Does air pollution trigger suicide? A case-crossover analysis of suicide deaths over the life span

Empty bottles, rising risks: A case-crossover study on psychotherapeutic medication depletion and suicide triggers

OBJECTIVE

The use of psychotherapeutic medications can reduce the risk of suicide among people with mental health disorders, but little is known about the impact of exhausting these medications. This study analyzes the temporal relationship between running out of psychotherapeutic medications and suicide using a case-crossover study design.

METHODS

Pharmacy and medical claims data from the Arkansas All-Payers Claims Database were linked to death certificates to identify decedents of suicide from 2013 through 2021. Psychotherapeutic medications were categorized using a National Drug Code (NDC) ontology from First DataBank®. The dispensed date and days' supply from pharmacy claims estimated when a decedent would exhaust any prescribed psychotherapeutic. A dichotomous variable indicated if a decedent exhausted at least one psychotherapeutic during the hazard window - the seven days leading up to and including the date of death. This exposure was compared to 11 control windows - the 11 weeks immediately preceding the hazard window. Conditional logistic regression analysis estimated the odds of exhausting at least one medication during the hazard window relative to the control windows.

RESULTS

Among 853 decedents who received 4375 psychotherapeutic prescriptions, 17.0 % exhausted at least one psychotherapeutic in the hazard window, the highest among all study windows. There was a 46 % increase in the odds of exhausting at least one psychotherapeutic during the hazard window compared to the control windows (AOR: 1.46; p = 0.0001).

CONCLUSION

There is a temporal relationship between exhausting at least one psychotherapeutic medication and suicide, highlighting the need for close monitoring of medication supply for patients treated with psychotherapeutics.

Differential effects of fine particulate matter constituents on acute coronary syndrome onset

Fine particulate matter has been linked with acute coronary syndrome. Nevertheless, the key constituents remain unclear. Here, we conduct a nationwide case-crossover study in China during 2015-2021 to quantify the associations between fine particulate matter constituents (organic matter, black carbon, nitrate, sulfate, and ammonium) and acute coronary syndrome, and to identify the critical contributors. Our findings reveal all five constituents are significantly associated with acute coronary syndrome onset. The magnitude of associations peaks on the concurrent day, attenuates thereafter, and becomes null at lag 2 day. The largest effects are observed for organic matter and black carbon, with each interquartile range increase in their concentrations corresponding to 2.15% and 2.03% increases in acute coronary syndrome onset, respectively. These two components also contribute most to the joint effects, accounting for 31% and 22%, respectively. Our findings highlight tailored clinical management and targeted control of carbonaceous components to protect cardiovascular health.

The short-term effects of individual and mixed ambient air pollutants on suicide mortality: A case-crossover study

It is critical to explore intervenable environmental factors in suicide mortality. Based on 30,688 suicide cases obtained from the Mortality Surveillance System of the Jiangsu Provincial Centre for Disease Control and Prevention, we utilized a case-crossover design, and found that the OR of suicide deaths increased by a maximum of 0.71 % (95 % CI: 0.09 %, 1.32 %), 0.68 % (95 % CI: 0.12 %, 1.25 %), 0.77 % (95 % CI: 0.19 %, 1.37 %), 2.95 % (95 % CI: 1.62 %, 4.29 %), 4.18 % (95 % CI: 1.55 %, 6.88 %), and 0.93 % (95 % CI: 0.10 %, 1.77 %), respectively, for per 10 μg/m3 increase in the particulate matter (PM) with diameters ≤ 2.5 µm (PM2.5), PM with diameters ≤ 10 µm (PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and per 0.1 mg/m3 increase in carbon monoxide (CO) concentrations with the conditional logistic regression analysis. People living in county-level cities were more susceptible. Particularly, a significant positive association was found between air pollutant mixture exposure and suicide deaths (OR=1.04,95 % CI: 1.01, 1.06). The excess fraction of suicide deaths due to air pollution reached a maximum of 8.07 %. In conclusion, we found associations between individual and mixed ambient air pollutants and suicide deaths, informing the development of integrated air pollution management and targeted measures for suicide prevention and intervention. ENVIRONMENTAL IMPLICATION: As a major contributor to the global burden of disease, air pollution was confirmed by accumulating studies to have adverse impact on mental health, and potentially lead to suicide deaths. However, systematic studies on the association between air pollution and suicide mortality are lacking. We explored the associations of multiple air pollutants and pollution mixtures with suicide deaths and assessed excess suicide mortality due to air pollution, emphasizing the importance of air pollution control on suicide prevention. Our study provides evidence to support mechanistic studies on the association between air pollution and suicide, and informs comprehensive air pollution management.

The short-term effect of ambient particulate matter on suicide death

BACKGROUND

Air pollution can cause various respiratory and neurological diseases and continuous exposure can lead to death. Previous studies have reported that particulate matter (PM) exposure increases the risk of depression, suicidal thoughts, and suicidal death; however, the results are inconsistent and limited. This study aimed to examine the relationship between short-term PM exposure and suicide deaths, as well as investigate the short-term effects of PM on suicide death within vulnerable groups based on factors such as sex, age group, suicide-related information (note, method, and cause), psychiatric disorders, and physical diseases.

METHODS

Data on a total of 28,670 suicide deaths from 2013 to 2017, provided by the Korea Foundation for Suicide Prevention, were analyzed. The study design employed a time-series analysis with a two-stage approach. In the first step, a generalized additive model combined with a distributed lag nonlinear model was used to estimate the short-term effect of PM exposure on suicide risk specific to each city. In the second step, the estimated results from each city were pooled through a meta-analysis to derive the overall effect. We determined the effects of single lag, cumulative lag, and moving average PM concentrations from days 0-7 before suicide.

RESULTS

We confirmed an association between exposure to PM10 (≤ 10 μm in diameter) and deaths due to suicide. In particular, among individuals with psychiatric disorders and those who employed non-violent suicide methods, increased exposure to PM10 was associated with a higher risk of death by suicide, with percentage changes of 5.92 (95% confidence interval [CI]: 3.95-7.92) and 11.47 (95% CI: 7.95-15.11), respectively. Furthermore, in the group with psychiatric disorders, there was an observed tendency of increasing suicide risk as PM10 levels increased up to 120 µg/m3, whereas in the group with non-violent suicide deaths, there was a pronounced trend of rapid increase in suicide risk with an increase in PM10 up to 100 µg/m3.

CONCLUSIONS

These results show an association between short-term exposure to PM and suicide. Our study adds evidence for the benefits of reducing PM in preventing diseases and improving mental health.

Youth Suicidality in the Context of Disasters

PURPOSE OF REVIEW

The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters.

RECENT FINDINGS

There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.

Updated assessment of occupational safety and health hazards of climate change

Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988-2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014-2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.

Hot weather and death related to acute cocaine, opioid and amphetamine toxicity in British Columbia, Canada: a time-stratified case-crossover study

BACKGROUND

Previous research has shown that cocaine-associated deaths occur more frequently in hot weather, which has not been described for other illicit drugs or combinations of drugs. The study objective was to evaluate the relation between temperature and risk of death related to cocaine, opioids and amphetamines in British Columbia, Canada.

METHODS

We extracted data on all deaths with cocaine, opioid or amphetamine toxicity recorded as an underlying or contributing cause from BC vital statistics for 1998-2017. We used a time-stratified case-crossover design to estimate the effect of temperature on the risk of death associated with acute drug toxicity during the warmer months (May through September). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each 10°C increase in the 2-day average maximum temperature at the residential location.

RESULTS

We included 4913 deaths in the analyses. A 10°C increase in the 2-day average maximum temperature was associated with an OR of 1.43 (95% CI 1.11-1.86) for deaths with only cocaine toxicity recorded (n = 561), an OR of 1.15 (95% CI 0.99-1.33) for deaths with opioids only (n = 1682) and an OR of 1.11 (95% CI 0.60-2.04) for deaths with amphetamines only (n = 133). There were also elevated effects when toxicity from multiple drugs was recorded. Sensitivity analyses showed differences in the ORs by sex, by climatic region, and when the location of death was used instead of the location of residence.

INTERPRETATION

Increasing temperatures were associated with higher odds of death due to drug toxicity, especially for cocaine alone and combined with other drugs. Targeted interventions are necessary to prevent death associated with toxic drug use during hot weather.

