The health, economic, political, and environmental implications of climate change affect all of us. The tolls on our mental health are far reaching. They induce stress, depression, and anxiety; strain social and community relationships; and have been linked to increases in aggression, violence, and crime.
Heat profoundly affects the human mind. The more neurotransmitters needed to cool the body, the less available to suppress emotions like aggression, impatience or violence. Heat increases circulating levels of the stress hormone, cortisol. Psychiatric hospital visits increase during hotter weather.
Virtually everywhere around the world we’re facing warmer temperatures, and there is a lot of evidence of direct effects of warming on mental health.
Although the psychological impacts of climate change may not be obvious, they are no less serious because they can lead to disorders, such as depression, antisocial behavior, and suicide. Therefore, these disorders must be considered impacts of climate change as are disease, hunger, and other physical health consequences.
Of the 36% of Americans who are personally concerned a great deal about climate issues, 72% are Democrats, and 27% are Republicans (PEW Research).
It was Raymond Chandler who wrote of nights with a hot wind blowing into Los Angeles, a wind that makes “your nerves jump.”
“On nights like that every booze party ends in a fight,” he wrote. “Meek little wives feel the edge of the carving knife and study their husbands’ necks. Anything can happen.”
Now there’s research that says climate change may damage our mental health, just like Chandler’s hot wind from the Santa Ana Mountains.
Last week, a team of 28 specialists convened by the Lancet medical journal listed climate change among the greatest threats to mental health globally.
Ferocious storms and more frequent weather extremes will affect the human psyche in costly ways, some scientists predict, from more depression and anxiety to increased suicide rates.
One working theory is that some of the same neurotransmitters used by the brain to regulate the body’s temperature are also used to control emotions. The more neurotransmitters needed to cool the body, the less available to suppress emotions like aggression, impatience or violence.
. . . National Post
How Climate Change Affects Mental Health.
A new report shows global warming affects our psyches just as much as our earth.
When we talk about climate change, we tend to think about its effects on our environment, melting polar ice caps, extreme swings in weather, more frequent droughts, flooding, and higher incidences of natural disasters. But what about the effect on our moods, thoughts, and feelings? A new report written by the American Psychological Association, Climate for Health, and ecoAmerica argues that our mental wellbeing is just as vulnerable to global warming as is our earth.
. . . Psychology Today
MENTAL HEALTH AND OUR CHANGING CLIMATE:
IMPACTS IMPLICATIONS, AND GUIDANCE
WHY WE OFFER THIS REPORT
When you think about climate change, mental health might not be the first thing that comes to mind. Americans are beginning to grow familiar with climate change and its health impacts: worsening asthma and allergies; heat-related stress: foodborne, waterborne, and vector-borne diseases; illness and injury related to storms; and floods and droughts. However, the connections with mental health are not often part of the discussion.
It is time to expand information and action on climate and health, including mental health. The health, economic, political, and environmental implications of climate change affect all of us. The tolls on our mental health are far reaching. They induce stress, depression, and anxiety; strain social and community relationships; and have been linked to increases in aggression, violence, and crime. Children and communities with few resources to deal with the impacts of climate change are those most impacted.
To compound the issue, the psychological responses to climate change, such as conflict avoidance, fatalism, fear, helplessness, and resignation are growing. These responses are keeping us, and our nation, from properly addressing the core causes of and solutions for our changing climate, and from building and supporting psychological resiliency.
To help increase awareness of these challenges and to address them, the American Psychological Association and ecoAmerica sponsored this report, Mental Health and Our Changing Climate: Impacts, Implications, and Guidance. This is an updated and expanded version of our 2014 report, Beyond Storms & Droughts: The Psychological Impacts of Climate Change, which explored how climate change can impact mental health and provided guidance to engage the public. This updated report is intended to further inform and empower health and medical professionals, community and elected leaders, and the public. Our websites offer webinars and other resources to supplement this report.
On behalf of the authors, the many professionals who contributed directly and indirectly to this work, and all those involved in expanding awareness of and action on climate and mental health, thank you for taking the time to review and share this important resource.
We invite your feedback, and as the field continues to grow, we’ll continue to update this work.
Thus far, most research and communications on the impacts of climate change have emphasized the physical health effects, while mental health has been secondary. Building upon Beyond Storms and Droughts: The Psychological Impacts of Climate Change, the goal of this updated report is to increase awareness of the psychological impacts of climate change on human mental health and well-being. The report provides climate communicators, planners, policymakers, public health professionals, and other leaders the tools and tips needed to respond to these impacts and bolster public engagement on climate solutions.
The impacts of climate change on people’s physical, mental, and community health arise directly and indirectly. Some human health effects stem directly from natural disasters exacerbated by climate change, like floods, storms, wildfires, and heatwaves. Other effects surface more gradually from changing temperatures and rising sea levels that cause forced migration. Weakened infrastructure and less secure food systems are examples of indirect climate impacts on society‘s physical and mental health.
Some communities and populations are more vulnerable to the health-related impacts of climate change. Factors that may increase sensitivity to the mental health impacts include geographic location. presence of pre-existing disabilities or chronic illnesses, and socioeconomic and demographic inequalities, such as education level, income, and age.
In particular, stress from climate impacts can cause children to experience changes in behavior, development, memory, executive function, decision-making, and scholastic achievement.
The connection between changes in the climate and impacts on a person can be difficult to grasp. Although people’s understanding and knowledge of climate change can increase by experiencing the effects directly, perception, politics, and uncertainty can complicate this link. Psychological factors (like psychological distance), a political divide, uncertainty, helplessness, and denial influence the way people comprehend information and form their beliefs on climate change. Research on the impacts of climate change on human well-being is particularly important given the relationship among understanding, experiencing, and comprehending climate change. People’s willingness to support and engage in climate solutions is likely to increase if they can relate them to local experiences or if they see the relevance to their own health and well-being. Additionally, individuals who have higher perceived environmental self-efficacy, or the sense of being able to positively contribute, are more motivated to act on climate solutions.
Climate solutions are available now, are widespread, and support psychological health. Increasing adoption of active commuting, public transportation, green spaces, and clean energy are all solutions that people can choose to support and integrate into their daily lives. These climate solutions, among others, can help to curb the stress, anxiety, and other mental illnesses incurred from the decline of economies, infrastructure, and social identity that comes from damage to the climate.
