The influence of several changes in atmospheric states over semi-arid areas on the incidence of mental health disorders

A randomised controlled trial assessing the effects of weather sensitivity profile and walking in nature on the psychophysiological response to stress in individuals with coronary artery disease. A study protocol

BACKGROUND

The following protocol pertains to a pioneer study, aiming to investigate how weather sensitivity and walking in different environments affects the psychophysiological responses to the stress of individuals with coronary artery disease (CAD) during rehabilitation (WE_SENSE_THE_NATURE). This randomised control trial will provide fresh insight on the influence of the environmental exposure in CAD patients, as it is seldom investigated in association to the disease. Additionally, findings on the link between personality traits and cognitive functions (especially cognitive flexibility), and weather sensitivity may help reveal a fine-grained perspective on the treatment possibilities for individuals with CAD at risk to stress-vulnerability.

METHODS

The proposed protocol is for a randomised control trial among individuals attending a cardiac rehabilitation program. We aim to recruit 164 individuals, collecting information related to demographic characteristics, weather sensitivity, functional capacity, personality traits, subjective mental health status, cognitive function, and basal cortisol level of participating individuals. Basal cortisol level refers to cortisol concentration in saliva and will be tested in the morning and the afternoon prior to the day of the experiment. After baseline measurements, the patients will be randomly assigned to either walking outdoors or walking indoors. All measures and their sequential order will remain the same within each group, while the treatment condition (i.e., walking environment) will vary between groups. On the day of the experiment, hemodynamic parameters (assessed via 6-hour blood pressure measurements), stress level (consisting of assessments of cortisol level), and mood (assessed using visual analogues scale) will be registered. Cold stress test will be administered to evaluate the effect of walking in different environments.

DISCUSSION

The outcomes of this study may have direct clinical applications for the use of different types of exercise environments in cardiac rehabilitation programs. Awareness about the potential influence of weather sensitivity on the psychophysiological reactions to stress in individuals with CAD may contribute to a timely planning and implementation of actions leading to improved medical care services and preventive measures, especially considering the expected weather oscillations and extreme weather events due to unfolding of the climate change.

TRIAL REGISTRATION

This protocol has been retrospectively registered in ClinicalTrials.gov with identifier code: NCT06139705 on November 20, 2023.

Effects of Changes in Seasonal Weather Patterns on the Subjective Well-Being in Patients with CAD Enrolled in Cardiac Rehabilitation

Objective: We examined whether seasonal and monthly variations exist in the subjective well-being of weather-sensitive patients with coronary artery disease (CAD) during cardiac rehabilitation. Methods: In this cross-sectional study, 865 patients (30% female, age 60 ± 9) were recruited within 2−3 weeks of treatment for acute coronary syndrome and during cardiac rehabilitation. The patients completed the Palanga self-assessment diary for weather sensitivity (PSAD-WS) daily, for an average of 15.5 days. PSAD-WS is an 11-item (general) three-factor (psychological, cardiac, and physical symptoms) questionnaire used to assess weather sensitivity in CAD patients. Weather data were recorded using the weather station “Vantage Pro2 Plus”. Continuous data were recorded eight times each day for the weather parameters and the averages of the data were linked to the respondents’ same-day diary results. Results: Weather-sensitive (WS) patients were found to be more sensitive to seasonal changes than patients who were not WS, and they were more likely to experience psychological symptoms. August (summer), December (winter), and March (spring) had the highest numbers of cardiac symptoms (all p < 0.001). In summary, peaks of symptoms appeared more frequently during the transition from one season to the next. Conclusion: This study extends the knowledge about the impact of atmospheric variables on the general well-being of weather-sensitive CAD patients during cardiac rehabilitation.

Weather-related subjective well-being in patients with coronary artery disease

One of the particularly vulnerable groups for adverse weather conditions is people with heart disease. Most of the studies analyzed the association between certain weather conditions and increased mortality, morbidity, hospital admissions, calls, or visits to the emergency department and used as statistical data. This study evaluated associations between daily weather conditions and daily weather-related well-being in patients with coronary artery disease (CAD). From June 2008 to October 2012, a total of 865 consecutive patients with CAD (mean age 60 years; 30% of women) were recruited from the cardiac rehabilitation program at the Hospital Palanga Clinic, Lithuania. To evaluate the well-being, all patients filled in Palanga self-assessment diary for weather sensitivity every day from 8 to 21 days (average 15 ± 3 days) about their well-being (psychological, cardiac, and physical symptoms) on the last day. The weather data was recorded in the database eight times every day with a 3-hour interval using the weather station "Vantage Pro2 Plus" which was located in the same Clinic. The daily averages of the eight time records for weather parameters were calculated and were linked to the same-day diary data. We found that the well-being of patients with CAD was associated with weather parameters; specifically, general well-being was better within the temperature range 9-15 °C and worse on both sides of this range. Worsened general well-being was also associated with higher relative humidity and lower atmospheric pressure. Weather parameters can explain from 3 to 8% of the variance of well-being in patients with CAD.