Daily changes in ambient air pollution concentrations and temperature and suicide mortality in Canada: Findings from a national time-stratified case-crossover study

INTRODUCTION

Worldwide, approximately 1900 people die by suicide daily. Daily elevations in air pollution and temperature have previously been linked to a higher risk of death from suicide. To date, there have been relatively few studies of air pollution and suicide, particularly at a national level. National analyses play an important role in shaping health policy to mitigate against adverse health outcomes.

METHODS

We used a time-stratified case-crossover study design to investigate the influence of short-term (i.e., day to day) interquartile range (IQR) increases in air pollutants (nitrogen dioxide [NO₂], ozone [O₃], and fine particulate matter [PM_2.5]) and temperature on suicide mortality in Canada between 2002 and 2015. For air pollution models, odds ratios (ORs) derived from conditional logistic regression models were adjusted for average daily temperature, and holidays. For temperature models, ORs were adjusted for holidays. Stratified analyses were undertaken by suicide type (non-violent and violent), sex, age, and season.

RESULTS

Analyses are based on 50,800 suicide deaths. Overall, temperature effects were stronger than those for air pollution. A same day IQR increase in temperature (9.6 °C) was associated with a 10.1% increase (95% confidence interval (CI): 9.0%-11.2%) of death from suicide. For 3-day average increase of O₃ (IQR = 14.1 ppb), PM_2.5 (IQR = 5.6 μg/m³) and NO₂ (IQR = 9.7 ppb) the corresponding risks were 4.7% (95% CI: 3.9, 5.6), 3.4% (95% CI: 3.0, 3.8), and 2.0% (95% CI: 1.1, 2.8), respectively. All pollutants showed stronger associations with suicide during the warmer season (April-September). Stratified analyses revealed stronger associations for both temperature and air pollution in women.

CONCLUSIONS

Daily increases in air pollution and temperature were found to increase the risk of death from suicide. Females, particularly during warmer season, were most vulnerable to these exposures. Policy decisions related to air pollution and climate change should consider effects on mental health.

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.

Affective disorder and brain alterations in children and adolescents exposed to outdoor air pollution

BACKGROUND

Childhood and adolescence are critical periods for the development of the brain. However, a limited number of studies have explored how air pollution may associate with affective symptoms in youth.

METHODS

We performed a comprehensive review of the existing research on the associations between outdoor air pollution and affective disorders, suicidality, and the evidence for brain changes in youth. PRISMA guidelines were followed and PubMed, Embase, Web of Science, Cochrane Library, and PsychINFO databases were searched from their inception to June 2022.

RESULTS

From 2123 search records, 28 papers were identified as being relevant for studying the association between air pollution and affective disorders (n = 14), suicide (n = 5), and neuroimaging-based evidence of brain alterations (n = 9). The exposure levels and neuropsychological performance measures were highly heterogeneous and confounders including traffic-related noise, indoor air pollution, and social stressors were not consistently considered. Notwithstanding, 10 out of the 14 papers provide evidence that air pollution is associated with increased risk of depression symptoms, and 4 out of 5 papers provide evidence that air pollution might trigger suicidal attempts and behaviors. Besides, 5 neuroimaging studies revealed decreased gray-matter volume in the Cortico-Striato-Thalamo-Cortical neurocircuitry, and two found white matter hyperintensities in the prefrontal lobe.

CONCLUSIONS

Outdoor air pollution is associated with increased risks of affective disorders and suicide in youth, and there is evidence for associated structural and functional brain abnormalities. Future studies should determine the specific effects of each air pollutant, the critical exposure levels, and population susceptibility.

Is the excellent air quality a protective factor of health problems for Taitung County in eastern Taiwan? Perspectives from visual analytics

Taitung, an agricultural country in Eastern Taiwan, was famous for its fresh air with less industrial and petrochemical pollution. Air pollution may induce cardiovascular disease, chronic obstructive pulmonary disease (COPD), asthma, and stroke, poor air quality also resulted in a higher depression rate and less feeling of happiness; therefore, our study aims to use visualization tools to demonstrate the association between air quality index (AQI) and the among negative factors and try to find that whether Taitung got the benefit of good air quality on health issues. We retrieved data from the government of Taiwan and other open sources in the year 2019, then visual maps and generalized association plots with clusters demonstrated the relationship between each factor and each county/city. Taitung had the lowest AQI and asthma attack rate, but AQI had a negative relationship to air pollution-caused death (R = -0.379), happiness index (R = -0.358), and income (R = -0.251). The GAP analysis revealed that smoke and overweight were the nearest to air pollution causing death, also counties and cities were divided into two major clusters initially based on the air pollution-related variables. In conclusion, the World Health Organization (WHO) definition and the weight of each air pollution cause death may not be suitable for Taiwan due to too many confounding factors.

Urban green spaces and suicide mortality in Belgium (2001-2011): A census-based longitudinal study

BACKGROUND

Exposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality.

METHODS

We used data from the 2001 Belgian census linked to mortality register data (2001-2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10-Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO₂) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness.

RESULTS

We observed a 7% (95%CI 0.89-0.97) and 6% (95%CI 0.90-0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO₂. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods.

CONCLUSION

Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.

The mental health and well-being effects of wildfire smoke: a scoping review

BACKGROUND

Smoke from wildfires is a growing public health risk due to the enormous amount of smoke-related pollution that is produced and can travel thousands of kilometers from its source. While many studies have documented the physical health harms of wildfire smoke, less is known about the effects on mental health and well-being. Understanding the effects of wildfire smoke on mental health and well-being is crucial as the world enters a time in which wildfire smoke events become more frequent and severe. We conducted a scoping review of the existing information on wildfire smoke's impact on mental health and well-being and developed a model for understanding the pathways in which wildfire smoke may contribute to mental health distress.

METHODS

We conducted searches using PubMed, Medline, Embase, Google, Scopus, and ProQuest for 1990-2022. These searches yielded 200 articles. Sixteen publications met inclusion criteria following screening and eligibility assessment. Three more publications from the bibliographies of these articles were included for a total of 19 publications.

RESULTS

Our review suggests that exposure to wildfire smoke may have mental health impacts, particularly in episodes of chronic and persistent smoke events, but the evidence is inconsistent and limited. Qualitative studies disclose a wider range of impacts across multiple mental health and well-being domains. The potential pathways connecting wildfire smoke with mental health and well-being operate at multiple interacting levels including individual, social and community networks, living and working conditions, and ecological levels.

CONCLUSIONS

Priorities for future research include: 1) applying more rigorous methods; 2) differentiating between mental illness and emotional well-being; 3) studying chronic, persistent or repeated smoke events; 4) identifying the contextual factors that set the stage for mental health and well-being effects, and 5) identifying the causal processes that link wildfire smoke to mental health and well-being effects. The pathways model can serve as a basis for further research and knowledge synthesis on this topic. Also, it helps public health, community mental health, and emergency management practitioners mitigate the mental health and well-being harms of wildfire smoke.

Daylight saving time affects European mortality patterns

Daylight saving time (DST) consists in a one-hour advancement of legal time in spring offset by a backward transition of the same magnitude in fall. It creates a minimal circadian misalignment that could disrupt sleep and homoeostasis in susceptible individuals and lead to an increased incidence of pathologies and accidents during the weeks immediately following both transitions. How this shift affects mortality dynamics on a large population scale remains, however, unknown. This study examines the impact of DST on all-cause mortality in 16 European countries for the period 1998-2012. It shows that mortality decreases in spring and increases in fall during the first two weeks following each DST transition. Moreover, the alignment of time data around DST transition dates revealed a septadian mortality pattern (lowest on Sundays, highest on Mondays) that persists all-year round, irrespective of seasonal variations, in men and women aged above 40.