Major acute mental health impacts include increases in trauma and shock, posttraumatic stress disorder (PTSD), compounded stress, anxiety, substance abuse, and depression. Climate change induced extreme weather, changing weather patterns, damaged food and water resources, and polluted air impact human mental health. Increased levels of stress and distress from these factors can also put strains on social relationships and even have impacts on physical health, such as memory loss, sleep disorders, immune suppression, and changes in digestion.
Major chronic mental health impacts include higher rates of aggression and violence, more mental health emergencies, an increased sense of helplessness, hopelessness, or fatalism, and intense feelings of loss. These feelings of loss may be due to profound changes in a personally important place (such as one’s home) and/or a sense that one has lost control over events in one’s life due to disturbances from climate change. Additionally, a sense of loss regarding one’s personal or occupational identity can arise when treasured objects are destroyed by a disaster or place-based occupations are disrupted by climate change.
Personal relationships and the ways in which people interact in communities and with each other are affected by a changing climate. Compounded stress from a changing environment, ecomigration, and/or ecoanxiety can affect community mental well-being through the loss of social identity and cohesion, hostility, violence, and interpersonal and intergroup aggression.
Psychological well-being includes positive emotions, a sense of meaning and purpose, and strong social connections. Although the psychological impacts of climate change may not be obvious, they are no less serious because they can lead to disorders, such as depression, antisocial behavior, and suicide. Therefore, these disorders must be considered impacts of climate change as are disease, hunger, and other physical health consequences.
Building resilience is essential to address the physical and mental health impacts of climate change. Many local governments within the United States and in other countries have created plans to protect and enhance infrastructure, but these plans tend to overlook the support needed to ensure thriving psychological well-being. There is an opportunity to include the resilience capacity of individuals and communities in the development of preparedness plans.
OUR CHANGING CLIMATE: A PRIMER
Our climate is changing at an accelerated rate and continues to have profound impacts on human health. This change jeopardizes not only physical health but also mental health.
From wildfires and drought in California to severe flooding in Maryland to Alaskan communities threatened by rising seas, we are clearly living through some of the most severe weather events in US. history as a result of damage to our climate. Thes impacts on our environment will, in turn, affect human health and community well-being.
Climate change is creating visible impacts worldwide, including many here in America. As seen in the tripling of heat waves between 2011 and 2012, weather patterns introduce lasting impacts, such as food insecurity. Similarly, rising sea-surface temperatures have been connected to increasing rates of disease for marine life and humans. Sea levels are estimated to increase anywhere from 8 inches to 6.6 feet due to warmer temperatures by 2100, putting 8 million Americans living in coastal areas at risk for flooding. In terms of our economy, Hurricane Sandy cost the United States around $68 billion in total. Droughts caused by increases in temperature and changing weather patterns cost California $2.7 billion in 2015 and Texas $7.62 billion in 2011. As these climate disturbances become more dramatic and persistent, we must prepare for these climate conditions.
COMMUNITIES ARE IMPACTED
Our communities’ health, infrastructure, and economy are directly connected to our climate. As temperatures increase, we experience higher levels of pollution, allergens, and diseases. Severe weather events threaten our businesses and vulnerable communities. Pollution and drought undermine our food and water supplies, and the latter increases the prevalence of wildfires that can destroy homes and communities. Although all Americans are affected, certain populations of concern will feel the impacts more severely. Together, communities can build resilience to a changing climate.
HEALTH IS IMPACTED
As severe weather events, poorer air quality, degraded food and water systems, and physical illnesses increase, the direct and indirect impacts on health must be understood. The next section highlights the physical health impacts of climate change, and the following sections delve deeper into the mental health impacts, and what can be done to protect human well-being.
THE CLIMATE AND HEALTH IMPACTS ON HUMANS
Health is more than the absence of disease. Health includes mental health, as well as physical well-being, and communities that fail to provide basic services and social support challenge both. As we think about the impacts of climate change on our communities, we need to recognize not only the direct effects but also the indirect consequences for human health based on damage to the physical and social community infrastructure. Regardless of how these impacts surface, whether they occur within a matter of hours or over several decades, the outcomes of climate change are interconnected to all facets of our health.
Recent increases in natural disasters illustrate the relationship between the acceleration of climate change and severe weather.
Areas that endure a natural disaster face a number of risks and difficulties. Direct physical impacts range from brute physical trauma to more pernicious effects, like increased incidence of infectious disease, asthma, heart disease, and lung problems. These physical health impacts interact with mental health impacts.
Major and minor acute physical injury
Natural disasters lead to increased rates of death and injury. The most common causes of mortality during floods are drowning and acute physical trauma. This past year alone, deaths from flash floods have more than doubled the 10-year average. Many people sustain non-fatal injuries, such as cuts and broken bones.
Infrastructure, food, and water
The direct effect of a natural disaster is often exacerbated by a cascade of indirect consequences that follow. Natural disasters can lead to technological disasters (such as power outages), breakdowns in the water, sewer, and other infrastructure, or urban fires. For instance, the risk of carbon monoxide poisoning related to power outages increases as a result of climate change-induced disasters. Disruptions to medical infrastructure, including the provision of medical supplies, can transform minor issues into major and even fatal problems. In addition, disruptions in other types of services (e.g., cell phone communication, transportation, or waste management) add stress and difficulty during the aftermath of a disaster. These disruptions may impact people’s physical health by making it more difficult to access health care or by potentially increasing exposure to pests or hazardous substances (e.g., when there is no garbage pick-up. Loss of income while businesses are closed due to natural disasters can be a major threat to food security, especially for non-professionals or small business owners.
Additional health threats follow in the wake of a disaster. Floodwater has been shown to introduce toxic materials, water-borne diseases (e.g., respiratory illnesses, skin infections, and neurologic and gastrointestinal illness where there are poor hygiene resources), and vector-borne illnesses (e.g., West Nile). Other after effects of flooding include heart attack, heat stroke, dehydration, and stroke, particularly when the affected areas lack the necessary medical supplies. In addition, post-flood mold due to fungal growth inside houses can worsen allergy or asthma symptoms.
MORE GRADUAL HEALTH EFFECTS
Ongoing effects of climate change include rising sea levels, increases in temperature, and changes in precipitation that will affect agricultural conditions. The impacts on human health are less dramatic in the short term but in the long run can affect more people and have a fundamental impact on society.