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals-An Exploratory Study

Background: The number of meteoropaths, or people negatively affected by weather conditions, is rising dramatically. Meteoropathy is developing rapidly due to ever poorer adaptations of people to changes in weather conditions. Strong weather stimuli may not only exacerbate symptoms in people with diseases of the cardiovascular and respiratory systems but may also induce aggressive behavior. Researchers have shown that patients suffering from mental illnesses are most vulnerable to changes in the weather and postulate a connection between the seasons and aggressive behavior. Methods: The goal of the study was to analyze the relationship between coercive measures and weather factors. The researchers identified what meteorological conditions prevailed on days with an increased number of incidents of aggressive behavior leading to the use of physical coercion towards patients in a psychiatric hospital in Poland. In order to determine the impact of weather conditions on the frequency at which physical coercion measures were used, the hospital’s “coercion sheets” from 1 January 2015 to 31 March 2017 were analyzed. The data were correlated with meteorological data. In order to determine the relationship between the occurrence of specific weather conditions and the number of coercive interventions (N), researchers utilized Spearman’s rank correlation analysis together with two-dimensional scatter diagrams (dependency models), multiple regression, stepwise regression, frequencies, and conditional probability (%). Results: Lower barometric pressure and foehn wind increased aggressive behavior in patients that led to coercive measures. For temperature (positive correlation) and humidity (negative correlation), there was a poor but statistically significant correlation. Conclusions: Monitoring weather conditions might be useful in predicting and preventing aggression by patients who are susceptible to weather changes

Attributable risk and economic cost of hospital admissions for mental disorders due to PM2.5 in Beijing

BACKGROUND

Few studies have estimated the attributable risk and economic cost of mental disorders (MDs) due to particulate matters with aerodynamic diameter of <2.5 μm (PM_2.5) exposure in Beijing.

OBJECTIVES

This study aims to identify the possible correlation between PM_2.5 and risk of hospital admissions (HAs) for MDs in Beijing and calculate the attributable risk and economic cost.

METHODS

A generalized additive model (GAM) with controlling for time trend, meteorological conditions, holidays and day of the week was used to estimate the associations. Stratified analyses were performed by age, gender and season. We further estimated the health and economic burden of HAs for MDs attributable to PM_2.5.

FINDINGS

A total of 17,252 HAs for MDs were collected. A 10 μg/m³ daily increase in PM_2.5 was associated with a statistically significant risk increase of 3.55% for HAs for MDs. The effects of PM_2.5 exposures on HAs for MDs were more pronounced in males, elderly (≥65 years old) individuals and in cold seasons. Using WHO's air quality guidelines as the reference, 15.12% of HAs and 16.19% of the related medical expenses for MDs were attributed to PM_2.5 during the study period.

NOVELTY

PM_2.5 accounts for substantial morbidity and economic burden of MDs for both the society and households, which shows environmental protections are essential to improve mental health status of the population.

Weather conditions influence the number of psychiatric emergency room patients

The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p < 0.001). Three PCs explained 76.8% percent of the variance with PC1 loading mostly on temperature, PC2 on cloudiness and low pressure, and PC3 on windiness. PC1 and PC2 showed strong association with number of patients in the emergency room (p < 0.010) indicating higher patient numbers on warmer and on cloudy days. Further, PC1, PC2, and PC3 predicted the number of patients presenting in the emergency room for up to 7 days (p < 0.050). A secondary analysis revealed that the effect of temperature on number of patients was mostly due to lower patient numbers on cold days. Although replication of our findings is required, our results suggest that weather influences the number of psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

Correlation between suicide and meteorological parameters

OBJECTIVE

The aim of this study was to investigate the link between suicide and meteorological parameters in the 23 wards of Tokyo, Japan.

MATERIALS AND METHODS

Monthly data (from January 2008 to December 2012) of suicide stratified by the type of suicide, i.e. hanging, drowning and jumping, were obtained from the Tokyo Medical Examiner's Office official web site. Monthly meteorological parameters (atmospheric pressure, air temperature, humidity and daylight hours) in the 23 wards of Tokyo were also used for the required period. The effects of meteorological parameters on suicide were explored.