Escaping from Air Pollution: Exploring the Psychological Mechanism behind the Emergence of Internal Migration Intention among Urban Residents

Rapid urbanization with poor city planning has resulted in severe air pollution in urban areas of low- and middle-income countries. Given the adverse impacts of air pollution, citizens may develop ideation of averting behaviors, including migration to another region. The current study explores the psychological mechanism and demographic predictors of internal migration intention among urban people in Hanoi, Vietnam-one of the most polluted capital cities in the world. The Bayesian Mindsponge Framework (BMF) analytics was used to construct a model and perform Bayesian analysis on a stratified random sampling dataset of 475 urban people. We found that migration intention was negatively associated with an individual's satisfaction with air quality. The association was moderated by the perceived availability of a nearby alternative (i.e., a nearby province/city with better air quality). The high migration cost due to geographical distance made the moderation effect of the perceived availability of a faraway alternative negligible. These results validate the proposed psychological mechanism behind the emergence of migration intention. Moreover, it was found that male and young people were more likely to migrate. While the brain drain effect did not clearly show, it is likely due to complex underlying interactions of various related factors (e.g., age and gender). The results hint that without air pollution mitigation measures, the dislocation of economic forces might occur and hinder sustainable urban development. Therefore, collaborative actions among levels of government, with the environmental semi-conducting principle at heart, are recommended to reduce air pollution.

The Public's Perceptions of Air Pollution. What's in a Name?

Air pollution is a major global health threat. There is growing evidence for a negative effect of air pollution on health and well-being. Relationships between air pollution and health are mediated by health risk perceptions and play a crucial role in public response to it. Air pollution in the public's mind is often different from air pollution defined by the scientific community. Therefore, in order to develop successful prevention and alleviation strategies, an understanding of public risk perceptions is key. The central question of this paper is: 'How does "the public" (in Brussels) perceive air pollution?' This research is an attempt to enrich the limited body of qualitative research in the field, approaching the topic of perception from 4 different, complementary angles: definition, association, categorisation and problematisation. About 51 interviews were conducted in the Brussels-Capital Region. Consistent with earlier research, this research illustrates that perceptions of air pollution are diverse, subjective, context-dependent and often deviate from conceptualisations and definitions in the scientific community. Respondents underestimate the potential harm and problematisation depends on comparative strategies and perceived avoidability. The novel aspect of this paper is the identification of 5 mental schemes by which specific elements are categorised as being air pollution: (1) the source of the element, (2) its health impact, (3) its climate impact, (4) its functionality and (5) sensory perceptions. The insights gained from this research contribute to the field of environmental epidemiology through a better understanding of how 'the public' perceives air pollution and in what way this may deviate from how it is perceived by experts. We hope to raise the awareness among experts and policy makers that air pollution perceptions are far from universal and consensual but on the contrary individual and contested.

Children mirror adults for the worse: evidence of suicide rates due to air pollution and unemployment

Background

Every year, more than 700,000 people die due to suicide, one of the most common reasons for youth death. While many studies have revealed two main factors for suicidal behavior: impulsive suicidal behavior due to mental illness and financial stress, it is not clear what happens if individuals face deterioration of mental health and economic recession. This paper attempts to answer this question and how suicide rates are correlated with these factors.

Methods

We empirically investigate whether economic recessions and air pollution trigger suicides by examining Japan, a country with one of the highest suicide rates, from 2014 to 2021. We take advantage of the characteristics of the COVID-19 pandemic and the periods before the pandemic, when both economic recessions and reductions in air pollution occurred simultaneously. Using monthly and municipal- level data, we construct a triple difference model that takes air pollution and unemployment as treatments.

Results

Our findings show that high (upper half of each period) levels of air pollution and unemployment have substantial impacts on the suicide rates of adults (22.9% in the short term) and children (42.7% in the short term, 36.0% in the long term), indicating that the increase in suicide rates among children is almost twice as high as that among adults. Our study finds that unemployment and air pollution alone are not associated with increased suicide rates but their simultaneous occurrence triggers suicides during the pandemic.

Conclusions

Our study urges suicide prevention, particularly among children, as an essential consideration for public health. Furthermore, our results indicate the need for the government to allocate resources to recover air quality and the economy simultaneously during a recession to reduce suicide mortality of both child and adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14013-y.

Short-Term exposure to ambient air pollution and onset of work incapacity related to mental health conditions

The OECD estimates that greater work absenteeism is one of the main drivers behind the impact of air pollution on gross domestic product loss, but research linking air pollution with work absenteeism is scarce. With air pollution increasingly being linked to poor mental health, and poor mental health having become one of the main reasons for work absenteeism, we examined whether the onset of work incapacity related to mental health conditions is associated with short-term fluctuations in ambient black carbon (BC), nitrogen dioxide (NO₂), ozone (O₃), and particulate matter 2.5 (PM_2.5), estimating the contributions of these pollutants jointly, while accounting for relative humidity, total solar radiation and temperature. We conducted a bidirectional time-stratified case-crossover study with daily air pollution estimates by municipality linked with 12 270 events of work incapacity related to mental health conditions in 2019 in Belgium. We ran single- and multi-pollutant conditional logistic regression models for three different exposure windows (lag 0, 0-1 and 0-2), considering potential confounding by relative humidity and total solar radiation. We observed positive associations between work incapacity related to mental health conditions and BC, NO₂, and O₃ exposure, but findings for PM_2.5 were inconsistent. Results from multi-pollutant models showed a 12% higher risk of work incapacity for an IQR increase in NO₂ and O₃ at the day of the event (lag 0), with estimates increasing to about 26% for average concentrations up to two days before the event (lag 0-2). We found evidence for effect modification by age and season in the association with NO₂, with highest effect estimates in the age group 40-49 years and in spring and summer. For O₃, we observed effect modification by type of mental health problem. This country-wide study suggests that air pollution aggravates within 48 h a likely existing propensity to enter work incapacity because of mental health conditions.

Association of short-term particulate matter exposure with suicide death among major depressive disorder patients: a time-stratified case-crossover analysis

There is growing evidence that suggests a potential association between particulate matter (PM) and suicide. However, it is unclear that PM exposure and suicide death among major depressive disorder (MDD) patients, a high-risk group for suicide. We aimed to assess the effect of short-term exposure to PM on the risk of suicide in MDD patients who are at high risk for suicide. We investigated the risk of suicide among 922,062 newly-diagnosed MDD patients from 2004 to 2017 within the Korean National Health Insurance Service (NHIS) database. We identified 3,051 suicide cases from January 1, 2015, to December 31, 2017, within the death statistics database of the Korean National Statistical Office. PMs with aerodynamic diameter less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 2.5–10 μm (PM2.5–10) were considered, which were provided from the National Ambient Air Monitoring System in South Korea. Time-stratified case-crossover analysis was performed to investigate the association of particulate matter exposure to suicide events. The risk of suicide was significantly high upon the high level of exposure to PM2.5, PM2.5–10 (coarse particle) and PM10 on lag 1 (p for trend < 0.05). Short-term exposure to a high level of PM was associated with an elevated risk for suicide among MDD patients. There is a clear dose–response relationship between short-term PM exposures with suicide death among MDD patients. This result will be used as an essential basis for consideration when establishing an air pollution alarm system for reducing adverse health outcomes by PM.

High temperatures trigger suicide mortality in Brussels, Belgium: A case-crossover study (2002-2011)

BACKGROUND

Temperature may trigger the risk of suicide, however, the extent and shape of the associations show geographical variation. Here, we investigate the short-term effects of temperature on suicide deaths occurring in Brussels between January 1st, 2002 and December 31st, 2011.

METHODS

We conducted a bidirectional time-stratified case-crossover study with cases being suicide deaths occurring among Brussels residents aged 5 years or older. Cases were matched by day of the week with control days from the same month and year. The exposure was the daily average temperature measured at the Uccle station (Brussels) and obtained from the Belgian Royal Meteorological Institute. We combined conditional logistic regression with distributed lag non-linear models (DLNM) to obtain one week (lag 0-6) cumulative risk ratios (RR) and their 95% confidence intervals (CI) for the effects of moderate and extreme cold (5th and 1st percentiles of temperature, respectively) and moderate and extreme heat (95th and 99th percentiles of temperature, respectively), relative to the median temperature.

RESULTS

In total, 1891 suicide deaths were included. The median temperature was 11.6 °C, moderate and extreme cold temperatures were 0 and -3.1 °C, respectively, and moderate and extreme high temperatures were 20.9 and 24.4 °C, respectively. The cumulative risk of suicide mortality was almost twice higher among lags 0 to 6 for both moderate and extreme heat, relative to the period median temperature (e.g. moderate heat RR = 1.80 CI:1.27-2.54). No statistically significant associations were observed for cold temperatures.