Severe and changing weather
Periods of higher-than-normal heat result in higher rates of heat exhaustion, heat cramps, heat stroke, hospital admission for heart-related illnesses, and death.
It’s estimated that the average American citizen will experience between 4 and 8 times as many days above 95 degrees Fahrenheit each year as he or she does now by the end of the century. This increase will likely push Arizona’s above-95-degree days from 116 today to as many as 205 by 2099. In contrast, extreme winter storms can expose people to hypothermia and frostbite. Altered growing seasons and ocean temperatures change the timing and occurrence of diarrhea, fever, and abdominal cramps from pathogen transmissions in raw food. Additionally, changing weather patterns influence the expansion of the migration patterns of animals and insects. This expansion has already begun to result in the spread of vector-borne illness, such as Lyme disease, malaria, dengue fever, plague, and Zika virus to new U.S. geographic areas. For example, vector-borne illnesses carried by mosquitoes can capitalize on receding floodwater for mosquito breeding.
Respiratory issues and allergens
People exposed to ozone air pollution, which is emitted mostly by cars and industrial facilities and is intensified by warmer temperatures, are more likely to visit the hospital for respiratory issues, suffer from asthma, and die prematurely of strokes or heart attacks. Hotter and drier summers increase the frequency and intensity of large wildfires that contribute to smoke inhalation. Pollution contributes to higher levels of pollen and translates into longer and more prevalent allergy seasons.
Fetal and child development
CIimate-driven physical stress on mothers can cause adverse birth outcomes, such as preterm birth and low birth weight. Scientific research shows that children and developing fetuses are at particular risk from air pollution, heat, malnutrition, infectious diseases, allergies, and mental illnesses, which have detrimental impacts on development.
Water and food supply
Nutrition and food safety can be affected because climate change can lower crop yields, reduce the nutritional quality of food, interrupt distribution chains, and reduce access to food because families lose income. For example, higher C02 concentrations lower the levels of protein and essential minerals of widely consumed crops such as wheat, rice, and potatoes. Barriers to food transport, such as damage to infrastructure and displacement of employees, affect food markets by increasing food costs. Droughts, floods, and changes in the availability of fertile land lead to hunger and malnutrition, though these changes are less likely in wealthy countries, such as the United States. Nevertheless, there will be an increased likelihood of a global food market crisis as climate change accelerates. A two-degree Celsius increase in temperature places 100-400 million people at risk of hunger, according to the World Bank.
Increased average temperatures and decreased air quality also lead to changes in the type of activities that people engage in, particularly outdoor activities and recreation. These changes, in turn, may be associated with increased rates of obesity and cardiovascular disease. Although people may compensate by exercising in indoor environments, reduced access to the restorative potential of outdoor environments may indirectly increase stress and bypass the long-term emotional benefits of taking physical activity outdoors.
LINKING PHYSICAL IMPACTS, MENTAL HEALTH, AND COMMUNITY WELL-BEING
The ability to process information and make decisions without being disabled by extreme emotional responses is threatened by climate change. Some emotional response is normal, and even negative emotions are a necessary part of a fulfilling life. In the extreme case, however, they can interfere with our ablllty to think rationally, plan our behavior, and consider alternative actions. An extreme weather event can be a source of trauma, and the experience can cause disabling emotions. More subtle and indirect effects of climate change can add stress to people’s lives in varying degrees. Whether experienced indirectly or directly, stressors to our climate translate into impaired mental health that can result in depression and anxiety. Although everyone is able to cope with a certain amount of stress, the accumulated effects of compound stress can tip a person from mentally healthy to mentally ill. Even uncertalnty can be a source of stress and a risk factor for psychological distress. People can be negatively affected by hearing about the negative experiences of others, and by fears, founded or unfounded, about their own potential vulnerability.
PHYSICAL HEALTH AND MENTAL HEALTH
Compromised physical health can be a source of stress that threatens psychological well being. Conversely mental health problems can also threaten physical health, for example, by changing patterns of sleep, eating, or exercise and by reducung immune system function.
Although resndents‘ mental and physical health affect communlties, the impacts of climate on community health can have a particularly strong effect on community fabric and interpersonal relationships. Altered environmental condtions due to climate change can shift the opportunities people have for social interaction, the ways in which they relate to each other. and their connectlons to the natural world.
COMPREHENDING CLIMATE CHANGE
Witnessing the visible impacts of climate change may help people overcome barriers to grasping the problem; however, comprehension has many facets.
PERCEPTION IS DIFFICULT
Although most people are generally aware that climate change is occurring, it continues to seem distant: something that will happen to others, in another place, at some unspecified future date. Psychologists refer to this idea as psychological distance. Terms such as “climate change” and “global warming” draw attention to the global scale rather than the personal impacts. Additionally, the signal of climate change is obscured by the noise of daily and seasonal weather variation. All this makes the issue easier for people to push aside, particularly when faced with other pressing life issues. When people learn about and experience local climate impacts, their understanding increases. Local effects of climate change are often more personally relevant than the general phenomenon of a warming climate, and particularly when knowledge of direct effects is combined with news stories of the imminent risks of climate change. Perceived experience of impacts is associated with increased concern and awareness about climate change, direct experience also increases people’s understanding of climate change. However, direct experience does not necessarily lead to behavior change. For example, experiencing water shortages may increase behavior changes in water use but not encourage other sustainable behavior. Similarly, research suggests experiencing temperature change has no impact on water use behavior.
A PARTISAN ISSUE
Politically polarized in the United States, climate change is perceived as an issue that belongs with the political left, which can suppress belief and concern and discussions about solutions. For example, of the 36% of Americans who are personally concerned a great deal about climate issues, 72% are Democrats, and 27% are Republicans. Political orientation can make open conversations about climate impacts and solutions difficult, and make those who are concerned about climate change feel isolated or paranoid in some circles.
Concerns about health impacts provide common ground for discussion with both ends of the political spectrum. Describing the health-related impacts of climate change and the relevant benefits of taking action to address the impacts can inspire hope among those who dismiss climate change. For instance, conservatives showed decreased support for climate action when the negative health effects were described as affecting people in a faraway country as opposed to people who live in the United States. Listing several health impacts is overwhelming, causing fatalism and diminished engagement.