RESULTS

The number of suicides was 110.4±14.7 (80-149) for men and 55.6±9.1 (41-87) for women in the 23 wards of Tokyo, Japan. The mean air temperature was 16.6°C±7.7 °C (4.8-29.6 °C). The number of suicides by drowning for men was significantly and positively correlated with air temperature, and weakly and positively correlated with humidity. In addition, the number of suicides by drowning for men was significantly and negatively correlated with atmospheric pressure.

CONCLUSIONS

The number of suicides by drowning was associated with meteorological parameters, especially in men, in the 23 wards of Tokyo, Japan.

Daily weather variables and affective disorder admissions to psychiatric hospitals

Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables--namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature--influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

The influence of air-suspended particulate concentration on the incidence of suicide attempts and exacerbation of schizophrenia

The main objective of this study was to evaluate the role of the concentration of solid air-suspended particles (SSP) in the incidence of mental disorders. The study is based on 1,871 cases, registered in the Beer-Sheva Mental Health Center (BS-MHC) at Ben-Gurion University (Israel) during a 16-month period from 2001 to 2002; 1,445 persons were hospitalized due to exacerbation of schizophrenia (ICD-10: F20-F29) and 426 after committing a suicide attempt using a variety of means as coded in the ICD-10 (ICD-10: X60-X84). Pearson and Spearman test correlations were used; the statistical significance was tested at p < 0.1. A significant correlation between variations of SSP number concentration (N C ) during eastern desert wind during early morning hours and number of suicide attempts, N SU , was found (ρ > 0.3, p < 0.05), whereas correlation between N C and N SU during western air streams (sea breeze) was not observed (p > 0.2). A trend towards positive correlation (ρ > 0.2, p < 0.1) between the N C and number of persons with exacerbation of schizophrenia as manifested in psychotic attack (N PS ) in periods with dominant eastern winds (4-9 am, local time) has been observed, while in the afternoon and evening hours (1-8 pm local time) with dominant western winds, N C and N PS are not correlated (p > 0.1). Obviously, concentration of SSP is not the one and only parameter of air pollution state determining meteorological-biological impact, involving incidence of mental disorders, although its role can scarcely be overstated. However, since it is one of the simplest measured parameters, it could be widely used and helpful in the daily struggle for human life comfort in semi-arid areas as well as urban and industrial surroundings, where air pollution reaches crucial values. This study may permit determination of the limits for different external factors, which do not overcome threshold values (without provoking avalanche situations), to single out the group of people at increased risk (with according degree of statistic probability), whose reactions to the weather violations can involve the outbreak of frustration points and prevent or alleviate detrimental mental effects.

Possible effects of changes in the meteorological state over semi-arid areas on the general well-being of weather-sensitive patients

BACKGROUND

The influence of the changes in atmospheric states, typical for areas close to big deserts, on general well-being of hypertensive persons was analyzed.

METHODS

Under test was the group of 20 hypertensive weather-sensitive patients; their blood pressure, pulse rate and appearance of 4 symptoms of discomfort sensations: arthritic pain, unjustified anxiety, severe headache and inexplicable tiredness- were registered. Symptoms are classified in ICD-9 code (780-790) and scored on a 4-point scale. Results were defined as positive (no departure from the range of normal values) or problematic; the daily number of the latter results was collected under the name "pathological reactions" NPR if at least two of these 7 checked symptoms (of one patient) were outside the normal range. Comparison of the current weather conditions with their means, questioning of patients and repeated examinations are used to gain information. The data was analyzed employing the SAS statistical software. Pearson and Spearman correlations were used, applied on the best and worst days, when a minimum and a maximum of pathological changes NPR in the patients' well-being were observed. The statistical significance was p < 0.05 in all cases.

RESULTS

~1500 medical observations and verbal statements were registered in the Primary Care Clinic (Be'er-Sheva, Israel) during 2001-2002. No meaning correlation was found between NPR and absolute values of temperature, humidity and atmospheric pressure. Variations in wind speed WS and direction were expressed in blood pressure changes and in exacerbation of discomfort of various degrees. Unfavorable conditions correspond to days with dominant desert air streams and to high WS, when NPR reaches 85.7%; during the days with prevalent sea breeze NPR was ≤22.9%. The role of wind direction in NPR occurrence is prevalent when WS > 4 m·s-1. The Spearman test gives higher correlation than Pearson test (ρ ~ 0.14, p < 0.03 against ρ ~ 0.1, p < 0.04).

CONCLUSIONS

NPR is more affected by the air streams than by absolute values of meteorological parameters. The method of this study might give to family doctors some additional tools to predict deterioration in general feelings of chronic patients and could be related to other health problems influenced by the meteorological environment.