CONCLUSIONS

In Brussels, a western European city with temperate climate, high temperatures may trigger suicide deaths up to one week later. In the context of climate change, adaptation strategies must take into consideration the effects of temperature on mental health.

Brain Drain out of the Blue: Pollution-Induced Migration in Vietnam

Air pollution is a major problem that severely affects the health of inhabitants in developing countries’ urban areas. To deal with the problem, they may consider migration to another place as an option, which can result in the loss of skillful and talented workforces. This situation is called the brain drain phenomenon. The current study employed the Bayesian mindsponge framework (BMF) on the responses of 475 urban inhabitants in Hanoi, Vietnam—one of the most polluted capital cities in the world—to examine the risk of losing talented workforces due to air pollution. Our results show that people with higher educational levels are more likely to have intentions to migrate both domestically and internationally due to air pollution. Regarding the domestic migration intention, younger people and males have a higher probability of migrating than their counterparts. Age and gender also moderate the association between educational level and international migration intention, but their reliability needs further justification. Based on these findings, we suggest that environmental stressors caused by air pollution can influence citizen displacement intention on a large scale through the personal psychological mechanism of cost-benefit judgment. Due to the risk of air pollution on human resources, building an eco-surplus culture is crucial for enhancing environmental and socio-economic resilience.

Air pollution in association with mental and self-rated health and the mediating effect of physical activity

BACKGROUND

Recent studies showed that air pollution might play a role in the etiology of mental disorders. In this study we evaluated the association between air pollution and mental and self-rated health and the possible mediating effect of physical activity in this association.

METHODS

In 2008, 2013 and 2018 the Belgian Health Interview Survey (BHIS) enrolled 16,455 participants who completed following mental health dimensions: psychological distress, suboptimal vitality, suicidal ideation, and depressive and generalized anxiety disorder and self-rated health. Annual exposure to nitrogen dioxide (NO₂), particulate matter ≤ 2.5 µm (PM_2.5) and black carbon (BC) were estimated at the participants' residence by a high resolution spatiotemporal model. Multivariate logistic regressions were carried out taking into account a priori selected covariates.

RESULTS

Long-term exposure to PM_2.5, BC and NO₂ averaged 14.5, 1.4, and 21.8 µg/m³, respectively. An interquartile range (IQR) increment in PM_2.5 exposure was associated with higher odds of suboptimal vitality (OR = 1.27; 95% CI: 1.13, 1.42), poor self-rated health (OR = 1.20; 95% CI: 1.09, 1.32) and depressive disorder (OR = 1.19; 95% CI: 1.00, 1.41). Secondly, an association was found between BC exposure and higher odds of poor self-rated health and depressive and generalized anxiety disorder and between NO₂ exposure and higher odds of psychological distress, suboptimal vitality and poor self-rated health. No association was found between long-term ambient air pollution and suicidal ideation or severe psychological distress. The mediation analysis suggested that between 15.2% (PM_2.5-generalized anxiety disorder) and 40.1% (NO₂-poor self-rated health) of the association may be mediated by a difference in physical activity.

CONCLUSIONS

Long-term exposure to PM_2.5, BC or NO₂ was adversely associated with multiple mental health dimensions and self-rated health and part of the association was mediated by physical activity. Our results suggest that policies aiming to reduce air pollution levels could also reduce the burden of mental health disorders in Belgium.

Investigating relationship between particulate matter air concentrations and suicides using geographic information system

Exposure to particulate matter is an important risk factor for mental health disturbances and overall mortality. However, the knowledge on relationship between long-term particulate matter level and suicide rate is limited and requires in-depth study. Population and air pollution data were obtained from the Polish Central Statistics Office and Chief Inspectorate of Environmental Protection for the period 2014-2015. Aspatial multivariate and one factor regression analysis were performed and followed by spatial global regression analysis for district reference units in geographic information system (GIS). At the district level of aggregation, data showed spatial stationarity. The best-fitting spatial global model was based on number of disorders caused by the use of psychoactive substances, number of people treated in psychiatric hospitals, population density, unemployment rate and per capita income. Global spatial model with PM2.5 level parameter was an improvement over the one without it (adj. R2 = 0.87 compared to adj. R2 = 0.83). There is a positive relationship between particular matter concentrations and suicides in Poland. Application of Geographic Information Science analytical functions in medicine can be viewed as a new efficient methodological approach.

Exposure to ambient air pollution during childhood and subsequent risk of self-harm: A national cohort study

A growing body of evidence indicates that exposure to air pollution not only impacts on physical health but is also linked with a deterioration in mental health. We conducted the first study to investigate exposure to ambient particulate matter with an aerodynamic diameter of less than 2.5 μm (PM_2.5) and nitrogen dioxide (NO₂) during childhood and subsequent self-harm risk. The study cohort included persons born in Denmark between January 1, 1979 and December 31, 2006 (N = 1,424,670), with information on daily exposures to PM_2.5 and NO₂ at residence from birth to 10th birthday. Follow-up began from 10th birthday until first hospital-presenting self-harm episode, death, or December 31, 2016, whichever came first. Incidence rate ratios estimated by Poisson regression models revealed a dose relationship between increasing PM_2.5 exposure and rising self-harm risk. Exposure to 17-19 μg/m³ of PM_2.5 on average per day from birth to 10th birthday was associated with a 1.45 fold (95% CI 1.37-1.53) subsequently elevated self-harm risk compared with a mean daily exposure of <13 μg/m³, whilst those exposed to 19 μg/m³ or above on average per day had a 1.59 times (1.45-1.75) elevated risk. Higher mean daily exposure to NO₂ during childhood was also linked with increased self-harm risk, but the dose-response relationship observed was less evident than for PM_2.5. Covariate adjustment attenuated the associations, but risk remained independently elevated. Although causality cannot be assumed, these novel findings indicate a potential etiological involvement of ambient air pollution in the development of mental ill health.

Silent but Damaging: Exploring the Link Between Air Pollution and Vocational and General Well-Being

Air pollution has become a daunting challenge with the potential to endanger people’s lives across the globe. However, little is known about the psychological and vocational implications of air pollution. Drawing on feeling-as-information theory, we investigate the within-person relationships of ambient air pollution with vocational and general well-being outcomes (i.e., career choice anxiety and state optimism) through the mediating mechanism of mood state. We tested our hypotheses using an experience sampling method (ESM) with survey data from 67 undergraduate students in South Korea collected over 10 consecutive days. Results showed that daily ambient air pollution predicted higher career choice anxiety and lower state optimism via an increased negative mood. Furthermore, the indirect relation of air pollution with career choice anxiety was found to be stronger for individuals with lower family socioeconomic status. In a supplementary study, we interviewed 16 undergraduate students in South Korea to explain the ESM results in greater depth. Theoretical and practical implications, as well as study limitations, are discussed.

Effects of Air Pollution on Assaults: Findings from South Korea

This study investigates the effects of concentration of air pollution on assault rates for 204 police districts of South Korea from 2001 to 2018. A series of panel spatial Durbin models for the concentration of ozone, fine dust, and nitrogen dioxide—three key air pollutants of the country—identify the significant impacts of air pollution on assault rates that vary from each other. Ozone is expected to induce more assaults both locally and regionally. Fine dust decreases assault rates of an area and also in neighboring areas. Nitrogen dioxide yields positive effects on the surrounding areas’ assault rates but not in area of pollution itself. Findings of this study suggest the need to incorporate active measures on air pollution and violent crime at both city and inter-city levels. They also propose the active sharing of information on air pollution and crime between cities and regions as a collaborative response.

The Effect of Meteorological, Pollution, and Geographic Exposures on Death by Suicide: A Scoping Review

Suicide is a significant public health concern worldwide and in the United States. Despite the far-reaching impact of suicide, risk factors are still not well understood and efforts to accurately assess risk have fallen short. Current research has highlighted how potentially modifiable environmental exposures (i.e., meteorological, pollution, and geographic exposures) can affect suicide risk. A scoping review was conducted to evaluate the strength of the historical and current literature on the environment’s effect on suicide and suicide risk. Three databases (i.e., Medline, Embase, and PsychInfo) were reviewed to identify relevant studies and two authors independently reviewed studies considering pre-determined inclusion criteria. A total of 46 meteorological studies were included as well as 23 pollution studies and 12 geographic studies. Descriptive statistics, including counts, percentages, review of studies’ sample size (minimum, maximum, median, and interquartile range), were calculated using Excel and SAS 9.4. Overall, strong evidence supports that exposure to sunlight, temperature, air pollution, pesticides, and high altitude increases suicide risk, although effect sizes range from very small to small.