UNCERTAINTY AND DENIAL
People feel uncertain about the threat of climate change and how to minimize the damage. The media have been criticized for promoting an inaccurate perception of climate change: for example, that there is more scientific controversy about climate change than actually exists. In some cases, information that increases perceptions of the reality of climate change may feel so frightening that it leads to denial and thus a reduction in concern and support for action. In addition, communicating scientific information is not easy; this complexity itself may be a problem. One study showed that people who received more complex information on environmental problems 1) felt more helpless and more inclined to leave the problem to the government; and 2) those who felt ignorant about the topic were more likely to want to avoid hearing about more negative information.
Worldviews and ideologies act as filters to help increase or decrease concern about climate change and motivate action toward solutions. People do not perceive the world neutraly. Instead, through directionally motivated cognition, individuals strive to maintain a world consistent with the ideology and values of their social groups. Because of this, individuals whose worldviews conflict with climate change realities actually may not perceive certain climate effects. Myers, Maibach, Roser-Renouf, Akerlof, and Leiserowitz (2012) found that individuals who were 1) either very concerned about or skeptical of climate change tended to report personal experience with climate change (or lack thereof) based on their pre-existing beliefs about its existence; and 2) individuals less engaged with the issue of climate change changed their beliefs about the existence of climate change based on perceived personal experience with its impacts. Ideologies of climate change and action may also contribute to widespread psychological denial. The distress of climate change can manifest in negative reactions to climate activism. These reactions are reflected in outlets such as social media, and researchers believe this behavior shifts others to denial.
CLIMATE SOLUTIONS BENEFIT MENTAL HEALTH
Physical commuting enhances a sense of well-being. Choosing to bike and/or walk (assuming it is safe and practical to do so) is one individual step that can help reduce the use of climate change-driving fossil fuels. Physical commuting also directly impacts depression, anxiety, PTSD, and other mental illnesses. People who bike and walk to work, school, appointments, and other activities not only reduce emissions and improve their physical health but also experience lower stress levels than car commuters. For instance, individuals who utilized the Washington DC. bikeshare program reported reduced stress levels and weight loss. Similarly, adolescents who actively commute to school show not only lower levels of perceived stress but also increased cardiovascular fitness, improved cognitive performance, and higher academic achievement.
Public transportation invigorates community mental health. Moving people from individual cars to public transit also results in lower greenhouse gas emissions. In addition, several studies have shown that using public transportation leads to an increase in community cohesion, recreational activities, neighborhood walkability, and reduced symptoms of depression and stress associated with less driving and more exercise. Meanwhile, traffic driving worsens air quality and contributes to reduced productivity and increased healthcare costs. Sound transportation systems and urban planning should be expanded as they lead to beneficial mental health and climate outcomes. Green spaces diminish stress. Parks and green corridors have been connected to improved air quality and can increase mental well-being. For example, trees sequester carbon, and green spaces absorb less heat than paved surfaces and buildings. More time spent interacting with nature has been shown to significantly lower stress levels and reduce stress-related illness. Interestingly, this evidence is supported across socioeconomic status, age, and gender. Likewise, individuals who move to areas with access to more green space showed sustained mental health improvements, while individuals who moved to areas with less access to green space experienced substantial negative mental health impacts. However, although a person’s physical and mental health is determined to a large degree by the neighborhood in which he or she lives, relocating to a greener neighborhood isn’t always an option. As planners and policymakers make decisions that will reshape the landscapes of our cities and communities, it is important to recognize the significance and role green areas have in improving air quality, reducing stress, and ensuring a healthy living environment for everyone.
Clean energy reduces health burdens. Wind, solar, hydro, and other clean energy as well as energy efficiency are not only climate-friendly; they also reduce particulates and pollution in the air. Studies on air quality and children’s lung development have shown that as air pollution is reduced, children display significant lung function improvements. Further research revealed that children exposed to higher levels of urban pollution are more likely to develop attention problems and symptoms of anxiety and depression, as well as lower academic performance and brain function. Clean energy provides an opportunity to protect populations of concern, such as children, who experience these impacts more severely.
Although the co-benefits are clear, more comprehensive research on the positive mental health outcomes of climate solutions is needed to bolster support. Research can further promote dynamic solutions as opportunities to improve our health. It is important to increase awareness of the daily choices we make, from how to get to work to the sources of energy to, the more climate-friendly behaviors become mainstreamed, the more they help populations of concern: children, elderly, sick, low income, etc. Fortunately, tangible and effective climate solutions are available today to implement and build upon.
MENTAL HEALTH IMPACTS
The mental health effects of Climate change are gaining public attention. A 2071 government report (US. Global Change Research Program) reviewed a large body of research to summarize the current state of knowledge. This report builds on that knowledge, and considers the direct and indirect effects of Climate change on mental health.
We start by describing the mental health effects on individuals, both short and long term, acute and chronic, the stressors that accumulate in the aftermath of a disaster, and the impacts that natural disasters have on social relationships, with consequences for health and well-being. We move on to discussing the individual-level impacts of more gradual changes in climate, including impacts on aggression and violence, identity, and the long-term emotional impacts of Climate change. Next, we discuss the impacts of climate change on communities and on intergroup and international relationships. Finally, we address the problem of inequity, the fact that certain populations are relatively more vulnerable to these mental health impacts compared to others.
IMPACTS ON INDIVIDUALS
Climate change has acute and chronic impacts, directly and indirectly, on individual well-being. Acute impacts result from natural disasters or extreme weather events. Chronic impacts result from longer term changes in climate. This discussion emphasizes the impacts experienced directly by individuals; however, it also touches on indirect impacts (witnessing others being impacted), which have profound implications for mental health.
Trauma and shock
Climate change-induced disasters have a high potential for immediate and severe psychological trauma from personal injury, injury or death of a loved one, damage to or loss of personal property (e.g., home) and pets, and disruption in or loss of livelihood. An early meta-analysis of studies on the relationship between disasters and mental health impacts found that between 7% and 40% of all subjects in 36 studies showed some form of psychopathology. General anxiety was the type of psychopathology with the highest prevalence rate, followed by phobic, somatic, and alcohol impairment, and then depression and drug impairment, which were all elevated relative to prevalence in the general population. More recent reviews concluded that acute traumatic stress is the most common mental health problem after a disaster. Terror, anger, shock, and other intense negative emotions are likely to dominate people’s initial response. Interview participants in a study about flooding conducted by Carroll, Morbey, Balogh, and Araoz (2009) used words such as “horrifying,” “panic stricken,” and “petrified“ to describe their experience during the flood
Post-traumatic stress disorder (PTSD)
For most people, acute symptoms of trauma and shock are reduced after conditions of security have been restored. However, many continue to experience problems as PTSD manifests as a chronic disorder. PTSD, depression, general anxiety, and suicide all tend to increase after a disaster.
