Medicine, among other medical and scientific groups.

The American Psychological Association is also a member of the consortium. It, too, released a massive report on the mental health effects of climate change in March.

Not Politically Motivated

The report's release was not politically motivated, said Howard Kurtzman, PhD, the American Psychological Association's acting executive director for science.

Mental Health and Our Changing Climate: Impacts, Implications, and Guidance, was an update of a 2014 report, he said. In fact, when the American Psychological Association started the update, there was a sense of optimism in the wake of the Paris accord, Dr Kurtzman told Medscape Medical News.

The 2017 report — which incorporated more and newer evidence — has received more attention, likely in part because of the concerns about the Trump administration, Dr Kurtzman said. But, he also said, "I think people are ready to hear this message."

The message? That climate change has effects not only on physical health —through the spread of disease and the reemergence of old disease, for example — but also on mental health and that certain communities are at higher risk for damage from climate change because of where they live or because they have preexisting mental health issues or live in poverty, said Dr Kurtzman. "On the other hand, there are ways people and communities can address this challenge," he said.

That includes taking political action, and also supporting each other and learning how to prepare. "We need to find ways to help people and communities obtain a sense of control," Dr Kurtzman said.

Psychologists can help patients build resilience and learn how to adapt, he said. They should also work together with other colleagues in the health field, said Dr Kurtzman.

"There's much more to be done in terms of us working together, but I'm sure we'd all agree on the importance of that," he said.