Qualitative research about public health risk perceptions on ambient air pollution. A review study

Background

Understanding public health risk perceptions is essential in efficient environmental health management. In the light of the negative impact of air pollution on health and the direct and indirect mediation of this impact through risk perceptions, it is crucial to better understand the lay perceptions of air pollution. Since qualitative research methods are well suited for this aim, the central objective of this study is to present a review of qualitative research articles in the field of environmental epidemiology that investigate health risk perceptions of ambient air pollution since the 2000s.

Methods

We followed the PRISMA-guidelines which resulted in a selection of 20 scientific articles published in peer-reviewed academic journals that used qualitative research methods and reported on health risk perceptions about ambient air pollution.

Results

Qualitative research in the field of environmental epidemiology is still scarce. Most of the studies included in the review were based on face-to-face interviews and focus group discussions; a minority used a mixed-method approach. Interesting contributions were made with respect to both the perception of exposure to air pollution and the perception of the health effect associated with air pollution.

Conclusions

The review suggests that data generated through qualitative research might complement the traditionally quantitative field of environmental epidemiology. Mixed method multidisciplinary research is likely to provide a more holistic explanation of environmental health patterns observed through quantitative research. These explanations are key in managing environmental health and in developing successful prevention, mitigation and communication strategies. Implementing qualitative research methods contribute to the field of environmental epidemiology as it i) allows for triangulation of findings; ii) generates nuanced findings and new research questions; iii) triggers in-depth understandings of quantitatively identified patterns; iv) leads to additional surprising and/or multifaceted responses; v) enhances relationships between researcher and respondent; vi) increases the awareness of important context-dependent dynamics or interactions that may generate biases and vii) grasps the local, contextual, situational and cultural elements that interact with health risk perceptions.

•

Qualitative research in the field of environmental epidemiology is scarce.

•

Qualitative research data (QRD) can contribute to understand perceptions about exposure to air pollution and its effects.

•

QRD can complement the traditionally quantitative field of environmental epidemiology.

•

Mixed methods multidisciplinary research is likely to provide the most holistic explanations for environmental health research.

•

These explanations are key in managing environmental health.

Suicide and Associations with Air Pollution and Ambient Temperature: A Systematic Review and Meta-Analysis

Given health threats of climate change, a comprehensive review of the impacts of ambient temperature and ar pollution on suicide is needed. We performed systematic literature review and meta-analysis of suicide risks associated with short-term exposure to ambient temperature and air pollution. Pubmed, Scopus, and Web of Science were searched for English-language publications using relevant keywords. Observational studies assessing risks of daily suicide and suicide attempts associated with temperature, particulate matter with aerodynamic diameter ≤10 μm (PM₁₀) and ≤2.5 mm (PM_2.5), ozone (O₃), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO) were included. Data extraction was independently performed in duplicate. Random-effect meta-analysis was applied to pool risk ratios (RRs) for increases in daily suicide per interquartile range (IQR) increase in exposure. Meta-regression analysis was applied to examine effect modification by income level based on gross national income (GNI) per capita, national suicide rates, and average level of exposure factors. In total 2274 articles were screened, with 18 studies meeting inclusion criteria for air pollution and 32 studies for temperature. RRs of suicide per 7.1 °C temperature was 1.09 (95% CI: 1.06, 1.13). RRs of suicide per IQR increase in PM_2.5, PM₁₀, and NO₂ were 1.02 (95% CI: 1.00, 1.05), 1.01 (95% CI: 1.00, 1.03), and 1.03 (95% CI: 1.00, 1.07). O₃, SO₂, and CO were not associated with suicide. RR of suicide was significantly higher in higher-income than lower-income countries (1.09, 95% CI: 1.07, 1.11 and 1.20, 95% CI: 1.14, 1.26 per 7.1 °C increased temperature, respectively). Suicide risks associated with air pollution did not significantly differ by income level, national suicide rates, or average exposure levels. Research gaps were found for interactions between air pollution and temperature on suicide risks.

The association between ozone and fine particles and mental health-related emergency department visits in California, 2005-2013

Recent studies suggest that air pollutant exposure may increase the incidence of mental health conditions, however research is limited. We examined the association between ozone (O3) and fine particles (PM2.5) and emergency department (ED) visits related to mental health outcomes, including psychosis, neurosis, neurotic/stress, substance use, mood/affective, depression, bipolar, schizotypal/delusional, schizophrenia, self-harm/suicide, and homicide/inflicted injury, from 2005 through 2013 in California. Air monitoring data were provided by the U.S. EPA's Air Quality System Data Mart and ED data were provided by the California Office of Statewide Health Planning and Development. We used the time-series method with a quasi-Poisson regression, controlling for apparent temperature, day of the week, holidays, and seasonal/long-term trends. Per 10 parts per billion increase, we observed significant cumulative 7-day associations between O3 and all mental health [0.64%, 95% confidence interval (CI): 0.21, 1.07], depression [1.87%, 95% CI: 0.62, 3.15], self-harm/suicide [1.43%, 95% CI: 0.35, 2.51], and bipolar [2.83%, 95% CI: 1.53, 4.15]. We observed 30-day lag associations between O3 and neurotic disorder [1.22%, 95% CI: 0.48, 1.97] and homicide/inflicted injury [2.01%, 95% CI: 1.00, 3.02]. Same-day mean PM2.5 was associated with a 0.42% [95% CI: 0.14, 0.70] increase in all mental health, 1.15% [95% CI: 0.62, 1.69] increase in homicide/inflicted injury, and a 0.57% [95% CI: 0.22, 0.92] increase in neurotic disorders per 10 μg/m3 increase. Other outcomes not listed here were not statistically significant for O3 or PM2.5. Risk varied by age group and was generally greater for females, Asians, and Hispanics. We also observed seasonal variation for outcomes including but not limited to depression, bipolar, schizophrenia, self-harm/suicide, and homicide/inflicted injury. Ambient O3 or PM2.5 may increase the risk of mental health illness, though underlying biological mechanisms remain poorly understood. Findings warrant further investigation to better understand the impacts of air pollutant exposure among vulnerable groups.

Association between particulate matter air pollution and risk of depression and suicide: a systematic review and meta-analysis

An increasing number of studies examined the potential effects of ambient particulate matter (PM: PM2.5 and PM10-PMs with diameters not greater than 2.5 and 10 μm, respectively) pollution on the risk of depression and suicide; however, the results have been inconclusive. This study aimed to determine the overall relationship between PM exposure and depression/suicide based on current evidence. We conducted a systematic review and meta-analysis of current available studies. Thirty articles (20 for depression and 10 for suicide) with data from 1,447,313 participants were included in the meta-analysis. For a 10 μg/m3 increase in short-term exposure to PM2.5, we found a 2% (p < 0.001) increased the risk of depression and a 2% (p = 0.001) increased risk of suicide. A 10 μg/m3 increase in long-term exposure to PM2.5 was associated with a more apparent increase of 18% (p = 0.005) in depression risk. In addition, a 10 μg/m3 increase in short-term exposure to PM10 was associated with a 2% (p = 0.003) increase in depression risk and a 1% (p = 0.002) increase in suicide risk. Subgroup analyses showed that associations between PM and depression were more apparent in people over 65 years and from developed regions. Besides, the study design and study quality might also have an impact on their associations. The meta-analysis found that an increase in ambient PM concentration was strongly associated with an increased risk of depression and suicide, and the associations for depression appeared stronger for smaller particles (PM2.5) and at a long-term time pattern.

Association of suicide with short-term exposure to air pollution at different lag times: A systematic review and meta-analysis

BACKGROUND

Suicide is a major public health problem, with some environmental risk factors.

OBJECTIVES

This meta-analysis study explored the association between short-term exposure to air pollution and suicide mortality, with an emphasis on different lag times.