For example, among a sample of people living in areas affected by Hurricane Katrina, suicide and suicidal ideation more than doubled, one in six people met the diagnostic criteria for PTSD, and 49% of people living in an affected area developed an anxiety or mood disorder such as depression. Similarly, 14.5% showed symptoms of PTSD from Hurricane Sandy, and 15.6% of a highly affected community showed symptoms of PTSD several years after experiencing extreme bushfire. PTSD is often linked to a host of other mental health problems, including higher levels of suicide, substance abuse, depression, anxiety, violence, aggresson, interpersonal difficulties, and job-related difficulties.
Incidence of PTSD is more likely among those who have lost close family members or property. Individuals who experience muitiple or long-lasting acute events, such as more than one disaster or multiple years of drought, are likely to experience more severe trauma and may be even more susceptible to PTSD and the other types of psychiatric symptoms described above. For example, a study showed that refugees exposed to multiple traumatic events experienced a higher rate of immediate and lifetime PTSD and had a lower probability of remission than refugees who had experienced few traumatic events. The likelihood of suicide is higher among those who have been exposed to more severe disasters.
In general, climate change can be considered an additional source of stress to our everyday concerns, which may be tolerable for someone with many sources of support but can be enough to serve as a tipping point for those who have fewer resources or who are already experiencing other stressors. Stress manifests as a subjective feeling and a physiological response that occur when a person feels that he or she does not have the capacity to respond and adapt to a given situation. Thus, climate-related stress is likely to lead to increases in stress-related problems, such as substance abuse, anxiety disorders, and depression. These problems often carry economic costs incurred by lost work days, increased use of medical services, etc, which, in turn, create additional stress for individuals and society and have their own impacts on mental and physical health. Stress can also be accompanied by worry about future disasters and feelings of vulnerability, helplessness, mourning, grief, and despair. Following disasters, increased stress can also make people more likely to engage in behavior that has a negative impact on their health (e.g., smoking, risky behavior, and unhealthy eating habits; e.g. Stain et al. (2011) found that people living in a drought-affected area who had also recently experienced some other adverse life event were more likely to express a high degree of worry about the ongoing drought conditions. Although not as dramatic and acute a disaster as a hurricane, drought is associated with psychological distress, and one study found increased rates of suicide among male farmers in Australia during periods of prolonged drought. Several studies have found that many victims of a flood disaster express psychological distress even years after the flood.
Impacts of stress on physical health
High levels of stress and anxiety also appear to be linked to physical health effects.
For example, chronic distress results in a lowered immune system response, leaving people more vulnerable to pathogens in the air and water and at greater risk for a number of physical ailments. Sleep disorders also increase in response to chronic distress. Doppelt (2016) has described potential physiological responses to the stress of climate change, such as increased levels of the stress hormone cortisol, which, if prolonged, can affect digestion, lead to memory loss, and suppress the immune system. The World Heart Federation (2016) lists stress as a serious risk factor in developing cardiovascular disease.
Strains on social relationships
Particularly in home environments, disasters precipitate a set of stressors that can strain interpersonal interactions. A review of research on the impacts of natural disasters identified problems with family and interpersonal relations, as well as social disruption, concerns about the wider community, and feelings of obligation to provide support to others. Families whose homes are damaged by a flood, storm, or wildfire may need to be relocated, sometimes multiple times, before settling permanently. Family relationships may suffer. Separation from one another and from their systems of social support may occur. Children may have to attend a new school or miss school altogether; parents may find themselves less able to be effective caregivers. In addition, even those who are able to remain in their own home may still lose a sense of their home as a safe and secure environment. This has implications for interpersonal connections, as a home provides the context for social relationships. When the physical home is damaged, it changes the dynamic of the social relationships, often negatively. Domestic abuse, for example, including child abuse, often increases among families who have experienced disasters, such as Hurricane Katrina or the Exxon Valdez oil spill.
Aggression and violence
The psychological impacts of warmer weather on aggression and violence have been extensively studied. Lab-based experiments and field-based surveys have demonstrated a causal relationship between heat and aggression. In other words, as the temperature goes up, so does aggression. This influenced researcher Craig Anderson (2012) to predict a demonstrable increase in violence associated with increased average temperatures. The relationship between heat and violence may be due to the impacts of heat on arousal, which results in decreases in attention and self-regulation, as well as an increase in the availability of negative and hostile thought, effect on cognitive function, which may reduce the ability to resolve a conflict without violence. Although this impact can manifest as an acute impact (e.g., as a result of a heat wave), due to the pervasive warming trends, and the shifting of climate zones, it is listed under chronic impacts.
Mental health emergencies
There is evidence that increases in mean temperature are associated with increased use of emergency mental health services. This is true not only in hot countries, like Israel and Australia, and in parts of the United States but also in relatively cooler countries, such as France and Canada. Higher temperatures have been linked to increased levels of suicide. It appears that the distress of feeling too hot can overwhelm coping ability for people who are already psychologically fragile. Climate emergencies can also exacerbate preexisting symptoms and lead to more serious mental health problems.
Loss of personally important places
Perhaps one of the best ways to characterize the impacts of climate change on perceptions is the sense of loss. Loss of relationship to place is a substantial part of this. As climate change irrevocably changes people‘s lived landscapes, large numbers are likely to experience a feeling that they are losing a place that is important to them, a phenomenon called solastalgia. This psychological phenomenon is characterized by a sense of desolation and loss similar to that experienced by people forced to migrate from their home environment. Solastalgia may have a more gradual beginning due to the slow onset of changes in one’s local environment. Silver and Grek-Martin (2015) described the emotional pain and disorientation associated with changes in the physical environment that were expressed by residents of a town damaged by tornadoes, even by residents who had not experienced personal loss.
Loss of place is not a trivial experience. Many people form a strong attachment to the place where they live, finding it to provide a sense of stability, security, and personal identity. People who are strongly attached to their local communities report greater happiness, life satisfaction, and optimism; whereas work performance, interpersonal relationships, and physical health can all be negatively affected by disruption to place attachment. For instance, Scannell and Gifford (2016) found that people who visualized a place to which they were attached showed improved self-esteem and sense of belonging relative to those who visualized a place to which they were not attached.