METHODS

A systematic search was used to find relevant studies in databases including Scopus, Web of Knowledge, Pubmed, and Embase published up to 19 May 2020. The inclusion criteria included case-crossover or time-series studies assessing the association of criteria air pollutants with suicide mortality at different Lag Days of 0-7 (LD0 to LD7) and Cumulative Lags of 1-7 days (CL1 to CL7). Odds ratios (OR) were calculated with 95% confidence intervals (CI).

RESULTS

Of 1436 retrieved articles, 11 were eligible for data extraction, representing data on 283,550 suicides published between 2010 and 2019. The odds of suicide death increase with each 10 μg/m³ increase in the mean concentrations of NO₂ at CL1 (1.013: 1.006-1.021), CL2 (1.028: 1.003-1.053), CL3 (1.035: 1.001-1.070), and LD2 (1.011: 1.001-1.022), SO₂ at CL1 (1.024: 1.014-1.034), CL2 (1.030: 1.012-1.048), CL3 (1.029: 1.009-1.049), and CL4 (1.027: 1.005-1.049), O₃ at CL6 (1.008: 1.000-1.016), PM₁₀ at CL1 (1.004: 1.000-1.008), and PM_2.5 at CL1 (1.017: 1.003-1.031). Besides, the odds of suicide death increases with each 0.5 mg/m³ increase in the mean concentration of CO at LD6 (1.005: 1.000-1.011). However, it decreased with increased O₃ exposure at LD3 (0.997: 0.994-1.000).

CONCLUSION

The study supports a positive association between air pollution and suicide mortality. No immediate risk was elucidated but the possible effects seem to be exerted cumulatively.

Meteorological Variables and Suicidal Behavior: Air Pollution and Apparent Temperature Are Associated With High-Lethality Suicide Attempts and Male Gender

This study analyzed the impact of meteorological variables and high-lethality suicide attempts (HLSA) to assess a potential time shift of HLSA affected by climate evolution to predict the suicide attempt cases over different periods of the year. After attempting suicide, 225 subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the psychiatric unit from March 2016 to July 2018. Socio-demographic and clinical characteristics as well as the meteorological variables were collected. The Mann-Kendall test as well as redundancy and cross-correlation analyses were performed to analyze the trends, statistically correlations, and correspondence of the trends, respectively between suicidal behaviors and climatic factors. Sixty-seven (29.8%) committed a HLSA. Our findings indicate a significant association between HLSA and male gender and apparent temperature with a strong correlation of 75% with a phase shift of -1 month. Solar radiation and air pollution (PM_2.5) have a positive correlation of 65 and 32%, respectively, with a zero-time lag. Limitations include that the data are limited to a single hospital; psychological factors, or other clinical variables that could be ruled out as a trigger have not been considered. Meteorological variables may not mirror the temperature that the patient is exposed to due to the air conditioning systems. Exploring those environmental factors associated with HLSA in a more detailed manner could lead to early intervention and prevention strategies for such distressing admissions.

Environmental exposures and health behavior in association with mental health: a study design

BACKGROUND

Air pollution, green space and smoking are known to affect human health. However, less is known about their underlying biological mechanisms. One of these mechanisms could be biological aging. In this study, we explore the mediation of biomarkers of exposure and biological aging to explain the associations between environmental exposures, health behavior and mental health.

METHODS

The study population of this cross-sectional study (n = 1168) is a subsample of the Belgian 2018 Health Interview Survey (BHIS). Mental health indicators including psychological and severe psychological distress, life satisfaction, vitality, eating disorders, suicidal ideation, subjective health and depressive and anxiety disorders, demographics and health behavior such as smoking are derived from the BHIS. Urine and blood samples are collected to measure respectively the biomarkers of exposure (urinary black carbon (BC) and (hydroxy)cotinine) and the biomarkers of biological aging (mitochondrial DNA content (mtDNAc) and telomere length (TL)). Recent and chronic exposure (μg/m3) to nitrogen dioxide (NO2), particulate matter ≤2.5 μm (PM2.5) and ≤ 10 μm (PM10) and BC at the participants' residence are modelled using a high resolution spatial temporal interpolation model. Residential green space is defined in buffers of different size (50 m - 5000 m) using land cover data in ArcGIS 10 software. For the statistical analysis multivariate linear and logistic regressions as well as mediation analyses are used taking into account a priori selected covariates and confounders.

RESULTS

As this study combined data of BHIS and laboratory analyses, not all data is available for all participants. Therefore, data analyses will be conducted on different subsets. Data on air pollution and green space exposure is available for all BHIS participants. Questions on smoking and mental health were answered by respectively 7829 and 7213 BHIS participants. For biomarker assessment, (hydroxy) cotinine, urinary BC and the biomarkers of biological aging are measured for respectively 1130, 1120 and 985 participants.

CONCLUSION

By use of personal markers of air pollution and smoking, as well as biological aging, we will gain knowledge about the association between environmental exposures, health behavior, and the mental health status. The results of the study can provide insights on the health of the Belgian population, making it a nationwide interesting study.

Suicide and apparent temperature in the two capitals cities in the iberian peninsula

Different authors have identified geographic variations in the rates of suicide. This study aims to discuss the limitations of the officially recorded suicide data and to evaluate the statistical relationship between a biometeorological index, Apparent Temperature (AT), and suicide in Madrid and Lisbon. We performed a time-series study. The association was analyzed using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of AT on suicides, a lag non-linear model was fitted in a generalized additive model. There was an average rate of 3.30 suicides/100,000 inhabitants in Madrid and of 7.92 suicides/100,000 inhabitants in Lisbon, and a downward trend was found throughout the period. In Madrid, there is no statistically significant association between AT and suicide. However, in Lisbon, under higher AT, there was a higher risk of suicide. The highest accumulated statistically significant Relative Risk (RR) of suicide was detected at 7 days after the exposure, when at 38 °C, the risk of suicide is 2.7 times that existing at the median AT, 20.62°. The average mortality rate recorded in Lisbon was 41.6% higher than that registered in Madrid. However, the limitations of suicide record databases in Spain and Portugal have to be taken into account when analyzing incidence and especially when comparing data from different countries. It is necessary to improve the filing systems of violent deaths in order to perform reliable epidemiological studies.

Long-term effects of ambient air pollutants on suicidal ideation in China: The Henan Rural Cohort Study

BACKGROUND

The association between ambient air pollutants exposure and suicidal ideation (SI) has rarely been explored, especially in Chinese population. Therefore, we aimed to investigate the long-term effects of ambient air pollutants on SI among a Chinese rural population.

METHOD

We recruited 29997 participants from the Henan Rural Cohort study in 2016-2017. SI was evaluated by using the ninth item of the Patient Health Questionnaire-9 (PHQ-9) in the baseline survey. We adopted a satellite-based spatiotemporal model to estimate participants' exposure to particulate matters (PMs) (PM with an aerodynamic diameter ≤1 μm (PM₁), ≤2.5 μm (PM_2.5) or ≤10 μm (PM₁₀), respectively) and nitrogen dioxide (NO₂), and then calculated the 3-year average concentrations of the four pollutants. We used logistic regression models to explore the association between long-term exposure to ambient air pollutants and SI. In addition, we conducted several stratified analyses to examine effect modification of selected factors.

RESULTS

The odds ratios (95% confidence intervals [CI]) of SI in response to each 1 μg/m³ increase in PM₁, PM_2.5, PM₁₀ and NO₂ concentrations were 1.08 (1.01, 1.15), 1.10 (1.02, 1.19), 1.05 (1.01, 1.09) and 1.12 (1.04, 1.21), respectively. Individuals exposed to PM₁, PM_2.5, PM₁₀ or NO₂ concentrations in the fourth quartile had a 1.36-fold (95%CI: 1.08, 1.72), 1.69-fold (95%CI: 1.05, 2.72), 1.49-fold (95%CI: 1.09, 2.05) or 1.71-fold (95%CI: 1.15, 2.85) risks of SI, compared to the ones with corresponding air pollutants in the first quartile. Besides, the risks of SI increased with the quartiles of air pollutants (PM₁: P_trend = 0.002, PM_2.5: P_trend = 0.003, PM₁₀: P_trend = 0.010, NO₂: P_trend = 0.010). Stratified analyses suggested that males, highly educated participants, ever-drinkers and people aged range 36-64 years were more vulnerable to the adverse effects of air pollutants.

CONCLUSIONS

This study provided evidence for the long-term effects of ambient PMs and NO₂ on SI in rural Chinese adults, particularly for males, highly educated participants, ever-drinkers and people aged range 36-64 years.

A Scoping Review of Non-Occupational Exposures to Environmental Pollutants and Adult Depression, Anxiety, and Suicide

PURPOSE OF REVIEW

Despite a call for better understanding of the role of environmental pollutant influences on mental health and the tremendous public health burden of mental health, this issue receives far less attention than many other effects of pollutants. Here we summarize the body of literature on non-occupational environmental pollutant exposures and adult depression, anxiety, and suicide-in PubMed, Embase, Web of Science, and PsychINFO through the end of year 2018.

RECENT FINDINGS

One hundred twelve articles met our criteria for further review. Of these, we found 88 articles on depression, 33 on anxiety, and 22 on suicide (31 articles covered multiple outcomes). The earliest article was published in 1976, and the most frequent exposure of interest was air pollution (n = 33), followed by secondhand smoke (n = 20), metals (n = 18), noise (n = 17), and pesticides (n = 10). Other exposures studied less frequently included radiation, magnetic fields, persistent organic pollutants (POPs), volatile organic compounds, solvents, and reactive sulfur compounds. The current literature, although limited, clearly suggests many kinds of environmental exposures may be risk factors for depression, anxiety, and suicide. For several pollutants, important limitations exist with many of the studies. Gaps in the body of research include a need for more longitudinal, life-course studies, studies that can measure cumulative exposures as well as shorter-term exposures, studies that reduce the possibility of reverse causation, and mechanistic studies focused on neurotoxic exposures.

The Grass Is Always Greener on My Side: A Field Experiment Examining the Home Halo Effect

Wood-burning pollution is a severe problem in southern Chile, where every winter, people are exposed to unhealthy ambient fine particulate matter (PM2.5) concentrations. Urban air quality is a major concern for health officials, but public awareness campaigns tend to focus on outdoor hazards. Our understanding of how residents are exposed and perceive air pollution risks in their homes remains incomplete. This study explores the ability of participants to perceive indoor air quality. We collected data on 81 households, combining perceptions of air quality with objective measurements of PM2.5. Residents’ evaluations of air quality were systematically compared to inspectors’ evaluations in order to examine the home halo effect. We found that residents tended to overestimate air quality in their homes. We discuss how our data supported the existence of a home halo effect, but also point out the possibility that individuals’ ability to perceive air quality in indoor spaces is limited by other factors.

Short-term effects of traffic noise on suicides and emergency hospital admissions due to anxiety and depression in Madrid (Spain)

Studies show a relationship between some mental illnesses and suicides and different environmental variables such as air pollution, characterized by stress at the neuropsychological level. Despite the fact that traffic noise is also a powerful neurological stressor, studies that relate traffic noise to these mental disorders are practically non-existent. The objective is to analyze the short-term impact that chemical air pollution, traffic noise and thermal extremes have on emergency hospital admissions due to anxiety, dementia and suicides in the city of Madrid. This ecological, longitudinal study uses generalized linear models with Poisson link to analyze the short-term impact of the average daily concentrations of chemical pollutants (NO₂, PM₁₀, PM_2.5, O₃), noise pollution indicators (Leq_day, Leq_night and Leq_24h) and temperatures during heat waves (T_heat) and cold waves (T_cold) on daily admissions to emergency services in the city of Madrid from 2010 to 2013 due to anxiety (ICD-10: F32), depression (ICD-10: F40-F42) and suicide (ICD-10: X60-X84). The results show no association between any of the chemical pollutants considered and the dependent variables studied. On the contrary, the values of Leq_day are associated with the three variables analyzed in lag 0 for the cases of anxiety and depression and in lag 1 for suicides, with RR: 1.20 (IC95% 1.14 1.26), RR: 1.11 (IC95% 1.06 1.16) and RR: 1.17 (IC95% 1.05 1.30), respectively, for increases of 1 dB(A) in the values of Leq_day. An association was also found between T_cold and admissions for anxiety in lag 9 with RR: 1.62 (IC95% 1.18 2.22) for increases of 1 °C in the values of T_cold. Traffic noise can be considered an important risk factor related to the illnesses and anxiety and depression and for suicides in the city of Madrid, although new studies are needed to support the findings shown here.

Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis

BACKGROUND

Particulate air pollution's physical health effects are well known, but associations between particulate matter (PM) exposure and mental illness have not yet been established. However, there is increasing interest in emerging evidence supporting a possible etiological link.

OBJECTIVES

This systematic review aims to provide a comprehensive overview and synthesis of the epidemiological literature to date by investigating quantitative associations between PM and multiple adverse mental health outcomes (depression, anxiety, bipolar disorder, psychosis, or suicide).

METHODS

We undertook a systematic review and meta-analysis. We searched Medline, PsycINFO, and EMBASE from January 1974 to September 2017 for English-language human observational studies reporting quantitative associations between exposure to PM < 1.0 μ m in aerodynamic diameter (ultrafine particles) and PM < 2.5 and < 10 μ m in aerodynamic diameter (PM 2.5 and PM 10 , respectively) and the above psychiatric outcomes. We extracted data, appraised study quality using a published quality assessment tool, summarized methodological approaches, and conducted meta-analyses where appropriate.

RESULTS

Of 1,826 citations identified, 22 met our overall inclusion criteria, and we included 9 in our primary meta-analyses. In our meta-analysis of associations between long-term (> 6   months ) PM 2.5 exposure and depression (n = 5 studies), the pooled odds ratio was 1.102 per 10 - μ g / m 3 PM 2.5 increase (95% CI: 1.023, 1.189; I 2 = 0.00 % ). Two of the included studies investigating associations between long-term PM 2.5 exposure and anxiety also reported statistically significant positive associations, and we found a statistically significant association between short-term PM 10 exposure and suicide in meta-analysis at a 0-2 d cumulative exposure lag.

DISCUSSION

Our findings support the hypothesis of an association between long-term PM 2.5 exposure and depression, as well as supporting hypotheses of possible associations between long-term PM 2.5 exposure and anxiety and between short-term PM 10 exposure and suicide. The limited literature and methodological challenges in this field, including heterogeneous outcome definitions, exposure assessment, and residual confounding, suggest further high-quality studies are warranted to investigate potentially causal associations between air pollution and poor mental health. https://doi.org/10.1289/EHP4595.

Ambient fine particulate matter is associated with increased emergency ambulance dispatches for psychiatric emergencies

AIMS

As a top ambient pollutant in urban area, fine particulate matter (PM_2.5) has been associated with the occurrence and deterioration of many medical conditions, while limited studies have observed the association with psychiatric conditions. This study aimed to investigate the association between short-term PM_2.5 exposure and psychiatric emergency events, and further explored the variation by age, sex and seasonal patterns, which have been suggested to be associated with both psychiatric risk and pollutant toxicity.

METHODS

We used time-series analysis to investigate the association between short-term exposure of PM_2.5 and emergency ambulance dispatches for psychiatric emergencies (EPE) (n = 158634) in Beijing, one of the top polluted cities in China during the study period between 2008 and 2014. Stratified analyses were conducted to examine the effects of age, sex and seasonal pattern.

RESULTS

Every 10 μg/m³ increase of the PM_2.5 concentration was associated with a 0.12% increase of the same-day overall EPE (95% CI: 0.03-0.22%, p = 0.013) and a 0.12% increase of the suicide-related EPE at lag 2 (95%CI: 0.01-0.24%, p = 0.041). The associations remained when adjusted for sunlight duration. An age effect was observed where children (age <18) showed a higher risk of suicide-related EPE after PM_2.5 exposure compared to adults (18 ≤ age≤64). We did not observe evidence of effect modification by sex and season based on the results of stratified analysis.

CONCLUSIONS

We found a positive association between acute PM_2.5 exposure and increased psychiatric emergency presentations indicated by emergency ambulance dispatches data. Children were more vulnerable and might develop psychiatric problems including those leading to suicide. Public awareness of the health risks of PM_2.5 is important to strengthen current efforts to reduce emissions.