Climate change is likely to have a significant effect on human well-being by increasing migration. When people lose their home to rising sea levels, or when a home becomes unsuitable for human habitation due to its inability to support food crops, they must find another place to live. Although it is difficult to identify climate change as the causal factor in a complex sequence of events affecting migration, a common prediction is that 200 million people will be displaced due to climate change by 2050. Migration in and of itself constitutes a health risk. Immigrants are vulnerable to mental health problems, probably due to the accumulated stressors associated with the move, as well as with the condition of being in exile. Adger, Barnett, Brown, Marshall, and O‘Brien (2013) found being forced to leave one‘s home territory can threaten one’s sense of continuity and belonging. Because of the importance of connection to place in personal identity, such displacement can leave people literally alienated, with a diminished sense of self and increased vulnerability to stress. Although empirical research on the psychological impacts of migration is rare, Tschakert, Tutu, and Alcaro (2013) studied the emotional experience among residents of Ghana who were forced to move from the northern region of the country to the capital, Accra, because local conditions no longer supported their farming practices. Also, respondents expressed nostalgia and sadness for the home left behind and helplessness due to changes in their environments, such as deforestation, that were described as sad and scary.
Loss of autonomy and control
Climate change will intensify certain daily life inconveniences, which can have psychological impacts on individuals’ sense of autonomy and control. The desire to be able to accomplish basic tasks independently is a core psychological need, central to human well-being, and basic services may be threatened due to dangerous conditions. This may make mobility a challenge, particularly for the elderly and those with disabilities. Exposure to unwanted change in one’s environment can also reduce one’s sense of control over one’s life, which, in turn, has negative impacts on mental health.
Loss of personal and occupational identity
A more fundamental loss is the loss of personal identity tied to mundane aspects of daily life. Losing treasured objects when a home is damaged or destroyed is one way in which climate change can significantly impair an individual’s sense of self and identity. This is because objects help provide a continuing sense of who we are, particularly objects that represent important moments in life (e.g., journals), relationships (e.g., gifts or photographs), or personal family history (e.g., family heirlooms). Interviewees in a study conducted by Carroll et al. (2009) indicated that flood victims were particularly troubled by the loss of personal possessions, such as things they had made themselves or special things they had spent time and effort to procure or maintain. Although this may seem acute, the losses are permanent; the impacts are persistent and therefore become chronic.
A loss of identity associated with climate change is also sometimes attributable to its effect on place-bound occupations. This is likely due to the close relationship between identity and place-based occupations, like farming and fishing. Because severe storms and high temperatures disrupt economic activity climate change may have an effect on occupational identity in general. Loss of occupation has been associated with increased risk of depression following natural disaster.
Helplessness, depression, fear, fatalism, resignation, and ecoanxiety
Gradual, long-term changes in climate can also surface a number of different emotions, including fear, anger, feelings of powerlessness, or exhaustion. A review by Coyle and Van Susteren (2011) described cases in which fear of extreme weather approaches the level of phobia and the “unrelenting day-by-day despair” that can be experienced during a drought. Watching the slow and seemingly irrevocable impacts of climate change unfold, and worrying about the future for oneself, children, and later generations, may be an additional source of stress. Albrecht (2011) and others have termed this anxiety ecoanxiety. Qualitative research provides evidence that some people are deeply affected by feelings of loss, helplessness, and frustration due to their inability to feel like they are making a difference in stopping climate change. Some writers stress the possible detrimental impact of guilt, as people contemplate the impact of their own behavior on future generations. Although the impacts of climate change are not always visible, they perpetuate a delayed destruction that, like the damage to climate, are incremental and can be just as damaging as acute climate impacts.
IMPACTS ON COMMUNITY AND SOCIETY
In addition to the effects on individual health and wellbeing, climate change affects how individuals interact in communities and relate to each other. For example, natural disasters can have a negative impact on community bonds. A changing climate will likely affect aspects of community wellbeing, including social cohesion, aggression, and social relationships.
SOCIAL COHESION AND COMMUNITY CONTINUITY
Compounded stress from climate change has been observed among various communities. For example, CunsoLo Willox et al. (2013) examined the impacts of climate change on a small Inuit COMMUNITY. Members of the community, who all reported a strong attachment to the land, said they had noticed changes in the local climate and that these changes contributed to negative effects on themselves. As a result of altered interactions with the environment, community members reported food insecurity, sadness, anger, increased family stress, and a belief that their sense of self-worth and community cohesion had decreased. Elders expressed specific concern for the preservation of Inuit language and culture as they directly influence mental wellbeing and social cohesion.
Social cohesion and social capital can protect communities against mental and physical health impacts during a climate related disaster. Regardless of socioeconomic or cultural backgrounds, communities with high levels of social capital and community leadership experience the quickest recoveries after a disaster and the highest satisfaction with community rebuilding.
When locaI conditions become practically uninhabitable, ecomigration, leading to environmental refugees, can result. Such migrations erode social networks, as communities disperse in different directions. Because social networks provide important practical and emotional resources that are associated with health and wellbeing, the loss of such networks places people’s sense of continuity and belonging at risk. The current Syrian conflict, which has resulted in mass migration, may partially stem from climate change driven precipitation changes, rising mean sea levels, and a decrease in soil moisture. These climate impacts were exacerbated during the drought from 2007 to 2010 due to human disruptions within natural systems, leading to crop failure and large-scale conflict, hunger, and desperation. Although such civil unrest cannot be attributed to a single cause, recent evidence suggests climate-change caused drought may have played a significant role in the unraveling of an already vulnerable political and ecological climate.
Heightened anxiety and uncertainty about one’s own future can reduce the ability to focus on the needs of others, negatively impacting social relationships with friends and co-workers, as well as attitudes toward other people in general.
High temperatures associated with climate change may increase people‘s aggressive tendencies. Aggression can also be exacerbated by decreased access to stress reducing green spaces and supportive social networks. Rising levels of frustration in society consequently lead to interpersonal aggression (such as domestic violence, assault, and rape). Ranson (2012) calculated that between 2010 and 2099, climate change would cause an estimated additional 30,000 murders, 200,000 cases of rape, and 3.2 million burglaries due to increased average temperatures.