Air pollution and self-perceived stress and mood: A one-year panel study of healthy elderly persons

BACKGROUND AND OBJECTIVES

Previous studies have suggested that air pollution is associated with depression and anxiety symptoms. Here, we investigate the association between personal exposure to NO₂ and perceived stress and mood in a panel of healthy elderly persons.

METHODS

In a one-year panel study, we included 20 healthy volunteers (10 male-female couples aged 58-76 years) with air pollution and health parameters measured every two months (120 observations). We measured personal exposure to NO₂ in the previous 5 days, perceived stress using the Perceived Stress Scale (PSS) and positive and negative affect with the Positive and Negative Affect Schedule (PANAS). We used linear and Poisson mixed models to evaluate the associations between the health outcomes and NO₂ adjusted for age, sex, temperature in the previous 5 days, sunlight in the previous day and physical activity (daily average number of steps on the previous week). Also, the interaction terms between NO₂ and physical activity were tested. We report % changes for PSS scores and unit changes (β) for positive and negative affect, and their 95% confidence intervals (CI), for changes in 10 μg/m³ of NO₂.

RESULTS

After adjustment, an increase by 10 μg/m³ in NO₂ concentrations was associated with a decrease of 1.3 points in the positive affect (95% CI -2.49 to -0.17) and an increase of 0.11 points in the negative affect (95% CI 0.02 to 0.20). The association with positive affect was stronger when physical activity was below median value of 9,362 steps per day (β = -2.68; CI: 4.87 to -0.49); p-value for interaction was 0.08. No statistically significant associations were observed with perceived stress.

CONCLUSION

Short-term exposure to air pollution may produce non-pathological alterations in mood in healthy elderly population.

Air Pollution and Suicide in Mexico City: A Time Series Analysis, 2000-2016

The association between air pollution and suicide has recently been under examination, and the findings continue to be contradictory. In order to contribute evidence to this still unresolved question, the objective of the present study was to evaluate the association between air quality and daily suicides registered in Mexico City (MC) between 2000 and 2016. Air quality was measured based on exposure to particulate matter under 2.5 and 10 micrometers (µm) (PM_2.5 and PM₁₀, respectively), ozone (O₃), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂), adjusting for weather variables (air temperature and relative humidity), and holidays. To this end, an ecologic time series analysis was performed using a Poisson regression model conditioned by time and stratified by gender and age groups. Models were also generated to explore the lagged and accumulative effects of air pollutants, adjusted by weather variables. The effects of the pollutants were very close to the null value in the majority of the models, and no accumulative effects were identified. We believe these results, in this case, no evidence of a statistical association, contribute to the current debate about whether the association between air pollution and suicide reported in the scientific literature reflects an actual effect or an uncontrolled confounding effect.

Ozone-induced dysregulation of neuroendocrine axes requires adrenal-derived stress hormones

Acute ozone inhalation increases circulating stress hormones through activation of the sympathetic-adrenal-medullary and hypothalamic-pituitary-adrenal axes. Adrenalectomized (AD) rats have attenuated ozone-induced lung responses. We hypothesized that ozone exposure will induce changes in circulating pituitary-derived hormones and global gene expression in the brainstem and hypothalamus, and that AD will ameliorate these effects. Male Wistar-Kyoto rats (13-weeks) that underwent sham-surgery (SHAM) or AD were exposed to ozone (0.8-ppm) or filtered-air for 4-hours. In SHAM rats, ozone exposure decreased circulating thyroid-stimulating hormone (TSH), prolactin (PRL), and luteinizing hormone (LH). AD prevented reductions in TSH and PRL, but not LH. AD increased ACTH ∼5-fold in both air and ozone-exposed rats. AD in air-exposed rats resulted in few significant transcriptional differences in the brainstem and hypothalamus (∼20 genes per tissue). By contrast, ozone-exposure in SHAM rats resulted in increases and decreases in expression of hundreds of genes in brainstem and hypothalamus relative to air-exposed SHAM rats (303 and 568 genes, respectively). Differentially expressed genes from ozone exposure were enriched for pathways involving hedgehog signaling, responses to alpha-interferon, hypoxia, and mTORC1, among others. Gene changes in both brain areas were analogous to those altered by corticosteroids and L-dopa, suggesting a role for endogenous glucocorticoids and catecholamines. AD completely prevented this ozone-induced transcriptional response. These findings show that short-term ozone inhalation promotes a shift in brainstem and hypothalamic gene expression that is dependent on the presence of circulating adrenal-derived stress hormones. This is likely to have profound downstream influence on systemic effects of ozone.

Association between particulate matter air pollution and risk of depression and suicide: systematic review and meta-analysis

BACKGROUND

Some recent studies examined the effect of ambient particulate matter (PM) pollution on depression and suicide. However, the results have been inconclusive.AimsTo determine the overall relationship between PM exposure and depression/suicide in the general population.

METHOD

We conducted a systematic review and meta-analysis of case-crossover and cohort studies to assess the association between PM2.5 (particles with an aerodynamic diameter of 2.5 µm or less) or PM10 (particles with an aerodynamic diameter between 2.5 and 10 µm) exposure and depression/suicide.

RESULTS

A total of 14 articles (7 for depression and 7 for suicide) with data from 684 859 participants were included in the meta-analysis. With a 10 µg/m3 increase in PM2.5 we found a 19% (odds ratio [95% CI] 1.19 [1.07, 1.33]) increased risk of depression and a marginally increased risk of suicide (odds ratio [95% CI] 1.05 [0.99, 1.11]) in the general population. We did not observe any significant associations between increasing exposure to PM10 and depression/suicide. Sensitivity and subgroup analyses were used to determine the robustness of results. The strongest estimated effect of depression associated with PM2.5 appeared in a long-term lag pattern (odds ratio [95% CI] 1.25 [1.07, 1.45], P &lt; 0.01) and cumulative lag pattern (odds ratio [95% CI] 1.26 [1.07, 1.48], P &lt; 0.01).

CONCLUSIONS

The meta-analysis suggested that an increase in ambient PM2.5 concentration was strongly associated with increased depression risk in the general population, and the association appeared stronger at long-term lag and cumulative lag patterns, suggesting a potential cumulative exposure effect over time.Declaration of interestNone.

Does ambient ozone air pollution trigger suicide attempts? A case cross-over analysis in Taipei

Epidemiologic studies indicated that exposure to ambient air pollutants was associated with increased mortality rates attributed to suicide. The objective of this study was to investigate the potential relationship between ambient ozone (O₃) levels and daily number of hospital admissions for suicide attempts in Taipei for the period 2008-2012 using a time-stratified case-crossover analysis. In the single-pollutant model (without adjustment for other pollutants), the risk of committing a suicide attempt increased by 9% on warm days and 27% on cool days for each interquartile range (IQR) rise in O₃ levels, respectively. The concentration of O₃ was thus significantly associated with daily number of suicide attempts both on warm and cool days. In the two-pollutant models, O₃ levels remained significant after the inclusion of other air pollutants (particulate matter (PM₁₀), PM_2.5, sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO)) on cool days. However, on warm days, no significant correlation was found between O₃ levels and reported daily number of suicide attempts. The relationship between O₃ and suicide attempts appeared to be dependent upon temperature; however, the basis for these observations requires further investigation.

Negative life events as triggers on suicide attempt in rural China: a case-crossover study

This study aims to investigate the potential triggering of negative life events (NLEs) on suicide attempt in rural China. A case-crossover design was used to study 1200 suicide attempters aged 15-70 years. NLEs were assessed by a modification of Paykel's Interview for Recent Life Events. NLEs had significant triggering effects on the day of and month of suicide attempt. Marriage/love, family/home, and friend/relationship were the types of NLEs found to trigger suicide attempt when occurring on the day and month of suicide attempt. Specifically, increased risk of suicide attempt was associated with quarreling with a partner or family member on the day and month of suicide attempt. Being disappointed in a love affair, fighting with a partner, family poverty and loss of face during the month of attempts were linked to increase odds of suicide attempt. Further, when month of suicide attempt was assigned as the case period, the impact of NLEs on suicide attempt was greater among those who were younger and without mental disorders. These findings provide knowledge of the triggering of NLEs on suicide attempt, especially among the young and those without mental disorders. Further, family conflicts should be a greater focus of attention in suicide prevention.