Climate change may increase conflict through several mechanisms. Violence may increase when competition for scarce natural resources increases or when ecomigration brings formerly separate communities into contact and they compete for resources, like jobs and land. In a recent metaanalysis, Hsiang, Burke, and Miguel (2013) found evidence that climate change can contribute to the frequency of intergroup violence (ie. political conflict and war). For example, in Houston, Texas, crime rates increased significantly following Hurricane Katrina, although Katrina migrants have not been definitively sourced as the cause. Meanwhile, restraints on crime weaken when existing social institutions are disrupted, thus increasing the probability of criminal behavior. For example, when government resources are devoted to damaged infrastructure from natural disasters, those resources may be diverted away from criminal justice systems, mental health agencies, and educational institutions, all of which tend to help mitigate crime. Agnew (2012) further pointed out that the effects of climate chanqe are likely to promote crime by “increasing strain, reducing social control, and weakening social support.”
Intergroup attitudes can also be negatively impacted by climate change. In a recent study, survey respondents displayed more negative attitudes toward policies to support minorities and immigrants when temperatures were high. An experimental study showed that people who were thinking about climate change became more hostile to individuals outside their social group (that is, people they consider to be unlike them) and more likely to support the status quo and its accompanying social inequities. Hostility toward individuals outside one’s social group can be a way of affirming one’s own group identity in the face of a perceived threat. In a vicious cycle, lower levels of social cohesion and connectedness, greater social inequalities, lack of trust between community members and for institutions, and other factors that inhibit community members from working together are associated with intergroup aggression.
THE PROBLEM OF INEQUITY
The impacts of climate change are not distributed equally. Some people will experience natural disasters firsthand, some will be affected more gradually over time, and some will experience only indirect impacts. This section describes some of the populations that are more vulnerable to the mental health impacts of climate change, including people who live in risk-prone areas, indigenous communities, low-income groups, certain communities of color, women, children, older adults, and people with disabilities or chronic illnesses. A thorough review of demographic differences in vulnerability to climate change can be found in Dodqen et al. (2016).
Communities in which people’s livelihoods are directly tied to the natural environment, through agriculture, fishing, or tourism, are at greater risk. Some parts of the world are geologically more vulnerable to storms, rising seas, wildfires, or drought. There are detailed reports of farmers in Australia who have been negatively affected by prolonged periods of drought caused by changing weather patterns. Additionally, communities in low-lying areas, such as coastal Louisiana and islands in the Chesapeake Bay, are losing their land to erosion and rising seas. This past year, residents of Isle de Jean Charles, Louisiana, became the first climate refugees in the United States; a $48 million budget was allocated to relocate residents to a less flood-prone area, inhabitants of indigenous communities often depend on natural resources for their livelihoods and are located in geographically vulnerable regions.
Communities that lack resources, both physical and financial, can experience climate impacts more severely. This can be demonstrated by higher incidents of extreme weather within impoverished communities. In disasters, socioeconomically disadvantaged communities often suffer the most. For example, following Hurricane Sandy, lower income residents reported weak or absent social support networks and had the greatest percentages of severe mental distress and diagnosis of depression or anxiety after the hurricane. Furthermore, 35% of children living in a household that earns less than $20,000 annually experienced feelings of sadness, depression, fear, or nervousness following the hurricane.
Indigenous communities are at risk of losing their cultural heritage, as well as their homes. Imperiled indigenous communities are found around the world, including the United States. In Alaska, for example, some native Alaskans have seen their villages literally vanish due to the thawing permafrost, and others are facing a similar outcome in the near future. For indigenous communities, climate change may threaten not oniy their physical home but also their lifestyle, including access to traditional food and culturally meaningful practices. Chief Albert Naquin of a Louisiana tribal community threatened by climate change stated, ”We’re going to lose all our heritage, all our culture”. Cunsolo, Willox et al. (2013) reviewed case studies of several Inuit communities and reported weakening social networks, increased levels of conflict, and significant stress associated with relocation or even thinking about relocation. In evocative language, Inuit community members interviewed by Durkalec et al. (2015) reported that an inability to go out on the sea ice (due to a changing climate) would make them feel like they “have no health” and ”can’t breathe,“ and they would ”be very sad,” “be lost,” or ”go crazy”.
The loss of any community is tragic, but the impact on native communities is particularly notable because it diminishes the cultural heritage and because indigenous communities are often defined by a special connection to the natural environment. This connection includes traditional patterns of behavior and environmental knowledge about the specific local ecosystem, knowledge that is disappearing, and about how to adapt to changing environments that could help us as a broader society as we adapt to the consequences of climate change.
CHILDREN AND INFANTS
Climate change has a big impact on young people. Children are more vulnerable to many of the effects due to their small size, developing organs and nervous systems, and rapid metabolisms. Children are more sensitive to temperature, because their physiological regulatory systems may be less effective (e.g., they sweat less) and because they are more likely to depend on others to help them regulate their behavior. Their small size makes very young children more susceptible to dehydration, and children under age five living in poverty represent 80% of victims of sanitation-related illnesses and diarrheal disease.
Climate impacts may have long-term and even permanent effects, such as changing the developmental potential and trajectory of a child. Currie and Almond (2011) reviewed evidence that even minor disturbances during childhood may have effects on health and earning potential that last into adulthood. Studies have shown that children who experience a flood or a drought during key developmental periods are shorter, on average, as adults. Fetuses are vulnerable to heat waves, with research shows that exposure to heat waves especially during the second and third trimesters of pregnancy leads to a lower average birth weight and possibly a greater incidence of preterm birth. Malnourishment or severe threat to health during the early years is associated with fewer years of schooling and reduced economic activity as adults, as well as with behavioral and motor problems and reduced IQ. Additionally, early exposure to disease provoked by climate change can have a major and permanent impact on neurological development, as can be dramatically seen in children exposed prenatally to the Zika virus.
Children can experience PTSD and depression following traumatic or stressful experiences with more severity and prevalence than adults. After climate events, children typically demonstrate more severe distress than adults. Furthermore, the prevalence of distress is also higher; higher rates of PTSD were found in children two years after a flood. Children’s mental health can also be affected not only by their experiences of stressors, such as natural disasters, extreme weather, and ecomigration, but also by the mental health of their caregivers. Children also have the potential to be emotionally affected if they become separated from their primary caregivers. Similar to physical experiences, traumatic mental experiences can have lifelong effects. Of course, early childhood is critical for brain development. Studies have documented that high levels of stress during childhood can affect the development of neural pathways, in ways that impair memory, executive function, and decision-making in later life.
Children are also at increased risk from disruptions to the educational system. Natural disasters, in particular can damage or destroy schools or make them inaccessible to teachers and students. After Hurricane Katrina, for example, 196,000 public school students had to change schools, and many of them missed a month or more of schooling. In this case, because the hardest-hit school districts were also some of the worst-performing ones, some students benefitted by transferring to better schools. However the effects on school achievement were negative.
Disasters may cause children to lose their social support networks to a greater extent. During adversity, people draw upon all of their personal resources, emotional and material. Although social networks can fill the gaps when individual resources become depleted during extreme trauma, the resources available from a tight-knit community may not go far, especially if the network is small or the community is poor. When disasters hit an area, they affect everyone and put entire neighborhoods in need of help. A study of children impacted by Hurricane Katrina found that those who were hit hardest by the storm also experienced less social support, likely because people in their immediate support network were themselves suffering.
Some communities of color are prone to experience increased impacts. A persistent reality in American culture is the existence of environmental injustice: Some racial and ethnic groups tend to be more exposed to environmental risks and to have fewer financial and political resources to buffer the impact. This is partly, but not completely, explained by economic status. Communities with fewer resources and greater exposure, for example, in Phoenix, Arizona, are likely to experience greater rates of high temperature impacts than majority groups. Lower-income communities are more likely to have outdated infrastructure, such as a lack of extreme weather warning systems, inadequate storm surge preparedness, and clogged or inadequate storm sewer systems, which places these communities at greater risk for the impacts of climate change. Areas with a high number of residents who lack access to health care or health insurance, or already experience poor health are more likely to be affected by climate change. Communities are also less resilient when they are weakened by social stressors, such as racism, economic inequality, and environmental injustices. Many of the communities in New Orleans that were affected by Hurricane Katrina possessed all of these characteristics, and the effects of racial disparities were clearly visible in the aftermath of the storm.
Certain lines and fields of work are more directly exposed to the impact of climate change. These occupations may include but not be limited to first responders, construction workers, health care workers, farmers, farm workers, fishermen, transportation workers, and utility workers. Inequitable health outcomes may arise directly through workers’ exposure to increased temperatures, air pollution, and extreme weather, and indirectly through vector-borne diseases, increased use of pesticides, and many other elements. According to the US Environmental Protection Agency, outdoor workers will be the first to endure the effects of climate change, as they will be exposed to extreme heat, which can cause heat stroke, exhaustion, and fatigue. As natural disasters occur more frequently, such as wildfires and flooding, firefighters and paramedics face increased safety risks. Agricultural workers face increased vulnerability to allergens, insects carrying diseases, such as West Nile, and pesticide exposure that are increased by changing weather and insect migration patterns.
ADDITIONAL POPULATIONS OF CONCERN
Individuals of all ages with disabilities or chronic mental or physical health issues may experience climate-related impacts at a greater extent. Often, people living with disabilities have disproportionately far lower access to aid during and after climate-related disasters. Those with mental health disorders can also experience exacerbated symptoms due to natural disasters. Degraded infrastructure creates barriers for people with mental illnesses to receive proper medical attention, leading to additional negative mental and physical health outcomes. For instance, following the 2012 Wisconsin heat wave, 52% of all heat-related deaths were among individuals with at least one mental illness. Half of those suffering from mental illness were taking psychotropic medications, which impede one’s ability to regulate one’s body temperature. These medications that treat mental illness are one of the main underlying causes of heat-related deaths. Additionally, those suffering from ongoing asthma and respiratory illnesses, like chronic obstructive pulmonary disease (COPD), are more sensitive to reduced air quality. Moreover, inequalities in the incidence of those who are chronically ill arise as a result of several socioeconomic factors.
Due to increased health and mobility challenges, the elderly are very susceptible to the risks of climate impacts. Higher rates of untreated depression and other physical illnesses reported among seniors contribute to this increased vulnerability. Research suggests the elderly, in particular, experience declines in cognitive ability when exposed to air pollution over the long ter. A study by Dominelii (2013) found that when infrastructure broke down (e.g., roads were impassable) due to floods. heat waves, or freeze-thaw events (all potentially climate-driven), formal care services were not available to vulnerable people, such as the elderly. They could not get to the services, and their normal services could not come through. Heat can have a particuIarly severe impact on the elderly and on people with pre-existing mental health problems; some of the medications associated with mental illness make people more susceptible to the effects of heat. Extreme temperatures or pollution can also make it more difficult for seniors to engage in regular outdoor activities, thus depriving them of the associated physical and mental benefits.
The stress directly related to supporting a child makes women more affected by climate change. Because of a mother’s frequent caregiver role, and because, on average, women have fewer economic resources than men, women may also be more affected, in general, by the stress and trauma of natural disasters. Possible loss of resources, such as food, water, shelter, and energy, may also contribute to personal stress. Epidemiological studies of post-disaster cohorts and the general population, suggest that women are more likely to experience mental health problems as a result of trauma. For example, the prevalence of PTSD in the general population is reported to be approximately twofold greater in women than in men.
Developing plans to adapt and cope is critical in addressing the physical and psychological impacts of climate change. Resilience can be defined as the ability of a person (or a community) to cope with, grow through, and transcend adversity.
Climate change is no longer a distant, unimaginable threat; it is a growing reality for communities across the globe. Recognizing the risk, many local governments in the United States (as well as other places around the world) have created preparation or adaptation plans for shoring up physical infrastructure to withstand new weather and temperature extremes. These plans, while an important step, generally overlook the psycho-social impacts of a changing climate and do little to create or support the soft infrastructure needed for community psychological wellbeing. How can communities prepare themselves to minimize suffering and promote resilience in the face of the challenging impacts of climate change? Resilient communities can create the physical and social infrastructure that makes them less susceptible to negative effects.
On an individual level, resilience is built internally and externally through strategies, such as coping and self-regulation, and community social support networks. Most people come through adversity with positive adjustment and without psychopathology. In fact, some individuals may even experience what is called post-traumatic growth and come through a significant disruption with the feeling of having gained something positive, such as stronger social relationships or spectfic skills.
Even so, much can be done to increase the resilience capacity of individuals and communities, particularly in response to climate change.
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